Pathology of the cardiovascular

system

Atherosclerosis and Hypertension

Arterosclerosis

Definition / description

Thickening and hardening of arteries with loss of

their elastic properties.
General term which does not imply a cause
Arteriosclerosis

Three of the most common types

Atherosclerosis
Mnckebergs medial calcific sclerosis
Arteriolosclerosis (Affects small arteries and
arterioles
Consequence of arteriosclerosis

Vessel thickening / narrowing of lumen / poor

tissue perfusion
Inelasticity of vessels / predisposition to
vessel rupture
Alteration in vascular endothelium /
increased predisposition to thrombosis
Atherosclerosis

Degenerative disorder which results from the

response of the arterial wall to wear and tear
Diabetes and hypertension accelerate the
development of atherosclerosis
Affects the medium to large arteries
Characterised by the focal accumulation of
lipid rich materials in the tunica intima
Also has an effect on the structure and
function of the tunica media
Atherosclerosis
Atherosclerosis
Atherosclerosis

Primarily an inflammatory process and is

asymptomatic unless
Significant narrowing of the lumen
Sudden occlusion caused by plaque rupture
Emboli
Aneurysms
 Aorta
Coronary arteries
Cerebral arteries
Common iliac arteries
Femoral arteries
Risk factors associated with the
development of atherosclerosis

Constitutional risk factors

Age
Gender- more prevalent in males than
females until the menopause after which the
risk is equal
Genetic predisposition
 Strong / Hard risk factors

Smoking
Hypertension
Hyperlipidaemia
Diabetes mellitus
 Soft risk factors

Lack of exercise
Obesity
Diet
Stress and personality traits
Pathogenesis

Most widely accepted theory is the

Response to injury hypothesis

Pathogenesis

Damage to the endothelium

Results in platelet adhesion to damaged area
Allows increased permeability of lipids and LDL
into the tunica intima
Formation of fatty streaks
Macrophages adhere to the endothelium and
them move into the tunica intima
The macrophages take up LDL to become foam
cells
Pathogenesis

Activated platelets release platelet derived growth

factor which results in migration and proliferation
of smooth muscle cells in the intima
Development of lipid plaque
Smooth muscle cells deposit excess collagen
and elastin in the intima
Greater macrophages infiltrate the intima and
phagocytose LDL and then release free lipid
Pathogenesis

Complicated plaques
As lesion develops pressure causes atrophy of
the of the underlying media
Muscle is replaced by collagen
Results in weakening of the arterial wall
A fibrous cap of collagen forms
Endothelium becomes fragile and ulcerates
resulting in platelet aggregation and thrombi
formation
Mnckebergs medial calcific sclerosis

Characterised by focal calcification in the media of

small and medium sized arteries
Femoral tibial radial and ulnar arteries commonly
involved
Idiopathic
Degenerative disease
Little or no inflammation evident
Does not cause obstruction or symptoms
Increase in pulse pressure (systolic hypertension)
caused by loss of elasticity
Hypertension

Defined clinically as a resting blood pressure

above 140 / 90 mm Hg in a patient aged less
than 50 or aove 160 / 95 mm Hg in older
patients
Aetiological classification

Two types
Primary (essential) hypertension (90% of cases)
Secondary hypertension elevated blood pressure
due to an identifiable cause (10% of cases)
Pathological classification

Benign hypertension stable elevation of

blood pressure over a number of years

Malignant hypertension rapid elevation of

blood pressure over a short period of time
Causes of primary hypertension

Genetic predisposition
Socio-economic factors
Dietary factors
Hormonal factors
Neurological factors
Causes of secondary hypertension

Renal disease (due to activation of renin-

angiotensin-aldosterone system)
Endocrine disorders
Drugs
pregnancy
Vessels changes in benign
hypertension

Changes develop gradually

Hypertrophy and thickening of tunica media
Thickening of the elastic lamina
Fibroelastic thickening of the tunica intima
Hyaline deposition in arterial wall
Effects of vessel change in benign
hypertension

Reduced size of the lumen

Increased rigidity
Increased fragility
Vessel changes in malignant
hypertension

Acute destructive changes in the small

arteries associated with the rise in pressure
Results in necrosis of the vessel walls
Effect of vessel change in malignant
hypertension

Cessation of blood flow through the small

vessels
Multiple foci of tissue necrosis
Disease processes associated with
hypertension

Atherosclerosis
CVA
Cardiac failure
Renal failure
 Hypertension is often asymptomatic and in
primary hypertension no obvious cause can
be found