高血壓病理學課件

1、高血壓病理學高血壓病理學高血壓病理學Hypertension - IntroductionSilent Killer painless complicationsdizziness, headache, and visual difficulties,It is the leading risk factor MI, DM, StrokeResponsible for the majority of office visits, Number one reason for drug prescription.25% of population, 35% aware. 5% .! Complic

2、ations bring to diagnosis but lateChronic, vascular & end organ damage.2021/4/272高血壓病理學高血壓病理學高血壓病理學HypertensionHypertension - IntroductionSilent Killer painless complicationsdizziness, headache, and visual difficulties,It is the leading risk factor MI, DM, StrokeResponsible for the majority of offic

3、e visits, Number one reason for drug prescription.25% of population, 35% aware. 140, Diastolic 90 mm of Hg*Normal* 130 210/1202021/4/273Introduction“Sustained increasRegulation of BP:BP = Cardiac Output x Peripheral ResistanceEndocrine FactorsRenin, Angiotensin, ANP, ADH, Aldosterone.Neural FactorsS

4、ympathetic & ParasympatheticBlood VolumeSodium, Mineralocorticoids, ANPCardiac FactorsHeart rate & Contractility.2021/4/274Regulation of BP:BP = Cardiac Control of Blood Pressure:BPCardiac OutputPeripheralResistanceBlood VolumeNa+, AldosteroneVasoconstrictorsAngiotensin IICatecholaminesVasodilatorsP

5、g & KininsLocal FactorspH, HypoxiaNeural FactorsAdrenergic Cons Adrenergic - DilCardiac FactorsRate & Contract.Humoral Factors2021/4/275Control of Blood Pressure:BPCaEtiologic Classification:Primary or Essential Hypertension(95%)Secondary Hypertension (5-10%)Renal GN, RAS, Renin tumorsEndocrine Cush

6、ing, OCP, Thyrotoxicosis Myxdema, Pheochromocytoma, Acromegaly.Vascular Coarctation of Aorta, PAN, Aortic insufficiency.Neurogenic Psychogenic, Intracranial pressure, olyneuritis etc.2021/4/276Etiologic Classification:PrimaPathogenesis of Hypertension:? Pathogenesis in Essential hypertension - Multi

7、factorialIncreased blood volume - Sodum retention ADH, Aldosterone.Increased sympathetic tone - Adrenal tumours, sympathetic stimulation.Increased vasoactive hormones - Cushings, Pheochromocytoma, 2021/4/277Pathogenesis of Hypertension:?Pathogenesis of Renovascular HTN:GFRRenin by JGAAngiotensin IIV

8、asoconstriction P. ResistanceSodium RetentionBlood VolumeAldosteroneHypertension2021/4/278Pathogenesis of Renovascular HConsequences of Hypertension:Blood VesselsAtherosclerosis and its complications aneurism, Dissection, Rupture, necrosis. Arteriolosclerosis, HeartHypertensive cardiomyopathy, IHD,

9、MI.KidneyBenign/Malignant nephrosclerosis. InfarctionEyes: Hypertensive retinopathyBrain: Haemorrhage, infarction, splinter & Lacunar hemorrhages2021/4/279Consequences of Hypertension:BHyperplastic Arteriolosclerosis:Onion Skin ThickeningOf arterioles.Narrow Lumen2021/4/2710Hyperplastic Arterioloscl

10、erosiBenign Nephrosclerosis:Leathery Granularity due to minute scarring2021/4/2711Benign Nephrosclerosis:LeatheLeft Ventricular Hypertrophy:Left Ventricular Hypertrophy2021/4/2712Left Ventricular Hypertrophy:LCerebral Infarction (Stroke) :HaemorrhagicNecrosis2021/4/2713Cerebral Infarction (Stroke) :

11、Subarachnoid Haemorrhage:Cerebral Blood vesselsSpecial features:Thin walled*End arteries*Cong. Aneurisms2021/4/2714Subarachnoid Haemorrhage:CerebLacunar Infarcts:Chronic hypertensionArteriolosclerosis of deep penetrating arterioles of brain stem.Single or multiple cavitary infarcts lacunes.Lenticula

12、r nucleus, thalamusSlit Haemorrhages.2021/4/2715Lacunar Infarcts:Chronic hyperRenal Artery stenosis - AtrophyLeathery GranularityBenign Nephrosclerosis2021/4/2716Renal Artery stenosis - AtrophNormal Retina - Fundoscopy2021/4/2717Normal Retina - Fundoscopy2021Hypertensive Retinopathy:Grade I Thickeni

13、ng of arterioles.Grade II Focal Arteriolar spasms. Vein constriction.Grade III Hemorrhages (Flame shape), dot-blot and Cotton wool and hard waxy exudates.Grade IV - Papilloedema2021/4/2718Hypertensive Retinopathy:GradeMalignant Hypertension:May complicate any type of HTN.Necrotizing arteriolitis.Int

14、ravascular thrombosis.Rapidly progressive end organ damage.Renal failureHypertensive encephalopathy. Left ventricular failure.2021/4/2719Malignant Hypertension:May comNecrotizing arteriolitis:Fibrinoid NecrosisThrombosis2021/4/2720Necrotizing arteriolitis:FibriConclusions:Persistent increased blood

15、pressure (140/90)95% Essential, 5% secondary - RenovascularBenign and Malignant types (120Diastolic)Vessel damage & Arteriolosclerosis Complicates - Atherosclerosis, Diabetes, IHDIschemia or Infarction in end organs.Kidney, Brain, Heart & Eyes.Nephrosclerosis, renal damage, IHD, MI, Stroke & Retinop

16、athy.2021/4/2721Conclusions:Persistent increasSelf Assessment Questions:Define essential, hypertension?Briefly describe pathogenesis of renal damage in hypertension.Classify hypertension, briefly describe pathogenesis in each?Summarize common complications of hptn?What is nephrosclerosis? Briefly describe its pathogenesis?What is meant by malignant hypertension? Briefly describe clinical and pathological features?What are lacunar infarcts? a