Plethysmography testing /thoracic outlet syndrome

dms 214 unit 3

Plethysmography testing includes -

• pulse volume recordings

• photoplethysmography

Pulse volume recordings (PVR) measures changes in -

segmental limb volume with each cardiac cycle

During a PVR patient is examined in

supine position

During a PVR BP cuffs are placed at the -

same as segmental doppler pressures

During PVRs each cuff is inflated -

20-30mmHg above normal systolic pressure preset

Pulse volume recordings give a -

waveform but it is measuring the volume not pressure

present PAOD causes changes in -

PVR waveform

In PVR the 1st sign of PAOD is -

loss of the dichroitic notch

Pulse volume recoding waveforms are recorded on -

analogue chart recorder

photoplethysmography uses a PPG transducer to -

detect microcirculation pulses

photoplethysmography is displayed as a -

PPG wave from by using infrared light which reflect of RBCs

Thoracic outlet syndrome -

neurovascular compression by structured in the shoulder girdle \

• subclavian artery is compressed between the clavicle and 1st rib

compression is a common finding in -

thoracic outlet syndrome, rare to experience symptoms related to arterial compression

Thoracic outlet syndrome is commonly tested by using -

PPG to record digital waveform

Thoracic outlet syndrome symptoms can usually be reproduced in a -

specific position or with a particular activity

digital waveforms are recorded in various arm positions -

• arms resting in lap

• arms up with elbows bent at 45 degrees

• arms raised overhead

• arms abducted straight out at 90 degrees

• adson with head to left

• adson with head to right

Adsons maneuver -

arms up like field goal post

in thoracic outlet syndrome waveforms should be recorded -

in all positions

abnormal results in a thoracic outlet syndrome test cause -

reduction or flatline of waveform with any positions

in thoracic outlet syndrome any position that causes waveform to flatline should be held for at least -

30 seconds to see if patient develops symptoms

Raynaud Phenomenon -

cold sensitivity

Primary Raynaud tends to affect patients in -

teens years, females more than males

With primary Raynaud hands change-

color when exposed to cold

• white, then blue, then red (with warming)

primary Raynaud is the overreaction of -

autonomic sympathetic nervous system to cold stimuli

Secondary Raynaud is caused by -

vascular occlusion or stenosis

secondary Raynaud can also be caused by -

cold or emotional stress

patients with suspected secondary Raynaud should not -

have hands immersed in ice water

PPG waveforms and digital pressures can be used for diagnosis of -

secondary Raynaud

Pressure gradients > 20 mm Hg difference indicates -

arterial obstruction (secondary Raynaud’s)

1st step for cold sensitivity exam: PPG waveform analysis and/or digital temperature monitoring -

at rest first (warm hands)

• waveform may be normal or “peaked”

2nd step for cold sensitivity exam: PPG is secured to -

digit and wrist, hands may be covered with gloves

3rd step for cold sensitivity exam:

hands are placed in ice water bath for 30 to 60 seconds

4th step for cold sensitivity exam: digital waveforms and/or temperatures are measured at -

2, 5, 10 and 20 minutes post-immersion

anacrotic notch may indicate a -

stenosis