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Vascular Physiology > Vascular Pathophysiology > Flashcards

Vascular Pathophysiology Flashcards

1
Q

What are the characteristics inside an artery with stenosis?

A

Arterial stenosis creates focal acceleration of flow and distal turbulence proportional to severity.

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2
Q

A tighter stenosis creates ____ turbulence.

A

More

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3
Q

What are the characteristics of critical stenosis?

A

Critical stenosis causes reduction of flow and pressure distally.

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4
Q

Plaque is a ____ disease, not localized.

A

Systemic

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5
Q

What is the true indicator of the severity of stenosis?

A

Area

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6
Q

Why do we use diameter reduction rather than area reduction when diagnosing a stenosis?

A

Because you use the diameter in Angiography, and angio is the gold standard.

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7
Q

In angiography you don’t see vessel walls, you just see ____.

A

Flow

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8
Q

50% stenosis by diameter = __% stenosis by area.

A

75%

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9
Q

80% stenosis by diameter= __% stenosis by area.

A

96%

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10
Q

Pressure and flow will maintain until about __% stenosis by diameter.

A

50%

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11
Q

Significant stenosis causes a loss of energy in the form of what?

A

Heat

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12
Q

Significant stenosis causes a loss of energy in the form heat due to what?

A
  1. Change from potential to kinetic energy and back
  2. Distal turbulence dissipating energy in the form of heat
  3. High resistance collaterals use up energy
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13
Q

What is turbulence?

A

Chaotic flow: has many directions and many velocities (especially lower velocities)

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14
Q

What is the characteristic of turbulence on spectral waveform?

A

Spectral broadening- filling in of the systolic window.

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15
Q

Degree of turbulence is ____ to the severity of stenosis.

A

Proportional

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16
Q

____ ____ of velocity suggests >50% stenosis.

A

Focal doubling

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17
Q

Any significant stenosis should have what 2 things?

A
  1. focal acceleration

2. distal turbulence

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18
Q

These are existing vessels that carry more flow than usual and/or flow in retrograde to compensate for loss of flow from a main line artery.

A

Collaterals

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19
Q

Collaterals are brought about by what?

A

Abnormal pressure gradients

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20
Q

What is a subclavian steal?

A

It occurs when the proximal subclavian artery is occluded, causing low pressure in the left arm. Thus flow is drawn retrograde down the vertebral artery.

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21
Q

If a 10 mm native artery was occluded how many 2.5 mm collaterals would it take to compensate for its loss?

A

256

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22
Q

What is edema and how is it caused?

A

Edema is a build up of fluid in interstitial space and it is caused by excess venous pressure.

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23
Q

Fluid flows from an area of ____ pressure to an area of ____ pressure.

A

High to low

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24
Q

How does abnormally high intravenous pressure cause edema?

A

The osmotic gradient at the venular end is upset, preventing resorption of fluid, so the fluid stays in the interstitial space causing edema.

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25
Q

Name the 2 big vascular enemies.

A
  1. plaque

2. clot

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26
Q

What could be a cause of too much pressure in the veins?

A

Prolonged standing/sitting- too much blood pools in LEs. It helps to some calf activities.

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27
Q

How many mmHg of hydrostatic pressure is at the bottom of the calfs, what helps to break up this pressure?

A

90-100 mmHg, venous valve help to break up the column of fluid.

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28
Q

Venous stasis and ulcers are secondary to what?

A

Venous hypertension

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29
Q

What is a common site for venous ulcers?

A

Gaiter area by the malleolus/ ankles

30
Q

What is osmosis?

A

The diffusion across a semipermeable membrane from an area of low concentration to an area of high concentration.

31
Q

The osmotic gradient is created by what?

A

Plasma proteins

32
Q

Carotid disease can lead to ____, the 3rd leading cause of death.

A

Stroke

33
Q

2 types of strokes

A
  1. Ischemic

2. Hemorrhagic

34
Q

Ischemic Stroke

A

Lack of oxygen and blood flow (majority of strokes are ischemic)

35
Q

Hemorrhagic Stroke

A

Bleeding out into cranium causing pressure to build. Caused by aneurism or injury.

