Forensic Pathology for Police - Brainshare Public Online Library

218 10 Natural Deaths
Hypertensive Cardiovascular Disease
Hypertensive cardiovascular disease, or simply “hypertension,” is commonly known
as “high blood pressure.” This disorder is very common within the United States,
where it frequently is accompanied by atherosclerosis, hence the often-used combined
designation of “hypertensive and atherosclerotic cardiovascular disease.”
There are many possible underlying causes of hypertension, including adrenal
gland tumors, kidney diseases, renal artery fibromuscular dysplasia or other conditions,
and various endocrine disorders; however, a vast majority of cases are
referred to as “essential” or “idiopathic,” where an exact underlying cause cannot
be determined. The major change within the cardiovascular system that is
characteristic of hypertension is cardiac hypertrophy, which results in an enlarged
heart (cardiomegaly). The hypertrophy involves the left ventricle, and it tends to
be concentric (all walls of the left ventricle are thickened equally) (Fig. 10.10).
Microscopically, there are hypertrophic (enlarged) myocytes (Disc Image 10.23).
Fig. 10.10 A cross-section of a hypertrophic heart, related to hypertension (high blood pressure)
Because of the enlarged heart that occurs with hypertension, persons with this
disorder are at increased risk for sudden death due to an arrhythmia. In addition,
a variety of other vascular disorders occur with increased frequency in persons
with hypertension, including spontaneous brain hemorrhages, ruptured cerebral
artery berry aneurysms (see Central Nervous System below), and thoracic aortic
aneurysms/dissections. Another central nervous system finding that can be seen
in patients with hypertension is “lacunar” infarcts, small infarcts within the basal
ganglia, thalamus, and elsewhere. Characteristic kidney changes also occur in
hypertension.