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Adv. Vas. Son.

Test 2 Arterial Hemodynamics, Anatomy & Phydiology

QuestionAnswer
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