36
Q

2 Ischemic subcategories

A
  1. Hemodynamic lesion

2. Embolic lesion

37
Q

Hemodynamic lesion

A

plaque is tight enough that it reduces blood flow at the site (severe stenosis at the site).

38
Q

Embolic lesion

A

Erosion of plaque cause emboli to enter into cerebrocirculation.

39
Q

Plaques are ____ tissue- can be thought of as a form of cancer.

A

Living tissue

40
Q

Thrombus usually refers to ____, whereas plaque refers to ____.

A 
Thrombus= veins
Plaque= arteries
41
Q

What are the 4 classifications of plaque?

A
  1. fatty streak
  2. fibrous (soft)
  3. dense (calcific)
  4. complicated
42
Q

What are the characteristics of fatty streak plaque?

A

Foam cells/ cholesterol along the vessel wall.

43
Q

What are the characteristics of fibrous plaque?

A

It is soft, and produces a dark echo.

44
Q

What are the characteristics of dense plaque?

A

it is hard and calcific, producing bright echoes with acoustic shadowing.

45
Q

What are the characteristics of complicated plaque?

A

It is heterogeneous, having a different composition throughout. It is more likely to ulcerate and cause stroke.

46
Q

What are the common grades of stenosis?

A

80%) severe

Total occlusion

47
Q

Amaurosis fugax

A

temporary blindness in one eye (carotid territory)

48
Q

Hemiparesis

A

weakness in one side (carotid territory)

49
Q

Hemiplegia

A

loss of function in one side (carotid territory)

50
Q

Hemiparesthesia

A

one-sided tingling sensation (carotid territory)

51
Q

Dysphagia/ Aphasia

A

slurred or absence of speech (carotid territory)

52
Q

Homonymous Hemianopia

A

loss of 1/2 the visual field in both eyes (carotid territory)

53
Q

Carotid territory Sx’s are ____, they are referable to ____ hemisphere.

A

They are lateralizing Sx’s referring to one hemisphere

54
Q

Diplopia

A

binocular vision disturbance (vertebrobasilar territory)

55
Q

Syncope

A

loss of consciousness (vertebrobasilar territory)

56
Q

Vertigo

A

dizziness, spinning sensation (vertebrobasilar territory)

57
Q

Nausea

A

uneasiness of the stomach, feeling queasy (vertebrobasilar territory)

58
Q

Ataxia

A

loss of coordination (vertebrobasilar territory)

59
Q

Vertebrobasilar territory Sx’s are more ____, non-lateralizing. They can often suggest ____ circulation problems.

A

Sx’s are more vague, can suggest posterior circulation problems.

60
Q

What did the NASCET study suggest?

A

It suggested endarterectomy reduces stroke risk significantly in Pt’s with >70% stenosis.

61
Q

Where the 4 common sites for lower extremity ASO (arteriosclerosis obliterans) ?

A
  1. Aortoiliac bifurcation
  2. CF bifurcation
  3. adductor canal
  4. origins of tibials
62
Q

What is ASO?

A

An occlusive arterial disease most prominently affecting the abdominal aorta and the small- and medium-sized arteries of the lower extremities.

63
Q

What is the most common site of ASO?

A

SFA (mid to distal thigh) in adductor canal

64
Q

What are the stages of Sx for ASO?

A

Asymptomatic > claudication > rest pain > ischemic ulcer > gangrene

65
Q

What is claudication?

A

Pain with exercise relieved by rest.

66
Q

What is rest pain?

A

continuous, unrelenting ischemic pain. Usually at toes and feet. (similar to angina in the heart)

67
Q

What causes ulceration?

A

usually caused by injury, it takes much more perfusion to heal tissue than just to sustain it. (Pts with ulcers tend to have thickened toe nails and flaky skin)

68
Q

What is gangrene?

A

tissue death due to ischemia.

69
Q

Claudication is ____ pain, whereas rest pain is ____ pain.

A

claudication is muscle pain.

rest pain is tissue pain.

70
Q

Name some risk factors for atherosclerosis.

A

Age, hypertension, smoking, diabetes, family Hx, hypercholesterolemia, male sex, etc.

71
Q

__% of diabetics die from atherosclerotic death.

A

75%. Diabetes is devastating to the circulatory system, especially small vessels.

Vascular Physiology (7 decks)

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