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Part 1 > Hypertensive Retinopathy > Flashcards

Hypertensive Retinopathy Flashcards

1
Q

What changes do you see in Grade 1 HTN Retinopathy?

A
  1. Vasospasm w thickening & sclerosis of the arteriole –> narrowing & attenuation
  2. Copper –> Silver wiring
  3. More silver wiring as HTN gets worse
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2
Q

What changes do you see in Grade 2 HTN Retinopathy?

A
  1. Retinal arteriovenous nicking
  2. Hardened artery compresses on vein
  3. Significant narrowing/attenuation (<1/2)
  4. Salus’s sign: deflection of retinal veins at AV –> S sign
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3
Q

What changes do you see in Grade 3 HTN Retinopathy?

A
  1. Grade 2 Diastolic BP 110 to 115 mmHg (Stage 2 HTN)
  2. Disruption of BRB due to damage of arterioles & capillaries (fibrinoid necrosis/loss of endothelium cell lining the BV)
  3. Hypoxia
  4. Retinal hemes
  5. CWS
  6. Exudates
  7. Bonnet sign
  8. Gunn sign
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4
Q

What changes do you see in Grade 4 HTN Retinopathy?

A
  1. Malignant HTN (Diastolic BP 130 to 140 mmHg
  2. ONH Edema (due to INC in ICP, leakage of retinal vessels near the optic near, ischemia & axoplasmic flow stasis)
  3. Macular star (exudates fall in Henle’s layer). Found in OPL
  4. High risk of organ damage
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5
Q

Is tortuosity of arteries always a sign of HTN ret?

A

NO

Many people are born w naturally tortuous arteries

Early stages the arteries are actually straightened and than become tortuous over time (80% of the time tortuous arteries are NOT secondary to vascular disease)

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6
Q

What do retinal arterioles and venules share?

A

the same outer sheath when crossing

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7
Q

What happens to vision in chronic changes of grade 1 and 2?

A

Typically no visual changes

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8
Q

What happens to vision in acute changes of grade 3 and 4?

A

May have DEC in Vision

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9
Q

Simplified classification of HTN retinopathy for Mild Stage includes:

A
  1. Generalized arteriolar attenuation
  2. Focal arteriolar attenuation
  3. AV nicking (Salus, Bonnet, Gunn)
  4. Copper Wiring
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10
Q

Moderate HTN retinopathy (simplified classification) includes:

A
  1. Signs of mild HTNr etinopathy
  2. Retinal hemes
  3. MA
  4. CWS
  5. Exudates
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11
Q

Malignant HTN retinopathy (simplified classification) includes:

A
  1. Mild and moderate signs

2. Optic Nerve Edema

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12
Q

Benefits of simplified version vs Keith-Wagener Barker Classification?

A
  1. Better reliability & reproducibility
  2. Better in predicting long term risk of stroke
  3. More accurate in associating with CVD
  4. Easier to use
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13
Q

What kind of innervation makes arteries in choroid more susceptible to vasoconstriction?

A

Sympathetic!

NOTE: choriocapillaris is fenestrated (elevated BP INC amount of leakage)

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14
Q

Where is Elschnig’s spots, Siegrist’s streaks, and RPE/sensory retina detachments seen in?

A

HTN Choroidopathy

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15
Q

What is Elschnig’s spots?

A

Yellow circular lesions that later become pigmented due to RPE damage

Occurs over non-perfused areas of choriocapillaris

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16
Q

What are Siegrist’s streaks?

A

Linear pigmented areas that run along sclerotic choroidal arteries (RPE atrophy followed by hypertrophy & hyperplasia 2-3 weeks later)

17
Q

Tx form HTN retinopathy?

A

Control BP!!!

18
Q

Which HTN retinopathy grade warrants a non-urgent referral?

A

Grade 1/2

19
Q

Which HTN retinopathy grade warrants a More-urgent referral?

A

Grade 3

20
Q

Which HTN retinopathy grade warrants an urgent referral?

A

Grade 4

21
Q

How would you educate the pt about Mild HTN retinopathy in terms of education, f/u, etc?

A

Weak associations w STROKE, coronary heart disease, & cardiovascular mortality

Routine F/U w PCP. Monitor for vascular risk

RTC: 9-12 months

22
Q

How would you educate the pt about Moderate HTN retinopathy in terms of education, f/u, etc?

A

Strong association: stroke, CHD, CVD mortality

See PCP ASAP for BP control. Monitor for vascular risk

RTC: 4-6 months

23
Q

How would you educate the pt about Malignant HTN retinopathy in terms of education, f/u, etc?

A

HIGH mortality risk (3 year survival rate is only 6%)

Urgent Tx & referral to the ER

Lower BP slowly*** as end organ tissues have adapted to severely elevated pressure –> sig drop in perfusion could lead to CEREBRAL INFARCTION, MI, & BLINDNESS

RTC: 1-2 months

24
Q

Where are arterioles located in the retina?

A

RNFL

25
Q

Where are the Superficial capillary plexus located in retina?

A

GCL

26
Q

Where are the Intermediate capillary plexus located?

A

GCL/IPL

27
Q

Where is the deep capillary plexus located?

A

INL/OPL

28
Q

What effect does high BP have on arterioles?

A

Eventually causes Internal elastic lamina to become more firm/sclerotic w hyalinization (arteriolosclerosis)

NOTE: arterioles are affected > capillaries

29
Q

What % of pts with HTN have the chance of developing HTN retinopathy?

A

50-80%!

30
Q

JNC 8 Recommendations?

A

> = 60 years old target is <150/<90

<60/>18 yo target is <140/<90

31
Q

124/80 is considered what BP?

A

Pre-HTN

RECALL:
Normal=<120/<80
Pre-HTN=120-139/80-89
HTN Stage 1=140-159/90-99
HTN Stage 2=160-179/100-109
HTN urgency=180-199/110-119
HTN emergency=>200/>120
32
Q

145/90 is considered what BP?

A

Stage 1 HTN

RECALL:
Normal=<120/<80
Pre-HTN=120-139/80-89
HTN Stage 1=140-159/90-99
HTN Stage 2=160-179/100-109
HTN urgency=180-199/110-119
HTN
33
Q

122/100 is considered what BP?

A

Stage 2 HTN

RECALL:
Normal=<120/<80
Pre-HTN=120-139/80-89
HTN Stage 1=140-159/90-99
HTN Stage 2=160-179/100-109
HTN urgency=180-199/110-119
HTN
34
Q

New research states that systolic OR diastolic BP is a better predictor of cerebrovascular/CVD?

A

Systolic**

35
Q

Which, systolic or diastolic BP, is more related to stages of HTN retinopathy?

A

Diastolic!!

Part 1 (31 decks)

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