Chapter 11: Indirect Assessment of Arterial Disease Flashcards
A series of maneuvers testing the digital perfusion of the hand while compressing and releasing the radial and ulnar arteries
Allen test
The ratio of ankle systolic pressure to brachial systolic pressure
ankle-brachial index
pain in muscle groups brought on by exercise or activity that recedes with cessation of activity; can occur in the calf, thigh, or buttock
claudication
An indirect physiological test that detects changes in back-scattered infrared light as an indicator of tissue perfusion
photoplethysmography
an indirect physiologic test that measures the changes in volume or impedance in a whole body, organ, or limb
plethysmography
vasospasm of the digital arteries brought on by exposure to cold; can be caused by numerous etiologies
Raynaud’s Disease
Pain in the extremity without exercise or activity, thus, “at rest”; can occur in the toes, foot, or ankle area
Rest pain
Compression of the brachial nerve plexus, subclavian artery, or subclavian vein at the region where these structures enter or exit the thoracic cavity
Thoracic outlet syndrome
Intermittent claudication is located in the _____, _____, _____, _____.
buttock, thigh, hip, calf
Intermittent claudication and exercise.
always
Intermittent claudication is relieved by ______.
stopping
Spinal stenosis is located in the ____, _____, ______, and ____.
buttock, thigh, hip, calf
Spinal stenosis and exercise.
yes, but also with standing
Spinal stenosis is relieved by _____.
sitting, flexing, and moving spine
Herniated disc is located _____.
radiates down leg
Herniated disc and exercise.
variable
Herniated disc is relieved by _____.
varies; aspirin or anti-inflammatories
Osteoarthritis is located in the ____, _____, and _____.
hips, knees, ankles
Osteoarthritis and exercise.
variable; not always produced
Osteoarthritis is relieved by _____.
varies; aspirin or anti-inflammatories
Ankle-Brachial Index >1.30
incompressible PAOD
Ankle-Brachial index 0.9-1.30
normal
ABI 0.75-0.89
mild paod
ABI 0.50-0.74
moderate PAOD
ABI <0.50
severe PAOD
ABI <0.35
tissue threatening PAOD
Doppler waveforms proximal to knee are ____.
multiphasic
Plethysmography waveforms exhibit a _____.
dicrotic notch
Pulse waveforms have a well-defined _____.
peak
Resting and postexercise ABIS are _____.
0.90-1.30
Single (wide) above knee cuff systolic pressure is ______ higher brachial.
equal to
High thigh (narrow) cuff systolic pressure > or equal to _____ abover higher brachial.
30 mm Hg
All pulse waveforms have ____ systolic upstroke.
short
Difference between adjacent limb segments is < or equal to ____ mm HG.
30
Difference between brachial systolic pressures is < or equal to ___ mm Hg.
20
Resting and postexercise digit-brachial indices are > or equal to ____.
0.90
< or equal to ___ mm Hg systolic pressure between above and below elbows
20
Gradient between brachial systolic pressures is < or equal to ___ mm Hg.
20
Pulse waveform and temperature normal recovery time < or equal to ___.
10 minutes
Peripheral arterial occlusive disease has an ABI less than ___.
0.90
Digital ischemia in the lower extremity has a TBI less than ___.
0.80
Digital ischemia in the upper extremity has a TBI less than ___.
0.90
diminished or flat digital PPG waveforms during provocative arm/shoulder maneuvers and the development of symptoms.
thoracic outlet syndrome
Raynaud’s disease has a DBI less than ____.
0.90
Positive Allen test with diminished digital waveforms during manual compression of radial or ulnar arteries
incomplete palmar arch
(radial/ulnar dependency)
Most common symptom of PAOD in the lower extremity
leg discomfort caused by activity
fatigue, or as a cramping, aching, or tiredness sensation; usually starts in calf, progressing to thigh and buttocks
intermittent claudication
In PAOD symptoms occur ____ to the disease process.
distal
correction requiring sitting or spinal flexure
spinal stenosis
Claudication distances decrease, symptom recovery time _____ as PAOD progresses.
increases
Rest pain
forefoot pain may be constant
patient recumbent, raising leg a foot or so above heart level will usually cause blanching of the skin on the foot, becomes red with dependency
elevation pallor/dependent rubor
first indication of aneurysmal disease
blueness of the toes
most common site for aneurysmal disease
popliteal level
___ % of all extrinsic compression-related symptoms in upper extremity.
95
Cold sensitivity is generally referred to as ______.
Raynaud’s phenomenen
Primary Raynaud’s origin
idiopathic
Secondary Raynaud’s origin
underlying disease process
coexisting clinical conditions for PAOD exam
stroke/ishemic attack
carotid artery disease
heart attack
coronary artery disease
hypertension
diabetes
lipid disorder
symptoms related to positional causes of arm fatigue/numbness/aching and/or symptoms related to cold sensitivity
upper extremity indications
How long should patient rest before starting a systolic pressures exam?
10-15 minutes
The width of the cuff should be at least __% wider than limb segment.
20
If the blood pressure cuff is too narrow:
falsely elevated pressure
If the blood pressure cuff is too wide:
falsely lowered pressure
Systolic pressure exam cuff should be inflated ___ mm Hg about flat point.
20
During systolic pressure exam deflate cuff slowly ___.
3 mm Hg/s
indicate overall severity of PAOD between heart and ankle level
ABI
calculated by dividing the highest systolic pressure at ankle level by the higher of two brachial systolic pressures
ABI
presence of differing ipsilateral resting normal and abnormal ankle pressures; associataion with potential cardiovascular problems
PAOD isolated to a single ipsilateral tibial artery
ABI must alter by at least ____ to be significant.
0.15
A normal drop of ___ mm Hg as blood flows from heart to distal segments of lower extremity; increase in amplitude of pulses distally
10
Normal resting ankle systolic pressure
50 mm Hg
Normal resting ABI
0.90
indications of calcific vessels
Doppler signal does not reappear at a clearly defined pressure; increases in amplitude with further cuff deflation
technique of elevating an extremity; valuable to determine healing potential of pedal lesion
Pole test
measuring systolic pressures segmentally at two or three levels more proximally and comparing waveforms
segmental limb systolic pressures
Drops greater than 30 mm Hg in distal pressure between adjacent segments indicate:
presence of obstruction proximally
In the upper extremity, the most common location for PAOD is:
subclavian level and proximal axillary
Lower extremity locations Doppler Waveforms
CFA
SFA
POP
Distal PTA and DPA
upper extremity locations Doppler waveforms
subclavian
axillary
brachial
distal radial
distal ulnar
exhibit a degree of flow reversal in late systole/ early diastole
bidirectional waveform
More reversal in flow relates to ____ resistance to flow.
greater
Normal progression of PAOD _____ flow energy distal to lesions
reduces
arteriolar bed cannot dilate further and blood flow into affected segment(s) begin to drop
critical stage PAOD
PVR inflation of cuff
65 mm Hg
relate to moment-to-moment changes in limb volume; difference between arterial inflow and venous outflow
PVR
Normal PVR waveform
brisk upstroke with well-defined peak
usually shows a “notch” on downstroke in early diastole, which then returns to baseline in a concave manner before onset of next cardiac cycle
dicrotic notch
Moderate to severe PAOD waveforms
delayed onset to peak, more rounded
Diastolic phase becomes ____ as PAOD progresses
convex
