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Adv. Vas. Son.
Test 2 Arterial Hemodynamics, Anatomy & Phydiology
| Question | Answer |
|---|---|
| With a normal peripheral arterial waveform what do you see in systole? | In systole, intra-aterial pressure is high, flow moves forward |
| With a normal peripheral arterial waveform what do you see in diastole? | In diastole intra-arterial pressure is decreased and pressure distally is high (due to peripheral resistance); pressure gradient (& flow) reverses |
| With normal peripheral arterial waveform what is the third component thought to be due to what? | The third component is thought to be due to the elasticity of the arterial wall (rebounding) |
| What is seen with a large sample volume? | Wide spectrum- spectral broadening |
| What is seen with a small sample volume? | Narrow spectrum- minimal spectral broadening |
| What happens distal to maximum stenosis? | Distal to maximum stenosis, velocities decrease and laminar flow is disrupted-turbulence occurs |
| What is turbulence? | Turbulence is irregular motions of fluid elements; cross-currents, eddy's etc. |
| A 75% area reduction (50% diameter, if circumferential) will cause what? | Will cause a velocity increase, and a distal pressure decrease |
| Velocity increases as the area ________? | Decreases |
| By measuring either the velocity or the increase in velocity we can estimate what? | Estimate the percent of arterial stenosis |
| The greater the narrowing, the faster the ______? | The faster the velocity |
| What is the intima? | The inner-most layer, consists of one layer of endothelial cells supported by an internal elastic lamina. |
| What is the Endothelium? | Single cell layer that lines the inner surface of the artery, In contact with the intraluminal moving blood It provides the following functions: Permeability, Antithrombogenic, and Vasoreactivity |
| What is the Media? | The middle layer. Consists primarily of smooth muscle cells, Allows rhythmic changes in the arterial size that occurs during the cardiac cycle, Collagen is also found in this area of the wall structure |
| What is the Adventitia? | The outer layer. Contains connective tissue & collagen. Contains the Vasa Vasorum; tiny blood vessels that supple the artery wall |
| Where is the Vasa Vasorum found? | In the Adventitia |
| What are the smallest vessels in the circulatory "tree"? | Capillaries |
| Small arterioles lead into what? | Into the single-cell wall capillary beds |
| Venules carry blood back into the what? | Venous drainage system |
| Blood flow in the lower extremities is controlled by? | Cardiac output, Intraluminal wall resistance, Arterial wall compliance, Dynamics of arteriolar vasoconstriction and vasodilation in the distal vascular beds |
| What is shown with low demand? | Vasoconstriction in distal arteries, Arteriovenous shunting in muscle capillary beds, Not much blood flow to skeletal muscles, Large blood volume exists in viscera and cerebral distributions, High resistance in flow from aorta to arterioles |
| At rest what happens to arterioles? | Vasoconstriction |
| Exercise creates what? | Exercise creates Demand |
| Mild exercise=? | Mild demand |
| Arterioles in lower extremities are vasoconstricted when? | At rest |
| Arterioles vasodilate when? | During exercise, ischemia, chemical-emotinal stimulation |
| What are the "Triggers" for Vasodilation? | Endothelium-mediated nitric oxide (NO) causes smooth muscle cells to relax |
| Increased blood flow =? | Increased amount of NO |
| Heavy exercise creates heavy demand which does what? | Maximum arteriole vasodilation, 100% of capillaries open, A-V shunts close, Heart rate & Cardiac Output increases, Shunting of blood from viscera to muscles, & Dermal Vasoconstriction |
| With PTs w/ Occlusive Disease during exercise, vasodilation "triggers" Occur are? | ↓ O2, ↑ lactic acid, ↑ in tissue CO2, ↑ epinephrine, ↑ in Nirtric Oxide (NO), ↓ in distal pressure, But NO increase in flow distally |
