Atherosclerosis

By:

Jay Aries T. Gianan

EMT-B, RM, RN, LPT, MAN
Objectives:
• What is cardiovascular disease?
• What is coronary heart disease?
• What is coronary artery disease?
• What is arthrosclerosis?
• What is Atherosclerosis?
• Risk factors
• Pathophysiology
• Types
• Signs and symptoms
• Complications
• Diagnostic exam
• Treatment
• Nursing management
• Surgical management
What is cardiovascular disease?
Cardiovascular disease
• Cardiovascular disease (CVD) is a
general term for conditions
affecting the heart or blood
vessels. It's usually associated with
a build-up of fatty deposits inside
the arteries (atherosclerosis) and
an increased risk of blood clots.
• Coronary heart disease
• Coronary artery disease
• Strokes and TIAs
• Peripheral arterial disease
• Aortic disease
Coronary heart disease
• Coronary heart disease is the
term that describes
what happens when your
heart's blood supply is blocked
or interrupted by a build-up of
fatty substances in the coronary
arteries. Over time, the walls of
your arteries can become furred
up with fatty deposits.
Coronary artery disease?
• Coronary artery disease occurs
when the flow of oxygen-rich
blood to the heart muscle is
blocked or reduced.
• Atherosclerosis
• Angina
• Acute Coronary Syndrome
• Heart attacks (MI)
• Heart failures
 Cardiovascular Disease (CVD)

Coronary Artery Strokes and transient Peripheral Arterial

Aortic Disease
Disease ischemic attack (TIA) Disease

Acute Coronary Myocardial

Atherosclerosis Angina Pectoris
Syndrome Infarction

AP type 1 AP type 2 AP type 3 MI type 1 MI type 2

Vasospastic
Stable Angina Unstable Angina NSTEMI STEMI
Angina
What is Atherosclerosis?
Arteriosclerosis
• Arteriosclerosis is a broader term for
the condition in which the arteries
narrow and harden, leading to poor
circulation of blood throughout the
body.
• Arteriolosclerosis
• Hardening of small arteries
(arterioles)
• Moenckeberg medial calcific
sclerosis
• The hardening of small to
medium-sized arteries.
• Atherosclerosis
Atherosclerosis
• Atherosclerosis is a disease in which
plaque builds up inside your arteries.
Plaque is made up of fat, cholesterol,
calcium, and other substances found in
the blood.
• Affects coronary arteries.
• This limits the flow of oxygen-rich blood
to your heart muscle.
• Beginning of cardiovascular diseases.
• Dysrhythmias & Myocardial infarction
• Chronic Heart Failure
• Aneurysms & Stroke
Risk factors (EOSINOPHIL)
• E - Environmental influences
• O - Obesity
• S - Serum C reactive protein ↑ level
• IN - Infection (HSV, CMV)
• O – Oral contraceptives, Oestrogen
• P - Prothrombotic factors, physical
inactivity
• H - Homocystinuria
• I - Intake of alcohol
• L - Life stressful
 Hypertension, smoking, Plaque accumulates calcium salts and
hyperglycemia, hypercholesterolemia more dead cells overtime and will Atherosclerosis
harden

Endothelial cells is damage Endothelial cells cover the plaque

ј permeability of arterial wall Fragments of dead cells produce an

allowing LDLs to enter tunica intima area with a lipid core that begins
to form a plaque.

WBC normally flow from the blood Foam cells die and release its
vessels and do not attach to contents, nearby WBC engulfed
Endothelial cells as a stream passed. the release contents.

As Endothelial cells is exposed to This lead to the production of ͞foam

irritating stimuli or damage cell͟– a cell (both smooth muscle
cells & WBC) saturated of LDL
particles.
Endothelial cells express adhesion
molecules that can capture nearby
white blood cells. this process continues

WBC undergo morphological changes

that allow them to flatten and WBC engulf the modified LDLs w/c
squeezed between endothelial cells stimulate them to produced even
(diapedesis) more oxygen free radicals.

WBC produce free radicals which

Oxidized LDLs attract and activate
come in contact w/ LDLs, oxidation
WBC
occurs.
Signs and symptoms
• No symptoms until significant
blockage
• S – Sudden onset
• S – Substernal
• S – Spreads to arm
• S – Squeezing in character
• S – Short duration
• S – Sublingual nitroglycerin
relieves pain
 Complications

Kidney Failure Dysrhythmias

љ blood supply Damage heart

љ blood supply

Damage heart
Narrowing

Myocardial Infarction (Heart

Peripheral artery disease Atherosclerosis Chronic Heart Failure
Attack)

