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85 Cards in this Set

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  • Back
What sustains the high pressure gradient between arterial and venous sides of the circualation?
Pumping of the heart
The movement of any fluid between two points requires two things:
1. a route along which the fluid can flow
2. a difference in energy (pressure) levels between the two points
What is the ability of flowing blood to do (work) as a result of its velocity?
Kinetic energy
True or False
Lower resistance equals lower flow rate
False
Lower resistance equals higher flow rate
What describes the thickness of fluid?
Viscosity
True or False
The abnormal stenotic jet with it's characteristically elevated velocities is only found in the stenotic segment?
False
What occurs when all of the blood cells and layers travel at the same velocity?
Plug flow
True or False
Increased viscosity equals decreased velocity
True
The relationship between pressure volume and resistance relates to what law?
Poiseuille's Law
Laminar flow tends to become disturbed at what point?
When the Reynold's number exceeds 2000
The amount of blood ejected?
Stroke volume
List the five P's f acute arterial oclusion
Pain
Pallor
Pulselessness
Parasthesia
Paralysis
What are the major risk factors for Artherosclerosis?
Smoking
hyperlipidemia
Family history
What is the difference between a true aneurysm and a false aneurysm?
A true aneurysm is a dilatation of all 3 layers of the arterial wall, a false aneurysm does not contain all arterial walls
Where is the most common location for arterial aneurysms?
Infrarenal aorta
But they can occur in nearly any artery in the body
The most common form of arteritis is thromboangitis obliterans. What is another name for this?
Buerger's Disease
What syndrome is thought to be caused by compression of the popliteal arery by the medial head of the gastrocnemius muscle of fibrous bands? This syndrome is most commonly found in young men
Entrapment syndrome
A bruit that extends throughout ________ is usually associated with more severe arterial disease.
Diastole
What are some complications of an aneurysm?
Rupture of aortic aneurysms and distal embolization of peripheral aneurysms
What does a diminished or absent pulse suggest?
Arterial insufficiency
True or False
The absence of a bruit completely rules out disease
False
The absence of a bruit suggests normality but cannot rule out disease. In cases of severe stenosis, usually greater than 90% diameter reduction, the bruit disappears
What other than arterial disease in the extremeties, could result in a dampened DOPPLER waveform?
Uncompensated CHF
2 things that a higher pitched signal might suggest
1. very acute probe angle
2. significant arterial obstruction
Normal DOPPLER waveforms for upper and lower extremeties consist of what 3 parts?
(they all start with R)
Rapid upstroke with sharp peak
Rapid downstroke with sharp peak below baseline
Resumws forward flow
How does vasodilation of distal vessels effect the arterial signal of the extremeties?
Normally high resistant waveform can assume the qualities of low resistance
What quality might abnormal post-exercise waveforms lose?
Phasicity (become more monophasic)
How does temperature affect flow patterns in the extremeties?
Warm hands/feet = lower resistance
Cold hands/feet = higher resistance
Pulsatility index normally increases from the central to peripheral arteries. What does it mean if these values decrease?
Proximal occlusive disease
What element of a waveform can aid in the differentiating inflow from outflow disease?
Acceleration time
A proximal occlusion would increase or decrease acceleration time?
Increase
When using a CW Doppler probe to evaluate arterial flow, the acceptable range of insonation is?
Between 45-60 degrees
A narrow, loose cuff would give you a falsely ______ pressure
High
A wide and too large cuff would give you a falsely ______ pressure
Low
What arteries are used for ankle pressures?
Posterial tibial artery and dorsalis pedis artery
What are 2 additional AKAs for ABIs?
API (ankle/arm pressure index)
AAI (ankle/arm index)
Incompressible vessels will give you a false ______pressure
High
What alternative method is used for stressing the peripheral circulation when a patient can't walk or do exercises?
Reactive hyperemia testing
What test helps determine the healing potential of a wound or ulcer?
Laser Doppler
What are some of the limitations of plethysmography?
It cannot be specific to a single vessel because it measures volume changes in a large segment of a limb and may be difficult to discriminate between major arteries and collateral branches
True or False
Moderately or severely abnormal volume plethysmographic waveforms always reflect hemodynamically significant disease
True
True or False
Severity of disease is generally overestimated by volume plethysmographic
False
What is displacement plethysmography?
