BACKGROUND
Patients who present with acute ischemic stroke, carotid bruit or significant coronary artery disease benefit from evaluation of cerebrovascular disease including carotid artery stenosis. Recently, this assessment has become increasingly vital since selected asymptomatic individuals with internal carotid artery stenosis greater than 70% can benefit from carotid endarterectomy1. Cerebrovascular ultrasound or Carotid Duplex Ultrasonography (CDUS) is often used in patients with planned Coronary Artery Bypass Grafting (CABG), known atherosclerosis (coronary or peripheral artery disease), and syncope. Although studies2, 3 have shown correlation of carotid artery disease and coronary artery disease, its utility in asymptomatic patients is unclear4. This study aimed to evaluate the effective use of CDUS to diagnose significant cerebrovascular disease (CBVD) in this group of patients.
METHODS
After institutional IRB approval, we included 827 carotid ultrasounds consecutively ordered between March 1st, 2013 and August 31st, 2013 at Newark Beth Israel Medical Center. Demographic characteristics such as age, sex and clinical variables such as diabetes mellitus, systemic hypertension, coronary artery disease (CAD), peripheral artery disease (PAD), smoking status, carotid bruit and indications were formulated. This was a retrospective analysis and all investigators were blinded about the final report while performing chart review.
In addition to visualization of carotid arteries, vertebral and subclavian arteries were also examined. Stenosis in subclavian arteries, vertebral, basilar arteries or greater than 60% reduction in diameter of internal carotid artery (ICA) was considered significant cerebroavascular disease (CBVD). All ca...
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...assify severity of CAD which could affect degree of atherosclerosis in carotid vasculature and thereby could be a significant predictor of cerebrovascular disease. However, our study lends support to finding that routine use of CDUS has not been shown to reduce peri-operative stroke or mortality22. Moreover, this study data is different from previous studies15, 18 as it includes a cohort of patients awaiting heart transplant.
CONCLUSION
Recent guidelines from ACCF23 and USPSTF24 imply that performing screening CDUS in asymptomatic patients is not useful. Our study corroborates this finding thus suggesting development of better risk stratification models to identify pre-test probability of peri-operative stroke. This will help determine which cohort of patients will benefit most from carotid artery intervention, if needed, despite being on maximal medical therapy.
In more severe cases, a surgical procedure known as endarterectomy is suggested. An edarterectomy is an operation used to widen the carotid artery. This is usually an option if it has been determined that the internal carotid artery is narrowed by more than 70% and if the person in question has been displaying stroke-like symptoms during the previous six to eight months. This surgery is usually used to prevent the future risk of a stroke. This procedure has been shown to prevent blockage of the internal carotid artery over time and usually involves removing fatty deposits and clots in this important artery.
Lippincott, W. (2013). Management of Patients with Cerebrovascular Disorders. Brunner and suddarth's textbook of medical -surgical nursing 12th ed. + nursing diagnosis, (p. 1895). S.l.: Wolters Kluwer Health.
Diagnostic medical sonography is a profession where sonographers direct high-frequency sound waves into a patient’s body through the use of specific equipment to diagnose or monitor a patient’s medical condition. As described by the Bureau of Labor Statistics, this examination is referred to as an ultrasound, sonogram, or echocardiogram. The high-frequency sound waves emitted from the handheld device, called a transducer, bounce back creating an echo and therefore produce an image that can be viewed on the sonographers computer screen. This image provides the sonographer and physician with an internal image of the patient’s body that will be used in the diagnosis. The most familiar use of ultrasound is used in monitoring pregnancies and is provided by obstetric and gynecologic sonographers, who also provide imaging of the female reproductive system. Other types of sonography include; abdominal sonography, breast sonography, musculoskeletal sonography, neurosonography and cardiovascular sonography. Due to the vast nature of uses in sonography, most professionals study one field that they choose to specialize in. Diagnostic medical sonography is a rapidly growing field because of the increase in medical advances. The area of Cleveland, Ohio has continued to rise in the medical field with great strides, providing better career prospects with the availability of numerous employment positions.
Coronary artery disease (CAD) is the most common type of multifactorial chronic heart disease. It is a consequence of plaque buildup in coronary arteries. The arterial blood vessels, which begin out smooth and elastic become narrow and rigid, curtailing blood flow resulting in deprived of oxygen and nutrients to the heart [1].
