Aneurysm

Hypertension

Prof Dr Reetu Baral MD (Pathology)

Department of Pathology
Nobel Medical College Teaching Hospital
 ANEURYSM
An abnormal local dilation or out-pouching of a vessel
wall or cardiac chamber

Caused by weakened vessel wall from:

 Congenital defect
 Systemic disease
 Atherosclerosis
 Infection
 Trauma

Dr. Reetu Baral

Berry
aneurysm
Involve cerebral arteries at
bifurcations
Probably arise at congenital
points of weakness in wall
Can rupture and result in
subarachnoid hemorrhage
Clinically:
Headache
Stiff neck (meningeal irritation)
Death

Dr. Reetu Baral

Dissecting aneurysm

• Entry of blood into wall & extension

along the length of the vessel
• Form of hematoma, also called dissecting
hematoma
• Associated with:
• Hypertension
• Marfan’s syndrome

Dr. Reetu Baral

 Aneurysm: Complications

Rupture
Obstruction
Embolism
Compression
Ureter
Spine
Mass effect

Dr. Reetu Baral

Hypertension
Hypertension
• Hypotension: Low blood pressure results in:
• Inadequate organ perfusion
• Organ dysfunction
• Sometimes tissue death.
• Hypertension: High blood pressure causes:
• Vessel and end-organ damage
• Blood pressure is a function of cardiac output and peripheral
vascular resistance
• Cardiac output is a function of stroke volume and heart rate
(CO=SVxHR)
HYPERTENSIVE VASCULAR DISEASE
• “Essential hypertension”:
• Hypertension: BP>140/90 mmHg
• General population >25% are hypertensive
• Death may be due to (Untreated cases):
• Ischemic heart disease (IHD)
• Congestive heart failure
• Stroke
• Malignant hypertension: 200/120 mmHg
• Associated with Renal failure / Retinal hemorrhage with or without
papilledema
• Death within 1-2 years if untreated
Types and Essential Hypertension
causes of • Accounts for 90-95% cases
hypertension Secondary Hypertension
Renal
• Acute glomerulonephritis
• Chronic renal disease
• Polycystic disease
• Renal artery stenosis
Endocrine
• Adrenocortical hyperfunction (Cushing syndrome)
• Exogenous hormones (glucocorticoids, estrogen)
• Pheochromocytoma
Types and causes Cardiovascular
of hypertension
• Coarctation of the aorta
• Polyarteritis nodosa
Neurologic
• Psychogenic
• Increased ICP
• Sleep apnea
• Acute stress, including surgery
Pathogenesis: HTN

• HTN may be:

• Primary (idiopathic)
• Secondary to an identifiable underlying condition.
• In close to 95% of cases hypertension is idiopathic or “essential”.
• Secondary hypertension are due:
• Primary renal disease
• Renal artery narrowing (reno-vascular hypertension)
• Adrenal disorders
• Essential hypertension is compatible with long life unless:
• Myocardial infarction
• Stroke
• Prognosis of secondary hypertension depends on adequate
treatment of the underlying cause.
• Genetic disorders affecting blood pressure is:
• Gene defects in enzymes involved in aldosterone metabolism
• Mutations in proteins that affect sodium resorption
Pathogenesis: Hypertension

• Reduced renal sodium excretion:

• Decreased sodium excretion causes increase in fluid
volume and increased cardiac output - elevating blood
pressure
• At the new higher blood pressure, the kidneys excrete
additional sodium.
• Thus, a new steady state of sodium excretion is achieved,
but at the expense of an elevated blood pressure.
• Increased vascular resistance due to :
• Increased vascular resistance due to vasoconstriction
because of structural changes in vessel walls
• Genetic factors:
• Familial clustering – as evidenced by monozygotic twins
• Environmental factors can modify the impact of genetic
determinants:
• Stress
• Obesity
• Smoking
• Physical inactivity
• High levels of salt consumption
Morphology
1. HTN accelerates atherogenesis
2. Can lead to aortic dissection
and cerebrovascular
hemorrhage.
Morphology --- Contd.
• Small blood vessel disease related to
hypertension:
1. Hyaline arteriolosclerosis:
• Homogeneous, pink hyaline thickening
of the arteriolar walls
• Loss of underlying structural detail
• Luminal narrowing
• Leakage of plasma components across
injured ECs into vessel - increased ECM
production by SMCs
• In Kidney: Nephrosclerosis
2. Hyperplastic arteriolosclerosis:
• Seen in severe hypertension
• Vessels exhibit “onion skin,”
concentric, laminated thickening of
arteriolar walls and luminal narrowing
• The laminations consist of SMCs and
thickened, reduplicated basement
membrane.
• In malignant hypertension, these
changes are accompanied by fibrinoid
deposits and vessel wall necrosis
(necrotizing arteriolitis) - kidney.
Complications of Hypertension
• Cardiac hypertrophy
• Heart failure
• Aortic dissection
• Multi-infarct dementia
• Renal failure
• The end
• Next Class
• Infective endocarditis