Atherosclerosis

CARDIAC DISORDERS

1. Ratheesh.r.l ATHEROSCLEROSIS

2. Normal artery Diseased artery

3. 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. 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.

5. 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.

6. Atherosclerosis affecting coronary artery

7. Atherosclerosis affecting coronary artery

8. Atherosclerosis affecting cerebral artery

9. Risk factors: Modifiable risk factors  Nicotine use (i.e., Tobacco smoking, chewing)  Diet (contributing to hyperlipidimia )  Hypertension  Diabetes  Stress  Sedentary life style.

10. Non modifiable risk factors  Age  Gender  Family history

11. pathophysiology

12. Normal arterial wall The normal arterial wall consist of smooth muscles and connective tissue with an endothelial covering.

13. Formation of fatty streak The fatty streaks will develop in the coronory arteries at the age of15 onwards. When the fatty streak develop a yellow ting will be appear in the wall of blood vessels.

14. Stable plaque (fibrous plaque formation) The fibrous plaque stage is the beginning of progressive changes in the endothelium of arterial wall. This changes will appear in the age of 13 and increase with age. Normally the endothelium repairs immediately after injury but, in persons with CAD the endothelium is not rapidly replaced.

15. It allows the accumulation of LDL and growth factor which causes the thickening of the arterial wall. Then the fatty streak is eventually covered by collagen and forming a fibrous plaque which is greyish or whitish in colour .

16. Vulnerable plaque or complicated lesions It is the final stage of development of atherosclerotic lesions and it is the most dangerous stage. As fibrous plaque grows, the continuous inflammation can cause plaque instability, ulceration and rupturing. When rupturing occurs the bleeding will be get started and as a result aggregation of platelets will occur which will leads to the formation of thrombus.

17. Further, growth of thrombus and accumulation of platelets will leads to the total accumulation of platelets and the total occlusion of the arteries.

18. Clinical manifestations Chest pain Ischemia of heart muscles Inadequate cardiac output Dyspnea Sudden cardiac death Increased cardiac enzyme level Heart failure

19. MI Diaphoresis Palpitation Arrythmias Difficulty in speaking

20. diagnosis History collection and physical examination The family history, nutritional history and personal history should be collected from the patient. during physical examination the nurse should check the characteristics of pulse.(some times patient may have weak thready pulse)

21. ~ Auscultation for the heart sounds incase of atherosclerosis an oozing sound will be present, it is the turbulence sound during the flow of blood.

22. 2. Blood studies it is necessary to check the complete lipid profile of the patient. 3. Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through the heart. An ECG can often reveal evidence of a previous heart attack or one that's in progress.

23. 4. Holter monitoring it may be recommended sometimes. With this type of ECG, patient wear a portable monitor for 24 hours as the patient go about his normal activities. 5. Echocardiogram. An echocardiogram uses sound waves to produce images of heart. During an echocardiogram, the doctor can determine whether all parts of the heart wall are contributing normally to the heart's pumping activity.

24. 6. Exercise stress test If the signs and symptoms occur most often during exercise, doctor may ask to walk on a treadmill during an ECG. This is known as an exercise stress test. In some cases, medication to stimulate the heart may be used instead of exercise.

25. 7. Cardiac catheterization or angiogram. To view blood flow through heart, the doctor may inject a special dye into coronary arteries. This is known as an angiogram. The dye is injected into the arteries of the heart through a long, thin, flexible tube (catheter) that is threaded through an artery, usually in the leg, to the arteries in the heart.

26. This procedure is called cardiac catheterization. The dye outlines narrow spots and blockages on the X-ray images. If the patient have a blockage that requires treatment, a balloon can be pushed through the catheter and inflated to improve the blood flow in coronary arteries. A mesh tube (stent) may then be used to keep the dilated artery open.

27. 8. CT scan. Computerized tomography (CT) technologies can help the doctor see calcium deposits in arteries that can narrow the arteries. If a substantial amount of calcium is discovered, coronary artery disease can be suspect.

28. MANAGEMENT LIFE STYLE MODIFICATIONS PHARMACOLOGICAL MANGEMENT SURGICAL MANAGEMENT

29. LIFE STYLE MODIFICATIONS Stop smoking. Smoking damages the arteries. If patient smoke or use tobacco in any form, quitting is the best way to halt the progression of atherosclerosis and reduce your risk of complications. Exercise most days of the week. Regular exercise can condition the muscles to use oxygen more efficiently.

30. Eat healthy foods. A heart-healthy diet based on fruits, vegetables and whole grains — and low in refined carbohydrates, sugars, saturated fat and sodium — can help to control the weight, blood pressure, cholesterol and blood sugar.

31. Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing. Avoid alcohol Avoid high fat and oil diet Drink more water

32. Pharmacological management Anti-platelet medications. The doctor may prescribe anti-platelet medications, such as aspirin , to reduce the likelihood that platelets will clump in narrowed arteries, form a blood clot and cause further blockage.

33. Beta blocker medications. These medications are commonly used for coronary artery disease. They lower the heart rate and blood pressure. Eg:propanolol atenolol

34. Angiotensin -converting enzyme (ACE) inhibitors. These medications may help slow the progression of atherosclerosis by lowering blood pressure. Eg : captopril ramipril

35. Calcium channel blockers. These medications lower blood pressure and are sometimes used to treat angina. Eg : verapamil amlodipin

36. Cholesterol lowering agents: To reduce the cholesterol level. Eg : atorvastatin

37. Surgical management Angioplasty and stent placement. In this procedure, the doctor inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A second catheter with a deflated balloon on its tip is then passed through the catheter to the narrowed area.

38. The balloon is then inflated, compressing the deposits against the artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open.

39. Coronary Artery Bypass Surgery. (CABG) The doctor may create a graft bypass using a vessel from another part of the body or a tube made of synthetic fabric. This allows blood to flow around the blocked or narrowed artery.

40. Embolectomy : It is the removal of emboli or clot from the artery. Thrombectomy : It is the removal of thrombus from the artery.

41. 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 called a carotid endarterectomy .

42. Nursing management Assess the patient for pain Monitor vital signs of patient 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.

43. Nurses need to explain the risk factors related to atherosclerosis and focus on life style changes. Nurses should educate patients about the effect of smoking on the arterial system. Encourage adherence of cholesterol lowering medications and other medications.

44. Recommend follow up of patients on statins to monitor required lowering cholesterol. Accompany any prescription of medication with dietary control.

45. 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.