Cost effectiveness and noninvasiveness seem to be a theme in developing preventative treatments of coronary artery disease. A study presented by the Journal of Magnetic Resonance Imaging proposes that the use of coronary wall MRI would encompass both of these factors. These MRI images compared coronary artery thickness of symptomatic and asymptomatic patients. It was found that these images could successfully detect artery wall thickness in asymptomatic patients who would have otherwise not been screened for risk factors.
Atherosclerosis is the culprit behind coronary heart disease (CHD) and stroke, which is the most common cause of death worldwide and in the United States10. Among the modifiable risk factors of CHD and stroke is the serum low density lipoprotein level (LDL)8, 11. Several randomized clinical trials have established that reducing the serum LDL level results in a reduction in the future risk of CHD and stroke in a linear relationship, in one study it was estimated that reducing the LDL by 1 % would reduce the risk by 1.7 %.1-4, 7, 9, 13
Cardiovascular Disease is defined by the American Heart Association as “Heart and blood vessel disease”. Atherosclerosis of the arteries, can lead to hypertension, heart failure, arrhythmias, heart valve problems, myocardial infarctions or a stroke (AHA, 2016). In this paper, all of heart and vessel diseases aforementioned, will be considered cardiovascular disease (CVD). According to
Ultrasounds are an important feature of technology used in our world today. The medical world uses ultrasounds and x-rays on an everyday bases. Ultrasounds are high-frequency sound waves and ultrasounds also produce sound waves that are beamed into the body causing return echoes that are recorded to visualize structures beneath the skin. Ultrasounds have thousands of different types and help doctors and patients see specific diseases and conditions that they cannot see otherwise. However, even though ultrasounds benefit people, many wonder if ultrasounds may have bad effects too.
... J. (2009). Heart disease and stroke statistics--2010 updated: a report from the American Heart Association. Journal of the American Heart Association. doi:10.1161/CIRCULATIONAHA.109.192667
.... Heart disease and stroke statistics 2010 update. A report from the American heart association. Circulation 2010; 70-78.
The World Health Organisation (2013) explains that an Ischaemic stroke occurs as a result of a blood vessel becoming blocked by a clot, reducing the supply of oxygen to the brain and, therefore, damaging tissue. The rationale for selecting Mary for this discussion is; the author wishes to expand her evidenced based knowledge of stroke since it is the principal cause of disability and the third leading cause of mortality within the Scottish population (Scottish Intercollegiate Guidelines Network (SIGN), 2008) and, therefore, a national priority. In response to this priority, the Scottish Government (2009) produced their ‘Better Heart Disease and Stroke Care Action Plan’. Additionally, they have introduced a HEAT target to ensure 90% of stroke patients get transferred to a specialised stroke unit on the day of admission to hospital (Scottish Government, 2012).
1. What is the difference between a. and a. Introduction The main aim of this report is to present and analyse the disease called Cerebrovascular Accident, popularly known as stroke. This disease affects the cerebrovascular system, which is a part of the cardiovascular system.
Stroke is a serious medical condition that affects people of all ages specifically older adults. People suffer from a stroke when there is decreased blood flow to the brain. Blood supply decreases due to a blockage or a rupture of a blood vessel which then leads to brain tissues dying. The two types of stroke are ischemic stroke and hemorrhagic stroke. An ischemic stroke is caused by a blood clot blocking the artery that brings oxygenated blood to the brain. On the other hand, a hemorrhagic stroke is when an artery in the brain leaks or ruptures (“About Stroke,” 2013). According to the Centers for Disease Control and Prevention (CDC), “Stroke is the fourth leading cause of death in the United States and is a major cause of adult disability” (“About Stroke,” 2013). Stroke causes a number of disabilities and also leads to decreased mobility in over half of the victims that are 65 and older. The CDC lists several risk factors of stroke such as heredity, age, gender and ethnicity as well as medical conditions such as high blood pressure, high cholesterol, diabetes and excessive weight gain that in...
Rumack, C. M., Wilson, S. R., & Charboneau, J. W. (2005). Diagnostic ultrasound (3rd ed.). St. Louis: Elsevier Mosby.
The arteries supply blood rich in oxygen to the body, the veins direct deoxygenated blood from the capillaries back to the heart. These roles make up the circulatory function. Blood flow through these blood vessels can be disrupted resulting in peripheral vascular diseases. These diseases occur as a result of narrowing or blocking of the blood vessels. The risk factors of peripheral vascular diseases include diabetes, smoking, high level of cholesterol, overweight, high blood pressure etc. these risk factors result to aneurysms, Raynaud’s diseases, Buerger’s disease, renal artery disease etc. With this diseases, the peripheral vascular system should be assessed to enable nurses and other health personnel make good