Hypertensive Retinopathy Flashcards
What are the different types of causes for HTN Retinopathy? (2 things)
- Chronic HTN
- Malignant / accelerated HTN
What are the CF of HTN Retinopathy, due to CHRONIC HTN?
Usually asymptomatic, only Dx via examination
What are the CF of HTN Retinopathy, due to Malignant / Accelerated HTN? (7 things)
- Headache
- N + V
- Flushed face
- Sudden painless loss of vision (bc vessel occlusion)
- Intermittent blurring of vision
- Visual field defects
- Signs of End organ damage (e.g HF, AKI, Chest pain)
What might you see on a Fundoscopy of HTN Retinopathy? (6 things)
- Papilloedema
- Retinal haemorrhages
- Hard exudates
- Cotton wool spots
- Arteriovenous nipping
- Silver / copper wiring
What is Silver / copper wiring? (2 points)
- Walls of arterioles –> thick + sclerosed
- This causes increased reflection of light
What is Arteriovenous nipping? (2 points)
- Walls of arterioles –> thick + sclerosed
- This causes compression of veins where they cross
What are Cotton wool spots caused by?
Ischaemia / infarction in retina –> damage to nerve fibres
What are Hard exudates caused by?
Damaged vessels leaking LIPIDS into retina
What are Retinal haemorrhages caused by?
Damaged vessels rupturing + leaking BLOOD into retina
What is Papilloedema caused by?
Ischaemia to Optic nerve –> optic nerve swelling + blurring of disc margins
What is the classification system for HTN Retinopathy called?
Keith-Wagener-Barker Classification
What is the Keith-Wagener-Barker Classification for HTN Retinopathy? (4 stages)
- Stage 1: Mild narrowing of arterioles
- Stage 2: AV nipping
- Stage 3: Hard Exudates + Cotton Wool patches + Haemorrhages
- Stage 4: Papilloedema / Signs of retinal oedema
(they build up, so 4 has 3 as well)
What Stage of Keith-Wagener-Barker does Malignant HTN Retinopathy usually present as?
Stage 4
Apart from Fundoscopy, what other investigations can you do for HTN Retinopathy? (2 things)
- Optical coherence tomography (OCT)
- IV Fluorescein angiography (IVFA)
What are some DDx that present similarly to HTN Retinopathy?
DM Retinopathy
How can you differentiate between DM vs HTN Retinopathy? (2 things)
- Hx
- Fundoscopy
What are the Fundoscopy findings that you will find in both DM + HTN Retinopathy?
Cotton wool spots
What are the Fundoscopy findings of DM Retinopathy that you WON’T find on HTN Retinopathy? (3 things)
- Microaneurysms
- Dot + Bot haemorrhages
- Neovascularisation
What is the Mx aim for HTN Retinopathy caused by Chronic HTN? (2 things)
- Reduce BP
- X RF: smoking + lipid levels
What is important about HTN Retinopathy caused by Malignant HTN?
Medical emergency
What are the Mx options for HTN Retinopathy caused by Malignant HTN? (2 things)
Same day specialist assessment
When should you refer HTN Retinopathy caused by Malignant HTN to Same day specialist assessment? (2 things)
- Signs of retinal haemorrhage / papilloedema @ fundoscopy
- Life threatening CF
What are the life threatening CF that make you refer HTN Retinopathy caused by Malignant HTN to Same day specialist assessment? (4 things)
- New onset confusion
- Chest pain
- HF signs
- AKI signs
If CF that cause you to refer HTN Retinopathy caused by Malignant HTN to Same day specialist assessment are present, what should you do?
Start Mx without waiting for ambulatory / home BP to confirm
What is the problem with Mx of Malignant HTN? (2 points)
- Have to reduce BP over 24-48 hours
- Lowering too quick –> organ hypoperfusion
What can you insert for continuous BP monitoring in Malignant HTN?
Arterial line
What are the Mx options for reducing BP in Malignant HTN? (3 things)
IV anti-HTN meds:
1. Nitroprusside
2. Labetalol
3. Nicardipine
What is long term stuff you should tell pt with Malignant HTN about their Eye recovery? (2 things)
- Most retinal changes will improve within 6 months (if well managed)
- But Arteriosclerotic changes in retina won’t change
