Quiz 3 (vessel recognition) Flashcards
(121 cards)
1
Q
what is the intimal wall thickness?
A
less than or equal to 0.9
2
Q
what axis is the intimal wall thickness measured?
A
longitudinal image (SAG)
3
Q
specular reflection
A
Demonstrate a sharp line that emanates from the intimal surface
4
Q
what is the black line on an carrotid on a SAG image indicate?
A
tunica media
5
Q
what does the outermost white line on a SAG carotid artery indicate?
A
tunica adventitia
6
Q
what are the characteristics of low pulsatility?
A
- broad systolic peak
- forward flow throughout diastole
- always completely above or below baseline (depending on direction of flow)
- low peripheral resistance flow as in the carotid, vertebral, and renal arteries
- monophasic waveform
7
Q
what are the characteristics of moderate pulsatility?
A
- tall and sharp systolic peak
- forward flow through all of diastole
- diastolic flow is relativity less than seen in low pulsatility waveforms
- flow is typically seen ECA
- dicrotic notch is found
- temporary cessation of forward flow
- biphasic waveform
8
Q
what does the ECA supply?
A
- face and neck
- SMA during fasting
9
Q
what is the dicrotic notch?
A
transition from systole to diastole. It is a normal finding that represents the closure of the aortic valve
10
Q
what is the dicrotic notch thinking about flow?
A
temporary cessation of forward flow followed by resumption of forward flow driven by the elastic rebound of the arterial wall
11
Q
what are the characteristics of high pulsatility?
A
- narrow, tall, sharp, systolic peaks
- brief flow reversal, then brief flow reversal
- triphasic waveform
- typically seen in resting state peripheral arteries
12
Q
monophasic waveform
A
all flow is above baseline
13
Q
biphasic waveform
A
single antegrade and single retrograde
14
Q
triphasic waveform
A
flow is systole is above baseline then reversed segment in diastole below baseline and third component of diastolic flow above the base line
15
Q
what is the CCA identity?
A
- moderate pulsatility
- close to baseline
- low diastolic flow
- sharp upstroke
16
Q
how do you locate the CCA?
A
place probe TRV on the anterolateral neck at the level of the thyroid. It is seen lateral to the lobe
17
Q
what are the characteristics of the ICA to differentiate it from the ECA?
A
- lower pulsatiity
- rounded peak window
- high diastolic flow
18
Q
wat are the characteristics of the ECA to differentiate it from the ICA?
A
- higher pulsatility
- higher upstroke
- closer to baseline
- lower diastolic flow
19
Q
how do you locate the ICA and ECA?
A
follow the CCA upward in TRV. It will bifurcate into ECA and ICA. The vessel with the bulb is ICA-lateral. The vessel that is narrower is ECA-medial
20
Q
what are the characteristics of the vertebrals?
A
- low pulsatility
- similar to ICA with lower velocity
- forward flow throughout diastole
- travels cephalad through transverse foramina of C6 to C2
21
Q
how do you locate the vertebral artery?
A
- find the CCA sagitally in anterolateral plane
- angle probe laterally slowly until vertebrals bodies are seen
- the artery and vein will be seen within gaps of vertebrae
22
Q
where is the subclavian located?
A
posterior to clavicle
23
Q
what are the characteristics of the subclavian artery?
A
- high pulsatility, high resistant signal
- sharp systolic upstroke
- triphasic signal
- reverse diastolic component
- forward diastolic component
24
Q
describe the appearance of the monophasic arterial flow?
A
- spectrum is completely above baseline
- systolic and diastolic portions
- flow does not touch baseline (0)
- good example is the low resistant ICA
25
describe the appearance of the biphasic arterial flow?
- all systolic portion is above baseline
- diastolic flow crosses the baseline and is below it
- high resistance flow pattern since flow reaches 0 and has negative component
- good example is abnormal triphasic waveform
26
describe the appearance of the triphasic arterial flow?
- systolic phase is above baseline
- first diastolic component is below baseline
- third component of diastolic flow is above baseline
- high resistant flow patterns
- good example is subclavian and femoral arteries
27
what does some abnormal flow pattern signify?
- approaching stenosis
- stenosis
- post stenosis
28
what are some abnormal flow patterns?
- internalization of ECA-antegrade ECA
- ---(CCA occlusion/ICA occlusion)
- externalization of CCA
- Thud flow
- Tardus Parvus waveform
- severe aortic regurgitation
29
what is the difference between 2 waveforms when they are both low resistant and one has a clean window and one does not?
clean window is larger superficial artery such as CCA and broadened is deeper vessels such as renal artery
30
what is a stenosis?
narrowing of the arterial lumen, causing a hemodynamically significant change in flow
31
what may happen if an stenosis or occlusion occurs?
collateralization
32
where does plaque commonly form and what does it involve?
