Unit 5: Carotid Procedures (signs, symptoms, indications, risk factors) Flashcards
What are the patient interactions you should have as a sonographer?
- Intros
- ID
- Ask how they are feeling
- Explain test
- Take history, sx, risk
- Answer questions
What are some medical risk factors?
- High BP
- Smoking/Secondhand smoke
- High cholestrol
- Diabetes
- Obstructive sleep apnea
- Cardiovascular disease.
Why is high blood pressure a risk factor?
The risk of stroke begins to increase at blood pressure readings higher than 120/80 mm HG.
Why is an abnormal heart rhythm a risk factor?
It can cause a blood clot to form.
What are some other risk factors?
- Personal or family hx of stroke, heart attack or TIA
- Age >55
- Race
- Overweight/obese
- Physical inactivity
- Heavy or binge drinking
- Use of illicit drugs
What race has a higher risk of stroke than others?
African Americans.
An appropriate indication for an exam must be present and documented in the medical record for what to occur?
Reimbursement.
Why should you confirm appropriate incidications for an exam?
- To give adequate attention to answer the questions involved,
- To avoid committing fraud.
What is the time frame of a TIA?
<24 hours with full recovery
What is the time frame for a CVA?
>24 hours with at least some residual symptoms.
where do 80% of ischemic stroke occurs?
Carotid territory (anterior brain)
Where is the vertebrobasilar territory?
Posterior brain.
What are the 4 types of carotid symptoms?
- TIA
- CVA
- Carotid territory
- Vertebrobasilar territory
What are 5 indications for a carotid duplex exam?
- TIA
- CVA
- Bruit
- Pre-op
- Post-op
In the carotid territory, what do the carotid arteries feed?
They feed the right and left cerebral hemispheres.
ICA, MCA, ACA, ACoA
What are the 4 carotid territory symptoms?
- Motor/sensory
- Visual
- Speech
- Behavior
What are the carotid territory symptoms dealing with the motor/sensory area?
- Unilateral symptoms:
- symptoms occur contralateral to the side of the brain/carotid with disease.
- Weakness (hemiparesis) on one side.
- Numbness on one side.
- Tingling (paresthesias) on one side.
- Facial droop on one side.
What are the carotid territory symptoms that are visual?
Amaurosis fugax
What is amaurosis fugax?
- It is a shade effect
- Monocular
- Ipsilateral to the carotid disease that caused it.
Why does amaurosis present symptoms on the same side as disease?
Because the emboli gets lodged right in the eye, not in the brain artery, so its on the same side as the disease.
What are the carotid territory symptoms that deal with speech?
- Dysphasia→difficulty with speech
- Aphasia→no speech.
What hemisphere controls speech?
The dominant hemisphere.
ie. right handed ? dominant left hemisphere
ie. left handed? dominant right OR left hemisphere.
Where do the carotid territory symptoms that affect behavior come from?
- May be from ischemia of temporal lobe
- May be from infarction of MCA branch
What feeds the vertrebrobasilar territory?
Basilar artery feeds brain stem, cerebellum, occipital lobes of brain.
What does the posterior brain circulation consist of?
Vertebral, basilar, posterior cerebral, posterior communicating arteries.
What are 6 vertebrobasilar symptoms?
- Vertigo
- Dysphagia
- Syncope
- Ataxia
- Bilateral parethesias
- Visual
What are 5 non-localized vertebrobasilar symptoms?
- Dizziness (light headedness)
- Syncope (transient loss of consciousness)
- Difficultly with speech
- Headache
- Confusion
What is vertigo?
Difficulty with equilibrium.
It is a sensation of having objects moving around oneself r moving oneself around in space.
What is dysphagia?
Inability to swallow.
What is diplopia?
Double vision.
What is a symptoms?
What the patient feels or experiences.
What is a sign?
What is obsevred/seen/heard/felt
What are risk factors?
SOmething that increases the likelihood of developing a disease.
What are some risk factors for a stroke?
- Hypertension
- Diabetes
- Smoking
- Hypercholesteromia
- Age
- Family history
- Obesity
- Hypercoaguability state
- Cardiac disease
What are some signs of a stroke?
- Bruit
- Hollenhorst plaque
- TIA
- Decreased unilateral carotid pulse
What is hollenhorst plaque?
It is plaque seen in retinal vessels through an eye exam.
T/F:
A bruit is nothing signifcant and should be ignored.
FALSE!!
The presence of a bruit is signifcant
What are some causes for a bruit?
- Moderate to severe ICA stenosis
- ECA source
- Aortic valve
- A bruit heard ONLY in the high neck is most likely from the bifurcation area.
- A bruit heard low in the neck may be from the heart or the common cardiac/brachiocephalic
T/F:
The lack of bruit does NOT rule out significant stenosis.
ie. ICA occlusion will not produce a bruit.
True.
Why might pulses be different on each side of the neck?
- Tortuous on one side
- Aneurysm on one side
- Technical error
- Obstruction on one side.
What is subcalvian steal?
It is a proximal SCA obstruction that causes vertebral flow on ipsilateral side to reverse and feed arm.
What are the symptoms of subclavian steal?
- may be asymptomatic
- Dizziness
- Arm claudication
What questions should you ask the patient pior to an exam?
- Why are you having this test?
- What symptoms did you have?
- How long did they last?
- Go through a list of risk factors.
