What is the treatment strategy for heart failure with angiotensin II?
The strategy used by these physicians was usually a temporary reduction or suspension (rather than a withdrawal) of the ACEi. It should be emphasized that it is this very pharmacological management strategy that led to a significant and substantial decrease in HF‐related events. Angiotensin IIreceptor blockers
When to refer a patient with low blood pressure to HF?
If BP does not improve, low BP is likely to be a sign of chronically impaired cardiac output, and it is preferable to refer the patient promptly to a HF Team to discuss other treatment options.
When to decrease blood pressure reducing drugs in patients with hypotension?
In instances of symptomatic or severe persistent hypotension (systolic blood pressure < 90 mmHg), it is recommended to first decrease blood pressure reducing drugs not indicated in HFrEF as well as the loop diuretic dose in the absence of associated signs of congestion.
Why do patients with heart failure have low blood pressure?
It is likely that this correlation is a consequence of the fact that more severe cardiac dysfunction causes a decline in systemic blood pressure, making low blood pressure a marker for more advanced HF [ 4 ]. This observation makes it difficult to study the benefits of antihypertensive therapy in this population.
What is the treatment for ocular hypertension?
Ocular hypertension is treated with prescription eye drops that can either help aqueous humor to drain from your eye or lower the amount of aqueous humor that your eye produces. Some examples are: prostaglandins (travoprost, latanoprost) rho kinase inhibitors (netarsudil)
What medications reduce IOP?
The medications available for reducing IOP in glaucoma patients include topical β-adrenergic antagonists (eg, timolol, betaxolol), carbonic anhydrase inhibitors (eg, dorzolamide, brinzolamide), cholinergics (eg, pilocarpine), α-adrenergic agonists (eg, brimonidine), prostaglandins (eg, latanoprost, travoprost), and ...
Which antihypertensive drug may also be used to treat glaucoma?
Clonidine. Clonidine is the first available a-2 agonist, for the treatment of glaucoma. Clonidine is a lipophilic molecule, which is a relatively selective a-2 adrenoceptor agonist with some a-1 adrenoceptor agonistic activity. It crosses the blood brain barrier and causes systemic hypotension.
When do you treat IOP?
If your intraocular pressure is 28 mm Hg or higher, you are treated with medicines. After 1 month of taking the drug, you have a follow-up visit with your eye doctor to see if the medicine is lowering the pressure and there are no side effects.
What drops lower eye pressure?
Some types of eye drops work by helping fluid drain from your eye, which lowers eye pressure. Examples include: Prostaglandins, like Xalatan (latanoprost), Travatan Z (travoprost), Zioptan (tafluprost), and Lumigan (bimatoprost) Rho kinase inhibitor, like Rhopressa (netarsudil)
Does aspirin lower IOP?
Prostaglandins play an important role in the regulation of intraocular pressure. Aspirin is well known to inhibit cyclooxygenase mediated prostaglandin synthesis.
Is Amlodipine contraindicated in glaucoma?
Conditions Contraindicated With Glaucoma Meds Calcium channel blockers such as Norvasc (amlodipine, Pfizer), Cardizem CD (diltiazem, Biovail) and Calan (verapamil, Searle) may interact with topical beta-blockers and can cause irregular heart beat.
Can amlodipine increase eye pressure?
After four weeks of treatment with amlodipine, the mean IOP reduced to 19.3 ± 1.8 mmHg and 18.7 ± 2.0 mmHg in left and right eye respectively in addition to significant blood pressure (BP) reduction. Analysis of IOP and blood pressure changes before and after the treatment with amlodipine, were done by paired “t” test.
Can I take metoprolol if I have glaucoma?
The beta1-selective beta-blocking agent Metoprolol gave a significant intraocular pressure decrease in different groups of open angle glaucoma patients in a concentration of 1% and 3%. The magnitude of effect corresponded to 33% of the untreated pressure level.
What drugs are used to treat open angle glaucoma?
Apraclonidine (Iopidine) and brimonidine tartrate (Alphagan) are alpha agonists, effective as adjunctive or, occasionally, primary therapy. Both may increase aqueous outflow in addition to decreasing aqueous production.
Which drug is used to treat open angle glaucoma?
