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Eye Disease > Hypertension > Flashcards

Hypertension Flashcards

1
Q

How is someone’s BP measured ?

A

Systolic Pressure/ Diastolic pressure

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2
Q

What does systolic pressure refer to?

A

Peak pressure due to ventricular contraction

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3
Q

What does diastolic pressure refer to?

A

Pressure during ventricular relaxation

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4
Q

Ideally, what do we want BP to be below?

A

120/80mmHg

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5
Q

What is BP measured in?

A

mmHg

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6
Q

According to the NHS, what is the normal range of BP?

A

90/60mmHg - 140/90mmHg

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7
Q

When is hypertension diagnosed ?

A

systolic BP >140mmHg OR the diastolic BP is >90mmHg on TWO successive occasions

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8
Q

When can malignant HTN be classified?

A

Systolic > 200mmHg OR diastolic >140mmHg

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9
Q

What px is systolic pressure more commonly elevated?

A

Older px

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10
Q

What px is diastolic pressure more commonly elevated?

A

Younger px (<50yrs)

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11
Q

What is HTN a RF for ? (There are 7)

A
  • Stroke
  • Myocardial infarction (heart attack)
  • Heart failure
  • Chronic kidney disease
  • Peripheral vascular disease
  • Cognitive death
  • Premature death
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12
Q

What happens if BP is left untreated?

A

BP will continue to rise and become resistant to treatment

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13
Q

What are two categories HTN can be classified into?

A

Primary or secondary (due to another disease
*primary account for 90% of cases

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14
Q

What are four non-modifiable RF for HTN?

A
  • age
  • race (higher in Afro-Caribbean)
  • fh
  • pregnancy
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15
Q

What are some modifiable RF for primary HTN?

A
  • regular exercise
  • healthy diet
  • relaxation
  • alcohol reduction
  • reduce sodium intake
  • increase potassium intake
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16
Q

Why is it important we are aware about HTN?

A

Retina is the only place where we can examine arterioles non-invasively- they look v similar to cerebral and coronary ones so can show they are at risk of a heart attack or stroke

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17
Q

Will elevated BP affect inner and outer retinal circulation similarly?

A

No- effects them differently

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18
Q

What kind of junctions are in the inner retinal vasculature?

A

Tight junctions- they form the blood retinal barrier

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19
Q

What is autoregulation?

A

When the diameter of blood vessels change in repose to change in BP (high BP = vasoconstriction)

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20
Q

Do inner retinal vasculature show auto regulation?

A

Yes

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21
Q

Do choroidal arterioles exhibit auto regulation ?

A

No

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22
Q

Why does hypertensive retinopathy happen?

A
  • Constant high BP
  • constant constriction of retinal arterioles
  • narrowed BVs to regulate blood flow
  • leads to diffuse and focal arteriolar narrowing
  • increased tortuosity
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23
Q

What does long term hypertension cause?

A

Arteriolosclerosis

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24
Q

What is aterteriolosclerosi?

A

Thickening + stiffening of arteriolar wall

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25
Q

How many stages are there of HR?

A

4

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26
Q

What is stage 1?

A

Mild to moderate narrowing or sclerosis of the arterioles

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27
Q

What is stage 2?

A
  • Mod to marked narrowing of arterioles (can be generalised or local)
  • Exaggeration of light reflex
  • Arteriovenous crossing changes
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28
Q

What is stage 3?

A
  • arterioles Narrowing + focal constriction
  • Retinal oedema
  • CWS
  • Retinal haemorrhages
  • Hard exudates
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29
Q

What is stage 4?

A

All of stage 3 + OD swelling

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30
Q

Which two stages are chronic ?

A

1 & 2, they will be asymptomatic

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31
Q

Which stages would a px be symptomatic + acute (short term high spike in BP)?

A

3 & 4

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32
Q

What is the name of the classification system to grade HR?

A

Keith-Wagener Barker Classification of hypertensive retinopathy

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33
Q

What will the BV look like in stage 1 and stage 2?

A

Straighter and narrower

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34
Q

In an older px with hypertensive retinopathy, why may you not see much of a difference in the a/v ratio?

A

Due to arteriosclerosis (thickening of cell walls stops them constricting)

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35
Q

What can arteriosclerosis lead to ?

A

Change in light reflex from the vessels

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35
Q

Why can we see a change in light reflex?

A

Because vessel walls becomes opaque —> broader, duller, diffuse reflex

36
Q

What is the way we describe the light reflex in HR?

A

Copper-wire appearance

37
Q

When would you see a ‘silver wire’ appearance?

A

When the sclerosis advances

38
Q

How does the arteriovenous crossing alter?

A

Nipping occurs

39
Q

What is nipping?

A

Venule is compressed by sclerosed arteriole

40
Q

If blood flow of the vein is reduced due to nipping, what may you see?

A

Vein after the crossing becomes more tortuous, larger and darker

41
Q

If there is severe changes to A/V crossing, what may happen?

A

BRVO

42
Q

What acute rise in BP mean?

A

Over short period of time the BP has spiked

43
Q

What occurs with the blood-retinal barrier in stage 3&3 of HR?

A

Disruption of the blood retinal barrier

44
Q

What happens when the blood-retinal barrier is disrupted?

A

Increased vascular permeability

45
Q

With severe HTN, can the arteries autoregulate?

