Week 1 Flashcards by FWU Enterprise

A critical stenosis is the narrowing of the arterial lumen resulting in a hemodynamically signification reduction in what 3 things?

Volume, pressure and flow

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In the aorta, how much of the area (%) has to be encroached before there is a reduction in pressure and flow distally?

90%

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In smaller vessels, how much of the area (%) has to be encroached before there is a reduction in pressure and flow?

70-90%

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With a complete occlusion of the ICA, what sound is heard?

Thumping

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During a stenosis, what sound is heard?

After the stenosis, what sort of sound is heard?

Whistle or high pitched

Garbled

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What is the measurement for CIMT? (carotid intima media thickness)

N= <0.9mm

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Slide 11 & 12 on wk1 carotid grading is pretty much all bolded but not good flashcard content

So look at that stuff

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Where do we sample when comparing the velocity in a stenosis?

Usually proximal, but can be wherever the velocity is the most normal (if there’s a stenosis in the proximal setting

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The higher the ratio, the greater the stenosis. True or False

True

directly proportional

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How much of a vessel needs to be stenosed for it to be considered critical?
(diameter reduction)

50-80%

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Diameter reduction is comparable to _____ measurements in a stenosis.

PSV

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What is the formula for percentage stenosis for diameter reduction?

1-(residual/original)x100

longitudinal view of a vessel is needed to obtain this measurement

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Residual diameter is the segment distal to the stenosis. True or False

False— it is the area within the stenosis

Original is the normal measurement

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Remember: hemodynamically significant lesions are those with _______ diameter reduction.

> 50%

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What view is required to obtain an area reduction image? What formula is used?

Transverse
Same formula as diameter reduction
1- (residual/original) x 100

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Remember: hemodynamically significant lesions are those with _______ area reduction.

> 75%

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For a hemodynamically significant stenosis:
_______% diameter reduction
_______% area reduction

> 50% DR

>75% AR

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_____ stenosis: deceleration spectral broadening with a peak systolic velocity (PSV) <125 cm/s

<15%

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______ stenosis: pansystolic spectral broadening with a PSV <125 cm/s

16-49%

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_______ stenosis: EDV >140 cm/s

80-99%

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_____ stenosis: pansystolic spectral broadening with a PSV of >125 cm/s and end diastolic velocity (EDV) <110 cm/s
or ICA/CCA PSV ratio >2 but <4

50-69%

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________ stenosis: pansystolic spectral broadening with PSV >270 cm/s or
EDV >110 cm/s or ICA/CCA PSV ratio >4

70-79%

____________: no flow; terminal thump

Complete occlusion

What is the ratio formula for calculating a hemodynamically significant stenosis?

Prox ICA PSV/ distal CCA PSV

What does the ratio of ICA/CCA have to exceed to be considered a hemodynamically significant stenosis?

Subtotal occlusion of ICA demonstrates what? (hint: it is a sign)

String sign Also trickle flow

The PSV is the first component of the spectral waveform to reduce due to a stenosis. True or false

True

Bruit appears as what on Color Doppler? (hint: it is a sign)

Confetti

What did the one nut say while chasing the other nut

Imma cashew

Subclavian steal syndrome shows a decrease in pressure on what side? What is the waveform?

The side of the innominate/subclavian stenosis will have lower pressure (usually by 20-40mm/Hg) Will have a damped/monophasci flow pattern

A TIA resolves within how many hours?

TIA affects which side of the body?

The opposite side, with the exception of amaurosis fugax (which affects the same side eye)

What does R.I.N.D. stand for?

Reversible Ischemic Neurological Deficit

What is R.I.N.D?

Neurological symptoms that completely resolve after >24hours

What is a CVA (cerebral vascular accident)?

Neurological symptoms that do not resolve and leave the patient with permanent deficit

Qu'est-ce que c'est amaurosis fugax?

Blindness affecting one eye. Usually described as a "shade being pulled over the eye"

Amaurosis fugax affects only a portion of the visual field. True or false

False-- can be all, partial or simply blurred vision

Infarction of the _______ is the most common cause of stroke.

MCA (middle cerebral artery)

When the frontal lobe is injured, what does the patient experience?

``` Loss of movement (paralysis) Unable to focus Difficulty with language, can't get words out Mood swings Difficulty problem solving ```

When the parietal lobe is injured, what does the patient experience?

Difficulties with hand-eye coordination Problems reading, writing and naming Lack of awareness

When the occipital lobe is injured, what does the patient experience?

Defects in vision or blind spots Blurred vision Visual illusions/hallucinations Difficulty reading & writing

When the temporal lobe is injured, what does the patient experience?

Difficulty understanding language and speaking (aphasia)

When the cerebellum is injured, what does the patient experience?

``` Difficulty coordinating fine movements Difficulty walking Tremors Dizziness (vertigo) Slurred speech ```

When the brainstem is injured, what does the patient experience?

Breathing, HR, & consciousness Difficulty swallowing Problems w/ balance & movement Dizziness & nausea (vertigo)

When the MCA is affected, what are the signs and symptoms?

``` Dysphasia/Aphasia Contralateral hemiparesis/hemiplegia Confusion Behavioural changes Agitated delirium ```

When the ICA is affected, what are the signs and symptoms?

``` Contralateral weakness Numbness or paralysis Ipsilateral amaurosis fugax Aphasia Bruit Occasional alteration in level of consciousness ```

When the ACA is affected, what are the signs and symptoms?

Contralateral hemiparesis (esp. in lower extremity) Incontinence Loss of coordination Impaired motor & sensory functions

When the PCA is affected, what are the signs and symptoms?

Dyslexia | Coma w/o paralysis

When the vertebrobasilar arteries are affected, what are the signs and symptoms?

``` Facial numbness Diplopia (double vision) Vertigo Dysphagia Amnesia Ataxia ```

When the anterior circulation is affected, what are the signs and symptoms?

``` *Unilateral* motor and sensory deficits Paresthesia- tingling or numbness *on one side* Dysphasia and or aphasia Monocular disturbances Behavioural abnormalities ```

When the posterior circulation is affected, what are the signs and symptoms?

``` *Bilateral* motor and sensory deficits Vertigo Ataxia (muscle incoordination) Bilateral visual field defects Bilateral paraesthesia Drop attack (falling to the ground without other symptoms) ```

What is an endarectomy?

This surgery removes the plaque and is done with a stenosis >70%

What are the non-surgical methods for treating carotid atherosclerosis?

Balloon angioplasty and atherectomy There's a risk of acute embolization secondary to these procedures Aspirin/anticoagulants/platelet inhibitors

Carotid exams are always a bilateral exam. True or false

True