Problems With Oxygen
     Transport


 Arteriosclerosis
        and
 Atherosclerosis
LIPIDS = FATS

TRIGLYCERIDES
PHOSOPHOLIPIDS
STEROIDS
CHOLESTEROL

Wax  like substance
Structural component of
 cell membranes
Hormones, Vit D, Bile Acids
Produced in Liver
COMPLEXES

Lipoproteins
 LDL
 HDL
 VLDL
Serum Lipids

   HDL
     High density lipids
     “good cholesterol”
     Protective effect against
      atheroscler...
Serum Lipids
 VLDL
  Very low density lipids
  Transport triglycerides
  Increase risk of premature
   atherosclerosis...
Arteriosclerosis

 Hardening  and  of elasticity
 of arterial walls
   Most common arterial
    disease
   Normal agin...
Atherosclerosis
 Formation   of obstructive lipid deposits
 Affectsarteries
 Lipid metabolism disorder
 Obstruction of...
Normal and
atherosclerotic arteries
ETIOLOGY

 AGE  & SEX
 GENETICS
 PRE EXISTING CONDITIONS
 SMOKING
 DIET
 EXERCISE OR LIFE STYLE
ATHEROSCLEROTIC LESIONS


   Fatty streak
   Raised fibrous plaque
   Atheroma - irreversible
Commonly Affected Sites

Coronary    arteries
Vascular bifurcations or
 branch areas
Abdominal aorta
Iliac arteries
F...
Progression of
Atherosclerosis
INCIDENCE &  RISK

 MALE  vs FEMALE UNTIL MENOPAUSE
 BLACK vs WHITE IN MEN AND WOMEN
 FAMILY PREDISPOSITION
 HIGH SER...
RISK FACTORS

 HIGH SERUM LIPIDS
 SMOKING
 OBESITY - LIFESTYLE
 PRE EXISTING CONDITIONS
   HTN
   DIABETES
   ATHER...
SERUM LIPID STUDIES

       WHAT DO MY
CHOLESTEROL LEVELS MEAN???

AMERICAN HEART ASSOCIATION
         HANDOUT
MANAGEMENT

  Dietary FATS
  Saturated 
  Polyunsaturated 
  Monounsaturated 
  Hydrogenated 
HX & NUTRITIONAL FACTS

 Calories vs. Fats
 Cooking recommendations
 Alcohol consumption
 Exercise
DRUG THERAPY

 Statins: Lipitor, Zocor
 HMG-COA Reductase Inhibitors:
    Mevacor
 Bile acid sequestrants: Questran
 N...
LET’S TAKE A LITTLE BREAK!!
CORONARY ARTERY DISEASE
CORONARY ARTERIES
ATHEROSCLEROTIC
    PROCESS
FACTORS THAT  O2 SUPPLY
          TO THE   
Vessel spasm
Tachycardia
Blood diseases
Bradycardia
FACTORS THAT  O2 DEMAND
          ON THE

 Heart rate increase
  Contractibility
  Afterload
 Hypertrophy of Left
...
RISK FACTORS

   MODIFIABLE        UNMODIFIABLE
   CHOLESTEROL       AGE
    LEVEL
   BP
                      SEX
...
RISK RATIO
ANGINA PECTORIS

 Temporary   imbalance
  between O2 supply and
  demand
 Symptom not a disease
  itself
 Pain results ...
ANGINA PECTORIS

 Stable  Angina
 Unstable angina
 Silent Ischemia
 Variant or Prinzmetal’s
  Angina
STABLE ANGINA

 Precipitated by exertion
 Impaired blood delivery due to 75%
  block
 Predictable pattern
 No change i...
UNSTABLE ANGINA

 Occurs at rest or without  O2
  demand
 Preinfacrtion Angina
 Can be > 90% blockage
 Extreme pain
...
SILENT ISCHEMIA      VARIANT ANGINA
 No pain              Arterial Spasms
 + ECG                No precipitating
 + C...
ASSESSMENT OF SXS
P  = PRECIPITATES
 Q = QUALITY
 R = RADIATES
 S = SEVERITY and
  SYMPTOMS
 T = TIMING
Characteristics of angina

CHEST PAIN
 Different for men and women
 : squeezing, fullness or
  pressure in the center o...
Characteristics of angina

 Vise squeezing chest
 Heavy weight placed on their chest
 Extend to the arm, especially the...
LAB TESTS

   Cardiac Enzymes
   Lipid profiles
   CBC & Lytes
   NTG Test
   ECG
   Stress Tests
   Cardiac Scans ...
PERCUTANEOUS TRANSLUMINAL
CORONARY ANGIOPLASTY
CORONARY ARTERY
STENT
Angiojet
CABG
NURSING
INTERVENTIONS
 TEACH          REFER
MEDICATIONS

 ASA
 NITRATES
 BETA ADRENERGIC BLOCKERS
 ACE INHIBITORS
 CALCIUM CHANNEL BLOCKERS
 ANGIOTENSIN II RECE...
ETIOLOGY
Lecture Xv Arteriosclerosis And Atherosclerosis 11
Lecture Xv Arteriosclerosis And Atherosclerosis 11
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Lecture Xv Arteriosclerosis And Atherosclerosis 11

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Lecture Xv Arteriosclerosis And Atherosclerosis 11