A

NO, they lose their ability to do so

46
Q

As the arteries cannot autoregulate, what happens? And how does this affect capillaries?

A

Blood flow cannot be moderated as it should + leads to damaged arterioles and capillaries

47
Q

What signs may you see with a px who’s arteries cannot auto regulate? (There are two)

A

Microaneururysms and CWS

48
Q

What is CWS a sign of ?

A

Retinal Ischaemia (axoplasmic flow is disrupted by this ischaemia)

49
Q

What does increased vessel permeability lead to?

A

Leakage

50
Q

What are four signs you may see with someone who has increased vessel permeability?

A
  • Flame haemorrhages
  • Retinal oedema
  • Hard exudates
  • Macula star
50
Q

What are four signs you may see with someone who has increased vessel permeability?

A
  • Flame haemorrhages
  • Retinal oedema
  • Hard exudates
  • Macula star
51
Q

What are hard exudates a leakage of ?

A

Lipoproteins

52
Q

Why does a macula star happen?

A

The hard exudates follow the path of the fibres of Henle

53
Q

What is swelling of the optic disc a sign of?

A

Malignant HTN

54
Q

Describe this picture.

A

Stage 4 HTN, poorly defined margins, papilloedema, tortuous vessel, macula star

55
Q

What stage is this?

A

4

56
Q

What is fibrinoid necrosis?

A

the inside lining of your blood vessels becomes damaged.

57
Q

What happens as a result of unregulated high BP?

A

Fibrinoid necrosis of end of arterioles

58
Q

What % of px with primary HTN will develop malignant HTN?

A

1%

59
Q

Why is malignant HTN rapidly fatal?

A

Can lead to heart failure, stroke, myocardial infarction or renal failure - DEATH

60
Q

What are 9 symptoms a px with malignant HTN may have?

A
  • HAs
  • Diplopia
  • Scotoma
  • Dimness in Vision
  • Photopsia (flashes)
  • Chest pain
  • Nausea/vomiting
  • Shortness of breath,
  • Weakness
61
Q

Which stages of HR may we see hypertensive choroidopathy?

A

3&4

62
Q

What is indicative of hypertensive choroidopathy ?

A

Yellow spots in the RPE showing the ischaemic parts of the choroid

*yellow spots are ischaemic infarcts

63
Q

Why does hypertensive choroidopathy happen?

A

Fibrinoid necrosis of choroidal vessels which leads to choroidal ischaemia

64
Q

What six signs can hypertensive choroidopathy lead to?

A
  • Diffuse pigment granularity in the RPE
  • Pigment clumping surrounded by atrophic areas
  • Hyperpigmented flecks
  • rpe detachment
  • Serous RD
  • Cystoid macula oedema
65
Q

What do the pigment clumping surrounded by atrophic areas replace?

A

The yellow spots

66
Q

How are the hyperpigmented flecks arranged? And what is the name of these flecks ?

A

In a linear fashion + Siegrist streaks

67
Q

What do px with hypertension and DM have a higher risk of ?

A

Cardiovascular events

68
Q

Can a px have HR AND DR in the Same eye?

A

YESSSSSSS

69
Q

Out of HR stage 3 and DR R3 which shows a ‘drier’ retina ?

A

HR stage 3

70
Q

Out of HR and DR which disease is more likely to have flame haemorrhages?

A

HR, DR More likely to have dot and boor

71
Q

What anterior eye condition is associated with HTN ?

A

Sub-conjucntival haemorrhage

72
Q

What stage is optic nerve head swelling a feature of ?

A

Stage 4

73
Q

After treatment of stage 4 HTN, what might the optic nerve head still look like?

A

Nerve pallor, optic nerve dysfunction

74
Q

What can acute obstructions of the supplying the optic nerve head lead to?

A

NA-AION (Anisha’s FAV)

75
Q

What signs and symptoms may someone with NA-AION have?

A
  • painless sudden loss of vision
  • reduced va
  • dyschromatopsia (reduced CV)
  • RAPD
  • Swollen optic disc
  • VF defect
76
Q

What is the main treatment of hypertensive retinopathy?

A

Manage the systemic HTN

77
Q

At 2 months, what is the mortality rate of px with malignant HTN?

A

50%

78
Q

What is the management for stage 1 & 2 HR?

A

Refer to GP for management of systemic HTN

79
Q

What is the management of stage 3 HR?

A

Refer to GP for management of systemic HTN
AND
Refer for ophthalmological assessment

80
Q

What is the management for stage 4 HR?

A

Medical emergency - same day referral

81
Q

Once stage 3 is treated, what will remain?

A

Stage 1 and 2 appearance so thinning of artery walls ect

82
Q

According to Keith, Wagner and Barker what are the 3-year survival rates for a px with stage I retinopathy?

A

70%

83
Q

According to Keith, Wagner and Barker what are the 3-year survival rates for a px with untreated HTN and with stage I retinopathy?

A

70%

84
Q

According to Keith, Wagner and Barker what are the 3-year survival rates for a px with untreated HTN and with stage II retinopathy?

A

62%

85
Q

According to Keith, Wagner and Barker what are the 3-year survival rates for a px with untreated HTN and with stage III retinopathy?

A

22%

86
Q

According to Keith, Wagner and Barker what are the 3-year survival rates for a px with untreated HTN and stage IV retinopathy?

A

6%

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