PREFERRED PRACTICE PATTERN
A 78-year-old male, with a history of TIA, presents for a general physical examination. He is on 81 mg of Aspirin, 40 mg of Lovastatin, and 50 mg of Hydrochlorothiazide. Vitals are: Pulse: 80 Respirations: 16, Blood Pressure: 132/88, Temperature: 98.2°F, and SpO2% of 99%. On physical examination, the physician hears a bruit in the left side of the neck. The patient is sent for carotid ultrasound which reveals 70% blockage of the left carotid and 35% blockage of the right carotid.
Carotid arteries become blocked or receive limited blood flow
Carotid stenosis: Narrowing of the artery
Plaque builds up in the artery
Plaque can be stable and asymptomatic
Clots can lead to a stroke
Can result in a sudden, specific neurological deficit
Ischemic (two types)
Thrombotic: Atherosclerotic plaques that form at the branching and curves of arteries in the brain can be large vessel thrombosis or small-vessel thrombosis.
Embolic: An embolus that forms somewhere other than in the brain, often the heart, and then travels to the brain and restricts or blocks blood flow to the brain.
About four million Americans suffer physical impairments and disability from stroke.
Two-thirds of all CVAs occur in individuals older than 65 years of age.
Incidence is greater in men than in women and twice as high in Blacks as in Whites.
Cerebral infarction (thrombosis or embolism) is the most common form, accounting for 70% of all strokes, followed by hemorrhages at 20%, and 10% unspecified.
Schematic representation of the normal carotid arterial pulse, five types of abnormal pulses, and pulsus alternans. D, diastole; ECG, electrocardiogram; phono, phonocardiogram; S, systole; S1, first heart sound; S2, second heart sound. (From Fuster V, Walsh RA, Harrington RA. Hurst’s The Heart, 13th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)
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