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Vascular Term 3 > Quiz 1 > Flashcards

Quiz 1 Flashcards

1
Q

what is a critical stenosis?

A

narrowing of the arterial lumen resulting in a hemodynamically significant reduction in volume, pressure, and flow

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2
Q

In the AORTA, how much of a cross sectional area must be encroached upon before there is a reduction in pressure and flow distally?

A

90%

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3
Q

in SMALLER VESSELS (such as carotid arteries) how much of a cross sectional area must be encroached upon before there is a reduction in pressure and flow distally?

A

70-90%

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4
Q

what is a reliable sonographic sign of a high grade stenosis?

A

colour aliasing

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5
Q

what happens to velocity as flow enters a stenotic area?

A

velocity of the colour flow increases to a point beyond primary settings

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6
Q

do we image aliasing?

A

yes

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7
Q

when is the only time we adjust velocity scale and colour gain?

A

if flow is not seen in an area of obvious plaque. we do this to show low flow

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8
Q

what helps to show low flow states?

A

power doppler

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9
Q

what does stenotic area sound like?

A

sounds will become high pitched or “whistling”

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10
Q

what is the sound of the waveform as you exit the stenotic zone and encounter post stenotic turbulence?

A

garbled

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11
Q

what does the flow sound like distal to a stenosis?

A

sounds becomes more low pitched again but its weaker in amplitude

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12
Q

what sound will be make when there is a complete occlusion?

A

thumping sound

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13
Q

what is the CIMT normal thickness?

A

<0.9mm

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14
Q

what are the 3 steps when measuring PSV within a stenosis?

A
  1. sample just prox to stenosis
  2. record the highest velocity within a stenosis more than once
  3. document post stenotic turbulence just distal to stenosis
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15
Q

what should the angle correct be when measuring the PSV within a stenosis?

A

should be parallel to vessel walls and 60 degrees

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16
Q

what do you do with sample volume inside a stenosis?

A
  • move SV through narrowed area slowly using track ball
  • listen for a high pitched sound
  • look for colour aliasing
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17
Q

what sample sites WITHIN a stenotic zone must you document?

A

2-3 similar velocities with PSV and EDV measurments

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18
Q

what sample sites must you document with a stenosis?

A
  • prior to stenosis
  • within stenosis
  • PST after stenosis
  • distal tardus parvus waveform
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19
Q

what do we compare in a ratio meausurments?

A

flow velocity within a stenosis to the flow velocity in a more proximal stenosis

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20
Q

when is the ratio for stenosis not useful?

A

only useful when there is no stenosis or disease in the proximal setting

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21
Q

the higher the ratio______________

A

the greater the stenosis (directly proportional)

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22
Q

when are ratio measurments useful?

A

decreased heart function where the velocities are globally low throughout

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23
Q

diameter reduction mild stenosis

A

<20% diameter reduction

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24
Q

diameter reduction moderate stenosis

A

20-50% diameter reduction

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25
Q

diameter reducton critical (moderatley severe) stenosis

A

50-80% diameter reduction

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26
Q

diameter reduction severe stenosis

A

> 80% diameter reduction

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27
Q

diameter reduction total occlusion

A

no residual lumen to measure

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28
Q

what is diameter reduction measurement comparable to?

A

PSV measurments in a stenosis

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29
Q

what plane do we calculate diameter reduction?

A

SAG (longitudinal)

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30
Q

where are disatance measurments taken?

A

original lumen and the residual lumen

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31
Q

what is the formula for determining diameter and area reduction?

A

1-(residual/original) X 100

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32
Q

hemodynamically significant lesions are those with what percent in DIAMETER?

A

> 50 diameter reduction

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33
Q

what plane do we calculate area reduction?

A

TRV with the stenotic area

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34
Q

where are area measurments taken?

A

original (distal or prox) and the residual lumen

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35
Q

hemodynamically significant lesions are those with what percent with AREA?

A

> 75%

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36
Q

what is acceleration time (rise time)?

A

time elapsed from onset of systole to peak systole

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37
Q

where is significant delay to peak systole obtained?

A

in a waveform distal to a significant stenosis as in tardus parvus waveform

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38
Q

when is flow velocity slower?

A

when blood must move around an area of blockage through high resistant collateral pathways

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39
Q

when is systolic rise time extended?

A

when blood must move around an area of blockage through high resistant collateral pathways

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40
Q

where do we place calipers for acceleraton time?

A

calculated by placing a caliper on the level at which the gradient begins to rise and finished at the first peak (early systolic peak ESP)

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41
Q

what arteries is AT used?

A

carotid arteries
renal arteries
peripheral arteries

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42
Q

<15% stenosis NASCET

A

deceleration, spectral broadening

PSV <125 cm/s

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43
Q

16-49% stenosis NASCET

A

pansystolic, spectral broadening

PSV <125 cm/s

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44
Q

50-69% stenosis NASCET

A 
pansystolic, spectral broadening 
PSV >125 cm/s
EDV <110 cm/s
OR
ICA/CCA PSV ratio >2 but <4
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45
Q

70-79% stenosis NASCET

A 
pansystolic spectral broadening
PSV >270 cm/s
EDV >110 cm/s
OR
ICA/CCA PSV ratio >4
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46
Q

80-99% stenosis NASCET

A

EDV >140 cm/s

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47
Q

complete occlusion NASCET

A

no flow, terminal thump

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48
Q

what could history of the patient include?