Brinzolamide and brimonidine (Simbrinza) This combination product contains the carbonic anhydrase inhibitor brinzolamide and the alpha2 adrenergic receptor agonist brimonidine. It is indicated for reduction of elevated intraocular pressure in patients with primary open-angle glaucoma.
How do Diuretics decrease intraocular pressure?
Osmotic diuretics increase the osmolarity of the glomerular filtrate and induce diuresis. This in turn hinders the tubular reabsorption of water, causing sodium and chloride excretion to increase as well. The diuretic effect of these agents can subsequently reduce IOP.
What is the difference between narrow angle and open angle glaucoma?
Narrow-angle glaucoma differs from open-angle glaucoma in that the iris blocks fluid from entering and exiting the eye. Fluid can cause increased pressure, leading to optic nerve damage. This can occur suddenly, necessitating immediate medical treatment.
What are the risk factors for narrow angle glaucoma?
Some risk factors can increase the likelihood of developing narrow-angle glaucoma. You have a higher risk of developing glaucoma if you: Have diabetes. Are 60 or older. Are a woman. Are of Inuit or Asian descent. Have a past history of cataracts. Are farsighted.
How does a drainage device help with glaucoma?
Drainage implant, or glaucoma drainage device: In this surgery, your physician will implant a small tube in your eye and create a reservoir that allows aqueous fluid to collect there. Your blood vessels absorb the fluid as it exits the eye. The good news is that treatment can slow the progression of narrow-angle glaucoma and prevent vision loss.
Does narrow angle glaucoma slow the progression of glaucoma?
The good news is that treatment can slow the progression of narrow-angle glaucoma and prevent vision loss. Studies show that cases of blindness caused by glaucoma have decreased since metrics for diagnosis were changed 1981 and 2000.
Is narrow angle glaucoma serious?
Glaucoma is serious, but narrow-angle glaucoma can be severe. Some people may not know they have it, and symptoms can suddenly appear. Intraocular pressure, or IOP, can suddenly build up in the eye. This is called acute narrow-angle glaucoma. It requires immediate medical attention or you could become blind.
Can narrow angle glaucoma cause vision loss?
Narrow-angle glaucoma is one of the eye conditions in the glaucoma family of diseases. ( Learn More) It can cause vision loss if untreated or undetected. Thankfully, eye doctors have several tools at their disposal to make a timely diagnosis. ( Learn More)
Can narrow angle glaucoma be unpredictable?
Narrow-angle glaucoma can be unpredictable . Follow guidance from your doctor to prevent worsening symptoms or effects. The good news is that consistent eye exams can help you detect it early, and early treatment is key to a better long-term prognosis.
Why is narrow angle difficult?
This is the most challenging of patients in the narrow-angle spectrum, because the patient simply presents with narrow anatomical angles, but without optic disc damage or a history of intermittent attacks. The clinician is often asked to determine whether or not the anterior chamber angles are occludable and predisposed to angle-closure attacks.
What is narrow angle glaucoma?
Narrow Angles. The term narrow angle refers to an anatomical condition in which there is irido-trabecular apposition caused by any number of factors. The incidence of narrow-angle glaucoma in the general population is around 1 percent, increasing in Inuit Eskimo and East Asian individuals.
What happens if the IOP is lower?
If the IOP is lower and the corneal edema improves, the clinician should re-examine the angle gonioscopically to determine if the closure is appositional only or if there is peripheral anterior synechiae (PAS) formation. If the angle is still open (i.e., with, at most, minimal PAS), the surgeon can perform a laser iridotomy.
How to use a 30-ga needle for TB?
needle on a TB syringe without the plunger. Direct the tip of the needle either to the six or 12 o'clock position to avoid touching the lens . Once in the anterior chamber, the physician can control the amount of aqueous that is released.
Is every narrow angle occludable?
It's important to note that not every narrow angle is occludable. This makes the history and exam vital in diagnosing patients who are at greatest risk for developing angle-closure glaucoma. The risk factors for developing primary angle-closure glaucoma are: • increasing age; • increasing lens thickness;
What happens if you block drainage angle?
If you have complete blockage of the drainage angle, you are experiencing an acute attack. This type of health event is a medical emergency and requires immediate care. In severe cases, eye pressure can increase suddenly and put you at risk of blindness if left untreated.
