1. Hypertension

2. Diseases of arterias C. Hypertensive Vascular Disease TYPES. essential hypertension. About 90-95% of hypertension is idiopathic and apparenly primary, secondary 5-10% is to renal disease or other causes About 5% of hypertensive persons show a rapidly rising blood pressure, which, if untreated, leads to death within 1 or 2 years – malignant hypertension.

3. Diseases of arterias C. Hypertensive Vascular Disease One of the most important risk factors coronary heart disease and cerebrovascular accidents. cardiac hypertrophy with heart failure, aortic dissectin, renal failure.

4. Diseases of arterias C. Hypertensive Vascular Disease Morphology hyaline arteriolosclerosis (in elderly patients, more severe in patients with hypertesion and diabetes, a homogenous, pink, hyaline thickening of the walls of arterioles with narrowing of the lumen) and hyperplastic arteriolosclerosis (in patients with more severe elavation of blood pressure, there is typical onion-skin, concentric thickening of the walls of arterioles with progressive narrowing of the lumens).

6. Hypertension - Introduction Silent Killer – painless – late symptoms dizziness, headache and visual difficulties 15- 20 % of population <35% aware Complications bring to diagnosis but late…

7. Classifying Blood Pressure Readings Category Systolic Diastolic Normal <120 < 80 Prehypertension 120-139 80-89 Stage 1 Hyper 140-159 90-99 Stage 2 Hyper =100 Malignant Hyper > 210 > 120

8. Types of Hypertension: Primary or Essential Hypertension (90-95%) Secondary Hypertension (5-10%) SUBTYPES Benign Malignant

9. Factors Influencing Essential Hypertension Genetic Environmental

10. Factors Influencing Essential Hypertension Genetic: Genes – Aldosteron metabolism 17 alpha hydroxylase Plymorphism- Renin agiotensen loci, recepter Liddle syndrome- mut –protiens( Na channels) Mendalian rare Susceptibility genes unknown Genes- Na load, sooth muscles constriction, growth, pressor subs level

11. Risk Factors Major diet and hyperlipidemia, hypertension, cigarette smoking, diabetes Minor obesity, lack of exercise, age, male, family history, stress, BCP, High CHO intake, hyperhomocysteinemia

12. ENVIRONMENTAL FACTORS

13. Table 11-3. Types and Causes of Hypertension Essential Hypertension Secondary Hypertension Renal Endocrine Cardio Vascular Neurologic

14. Pathogenesis- Essential Hypertension: ? Pathogenesis - Multifactorial Exact not known Various Hypotheses

15. Control of Blood Pressure: BP Cardiac Output Peripheral Resistance Blood Volume Na+, Aldosterone Vasoconstrictors Angiotensin II Catecholamines Vasodilators Pg & Kinins Local Factors pH, Hypoxia Neural Factors  Adrenergic – Cons ß Adrenergic - Dil Cardiac Factors Rate & Contract.. Humoral Factors

16. MECHANISM OF ESSENTIAL HYPERTENSION Homeostasis

17. SECONDARY HYPERTENSION - CAUSES Endocrine Renal diseases Coarctation of aorta Drugs Alcohol Pregnancy (pre – eclampsia)

18. ENDOCRINE CAUSES Cushing Syndrome Hyperaldosteronism Pheochromocytoma High BP

19. ATHEROMA COARCTATION OF AORTA VASCULAR CAUSES:

20. RENAL DISEASES Renal Artery stenosis

21. Pathogenesis of Renovascular HTN:  GFR Renin by JGA Angiotensin II Vasoconstriction  P. Resistance Sodium Retention  Blood Volume Aldosterone Hypertension

22. Target Organ Damage: Blood Vessels Heart Kidney Eyes Brain

23. Hyperplastic Arteriolosclerosis: Onion Skin Thickening Of arterioles. Narrow Lumen

24. Hyaline Arteriolosclerosis: Narrow Lumen Hyaline deposition

25. BLOOD VESSELS A T H E R O MA AORTIC DISSECTION

26. Heart Attack- Myocardial Infarction

27. Left Ventricular Hypertrophy: Left Ventricular Hypertrophy

28. Subarachnoid Haemorrhage:

29. Cerebral Infarction - Stroke:

30. Renal Artery stenosis - Atrophy

31. Benign Nephrosclerosis: Leathery Granularity due to minute scarring

32. Hypertensive Retinopathy: Hemorrhages (Flame shape) Papilloedema Narrowing of arterioles

33. HYPERTENSION: INVESTIGATION OF ALL PATIENTS Urinalysis for blood protein and glucose Blood urea electrolytes and creatinine Hypokalaemic alkalosis may indicate primary hyperaldosteronism but is usually due to diuretic therapy Blood glucose Serum total and high-density lipoprotein (HDL) cholesterol 12-lead ECG (left ventricular hypertrophy, coronary artery disease)

