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Pathology-my one > Hypertensive retinopathy > Flashcards

Hypertensive retinopathy Flashcards

1
Q

What is blood pressure?

A

The pressure that is exerted by the blood in blood vessels

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2
Q

What do the 2 numbers on blood pressure reading mean?

A

First number is systolic pressure during systole which is when ventricles contract

Second number is diastolic pressure during diastole when ventricles relax

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3
Q

What is normal blood pressure?

A

Between 90/60mmHg to 140/90 mmHg

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4
Q

What is hypertension/high bp?

A

Above 140/90 mmHg on two occasions

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5
Q

What is malignant HTN?

A

Above 200/140mmHg

Emergency

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6
Q

What can HTN cause?

A

Heart disease, stroke, renal problems, retinopathy, cognitive decline, premature death

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7
Q

What are the non-modifiable risk factors for HTN?

A

Age, FH, race (afro-caribbean), pregnancy

Diabetes and HTN=more risk of retinopathy

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8
Q

What are modifiable risk factors of HTN?

A

Obesity, smoking, alcohol, exercise

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9
Q

What are some ocular complications of HTN?

A

Sub-conjunctival haemorrhages

Cranial Nerve Palsies

Hypertensive retinopathy

Systemic diseases present bilaterally

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10
Q

What is sub-conjunctival haemorrhage?

A

Burst blood vessel within the eye, if recurrent then warrants referral to GP for CVD work up

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11
Q

What is hypertensive retinopathy?

A

Diffuse or focal narrowing of retinal arterioles in response to HTN

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12
Q

What can long term HTN cause?

A

Arteriolosclerosis

Thickening of arteriolar wall

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13
Q

How many grades of hypertensive retinopathy are there?

A

4

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14
Q

What is Grade 1 hypertensive retinopathy and how do you manage px?

A

Mild to moderate narrowing of retinal arterioles , turtousity

A/V ratio reduced (arteries thinner than normal eg. 1/3 ratio instead of 2/3)

Refer to GP is not already being treated

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15
Q

What is Grade 2 hypertensive retinopathy and how do you manage px?

A

Moderate to marked narrowing of arterioles - Local and/or generalised narrowing

Arteriovenous crossing changes

Copper/metallic appearance, increase in light reflex

Refer to GP is not already being treated

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16
Q

What sort of arteriovenous changes will you see in Grade 2?

A

Nipping/gunn’s sign: Thinning of venoule at arteriole crossing,

The hardened artery puts physical pressure on the vein and nips in

Severe AV crossing changes can cause BRVO

This sign may persist even when blood pressure is under control again

17
Q

What is the copper wire appearance caused by?

A

Increase in elastic and muscular components of artery wall

The narrow lumen gives a copper reflex

18
Q

What is silver wire?

A

Copper wire can become silver wire overtime when the column of blood can no longer be visualised

19
Q

What is beading?

A

Beading=changes in the colour of the artery, the risk is that that artery becomes occluded

20
Q

What is Grade 3 hypertensive retinopathy and how do you manage px?

A

Arterial narrowing and focal constriction

Cotton wool spots

Retinal haemorrhages

Hard exudates

Retinal oedema

Urgent referral to GP to get BP checked

21
Q

What sort of diastolic BP does patient have in grade 3?

A

Typically

Dystolic 110-115mmHg

22
Q

What type of hemorrhages will you see in grade 3?

A

Flame shaped hemorrhages which follow path of nerve fibre layer

23
Q

What is Grade 4 hypertensive retinopathy and how do you manage px?

A

Grade 3 plus optic disc swelling

Exudate at macula= macular star

Refer emergency to A&E

24
Q

What sort of diastolic BP does patient have in grade 4?

A

Malignant hypertension
Diastolic
130-140mmHg

25
Q

Why do you refer Grade 4 to A&E

A

Risk of ocular, cardiac, renal and cerebral damage

26
Q

What symptoms will Grade 4 have?

A

Blurred vision as macula involved

Diplopia, scotoma, dimness in vision, photopsia, chest pain, headaches, nausea, shortness of breath, weakness

27
Q

Is grade 1-3 symptomatic?

A

No

28
Q

Which grades of hypertensive retinopathy are reversible?

A

Grade 1 and 2

29
Q

What is hypertensive choriodopathy?

A

In grade 3-4 hypertensive retinopathy

Necrosis (death) of choriodal vessels causes choroidal ischameia (vessels die so no oxygen)

30
Q

How can you detect hypertensive choriodopathy?

A

yellow spots in RPE

31
Q

How can you detect CHRONIC hypertensive choriodopathy?

A

Yellow spots become pigmented clumps surrounded by atophic area

32
Q

How do you manage hypertensive retinopathy depending on the grades?

A

Grade 1-2 refer to GP for BP check

Grade 3 refer to ophthalmologist

Grade 4 send to A&E. Unlikely to see this in practise as people regularly have BP checked

Pathology-my one (12 decks)

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