A
  • previous stroke
  • smoker (now or prior)
  • elevated BP-HBP
  • elevated cholesterol-hyperlipidmia
  • diabetic
  • family history of any of the above
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49
Q

what are indications on req or history from referring physician?

A
  • headaches
  • bruit heard on auscultation by physician
  • present stroke
  • TIA
  • vertigo/dizziness
  • amaurosis fugax
  • limb wekaness-indicate which side
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50
Q

what could a bruit heard in the carotid artery be an indicaton of?

A

a carotid artery stenosis

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51
Q

when are bruits more commonly heard in the carotid artery?

A

70-90% stenosis

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52
Q

what can a false bruit be caused by?

A
  • a murmur radiating from a stenosed aortic valve
  • external carotid disease
  • intraluminal turbulence in the ICA
  • arteriovenous malformations
  • external compression from thoracic outlet syndrome
  • scarring due to neck surgery
  • tumor
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53
Q

what should be written on a technical report?

A
  • review images
  • write PSV, EDV and ratio where indicated for all vessels
  • draw areas of plaque
  • comments of collateral or stenosis when present
  • if TDS happens it should be mentioned
54
Q

The ratio of ICA/CCA would be less than _____ if there is no hemodynamically significant stenosis

A

2

55
Q

if ICA PSV is 120cm/s and the CCA PSV is 80cm/s –what would the ratio be ?

A

1.5

56
Q

if ICA PSV is 150cm/s and the CCA PSV is 75cm/s-what would the ratio be?

A

2

57
Q

what are some cases where a hemodynamically significant stenosis should be reported?

A
  • velocity doubles from CCA to ICA
  • the PSV of ICA is >125 cm/s
  • the ratio is 2 or more
58
Q

when the EDV of the ICA is _____ cm/s, there is a ______ stenosis

A

> 140 cm/s

>80%

59
Q

What is a carotid endarterectomy (CEA)?

A

surgical procedure to remove the atheromatous plaque material or blockage in the lining of the artery

60
Q

what is CEA done for?

A

reduce the risk of stroke

61
Q

when is CEA considered?

A

if the artery is narrowed by more than 70% especially if the patient is symptomatic

62
Q

what is important criteria in most severe stenoses?

A

measurement of the end diastolic velocity

63
Q

how is homogenous and heterogenous plaque indicated?

A

by filling in the area with the approproate density of echoes

64
Q

how is calcified plaque drawn?

A

indicated with XXXXXXX

65
Q

how do you draw an occlusion?

A

completely fill in the lumen

66
Q

what is trickle flow?

A

considered to be pre-occlusive with just a trickle of flow within lumen

67
Q

what do we do to see trickle flow?

A
  • decrease colour velocity scale (PRF)
  • Increase the colour gain
  • Increase the SV size to the lumen width
68
Q

do we document collaterals?

A

yes

take imahes and write in the comments

69
Q

when may collateral flow occur?

A
  • high grade or complete occlusion of ICA
  • SSS
  • CCA occlusion
70
Q

when internalization occurs of the ECA how will the ECA appear?

A

lower resistant with high flow

71
Q

if the ICA and occludes and the ECA suffers from internalization, what happens to the CCA?

A

becomes more high resistant

72
Q

confetti sign suggests?

A

bruit

73
Q

string sign/trickle onflow

A

pre occlusion

74
Q

what is importatnt when characterizong plaque?

A

length

75
Q

Sessile

A

a longer area of plaque

76
Q

what plaque causes less disturbance of flow?

A

longer area causes less than a short area of protruding plaque

77
Q

dropout from calcification may occur, how do we check if thats the case?

A
  • assess the colour before and after plaque

- assess the doppler signal before and after plaque

78
Q

in areas of narrowed lumen where should the angle correct be?

A

parallel to the ealss of the vessels

79
Q

do we make the gate bigger or smaller in the narrow flow zone?

A

open up and make bigger

80
Q

when is angle correct not necessary?

A

opthalmic artery flow because direction of flow is only important

81
Q

what outlines soft plaque?

A

colour

82
Q

when do we use a straight colour box?

A
  • tortous vessels

- TRV vessels

83
Q

what does post stenotic turbulent flow look like?

A
  • loss of sharp upstroke
  • jagged peak
  • flow above and below baseline
84
Q

transient ischemic attack (T.I.A)

A

when a patients symptoms resolve in <24 hours

85
Q

how long do TIA’s last?

A

usually sudden and brief, often lasting only 10 or 15 minutes.

86
Q

TIA’s are _____ in nature

A

multiple

87
Q

when are TIA’s at a high risk for stroke?