What is the procedure for a fellow eye attack?
To minimize the likelihood of the event, an eye doctor may perform a prophylactic (preventive) iridectomy (partial removal of the iris) or laser iridotomy (creates a hole in the outer edge of the iris ).
How to tell if you have open angle glaucoma?
Distinguishing symptoms of open-angle glaucoma include the following: Patchy blind spots in peripheral or central vision (often in both eyes) Tunnel vision (during advanced stages of the condition) Finally, unlike acute narrow-angle glaucoma, the onset of symptoms of open-angle glaucoma is slow.
Can prescription medications cause narrow angle glaucoma?
Medication side effects. Some prescription drugs may increase the risk for angle closure, such as eye drops to dilate the pupils. Many people will develop narrow-angle glaucoma slowly and gradually. No symptoms are present until eye damage is severe or an acute attack takes place.
Can angle closure glaucoma cause blurred vision?
Chronic angle-closure glaucoma will not produce symptoms until the condition has reached a certain level of severity. If a person experiences an acute attack, some early symptoms may occur. For example, people with the following symptoms should speak with an ophthalmologist immediately: Sudden blurred vision.
Can narrow angle glaucoma be chronic?
People with narrow drainage angles face an increased risk of this eye condition. Narrow-angle glaucoma can be either acute or chronic. If you have complete blockage of the drainage angle, you are experiencing an acute attack.
What is the narrow angle of the eye?
Narrow angles is a term used to describe the anatomy of the eyes in certain people that is different from what we determine to be normal. The area between the front, clear part of your eye called the cornea and the colored part inside your eye called the iris is the anterior chamber angle. Fluid known as aqueous humor is constantly produced in ...
What happens if you have an angle closure?
If angle closure occurs suddenly, the pressure in the eye can rise to dangerous levels within hours. The increased pressure causes the iris to be pushed forward and block the drainage system completely. This is known as acute angle closure glaucoma, which is a medical emergency. It can present with sudden, severe eye pain, headache, blurred vision, ...
Can narrow angles cause vision loss?
angles and 2) judge whether treatment will be necessary. People with narrow angles are at risk of angle closure which would prevent fluid from draining normally and cause pressure to build up in the eye. This can cause damage to the optic nerve and ultimately vision loss. Angle closure can either occur gradually over time or suddenly.
Can angle closure cause vision loss?
This can cause damage to the optic nerve and ultimately vision loss. Angle closure can either occur gradually over time or suddenly. Angle closure that occurs gradually causes the eye pressure to build up slowly over time, known as chronic angle closure glaucoma.
Do you have to have a narrow angle to get a pupil dilation?
This is important to do before we put in drops in your eyes to dilate your pupils, as people with narrow angles should not undergo pupil dilation before the narrow angles are corrected.
What causes narrow angle glaucoma?
Generally, narrow-angle glaucoma is caused by the iris (the colored part of the eye that surrounds the pupil) being bowed forward, restricting the space between the clear cornea and the iris where the drainage angle of the eye is located.
Which race has narrower anterior chamber drainage angles?
Race — Anatomically, individuals who are Asian, as well as Inuit and other northern indigenous people, have narrower anterior chamber drainage angles. This results in a higher incidence of narrow-angle glaucoma in these populations. Sex — When studied in Caucasians, narrow-angle glaucoma occurs three times more frequently in women than in men.
What causes a person to have a shallow anterior chamber?
Hyperopia — People who are highly farsighted are more likely to have eyes with shallow anterior chambers (the space in the front of the eye, between the cornea and iris) and narrow angles, increasing their risk for angle-closure glaucoma. Tumors and other causes — A tumor behind the iris, swelling associated with inflammation of the ciliary body ...
What causes angle closure glaucoma?
Tumors and other causes — A tumor behind the iris, swelling associated with inflammation of the ciliary body (intermediate uveitis) and alteration of the shape of the eye after surgery for a detached retina also can cause angle-closure glaucoma.
Can angle closure cause vision loss?
However, regardless of how long symptoms persist, each angle-closure episode potentially results in partial loss of your peripheral vision. For this reason, acute angle-closure glaucoma is considered a medical emergency. If the high eye pressure is not reduced within hours, it can cause permanent vision loss.
