HTN Flashcards
What is HTN retinopathy?
damage to the small blood vessels in the retina relating to systemic hypertension.
What causes HTN retinopathy?
Years of chronic hypertension or can develop quickly in response to malignant hypertension
What are risk factors for a hypertensive emergency?
inadequately treated hypertension
older age
black ethnicity
male gender
use of sympathomimetic drugs
use of monoamine oxidase inhibitors.
CKD
renal artery stenosis
endocrine e.g. primary aldosteronism
What signs do you see on fundoscopy for a pt with HTN retinopathy - Lots!
In HTN retinopathy, what is silver wiring?
where the walls of the arterioles become thickened and sclerosed causing increased reflection of the light
In HTN retinopathy, what is Arteriovenous nipping?
where the arterioles cause compression of the veins where they cross. This is again due to sclerosis and hardening of the arterioles.
In HTN retinopathy, what are cotton wall spots caused by?
ischaemia and infarction in the retina- damages nerve fibres.
In HTN retinopathy, what are hard exudates caused by?
damaged vessels leaking lipids into the retina
In HTN retinopathy, what are retinal haemorrhages and papilloedema caused by?
RH - damaged vessels rupture
P - ischaemia to optic nerve causing optic nerve. swelling and blurring of disc margins
What is the classification for HTN retinopathy?
Keith-Wagener Classification
Stage 1: Mild narrowing of the arterioles
Stage 2: Focal constriction of blood vessels and AV nicking
Stage 3: Cotton-wool patches, exudates and haemorrhages
Stage 4: Papilloedema
What is the management for HTN retinopathy?
Mild : controlling BP / risk factors e..g smoking and blood lipids + regular monitoring
Moderate: refer to exclude other associated e.g. DM, cardiac issues etc. + regular monitoring
Severe: refer for urgent treatment - high mortality. Renal, cardio and brain should be monitored for target organ damage
What other symptoms of HTN retinopathy
Usually asymptomatic e.g. chronic HTN
Malignant HTN :
* Intermittent blurring of vision
* Visual field defects
* Headache
* Flushed / red
* N&V
* Sudden painless loss of vision (vessel occlusion)
* Signs of end-organ damage (e.g. heart failure, acute kidney injury and chest pain)eye pain, headaches, reduced visual acuitiy
Diagnosed on fundoscopy features
Why should BP be lowered in a controlled fashion when very high?
Crucial to prevent ischeamic damage to vital organs e.g. optic nerve and brain
What is the relevance of optic disc swelling in HTN retinopathy ?
hallmark of malignant hypertension
blurring of margins
What are differenicals for HTN retinopathy?
- Diabetic retinopathy (also get retinal heamorrhages, cotton wool spots and hard exudates)
- Retinal vein occlusion
Conditions with optic disc oedema:
- diabetic papillopathy
- anterior ischaemic optic neuropathy
56 year old presents with acute onset vision loss and long standing high BP, what expect to see on fundoscopy?
talk me through this
flame shaped retinal haemorrhages
thinned, straight arteries
long standing HTN caused sclerotic vascular changes 2 arrows show silver / copper wiring in arterioles
swelling optic disc
Cotton wool patches
lipid exudates
Complications of HTN retinopathy?
Central/ branch retinal artery occlusion
Central/ branch retinal vein occlusion
ischemia
vitreous heamorrhage
retinal detachment
more advance DM retinopathy progression
chronic papilloedema - optic nerve atrophy and loss of visual acuity