Common carotid bifurcation and it involves the:
- distal CCA
- prox ECA/bulb
- prox ICA
33
what is plaque categorized as?
- homogenous
- soft
- heterogenous
- ulcerated
- calcified
34
Plaque should be carefully evaluated to determine the:
- extent
- location
- surface contour
- texture
- assess degree of luminal stenosis
- evaluate in SAG and TRV
- use gray scale ultrasound
35
CIMT
intima-media thickness
36
what is plaque a combination of?
increased thickness of intima-media layers and by echogenic material that encroaches on the lumen
37
plaque characterization-homogenous
-uniform and smooth surface
38
plaque characterization-calcified
produces posterior acoustic shadowing (asymptomatic patients)
39
plaque characterization-heterogenous
complex echo pattern-contains one or more sonolucent areas
40
plaque characterization-ulcerated
- focal depression or break in plaque surface
| - irregular border contour
41
fibromuscular Dysplasia
growth of cells in walls causing narrowing
42
carotid pseudoaneurysm
collection of blood between media and adventisa
43
carotid/vertebral artery dissection-intimal flap
flap in lumen, separation of wall
44
takayasus, temporal and giant cell arteritis
inflammation of vessel walls, lumen gets narrow (chemo)
45
Raynaud's phenomenon
blood flow is reduced to fingers and toes
46
Carotid body tumor
at bifurcation tumor causes widening and highly vascular and usually benign
47
thoracic outlet syndrome
compression of nerves, arteries, or veins from extra cervical rib
48
endarterectomy
surgical treatment for stenosis (peel plaque off)
49
carotid setting
go through artery and place stent in narrowing and widen back up
50
what is the gray scale characteristics of vessel?
- normal carotid has smooth vessel walls
- no appreciable plaque in lumen
- intimal-media layer is clearly visable
- uniform throughout vessel
- lumen is anechoic
- occasional reverberation artifacts in lumen because of IJV
51
what are the grayscale images in TRV gray scale?
- prox
- mid
- distal
- bifurcation
- prox ICA/bulb
52
what are the grayscale images of SAG gray scale?
- prox
- mid
- distal
- bifurcation with ICA and ECA (or separate)
53
what is the sonographers role of scanning carotids?
- assessing lumen for presence of wall thickening and plaque
- measuring the AP wall thickness
- follow protocol for carotid
- images are taken on the left and right side
54
when using color doppler, which axis do we access first?
TRV
55
how many axis do we take pictures with colour doppler?
2 (SAG and TRV)
56
using duplex flow where do we assess flow?
```
SCA
-prox
-mid
CCA
-distal
ECA (w temporal tap)
Bulb
ICA
-prox
-mid
-distal
```
57
what do you do if you noticed a area of plaque?
run the doppler sample carefully through the potential stenosis
58
where do you document increased doppler flow signal at levels of stenosis?
1. proximal to stenosis (asses flow change)
2. within stenosis (highest velocity)
3. distal to stenosis (detect post stenotic turbulence)
4. further downstream for tardus parvus waveform
59
when measuring velocity within stenosis, how many samples do you take?
3
60
what do you measure on all vessels?
-PSV (peak systolic velocity)
-EDV in ICA stenosis
for grading purposes
61
how do you document vertebral artery?
flow and direction with triplex doppler
62
what must be assessed if there is a reversal of flow in the vertebral artery?
ipsilateral (same side) SCA must be assessed for stenosis/occlusion
-also the ECA flow PSV
63
where can the SCA be accessed?
level of superior clavicle in the mid portion
64
what should the signal be in the SCA, INN A?
high resistant and triphasic
65
what does the water hammer associate with?
aortic regurgitation
66
what is subclavian steal syndrome?
blood in vertebrals retrogrades (reverses) flow
67
if SCA stenosis or occlusion is suspected then what do we access?
vertebral artery for subclavian steal syndrome
68
what is the average normal velocity in SCA?
140 cm/s
69
what is the average normal velocity in CCA?
80-100cm/s
70
what is the average normal velocity in ICA?
less than 125 cm/s
71
what is the average normal velocity in ECA?
120 cm/s
72
what is the average normal velocity in vertebrals?
