Atherosclerosis

Arteriosclerosis is the most common disease of the arteries; the term means “hardening of the arteries”.
It is the diffuse process whereby the muscle fibers and the endothelial lining of the walls of small arteries and arterioles become thickened.

1. Shrooti Shah M.Sc.Nursing 1 st year. CON, BPKIHS. Atherosclerosis 4/3/2012 2:14 PM 1

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3. Normal Artery Disease artery 4/3/2012 2:14 PM 3

4. Definition of arteriosclerosis Arteriosclerosis is the most common disease of the arteries; the term means “hardening of the arteries”. It is the diffuse process whereby the muscle fibers and the endothelial lining of the walls of small arteries and arterioles become thickened. 4/3/2012 2:14 PM 4

5. Definition of atherosclerosis Atherosclerosis is a different process, affecting the intima of the large and medium sized arteries. These changes consist of accumulation of lipids, calcium, blood components, carbohydrates and fibrous tissue on the intimal layer of the artery. These accumulation are referred to as atheromas or plaques. 4/3/2012 2:14 PM 5

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7. Atherosclerosis The major targets are the aorta, the coronary and cerebral arteries. Begins in infants and childhood and progresses slowly over the decades. Often produces critical ischemia of the intestines and lower extremities, a major cause of abdominal aortic aneurysms. 4/3/2012 2:14 PM 7

8. Atherosclerosis affecting coronary artery. 4/3/2012 2:14 PM 8

9. Atherosclerosis affecting coronary artery. 4/3/2012 2:14 PM 9

10. Atherosclerosis affecting cerebral artery 4/3/2012 2:14 PM 10

11. Risk factors : Modifiable risk factors Nicotine use (i.e., Tobacco smoking, chewing) Diet (contributing to hyperlipidimia ) Hypertension Diabetes Stress Sedentary life style. Non modifiable risk factors Age Gender Family history 4/3/2012 2:14 PM 11

12. Pathophysiology 4/3/2012 2:14 PM 12

13. Pathophysiology 4/3/2012 2:16 PM 13

14. Clinical manifestations The clinical signs and symptoms resulting from atherosclerosis depend on the organ or tissue affected. The consequences of atherosclerosis are: Myocardial infarction Ischemic heart disease(IHD) Cardiovascular accident ( Transient ischemic attack or stroke). Subarachnoid hemorrhage may result. Peripheral arterial diseases. Aneurysms. 4/3/2012 2:16 PM 14

15. Commonly affecting sites 4/3/2012 2:16 PM 15

16. Myocardial infarction 4/3/2012 2:16 PM 16

17. Stroke 4/3/2012 2:16 PM 17

18. Aneurysm 4/3/2012 2:16 PM 18

19. Diagnostic investigations: Blood test: Lipid profile ECG. Chest X-ray. Echocardiogram. Ankle/brachial Index. Angiography. Stress testing. 4/3/2012 2:16 PM 19

20. Medical management: Anti-cholesterol medications: Example : Statins . ( Atorvastatin , fluvastatin , Lovastatin ).Tab Atorvastatin10mg PO OD . Anti-platelet medications:Tab . Aspirin 75mg PO OD ., Tab. Clopidogrel 75mg PO OD. Thrombolytic therapy: Inj. Streptokinase . Beta blockers: E.g . Metaprolol , Atenolol , propanolol . Tab . Metaprolol 12.5 mg PO OD. Angiotensin -converting enzyme (ACE) inhibitors: E.g . enalapril . Tab . Enalapril 2.5mg or 5mg. depending on the blood pressure. Calcium channel blockers: E.g . Tab. Amlodipine 2.5mg, 5mg or 10 mg dose can be adjusted according to the blood pressure. Diuretics:E.g . Tab. Frusemide 20mg   4/3/2012 2:16 PM 20

21. Surgical management: Angioplasty : A catheter is inserted into the blocked or narrowed part of artery . A second catheter with a deflated balloon on its tip is then passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open. 4/3/2012 2:07 PM 21

22. Endarterectomy : In some cases, fatty deposits must be surgically removed from the walls of a narrowed artery. When the procedure is done on arteries in the neck (the carotid arteries), it's known as carotid endarterectomy . 4/3/2012 1:53 PM 22

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24. Carotid endarterectomy 4/3/2012 1:56 PM 24

25. Bypass surgery A graft bypass using a vessel from another part of your body or a tube made of synthetic fabric. This allows blood to flow around the blocked or narrowed artery 4/3/2012 1:57 PM 25

26. Bypass surgery 4/3/2012 1:57 PM 26

27. Nursing management Nurses need to assess patient’s learning needs. One way of motivating patients is to modify their behavior is to help them understand the nature of atherosclerosis, its prognosis and ways to control disease progression. Nurses need to explain the risk factors related to atherosclerosis and focus on life style changes. 4/3/2012 1:58 PM 27

28. Nursing management cont… Nurses should educate patients about the effect of smoking on the arterial system. Encourage adherence of cholesterol lowering medications and other medications. Recommend follow up of patients on statins to monitor required lowering cholesterol. Accompany any prescription of medication with dietary control. 4/3/2012 1:58 PM 28

29. Prevention Get regular medical checkups. Control blood pressure. Check cholesterol. Don’t smoke. Exercise regularly. Maintain a healthy weight. Eat a heart-healthy diet. Manage stress. 4/3/2012 2:03 PM 29

30. Prognosis If arteriosclerosis is left untreated it can be fatal by leading to a stroke or heart attack (where the coronary arteries are affected.) Especial caution is needed if a patient is also diabetic because the disease can progress very rapidly in diabetic patients. 4/3/2012 1:14 PM 30

31. References Smeltzer SC, Bare B. Textbook of medical-surgical nursing. 10 th edition. Philadelphia; Lippincott willimas & wilkins : 2004. http://www.emedicine.medscape.com/article/1950759-overview. Retrieved on 1st April.2012. http://www.mayoclinic.com/health/arteriosclerosisatherosclerosis/DS00525/DSECTION=symptoms .Retrieved on 1st April.2012. http://www.wikipedia.org/wiki/Atherosclerosis . Retrieved on 1st April.2012 . http://www.emedicinehealth.com/hardening_of_the_arteries/page12_em.html . Retrieved on 1st April. 4/3/2012 1:14 PM 31

32. THANK YOU… 4/3/2012 1:14 PM 32