| With exercise what happens to flow volume? | Flow volume ↑s to lower extremity vascular beds |
| In a normal situation, ankle pressure following exercise remains ______? | About the same as before exercise |
| What are the 2 most important factors with occlusive disease? | Cardiac output, and distal resistance |
| What is the purpose of waveform morphology? | Used to judge the presence or absence of disease, Affected primarily by the state of vasoconstriction/dilation in arterioles of the distal vascular beds, Arterio-venous fistulas can affect proximal flow |
| What are the risk factors for PAD? | Familial, Cholesterol >240 mg/dl, HTN, DM, severe obesity, Elevated triglycerides, LDL> 160 mg/dl, Depressed fibrinolytic system, Tobacco abuse, ↑ed oxidation of LDLs |
| What are the SXs of Mild Arterial Disease? | PT's asymptomatic (ASX), Not hemodynamically significant, May have abdominal bruit, W/exercise a mild ↓ in ankle pressure, Athero disease may be seen on US exam, but no flow reduction |
| What are the SXs of Moderate Arterial Disease? | ASX @ rest, Intermittent claudication |
| What is intermittent claudication? | Pain, Fatigue or cramping in calf, thigh, or buttock w/ exercise. SXs relieved by rest |
| Claudication is brought about by what? | A transient ischemic event in the muscles |
| What is the most common symptom of peripheral arterial disease? | Intermittent Claudication |
| What are the SXs of severe Arterial Disease? | Ischemic rest pain. Night pain in feet/toes (relieved by dependency) & Dependent rubor |
| What is Dependent Rubor? | Redness, light purple or deep red-violet color that develops on the foot when it hangs in a dependent position |
| Other SXs of Sever Arterial Disease? | Ischemic rest pain in feet/toes, Non-healing wounds on feet/toes, Ulceration on lower leg or foot, Tissue necrosis/Gangrene |
| What is some Arterial Pathology? | Atherosclerosis (ASO), Peripheral Arterial Disease (PAD)- ASO in legs, Thrombosis (preceded by ASO), Thrombo-emboli |
| What is Blue Toe Syndrome? | Toe turns blue due to Thrombo-emboli resulting in areas of cyanosis therefore the blue |
| What is another Arterial Pathology? | Aneurysm, If you have an AAA you're more likely to have a Popliteal aneurysm |
| What is Buerger's disease? | Small vessel thrombosis "fixed" occlusive disease |
| What is Raynaud's syndrome? | Small vessel vasospasm |
| What are some pulsatile masses? | Aneurysms, & Pseudoaneurysms |
| What are two other arterial pathologies? | Arteritis, & Arterial-Venous fistulas (AVF) |
| What is the definition of an Entrapment Syndrome? | Structures that extrinsically pinch or constrict arterial flow |
| What is Popliteal artery entrapment? | Claudication like symptoms |
| What is Nutcracker Syndrome? | Renal vein entrapment syndrome |
| What is Median Arcuate syndrome? | Compression of the celiac axis |
| What is SMA Syndrome? | Compression of the superior mesenteric artery |
| What is Thoracic Outlet Syndrome? | Compression of the Subclavian or Axillary artery |
| With the Atherosclerotic process what is the 1st part? | 1. Early Athero: Injury. Endothelial injury (due to ↑ in LDL, Hypercholesterolemia, etc.). Deposition of LDL into intima. Recruitment of lymphocytes, monocytes (inflammation response) |
| With the Atherosclerotic process what is the 2nd part? | Monocytes in intima become macrophages. Macrophages ingest lipids, lipoproteins. Macrophages become foam cells. Fatty streak forms. Early Atherosclerosis |
| With the Atherosclerotic process what is the 3rd part? | Migration/proliferation of smooth muscle cells from media. Neovasculature supplies plaque, feeds LDL & macrophages. Fibromuscular cap formation. Plaque Formation |
| With the Atherosclerotic process what is the 4th part? | Cell necrosis. Scar tissue formation (fibrosis). Macrophage lysis. Intraplaque hemorrhage. Rupture of fribrous cap. Ongoing inflammatory process. Advanced Atherosclerosis |
Created by:
EmilyGriffin
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