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Week 2 Flashcards

1
Q

Blood follows a path of?

A

Least resistance

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2
Q

What affects resistance in regards to hemodynamics?

A

Length and width

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3
Q

If blood were presented with two paths, a short and narrow one or a long and wide one, which path would it take?

A

The long and wide–the path of least resistance.

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4
Q

The most common collateral pathways involve the ______________.

A

Circle of Willis

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5
Q

What are 3 major collateral routes?

A

Other side of CoW
Posterior cerebral circulation
External carotid artery branches

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6
Q

Describe the pathway that blood can flow from the left hemisphere from the other side of the circle:

A

Right CCA→ rt. ICA → rt. ACA→ across the anterior communicating artery→ retrograde down the left ACA→ lt. MCA→ lt. hemisphere

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7
Q

Describe the alternate pathway that may originate from the posterior circulation:

A

Vertebral artery flow enters the basilar artery→ lt. posterior cerebral artery→ left posterior communicating artery→ distal lt. ICA→ lt. MCA

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8
Q

Describe the alternate pathway that may originate from the external carotid circulation:

A

Lt. ECA → ECA branch (superficial, temporal, maxillary or facial) → retrograde down an ICA branch (supraorbital, nasal or frontal) → continue to retrograde flow down the ophthalmic artery → carotid siphon → MCA → lt. hemisphere

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9
Q

What is the second most important source of collateral flow?

A

Anastomosis between branches of the ECA and ICA via orbital and ophthalmic arteries

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10
Q

What are the 6 intracranial-extracranial anastomoses?

A 
Lacrimal
Supraorbital
Anterior/Posterior ethmoidal
Medial Palpebral 
Frontal 
Dorsal Nasal Artery
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11
Q

The normal flow in the ophthalmic artery is retrograde and if there is an occlusion present, it will become antegrade flow. True or false

A

False

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12
Q

Adequate arterial perfusion relies on what? (3)

A

Cardiac output
Blood volume
Systemic blood pressure

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13
Q

If circulation is compromised, what can this lead to?

A

Hypoxia or anoxia

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14
Q

Why do collaterals develop?

A

Because of a change in the pressure gradient between the vessels, caused by a stenosis

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15
Q

If the pressure drops enough to attract flow from a vessel sitting further down the line, blood vessels may abandon their normal routes and take advantage of the new, lower pressure route. What is an example of this phenomenon?

A

SSS

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16
Q

In older individuals what can we see with their collateral pathways?

A

Hypoplastic or atherosclerotic

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17
Q

What branches of the ECA can be collaterals?

A

Superficial
Maxillary
Facial
Temporal

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18
Q

What branches of the ICA are involved in the ECA collateral circulation?

A

Facial
Nasal
Supraorbital

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19
Q

What is most essential to determine when examining the vertebrals?

A

Presence/absence of flow

Direction of flow

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20
Q

Vertebral basilar system provides 20-30% of cerebral blood flow. True or false

A

True

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21
Q

If there’s a vertebral occlusion, where is the blood flow shunted? (2)

A

Thyrocervical trunk

Costocervical trunk

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22
Q

Where do the vertebral arteries arise from?

A

Subclavian arteries

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23
Q

Basilar artery connects to the CoW via what vessel?

A

PCAA

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24
Q

What is nystagmus?