34. ANEURYSM DEFINITION “It is localized, permanent, abnormal dilatation of blood vessels that occurs mostly in the aorta or the heart”

35. ANEURYSM DEFINITION TYPES ETIOLOGYcongenital/ aquired: MACROSCOPIC: saccular/ fusiform TRUE OR FALSE

36. ANEURYSM (Contd) CAUSES : congenital BERRY ANEURYSM

37. T Y P E S & S I T E S OF A N E U R Y S M S

38. ANEURYSM (Contd) CAUSES Aquired INFECTIONS (MYCOTIC) SYPHILIS TERTIARY- endarteritis of vasavasorum media injury, aortic valve annulusl TRAUMA ATHEROSCLEROSIS CYSTIC MEDIAL DEGENERATION IMMUNOLOGIC SUPPURATIVE PROCESS SEPTIC EMBOLI

39. ANEURYSM DEFINITION TYPE MACROSCOPIC: Saccular: Portion of the wall, thrombus, 5- 20 cm Fusiform : cicumferential 20 cm

40. ANEURYSM T TRUE: intact vessel wall(thinned) At rosclerosis Syphilis Congenital Ventricular aneurysm FALSE: Ventricular rupture Hematoma extra vascular Arterial dissection

41. Aneurysms Abdominal aorta frequently affected Natural history is to rupture Ischemic intima and media? Male caucasians Early detection

42. ANEURYSM (Contd) PATHOGENESIS: (1)QUALITY OF CT (2) IMBALANCE OF DEGRADATION AND SYN OF COLLAGEN (3) SMOTH MUSCLE AND ECM LOSS(OTHER THAN COLLAGEN)

43. ANEURYSM (Contd) PATHOGENESIS: (1) QUALITY OF CT Marfans syndrome –fibrillin- TGF-b Loeys Dietz synd – TGF-b Ehlars Danlos syn – collagen III Vit C def

44. ANEURYSM (Contd) PATHOGENESIS: (2) IMBALANCE OF DEGRADATION AND SYN OF COLLAGEN: Inflammatory infiltrate -MMP-macrophages atheromatous plaque and vasculitis TIMMP dec Genetic predisposition- polymorph ism in MMP/ TIMMP

45. ANEURYSM (Contd) PATHOGENESIS: (3) SMOTH MUSCLE AND ECM LOSS(OTHER THAN COLLAGEN) Inappropriate syn ischemia- degeneration of media, increased syn of glycosaminoglycan Atherosclerosis Hypertention ath

46. ABDOMINAL AORTIC ANEURYSM > 50 YEARS, MALE BELOW RENAL ARTERIES AND ABOVE BIFURCATION OF AORTA ATHEROSCLEROSIS: plahin thin media, mural thrombi: MYCOTIC- Salmonella destroys media, HYPERTENSION FAMILIAL CONNECTIVE TISSUE COMPONENT DEFECT METALLOPROTEINASES (MMPs)

47. COURSE OF DISEASE RUPTURE & HAEMORRHAGE OCCLUSION OF BRANCH VESSELS; renal, ilial, meseteric EMBOLISATION COMPRESSION OF NEARBY STRUCTURES PULSATING MASS

48. COURSE OF DISEASE RUPTURE & HAEMORRHAGE Nil-less 4 cm 1% - 4-5 cm 11%- 5-6 cm 25%- more 6 cm Expands.2-.3 cm/ yr

49. TREATMENT OF DISEASE RUPTURE & HAEMORRHAGE 5cn or more- aggreorssive anti hypertensive surgery stents Mortality: Timely surgery-5% Emergency surgery 50%

50. THORACIC AORTIC ANEURYSM CAUSES MARFANS SYN LOEYS DIETZ SYN HYPERTENTION TERTIARY SYPHILIS COMPLICATIONS RESPIRATORY DISTRESS SWALLOWING DIFF RUPTURE-CORONARIES

51. THORACIC AORTIC ANEURYSM SITE TEAR TRANSVERS OR OBLIQUE10 CM AORTIC VALVES 1-5 CM LONG MIDDLE AND OUTER 1/3

52. SYPHILITIC ANEURYSM TERTIARY STAGE THORACIC AORTA OBLITERATIVE END ARTERITIS OF VASA VASORUM MEDIAL DESTRUCTION DUE TO ISCHAEMIA TREE BARKING CAR BOVINUM COMPRESSION EFFECTS

53. DeBakey Classification

54. Dissection