Cardiovascular Pathology

Name Definition
Hypertensive Emergency Severe hypertension with end-organ damage
(Usually exacerbation of Benign HTN)
- withdrawal of short-acting
antihypertensive drug (propranolol,
clonidine, beta-blockers)
- sympathomimetic drugs: cocaine,
amphetamine
- Pheochromocytoma
- Pre/eclampsia

End Organ Damage:

- Kidney  renal failure/hematuria
- Heart  Acute coronary syndrome (MI),
CHF w pulm. Edema, aortic dissection,
- Lungs  Pulm. Edema
Clinical:
- Severe headache, visual disturbance,
altered mentation
Fundoscopy: Hypertensive Retinopathy
- Moderate: retinal hemorrhage, exudate,
cotton wool spots
- Severe: Papilledema
Acute Target: Organ Damage
- Brain
i) Stroke: lacunar infarct, intracerebral
& subarachnoid hemorrhage &
Hypertensive encephalopathy
- Heart & Blood Vessel
i) Acute Coronary Syndrome (MI)
ii) Acute LHF
iii) Aortic Dissection
 - Kidney
i) Acute Hypertensive/Malignant
Nephrosclerosis
Hypertensive Urgency Severe hypertension in asymptomatic

WITHOUT ACUTE TARGET ORGAN DAMAGE

(asymp. HTN)

Fundoscopy: Moderate Hypertensive

Retinopathy (ie: no papilledema)

Requires different type of treatment

Essential (90-95%)
No single identifiable cause
1) Genetic Factors
2) Reduced Renal Sodium Excretion
- ^ Fluid volume, CO & PR  ^ BP
Secondary (5-10%)
i) Renal Disease
a. Renal Chronic Stenosis
(decreased glomerular flow & pressure
in afferent arteriole – RENIN secretion
by Juxtaglomerular cells)

3) Vasoconstrictive Influences Atherosclerosis

a. Environmental Factors (stress, - Elderly men (smoking, high
obesity, smoking etc.) cholesterol levels)

Fibromuscular Dysplasia
- Young female (string of beads)
- Focal stenosis & dilation
- Focal medial hyperplasia w
thickened fibromuscular ridges
adjacent

ii) Endocrine Disease

a. Pheochromocytoma
(nor/epinephrine)

iii) Vascular Disease

a. Coarctation of aorta
Effects of Hypertension on Heart
Increased systemic vascular resistance (afterload)
- Concentric Left Ventricular Hypertrophy (decreased LV Function)
- HTN accelerates atherosclerosis (^ Coronary Artery Disease)
i) ^ heart weight ( F >250 gm, M > 300 gm) -- ^ LV wall thickness (>1.5cm)
ii) Cardiohypertrophy
a. ^ cell size (diameter) & boxcar nuclei
iii) Interstitial Fibrosis (advanced)
iv) Heart Failure (cause of death)
Vascular Pathology in Essential Hypertension
Hyaline Arterio- & Arteriosclerosis “glass” HALLMARK OF BENIGN HYPERTENSION
- Thickening of wall of small muscular artery/arteriole
- Accum. Of pink, homogenous (hyaline) material
- Lumen narrowing & loss of underlying wall structure

Renal Pathology Hypertensive Nephrosclerosis/Benign Nephrosclerosis

- Hyaline arterio- & arteriosclerosis
Morphology
1) Glomerular sclerosis, hyalinization & tubular atrophy, arterial thickening, scattered
lymphocytic infiltrate
2) Advanced: small kidney w granular surface (preserved glomeruli)  “granular contracted
kidney”

Clinical: Proteinuria  chronic renal failure

Malignant (Acute Hypertensive) Nephrosclerosis
- Arteriolar & Glomerular Fibrinoid Necrosis
- Hyperplastic Arteriosclerosis
- Microinfarction & micro-hemorrhage (Flea Bitten Kidney)
- W/o treatment  acute renal failure

Hypertensive Encephalopathy
- When: BP: 240/140+ w neurologic (eg: Confusion)
o High BP  dilation of small cerebral arteries/arterioles  ^ permeability 
Cerebral edema  Raised intracranial pressure
- Posterior Reversible Encephalopathy Syndrome (PRES)
o No focal lesion (ie: no brain infarct or hemorrhage)
- Progress to coma & death