A

Rapid involuntary movement of the eye

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25
Vertebral flow is low or high resistance?
Low
26
What is the normal velocity for the vertebrals?
20-60cm/s
27
Which vertebral artery is more readily seen?
Right L=larger R=readily seen
28
Which vertebral artery is commonly larger?
Left
29
SSS is most often seen on which side?
Left
30
What amount of pressure difference is there between two arms when SSS is present?
20-40mmHg | slides are either saying 20 or 40, so maybe just know both
31
What's the typical PSV in the SCA when there's a SSS?
>400cm/s Loss of normal triphasic waveform One slide also said 500 so IDK
32
A syndrome is what?
The aggregate of signs, symptoms or other manifestations to constitute the characteristics of a morbid entity.
33
What can make an increase in pressure drop greater following a stenosis?
Exercise
34
Why does blood reverse down the vertebral artery as a result of SSS?
A drop in pressure in the SCA falls below the junction of the 2 vertebral arteries, therefore it becomes easier for blood to flow in a retrograde fashion. Pressure gradient
35
Why is SSS potentially harmful?
There may be a reduction of blood flow to the brain which can result in symptoms of vertebrobasilar insufficiency
36
Why will a right sided innominate artery stenosis have more of an impact on cerebral hemodynamics?
Because of the involvement of the right CCA
37
Ultrasound is a very accurate modality in diagnosing SSS. True or false
True-- 90-100%
38
If you see a reversal of flow in the vertebral artery, this is one of the first signs of SSS. True or false.
False-- it is the final stage Prior to constant flow, there is a deceleration of antegrade flow during systole and only retrograde flow in diastole Usually seen better in periods of exercise
39
What is reactive hyperemia?
Temporary increase of blood flow that occurs following a brief period of ischemia
40
When a patient has a SSS, what do they clinically present with?
Loud supraclavicular bruit Reduced pulse in affected arm Reduce BP in affected arm
41
Which arm has decreased pressure?
Ipsilateral
42
Because of the stenosis, the SCA will now have a triphasic waveform. True or false
False-- it normally has a triphasic waveform and will now appear damped (monophasic)
43
What does the loss of high resistant, high pulsatility flow of the distal SCA indicate?
The proximal SCA has an occlusion or stenosis.
44
What is thoracic outlet syndrome?
When the subclavian artery and brachial nerve plexuses become compressed Can lead to limb ischemia An entrapment syndome
45
What is Paget-Schroetter syndrome?
Effort induced DVT of the upper extremity veins in young patients Classified as TOS
46
What does TOS present as clinically?
Upper extremity circulation problem Cold, painful or numb extremities Can vary with limb positioning--if they lift the arm up it will show symptoms
47
Repeated irritation of TOS can cause thrombus formation in which can travel to the distal parts of the arm. True or false
True
48
Uncomplicated TOS means what?
No thrombus, plaque or aneurysm formation | Nerve compression
49
What are the patient positions when scanning for TOS?
Segmental BP and pulse volumes are obtained with: Arm in neutral position Arm in position that causes symptoms Arm in extreme positions
50
What will be seen in patients with TOS? (signals)
The radial artery signal goes flat | If there are no changes in Doppler signal or PVR waveforms the exam is over and TOS is negative
51
What is popliteal artery entrapment?
Common site for entrapment syndromes in young athletes Hyperextension of the knee or plantar extension can cause diminished flow in the calf and foot due to compression by the medial head of the gastrocnemius muscle
52
In popliteal entrapment syndrome, what amount of pressure drop will be seen?
20 mmHg
53
What is anterior compartment syndrome?
Where trauma (sports injuries or car accidents) can result in arterial compression and subsequent ischemic distal to the site of compression can occur
54
What is blue toe syndrome?
One of the most frequent manifestations of tissue ischemia Caused by occlusion of small vessels Usually caused by cholesterol crystals or a lump of plaque getting stuck in small vessels
55
If blue toe syndrome is left untreated, what can occur?
Gangrene
56
Who does blue toe syndrome usually occur in?
Elderly men who undergo an invasive vascular procedure Develops suddenly and rapid Usually only one foot
57
What is the diagnostic tool of choice for blue toe syndrome? (2)
US | CTA
58
What are the treatment options for blue toe syndrome?
Stenting Bypass surgery Anti-coagulants/anti-platelet
59
Who is more likely to have Raynaud's disease, men or women?
Women
60
What is Raynaud's disease?
Causes some area of the body such as fingers and toes, to feel numb and cold in response to cold temperatures or stress Smaller arteries that supply blood to the skin narrow, which limits the blood circulation to affected areas
61
In Raynaud's disease, the smaller arteries limiting blood to affected areas is because of vasospasm. True or false
True
62
What are the changes of color in the skin in a Raynaud's disease attack?
White-first Blue- cold and numb Red- as you warm and circulation comes back, it may feel tingly and swollen
63
What is the difference between primary and secondary Raynaud's disease?
Primary- more common. Not the result of an underlying associated medical condition that causes vasospasm Secondary- caused by an underlying problem. Tends to be more serious
64
Which type of Raynaud's disease typically shows symptoms later in life?
Secondary-- around 40yrs
65
What are some conditions that can cause secondary Raynaud's disease?
CT disease: scleroderma, lupus, rheumatoid arthritis, Sjorgen's syndrome Atherosclerosis, Buerger's disease and pulmonary hypertension Carpal tunnel syndrome, RSI's, smoking, fractures and certain medications
66
What is the test in diagnosing Raynaud's disease?
Cold test-- hands are placed in water until symptoms appear and then a device measures how long it takes the fingers to return to normal body temperature
67
What is nutcracker syndrome?
The compression of the left renal vein between the SMA and aorta
68
What can result from nutcracker syndrome?
Renal venous hypertension--resulting in the rupture of thin walled veins into the collecting system with resultant hematuria
69
What are splanchic vessels?
Consists of the blood supply to the gastrointestinal tract, liver, spleen, and pancreas
70
What can be caused from nutcracker syndrome?
Nausea and vomiting | Unusual manifestation of varicocele formation and varicose veins in the lower limbs
71
What are the signs of nutcracker syndrome?
``` Lt renal enlargement Persistent hematuria Proteinuria Hypertension RV thrombus ```
72
What are the surgical approaches for NCS?
Nephrectomy Nephropexy Renocaval reimplantation Intravascular stent
73
What are the 3 main symptoms of Leriche syndrome?
Claudication Impotence Decreased pulses to lower limbs
74
What is Leriche syndrome?
Blockage in the lower part of the aorta just before the starting point of the common iliac arteries Blood supply to lower limbs and groin is reduced
75
What are risk factors for Leriche syndrome?
Atherosclerosis | Smoking
76
What's another term for Leriche Syndrome?
Aorta iliac occlusive disease
77
What aids in the diagnosis of Leriche syndrome?
Ankle brachial index Arterial doppler study of aorta/iliac region Distal/bif will be occluded
78
What is Marfan's syndrome?
Genetic disorder that affects the body's connective tissue | Valvular heart disease that causes a thickened mitral valve leaflet displacement
79
What parts of the body can be affected by Marfan's?
Heart, blood vessels, bones, joints and eyes
80
What can occur from Marfan's syndrome?
Aortic aneurysm and dissection
81
What do people with Marfan's syndrome look like?
Long arms and legs Thin Tall Long thin fingers

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