Is narrow angle glaucoma more common in women than men?
Sex — When studied in Caucasians, narrow-angle glaucoma occurs three times more frequently in women than in men. Among African Americans, men and women appear to be affected equally.
Can narrow angle glaucoma cause eye pressure to increase?
While narrow-angle glaucoma is uncommon, when it occurs, it can cause much more rapid and severe increases in eye pressure and vision loss than the much more common form of glaucoma called primary open-angle glaucoma. This is especially true if the drainage angle closes suddenly, as it does in the acute angle-closure form of narrow angle glaucoma.
What is glaucoma?
Glaucoma is an eye disease that causes vision loss from damage to the optic nerve, which is responsible for carrying visual signals between the eye and brain.
What causes narrow-angle glaucoma?
Narrow-angle glaucoma occurs when the iris, the colored part of the eye that surrounds the pupil, bows forward, narrowing the gap between the cornea and the iris, where the eye’s drainage angle is located.
Who is at risk for narrow-angle glaucoma?
A person’s chance of developing narrow-angle glaucoma is increased if they have any of the following risk factors:
How is narrow-angle glaucoma treated?
Lowering your ocular pressure to a safe, steady level is the best strategy to treat narrow-angle glaucoma.
Why is my pulse pressure narrowing?
Blood loss through trauma or accidents will also cause the pulse pressure to narrow. Other causes of narrow pulse pressure include shock, congestive heart failure, cardiac tamponade and aortic valve stenosis. Abnormal pulse pressure readings, however, do not necessarily indicate health problems.
What does a low pulse pressure mean?
What Does a Narrow Pulse Pressure Indicate? A low or narrow pulse pressure is indicative of a decreased heart function and is usually a predictor of death in patients with mild to advanced heart failure, according to 2010 study published in Texas Heart Institute Journal.
What is the risk of heart disease if your pulse pressure is higher than 40?
A pulse pressure higher than 40 is abnormal and when it gets as high as 60, the patient is considered to be at risk of developing a cardiovascular disorder.
Does a high pulse pressure indicate health problems?
Abnormal pulse pressure readings, however, do not necessarily indicate health problems. For example, an individual's systolic reading will increase during and immediately after exercise while the diastolic reading will remain the same.
Is 120/80 blood pressure good?
Since a blood pressure reading of 120/80 is considered to be the normal or healthy blood pressure, the difference of 40 between the readings is also considered to be a healthy pulse pressure. Both high or wide pulse pressure and low or narrow pulse pressure are believed to be indicators of poor cardiac health.
What is the best treatment for narrow angles?
In general, treatment involves either laser surgery or cataract surgery.
Can narrow angles cause nausea?
Occasionally, patients with narrow angles suffer from intermittent episodes of angle closure attacks, and these are usually associated with a mild or moderate headache in dark light conditions, blurring of the vision for a few hours, redness, and sometimes nausea and vomiting.
What Is narrow-angle Glaucoma?
Risk Factors
Symptoms of Acute narrow-angle Glaucoma
Diagnosis of narrow-angle Glaucoma
Are Treatments available?
- Narrow-angle glaucoma can be successfully managed if detected early. Treatment can include one or more of the following: 1. Eye drops: These are meant to relieve eye pressure or decrease production of aqueous fluid. Their purpose is to preserve your eyesight, but they can cause some side effects, such as: 1.1. Blurry vision. 1.2. Dry mouth. 1.3. It...
Frequently Asked Questions
Stages and Types of narrow-angle Glaucoma
Symptoms of narrow-angle Glaucoma
Potential Complications of narrow-angle Glaucoma
Causes of narrow-angle Glaucoma
Open-Angle vs. narrow-angle Glaucoma
How Is narrow-angle Glaucoma Diagnosed?
Treatment Options For narrow-angle Glaucoma
Tips For Managing narrow-angle Glaucoma
- To prevent vision loss, follow the steps prescribed by your eye doctor. A surgical procedure may be necessary to slow the onset of the eye condition. Other lifestyle changes to promote eye health include: 1. A healthy diet rich in zinc, copper, selenium, and antioxidant vitamins C, E, and A 2. Limiting caffeine intake 3. Exercising regularly 4. Sle...
Common Questions & Answers