Hypertension and Arteriolosclerosis Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which type of arteriolosclerosis is commonly associated with hypertension and characterized by a homogenous appearance of the vessel wall?

Calcific arteriolosclerosis

Hyaline arteriolosclerosis (correct)

Hyperplastic arteriolosclerosis

Athero-arteriosclerosis

What is the primary complication associated with berry aneurysms?

High output heart failure

Spontaneous rupture causing intracerebral hemorrhage (correct)

Renovascular hypertension

Chronic kidney disease

Which of the following is a notable feature of hyperplastic arteriolosclerosis?

Presence of calcifications in the vessel wall

Affects primarily large arteries

Thickening of the vessel wall with a 'onion-skin' appearance (correct)

Associated with low blood pressure

What is a common consequence of untreated malignant hypertension?

Renal failure Signup and view all the answers

What pathological process is primarily responsible for the development of atherosclerosis?

Inflammation and fibrosis Signup and view all the answers

Which underlying cause can lead to secondary hypertension?

Renal artery stenosis Signup and view all the answers

Which statement accurately describes fibromuscular dysplasia?

Results in thickening of medium to large muscular arteries Signup and view all the answers

What percentage of the population is estimated to be affected by hypertension?

25% Signup and view all the answers

What is a characteristic feature of hyaline arteriolosclerosis?

Hyaline thickening of arteriolar walls Signup and view all the answers

Which condition leads to nephrosclerosis due to hyaline arteriolosclerosis?

Hypertensive nephropathy Signup and view all the answers

Which statement about hyperplastic arteriolosclerosis is true?

It features concentric laminated thickening of vessel walls. Signup and view all the answers

What is the most common pattern of arteriosclerosis associated with cardiovascular disease?

Atherosclerosis Signup and view all the answers

What is the primary pathological feature of an atheroma?

Raised lesion with a core of lipid Signup and view all the answers

What is the main mechanism behind the progression of atherosclerosis?

Inflammatory response to endothelial injury Signup and view all the answers

Which of the following is NOT a complication associated with atherosclerosis?

Coronary artery spasm Signup and view all the answers

What vascular change is associated with both diabetes mellitus and hypertension?

Hyaline arteriolosclerosis Signup and view all the answers

What is the main characteristic of a mycotic aneurysm?

It results from infection of a major artery weakening its wall. Signup and view all the answers

Which statement accurately differentiates between Type A and Type B dissections?

Type A dissections are more common and more dangerous, involving the ascending aorta. Signup and view all the answers

What is a potential complication of an aortic dissection?

Hemorrhage into the pericardial sac (cardiac tamponade) Signup and view all the answers

Which type of aortic dissection begins distal to the take-off of the major aortic branches?

Type B dissection Signup and view all the answers

What common form of injury is linked to hypertension regarding aortic dissection?

Pressure-related mechanical injury Signup and view all the answers

What is one of the inherited connective tissue disorders associated with aortic dissection?

Ehlers-Danlos syndrome Signup and view all the answers

Which histological feature is commonly seen in aneurysms?

Laminated mural thrombus Signup and view all the answers

What symptom might indicate a potential aortic dissection?

Sharp chest or back pain Signup and view all the answers

Study Notes

Hyaline Arteriolosclerosis

Homogeneous pink hyaline thickening of arteriolar walls leads to luminal narrowing
Leakage of plasma components across injured endothelial cells into vessel walls
Increased ECM production by smooth muscle cells in response to chronic hemodynamic stress.
Most significantly affects kidneys resulting in nephrosclerosis (glomerular scarring leading to hypertensive nephropathy)
Occurs in elderly patients (normotensive) and diabetics

Hyperplastic Arteriolosclerosis

Occurs with severe (malignant) hypertension
Characterized by onionskin concentric laminated thickening of arteriolar walls or Fibrinoid vessel wall necrosis (necrotizing arteriolitis)
Reduplicated basement membrane leads to narrowing of the lumen

Complications of Hypertension

CNS: Stroke (hemorrhagic and ischemic)
Blood Vessels: Arteriolosclerosis, Atherosclerosis Aneurysms and dissection
Heart: CHD, left ventricular hypertrophy & heart failure (hypertensive heart disease)
Kidney: Renal failure
Retina: Retinal hemorrhages

Arteriosclerosis

Arteriosclerosis = "hardening of the arteries"
Arterial wall thickening and loss of elasticity.