  1. 1. Problems With Oxygen Transport Arteriosclerosis and Atherosclerosis
  2. 2. LIPIDS = FATS TRIGLYCERIDES PHOSOPHOLIPIDS STEROIDS
  3. 3. CHOLESTEROL Wax like substance Structural component of cell membranes Hormones, Vit D, Bile Acids Produced in Liver
  4. 4. COMPLEXES Lipoproteins LDL HDL VLDL
  5. 5. Serum Lipids  HDL  High density lipids  “good cholesterol”  Protective effect against atherosclerosis  LDL  Low density lipids  “bad cholesterol”  Increased incidence of atherosclerosis
  6. 6. Serum Lipids  VLDL  Very low density lipids  Transport triglycerides  Increase risk of premature atherosclerosis  TRIGLYCERIDES  Stored body fat
  7. 7. Arteriosclerosis  Hardening and  of elasticity of arterial walls Most common arterial disease Normal aging process Hypertension Diabetes
  8. 8. Atherosclerosis  Formation of obstructive lipid deposits Affectsarteries Lipid metabolism disorder Obstruction of blood flow organs Underlying cause of CAD, MI, CVA, aneurysms and arterial vascular disease
  9. 9. Normal and atherosclerotic arteries
  10. 10. ETIOLOGY  AGE & SEX  GENETICS  PRE EXISTING CONDITIONS  SMOKING  DIET  EXERCISE OR LIFE STYLE
  11. 11. ATHEROSCLEROTIC LESIONS  Fatty streak  Raised fibrous plaque  Atheroma - irreversible
  12. 12. Commonly Affected Sites Coronary arteries Vascular bifurcations or branch areas Abdominal aorta Iliac arteries Femoral arteries
  13. 13. Progression of Atherosclerosis
  14. 14. INCIDENCE &  RISK  MALE vs FEMALE UNTIL MENOPAUSE  BLACK vs WHITE IN MEN AND WOMEN  FAMILY PREDISPOSITION  HIGH SERUM LIPIDS  SMOKING  OBESITY - LIFESTYLE  PRE EXISTING CONDITIONS
  15. 15. RISK FACTORS  HIGH SERUM LIPIDS  SMOKING  OBESITY - LIFESTYLE  PRE EXISTING CONDITIONS HTN DIABETES ATHEROSCLEROSIS
  16. 16. SERUM LIPID STUDIES WHAT DO MY CHOLESTEROL LEVELS MEAN??? AMERICAN HEART ASSOCIATION HANDOUT
  17. 17. MANAGEMENT Dietary FATS Saturated  Polyunsaturated  Monounsaturated  Hydrogenated 
  18. 18. HX & NUTRITIONAL FACTS  Calories vs. Fats  Cooking recommendations  Alcohol consumption  Exercise
  19. 19. DRUG THERAPY  Statins: Lipitor, Zocor  HMG-COA Reductase Inhibitors: Mevacor  Bile acid sequestrants: Questran  Nicotinic Acid: Niacin  Fibric Acids: Atromid, Lopid
  20. 20. LET’S TAKE A LITTLE BREAK!!
  21. 21. CORONARY ARTERY DISEASE
  22. 22. CORONARY ARTERIES
  23. 23. ATHEROSCLEROTIC PROCESS
  24. 24. FACTORS THAT  O2 SUPPLY TO THE  Vessel spasm Tachycardia Blood diseases Bradycardia
  25. 25. FACTORS THAT  O2 DEMAND ON THE  Heart rate increase   Contractibility   Afterload  Hypertrophy of Left Ventricle
  26. 26. RISK FACTORS  MODIFIABLE  UNMODIFIABLE  CHOLESTEROL  AGE LEVEL  BP  SEX  SMOKING  RACE  OBESITY  FAMILY HX  NTG + VIAGRA  DIABETES  ETOH  HOMOCYSTEINE
  27. 27. RISK RATIO
  28. 28. ANGINA PECTORIS  Temporary imbalance between O2 supply and demand  Symptom not a disease itself  Pain results from Lactic Acid
  29. 29. ANGINA PECTORIS  Stable Angina  Unstable angina  Silent Ischemia  Variant or Prinzmetal’s Angina
  30. 30. STABLE ANGINA  Precipitated by exertion  Impaired blood delivery due to 75% block  Predictable pattern  No change in symptoms over time  Pain relieved by rest or NTG
  31. 31. UNSTABLE ANGINA  Occurs at rest or without  O2 demand  Preinfacrtion Angina  Can be > 90% blockage  Extreme pain  Last longer than 10 minutes and poor relief from NTG or rest
  32. 32. SILENT ISCHEMIA VARIANT ANGINA  No pain  Arterial Spasms  + ECG  No precipitating  + Cardiac Enzymes factors  Rare  Occurs at rest
  33. 33. ASSESSMENT OF SXS P = PRECIPITATES  Q = QUALITY  R = RADIATES  S = SEVERITY and SYMPTOMS  T = TIMING
  34. 34. Characteristics of angina CHEST PAIN  Different for men and women  : squeezing, fullness or pressure in the center of your chest.  : stabbing, pulsating, or sharp
  35. 35. Characteristics of angina  Vise squeezing chest  Heavy weight placed on their chest  Extend to the arm, especially the left arm, neck, jaw, shoulder or back.  Nausea, fatigue, shortness of breath, anxiety, sweating or dizziness  Crescendo effect – builds up and gradually fades away
  36. 36. LAB TESTS  Cardiac Enzymes  Lipid profiles  CBC & Lytes  NTG Test  ECG  Stress Tests  Cardiac Scans (Thallium, MUGA, PET, LVEF)  Echo (TEE)  Cardiac Cath
  37. 37. PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY
  38. 38. CORONARY ARTERY STENT
  39. 39. Angiojet
  40. 40. CABG
  41. 41. NURSING INTERVENTIONS TEACH REFER
  42. 42. MEDICATIONS  ASA  NITRATES  BETA ADRENERGIC BLOCKERS  ACE INHIBITORS  CALCIUM CHANNEL BLOCKERS  ANGIOTENSIN II RECEPTOR BLOCKERS  THROMBOLYTIC THERAPY
  43. 43. ETIOLOGY

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