Tumors of the Heart and Hypertension Flashcards

1
Q

describe clinical presentation of heart tumors

A
  • sudden onset of severe, rapidly progressive HF without apparent cause and/or arrhythmia
  • silent until it impairs function
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2
Q

____ is the most common primary tumor of the heart and is predominantly found in ____

A

cardiac myxoma is the most common primary tumor of the heart and is predominantly found in females (age 30-60)

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3
Q

____ often calcify and can at times be seen on x-ray

A

cardiac myxomas often calcify and can at times be seen on x-ray

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4
Q

describe the gross and histological morphology of cardiac myxomas

A
  • gross:
    • lobulated pedunculated mass
    • most common location = LA
  • histo:
    • multinucleated stellate cells suspended in an edematous mucopolysaccharide rich stroma
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5
Q

describe what is seen in the image

A
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6
Q

describe clinical features of cardiac myxoma

A
  • most are asymptomatic
  • some may fragment and embolize
  • ball-valve obstruction of AV valve → syncopal episodes, sudden death
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7
Q

list the most common secondary heart tumors

A
  • direct extension of lung cancer
  • breast cancer
  • lymphoma
  • malignant melanoma
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8
Q

list renal causes of secondary hypertension

A
  • renal:
    • glomerulonephritis
    • renal artery stenosis
      • stenosis perceived as decreased blood supply → produces renin → activates angiotensin system
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9
Q

list endocrine causes of secondary hypertension

A
  • endocrine:
    • Cushing
    • OCP
    • thyrotoxicosis
    • myxdema
    • pheochromocytoma
    • acromegaly
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10
Q

list vascular causes of secondary hypertension

A
  • vascular
    • coarctation of aorta
    • polyarteritis nodosa
    • aortic insufficiency
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11
Q

list neurogenic causes of secondary hypertension

A
  • neurogenic:
    • psychogenic
    • intracranial pressure
    • polyneuritis
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12
Q

describe the pathogenesis of essential hypertension

A
  • essential: multifactorial
    • increased peripheral resistance (symp. tone)
    • stress, hormonal, neural
    • genetic, familial, life style
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13
Q

describe the pathogenesis of secondary hypertension

A
  • secondary: known abnormal control
    • increased blood volume → sodium retention, ADH, aldosterone
    • increased symp. tone → adrenal tumors
    • increased vasoactive hormones → Cushing’s, pheochromocytoma
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14
Q

describe malignant hypertension

A
  • may complicate any type of HTN
  • necrotizing arteriolitis
  • rapidly progressive end-organ damage
    • renal failure
    • LV failure
    • hypertensive encephalopathy
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15
Q

describe how hypertension can affect the large blood vessles

A
  • large blood vessels:
    • atherosclerosis
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16
Q

describe how hypertension can affect the small blood vessels

A
  • small blood vessels:
    • arteriosclerosis
      • hyaline and hyperplastic
17
Q

describe how hypertension can affect the heart

A
  • heart:
    • LVH, hypertensive cardiomyopathy → IHD, MI
18
Q

describe how hypertension can affect the kidney

A
  • kidney:
    • nephrosclerosis: benign and malignant
19
Q

describe how hypertension can affect the eyes

A
  • eyes:
    • hypertensive retinopathy
20
Q

describe how hypertension can affect the brain

A
  • brain:
    • hemorrhage, infarction
21
Q

describe hyaline arteriosclerosis

A
  • homogenous, pink, hyaline thickening of the walls of the arterioles with loss of underlying structural details and with narrowing of the lumen
  • leakage of plasma components across vascular endothelium and increasing ECM matrix production by smooth muscle cells
  • chronic hemodynamic stress in HTN or metabolic stress in diabetes accentuates endothelial injury
22
Q

describe what is seen in the image

A

hypertensive vascular disease

hyaline arteriosclerosis; the arteriolar wall is thickened with the deposition of amorphous proteinaceous material (hyalinized) and the lumen is markedly narrowed

24
Q

describe hyperplastic arteriosclerosis

A
  • related to more acute or severe elevations of blood pressure
  • onion-skin, concentric, laminated thickening of the walls of arterioles with progressive narrowing of the lumen
25
Q

describe what is seen in the image

A

hyperplastic arteriosclerosis: “onion-skinning” causing luminal obliteration

26
Q

describe necrotizing arteriolitis

A
  • deposits of fibrinoid and acute necrosis of the vessel wall