20-60 cm/s
73
signal nomenclature of SCA?
high resistant
| high pulsatiity
74
signal nomenclature of CCA?
mix of ECA and ICA
| medium pulsatiity
75
signal nomenclature of ICA?
low resistant
| low pulsatiity
76
signal nomenclature of ECA?
high resistant signal
| high pulsatility
77
signal nomenclature of vertebral?
low resistant
| low pulsatility
78
grading ICA stenosis-normal
less than 125 cm/s
| minimal or no spectral broadening
79
grading ICA stenosis-1-15%
less than 125 cm/s
| spectral broadening during deceleration phase of systole
80
grading ICA stenosis-16-49%
less than 125 cm/s
| spectral broadening throughout systole
81
grading ICA stenosis-50-79%
greater or equal to 125 cm/s with end diastolic less than 140 cm/s
-marked spectral broadening
82
grading ICA stenosis-80-99%
greater than 125 cm/s with end diastolic greater than 140 cm/s
-marked spectral broadening
83
grading ICA stenosis-occlusion
no signal
84
does ECA have little or lots of diastolic flow?
little diastolic flow
85
does ICA have little or lots of diastolic flow?
high diastolic flow
86
where is low resistant flow in the body?
cephalad (towards head or superficial) throughout cardiac cycle
87
what does high resistant waveform look like?
flow-forward flow in systole-low or reversed in diastole and third component forward flow above the baseline
88
does areas having high metabolic flow need low or high resistant flow?
low resistant flow
89
what factors affect ICA waveform?
- atheroma/plaque
- tortuosity
- aortic valve disease
- aortic arch/innominate disease
- distal carotid siphon disease
- intracranial vessel disease
- contralateral carotid occlusion
- high cardiac output states
90
what are some problems and pitfalls of waveform?
- Incorrect doppler sample volume(gate) position or size
- Doppler angle too large > 60 degrees
- Doppler settings too high for low velocity, low volume flow
- Tortuous vessels
- High grade stenosis
- Calcified plaque
91
how do you make sure you have the correct sample volume setting?
- Sample volume with angle correct at 60 degree
- Located centrally within vessel and parallel to walls
- Color flow box angled correctly
- Spectral waveform set correctly with baseline and velocity scale
92
where is a lumen with plaque measured?
in TRV
93
what are causes of pulsatile neck masses?
- Normal but prominent carotid artery bulb
- Ectatic carotid,brachiocephalic or subclavian artery
- Aneurysm of carotid artery
- Carotid body tumor
- Enlarged lymph node adjacent to carotid sheath
94
atherosclerosis
a chronic progressive disease
95
what does plaque of atherosclerosis consist of?
deposits of cholesterol and other lipids, calcium and large inflammatory cells called macrophages
96
plaque
sticky yellowish deposits
97
what problems can plaque cause?
- protrude into the artery causing a partial or complete obstruction to flow
- rupture causing a thrombus to form
- weaken the wall and cause aneurysm
98
atherosclerosis coronary arteries
angina, heart attack
99
atherosclerosis cerebrovascular circulation
stroke
100
atherosclerosis renal arteries
kidney disease
101
atherosclerosis aorta
aortic aneurysm
102
atherosclerosis peripheral arteries
leg claudication (pain when walking)
103
what are risk factors for atherosclerosis?
- smoking
- Hyperlipidemia
- Hypertension
- Diabetes
- Obesity
- Fam history
- Psychosocial factors
- unhealthy diet
- gender
- age
104
what high blood pressure can lead to the heart working harder and harm the arteries?
over 140/90mm
105
what is normal blood pressure?
120/80mm
106
how does smoking effect your arteries?
nicotine and carbon monoxide in cigarette smoke damages the epithelium
107
hyperlipidemia
elevated levels of cholesterol and triglycerides in the blood damages the epithelium
108
what do most diabetics die from?
heart attacks caused by atherosclerosis
109
what is the good cholesterol?
High Density Lipoprotein-HDL
110
what is the purpose of HDL?
maintains the inner walls-endothelium of blood vessels
111
what is good levels of HDL?
over 60mg/dl
112
what is the bad cholesterol?
Low Density Lipoprotein-LDL
113
why is LDL bad?
deposits in the walls of arteries and over time grows into plaque
114
what is plaque made up of?
cholesterol, cells, and debris
115
why is obesity a risk factor for atherosclerosis?
excess weight strains the heart and increases the risk
| -associated with high triglycerides and cholesterol
116
what are the signs of a heart attack?
1. chest discomfort
-pressure, squeezing, fullness, or pain, burning or heaviness
2. discomfort in the upper body
-neck, jaws, arms, and back
3. shortness of breath
4.sweating
5.nausea
6.light headedness
CALL 911
117
what is the leading cause of death in the US?
heart disease
118
what is the second leading cause of death in the US?
cancer
119
what is the third leading cause of death in the US?
stroke (secondary to atherosclerosis)
120
what is another name for stroke?
cerebrovascular accident (CVA)
121
what are the levels of LDL?
greater than 160 mg/dl is too high