Embolus ј BP in blood vessels љ blood supply

bleeding

Rupture
Stroke Aneurysm Stroke
Diagnostic Exam
• Physical exam
• Blood test
• Assess levels of certain fats,
cholesterol, sugar, and proteins in
your blood
• Angiography
• Narrowing of the vessels
• EKG (Electrocardiogram)
• Chest X Ray
• Echocardiography
• Computed Tomography Scan
• Stress Testing
• Nuclear stress test
Treatment
• Anti-Cholesterol Medication
• Statins “-statins” - simvastatin
• Antiplatelet Medication
• Aspirin - ASA
• Blood pressure medications
• Beta blockers “–lol” - metoprolol
• Diuretics
• ACE Inhibitors “-pril” – captopril
• Nitrates
• Ranozaline – for Angina
AC – Anti Clogging of Arteries
• A – Anti platelet
• Anti clumping
• Aspirin (ASA - acetylsalicylic acid)
• Clopidogrel (Plavix)
• Bleeding
• C – Cholesterol lowering drug “-statin”
• Lovastatin – “stay clean”
• Liver toxic
• Cirrhosis, Liver failure pt.
• No grapefruit
Beta Blockers “-lol”
• Brakes on the heart (slows the heart
rate)
• Block beats
• Atenolol, Propanolol
• Lol = low HR
• Side Effects (4Bs) – Hold the medication
• B – Bradycardia (↓HR, ↓60)
• B – Bottomed out BP(↓BP, ↓80/60)
• B – Breathing Problems
(COPD,Asthma)
• B – Blood sugar masking (DM)
• Always monitor the blood glucose
of the DM pt.
 Decrease BP
Diuretics Drain fluid (urinate) – “diuresis”
Dehydrate (dried body)
• K+ wasting
• K+ Sparring
• Furosemide, hydrochlorothiazide
• Spironolactone
• Dried
• Spares the potassium
• l/t ↓ K+: Eat fruits & green leafy
vegetables • Blocks aldosterone to release Na+
• Caution: Given if K+ is normal (3.5- & H2O
5.0) • Avoid salt substitutes
• Withhold if K+ is below 3.5 • Avoid K+ rich foods
• Green leafy vegetables
• Banana, orange, avocado
Angiotensin-converting enzyme (ACE) inhibitors
“-pril”
• Affects the RAAS (water regulation)
• Lisinopril, Captropril
• Chill heart
• ↓BP, rested & relax heart
• Side Effects (ACE)
• A – Angioedema
• Swollen red tongue
• C – Cough
• E – Electrolyte imbalance
• ↓Na+, ↑K+
Dilators (Vasodilators)
• Relieves pressure
• D – Decrease BP
• D – Dilates vessels
• D – Decrease vascular resistance
• Nitroglycerine
• Pillow (rested & relax heart)
• NO erectile drugs “-afil”
• Sildenafil(Viagra)
• Dropping BP so low l/t death
 Nursing Management (DRESS)
• D – Diet
• ↓ SCC (sodium, calories, cholesterol)
• R - Reduce
• Alcohol, caffeine
• E – Exercise
• Walking (30 mins/day)
• S – Stop
• Smoking and alcohol
• S – Stress
• reduction
Surgical Management
• Goal: Give O2 to heart muscle
• A – Angioplasty
• Balloon or stent placement
• B – Bypass
• (Coronary Artery Bypass Graft)
“Cabbage”
• C – Cut out the fatty blockage
• Endarterectomy
The nurse is reviewing laboratory
results for a patient admitted with
acute chest pain. Which
laboratory value should cause the
nurse the most concern?
1. AST 65 units/L
2. CK 320 units/L
3. Hematocrit 35%
4. APTT 35 seconds
A patient is prescribed lovastatin
(Mevacor) for hyperlipidemia. What
should the nurse instruct the patient
about this medication?
1. Abstain from alcohol use while taking
this drug
2. Take the drug with meals to minimize
gastric distress
3. Promptly report muscle pain or
tenderness to the physician
4. Consume a diet that includes no
more than 20% of calories from
saturated fat.
The nurse prepares a discharge
teaching plan for a 44-year-old
male patient who has recently
been diagnosed with coronary
artery disease. Which risk factor
should the nurse plan to focus on
during the teaching session?
A. Type A personality
B. Elevated serum lipids
C. Family cardiac history
D. Hyperhomocysteinemia
The nurse is determining nursing
diagnoses appropriate for a
patient scheduled for fibrinolytic
therapy. Which nursing diagnosis
would a priority for this patient?
1. Anxiety
2. Ineffective protection
3. Risk for powerlessness
4. Ineffective health maintenance
 Activity
• You are caring for a patient who has
undergone a PTCA with stent
placement. The patient suddenly
develops chest discomfort. In addition
to the characteristics of the chest
discomfort, identify the key factors
that need to be assessed.
• Describe the actions that you
would take and state why.
• Make an NCP for this patient