A

patients who present with multiple TIA’s in a short period of time

88
Q

where do TIA’s effect in the body?

A

affect the side of the body opposite its physical location in the brain

89
Q

what is the exception for where TIA’s effect in the body?

A

amaurosis fugax

90
Q

reversible ischemic neurlogical deficit (R.I.N.D)

A

symtoms lasting >24 hours but completely resolve thereafter

91
Q

cerebral vascular accident (C.V.A)

A

symtoms that do not resolve and leave the patient with a permanent deficit

92
Q

do CVA’s resolve?

A

no

93
Q

what is amaurosis fugax?

A

a degree of blindness affecting one eye which is usually described by the patient as “like a shade being pulled over one eye”

94
Q

how may the vison of a person with amaurosis fugax appear?

A

affect all or only a portion of the patient’s visual field or it may simply be “blurred vision”

95
Q

syncope

A

episodes of blacking out

96
Q

dizziness

A

may be accompanied by nausea

97
Q

numbness

A

affecting the face, tongue, etc or the limbs could be effected

98
Q

hemiparesis

A

Unilateral weakness of a limb or limbs on one side of the body

99
Q

aphasia

A

loss of ability to vocalize

100
Q

what are the symptoms of CVA?

A
  • syncope
  • dizziness
  • numbness
  • altered speech
101
Q

where does amaurosis affect?

A

the eye on the same side as the source of the problem

102
Q

what may a headache suggest?

A

indicate insufficient cerebral perfusion or impending stroke

103
Q

what is the most common cause of stroke?

A

infarction of the middle cerebral artery (MCA)

104
Q

what does the brains left hemisphere control?

A

the right side of the body

105
Q

what are the signs and symptoms of an affected MCA?

A
  • dysphasia or aphasia
  • contralateral hemoparesis more severe in face and upper extremity
  • confusion
  • behavoral changes
  • agitated delirium
106
Q

what are the signs and symptoms of an affected ICA?

A
  • contralateral weakness
  • numbness or paralysis
  • ipsilateral amaurosis fugax
  • aphasia
  • bruit
  • occasional alteration in level of consciousness
107
Q

what are the signs and symptoms of an affected ACA?

A
  • contralateral hemiparesis, especially of lower extremitiy
  • incontinence
  • loss of cordination
  • impaired motor and sensory functions
108
Q

what are the signs and symptoms of an affected PCA?

A
  • dyslexia

- coma without paralysis

109
Q

what are the signs and symptoms of an affected vetevbrobasilar?

A
  • facial numbness
  • diplopia
  • vertigo
  • dysphagia
  • amnesia
  • ataxia
110
Q

carotid/anterior circulation symtoms

A

UNILATERAL motor and sensory deficits

  • paresthesia
  • dysphasia and or aphasia
  • monocular disturbances
  • behavioural abnormalities
111
Q

paresthesia

A

tingling or numbness on one side

112
Q

vertebrovascular/posterior circulation symptoms

A

BILATERAL motor and sensort deficits

  • vertigo
  • ataxia
  • bilateral visual fiels defects
  • bilateral paresthesia
  • drop attack
113
Q

vertigo

A

a spinning sensation

114
Q

drop attack

A

falling to ground without other symptoms or loss of conciousness

115
Q

what are non localizong symtoms?

A
  • dizziness
  • syncope
  • headache
  • confusion
116
Q

what should a physical exam include?

A

palpation of easily accessible arteries

  • Auscultation of carotid and vertebral arteries for bruit
  • brachial systolic pressures on both arms
  • ophthalmoscopy
117
Q

what does a pressure diiference of 20 mmHg in both arms suggest?

A

Suspicious for SSS

118
Q

what patients are treated with endarterectomy?

A

most symptomatic patients with a stenosis >70% diameter reduction are treated surgically
-some are preformed in asymtomatic patients with a stenosis of >60%

119
Q

balloon angioplasty and atherectomy

A

non-surgical methods for treating carotid athersclerosis as well as other vessels

120
Q

what does balloon angioplasty and atherectomy have a risk of?

A

acute embolization

121
Q

what is offered as medical therapy in patients with carotid disease?

A

in the form of daily aspirin use

122
Q

who is aspirin given to?

A

patients with mild to moderate levels of stenosis and no history of hypertension

123
Q

what may be given to patients with TIA’s?

A

anticoagulents and platelet inhibitors

124
Q

Clopidogrel(Plavix)

A

platelet inhibitor

125
Q

heparin

A

antiocoagulant

126
Q

aspirin

A

anticoagulent

127
Q

what do you do of your patient has subclavian steal?

A

bilateral brachial pressure systolic measurments must be taken

128
Q

how do you know which side the stenosis is when measuring brachial pressure?

A

the side with the innominate or subclavian stenosis will have lower pressure
-damped or monophasic flow pattern

129
Q

what difference in pressure will the arm have with SSS?

A

40 mm/Hg difference

130
Q

if your patient has an occluded ICA or high grade stenosis:

A

-the OA flow will be reversed on the side of the occlusion

Vascular Term 3 (8 decks)

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