Arteriolosclerosis

Affects small arteries and arterioles
Associated with hypertension and/or diabetes mellitus

Mönckeberg Medial Calcific Sclerosis

Calcific deposits in muscular arteries
Typically in persons older than 50 years old
Radiographically visible
Palpable vessels
Do not encroach on vessel lumen and are usually not clinically significant

Atherosclerosis

Most frequent and clinically important pattern of arteriosclerosis
Characterized by intimal lesions =atheromas ( atherosclerotic plaques)
Atheromatous plaque = raised lesion with a core of lipid (cholesterol and cholesterol esters) covered by a firm, white fibrous cap

Progression of Atherosclerosis

Fatty streaks: Earliest lesion, may appear before puberty
Composed of lipid filled foamy macrophages

Congenital Abnormalities of Blood Vessels

Berry aneurysm: Thin walled arterial outpouching affects cerebral vessels of the circle of willis. The affected vessel is attenuated (weak). Complications include Spontaneous rupture causing fatal intracerebral hemorrhage
Arterio-venous fistula: Abnormal connection between artery and vein without intervening capillary bed. Can be congenital or acquired (due to rupture of aneurysm or penetrating wound). Complications include Large AV fistula can cause high output heart failure.
Fibromuscular dysplasia: Focal irregular thickening of the wall of medium sized and large muscular arteries. Occur due to a combination of medial and intimal hyperplasia and fibrosis leading to luminal stenosis. Most frequently affect young woman. Complications include Renovascular hypertension and rupture of the vessels.

Hypertension (HTN)

Sustained elevation of blood pressure above 140/90 mmHg.
Affects ~ 25% of population.

Classification of Hypertension

According to severity: Benign (95%) versus malignant (5%)
According to cause: Primary (essential) (95%) versus secondary (5%)
According to side of circulation: Systolic vs diastolic

Essential Hypertension

Results from an interaction between genetic and environmental factors including; stress, obesity, cigarette smoking, physical inactivity and heavy consumption of salt.

Secondary Hypertension

Renal: glomerulonephritis, renal artery stenosis and polycystic kidney diseases.
Endocrine: adrenocortical, pheochromocytoma, hyper and hypothyroidism.
Cardiovascular: coarctation of aorta and polyarteritis nodosa.
Neurogenic: psychogenic, increase intracranial pressure.

Malignant Hypertension

5% (also known as accelerated HTN)
Usually superimposed on preexisting benign hypertension
Characterized by rapidly rising blood pressure that, if untreated, leads to death within 1 to 2 years.
Systolic pressures > 200 mm Hg or Diastolic pressures > 120 mm Hg
Most common complication: Renal failure and retinal hemorrhages

Morphologic Changes in Hypertension

HTN is associated with arteriolosclerosis (small arterial disease)
Two forms of small blood vessel disease are hypertension related: 1- Hyaline arteriolosclerosis 2- Hyperplastic arteriolosclerosis

Aortic Aneurysm

Location: Usually below renal arteries and above bifurcation of aorta
Shape: Can be saccular or fusiform
Maximum Size: May be as large as 15 cm in diameter, and as long as 25 cm
Microscopic Features: atherosclerosis; thinning of media
Often Contains: laminated mural thrombus

Mycotic Aneurysm

Infection of a major artery that weakens its wall
Originates from:
- Embolization of a septic thrombus (infective endocarditis)
- Extension of adjacent suppurative process
- Circulating organisms infecting arterial wall

Aortic Dissection

Extravasation of blood that enters the wall of artery through an intimal tear, as a hematoma dissecting between its layers.
Often but not always aneurysmal.
Both true and false aneurysms as well as dissections can rupture, often with catastrophic consequences
A catastrophic event whereby blood dissects apart the media to form a blood-filled channel within aortic wall
Complications: Massive hemorrhage and cardiac tamponade (hemorrhage into the pericardial sac)

Risk Factors For Aortic Dissection

Hypertension: Major risk factor, can be caused by pressure-related mechanical injury and/or ischemic injury.
Inherited or acquired connective tissue disorders: Causes abnormal vascular ECM (e.g., Marfan syndrome, Ehlers-Danlos syndrome, vitamin C deficiency, copper metabolic defects)

Clinical Manifestations of Aortic Dissection

Cardiovascular manifestations: Sharp chest/ back pain, Weak pulses in downstream arteries, cardiac tamponade, Blood pressure difference between Rt & Lt arms, Hypotension, shock

Types of Aortic Dissection

Type A dissections: More common, More dangerous, Proximal to take off of major aortic branches, involves either ascending aorta only or both ascending and descending aorta.
Type B dissections: Distal to take off of major aortic branches, Does not involve ascending aorta, usually beginning distal to subclavian artery.

Marfan Syndrome

Most common among inherited or acquired connective tissue disorders associated with aortic dissection.
Autosomal dominant disease of fibrillin, an ECM scaffolding protein required for normal elastic tissue synthesis.
Manifestations include: Skeletal abnormalities (elongated axial bones) and ocular findings (lens subluxation)

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on Hyaline and Hyperplastic Arteriolosclerosis and their complications related to hypertension. This quiz covers the pathophysiology, effects on various organs, and the implications of these conditions in patients, particularly focusing on kidney involvement and severe hypertension effects.