Body part is immersed in a water-filled water tight container. Water temp must remain constant. When volume of immersed body part increases, the water is displaced into a glass chimney where a column of air is compressed. This in turn activates a spirometer and recording of the amount of displacement into the chiimney is made
When should waveforms and pressures for cold stress testing be obtained?
Immediately after cold stress and five minutes after cold stress
What is the normal range for transcutaneous oximetry?
60-80 mmHg
Transcutaneous oximetry helps to determine wound healing and amputation
T/F
True
Ulnar artery aneurysms can form in response to using the palm as a hammer
T/F
True
Subclavian aneurysms are often associated with embolization to the digits
T/F
True
Peak systolic velocities in arms vary widely with changes in skin temperature
T/F
True
Doppler signals in the arms are usually triphasic but if "quite" warm or exercised it may become lower resistant
T/F
True
Significant stenosis and occlusions commonly occur in adductor canal
T/F
True
Describe brachial artery reactivity testing
Endothelial dysfunction correlates with a higher than normal incidence of long term coronary events TRUE
Aneurysm of the abdominal aorta is equal to or greater than _____
3 cm
An aneurysm is an icrease in the diameter of _____% of an artery
50%
Renal arteries are best located in longitudinal view
T/F
False
SMA velocities when fasting are high resistance
T/F
True
Normal SMA velocities after eating are high resistance
T/F
False
Normal portal vein size
1-1.5 cm
Transplant kidneys are connected to iliac vessels
T/F
True
Increased size of transplant kidney is a sign of rejection
T/F
True
When an AV fistula is located close to the heart the potential for cardiac failure decreases
T/F
False
Can collateral arteries and veins form AV Fistulas?
Yes
Flow in artery proximal to the fistula is greatly increased or decreased especially during diastolic because fistula markedly reduces resistance
Increased
Describe the venous flow moving away from AVF
Elevated velocities, phasicity and increased pulsatility because of mixed arterial and venous flow
Describe the venous flow moving toward AVF
?? Decreased velocities, phasicity and decreased pulsatility??
Describe cystic adventitial disease
Cystic fluid accumulates in wall of peripheral artery. Which can cause narrowing or occlusion of the vessel. Apppears as a soft tissue mass on ultrasound
Why might you need to map the internal mammary artery?
To determine if the artery can be used as a recipient site for a TRAM flap in breast reconstruction or as a graft to Left anterior descending coronary artery
The radial artery can be mapped and harvested for what procedure?
Coronary artery bypass grafting
What arteries will you map for a TRAM flap?
superior epigastric
inferior epigastric
internal mammary
Why would you map the superior and inferior epigastric arteries?
The rectus abdominus muscle with best blood supply is used for TRAM flap in breast reconstruction
What are the most common used arteries for arteriography?
Common femoral
Axillary
Brachial
What is a hemodynamically significant stenosis?
Diameter reduction by 50% or cross section by 75%
Common sites for artherosclerosis?
greater vessels of aortic arch, bifurcation and adductor canal
MC site of aneurysms?
infrarenal aorta
femoral and popliteal
How does vasospasm appear?
Severe narrowing of the arterial lumen
What does computed tomography use to image the body?
ionizing radiation
What does endarterectomy remove?
atherosclerotic material and a portion of the intimal lining of the lumen
Common graft material for bypass?
synthetic (gore tex)
reversed vein...saphenous, cephalic or an in situ vein
What kind of guidance does angioplasty use?
Fluoroscopic
What is an atherectomy?
Alternative angioplasty that pulverizes plaque with a rotational device
Options for pseudoaneurysms?
Do nothing
Manual compression
Thrombin injection
Surgery
The superior epigastric and inferior epigastric arteries anastamose in what region?
water shed area
What are other names for volume plethysmography
pneumoplethysmography
air plethysmography
true plethysmography
What are two limitations of the laser doppler test?
1. ulcerated skin
2. patient inability to rest quietly
What artery is compressed for the standard allen test?
radial
What does the allen test evaluate for?
patency of wrist arteries and palmar arch