Atherosclerosis is a condition where plaque builds up inside arteries due to a buildup of fatty materials such as cholesterol. Over time, plaque hardens and narrows the arteries, reducing blood flow. The buildup is caused by inflammation and an abnormal accumulation of substances inside the artery wall. Atherosclerosis most often affects arteries of the heart but can impact any artery. It is usually asymptomatic until an artery is severely blocked, which can lead to a heart attack or stroke. Diagnosis involves tests like angiograms, stress tests, and ultrasounds. Treatment focuses on lifestyle changes and medications to control risk factors and reduce plaque buildup.

1. ATHEROSCLEROSIS
Om vERmA
LECTuRER mEdICAL SuRgICAL nuRSIng

3. Introduction
 Atherosclerosis (also known as Arteriosclerotic Vascular
Disease or ASVD)
 the condition in which an artery wall thickens as the result of a
build-up of fatty materials such as cholesterol
 affecting arterial blood vessels, a chronic inflammatory response
in the walls of arteries
 due to the accumulation of macrophage white blood cells and
promoted by Low-density lipoproteins without adequate
removal of fats and cholesterol from the macrophages by
functional high density lipoproteins

4.  It is commonly referred to as a hardening or furring of
the arteries.
 It is caused by the formation of multiple plaqueswithin
the arteries.
 It can restrict blood flow. These plaques can also burst,
causing a blood clot.
 Although atherosclerosis is often considered a heart
problem, it can affect arteries anywhere in your body.
 Atherosclerosis is a preventable and treatable
condition.

5.  A condition in which Hardening of arteries with loss of
elasticity Characterized by intimal lesions called atheroma
that protrude into the vessel lumen
. 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.

6.  Atherosclerosis (also known as Arteriosclerosis) or
hardening of the arteries, is an inflammatory disease that
results in scarring of the artery walls, primarily from
long term buildup of fatty deposits and calcifications.

7.  Which is an abnormal accumulation of liquid and fatty
substance and fibbers tissue in the vasicles wall this
substance create a blockage or narrow the vesicles in a
way that reduce blood flow to the myocardium .

8.  Nicotine use (i.e., Tobacco smoking, chewing)
 Diet (contributing to hyperlipidimia)
 Hypertension
 Diabetes
 Stress
 Sedentary life style.

9.  Nicotine can contribute to atherosclerosis. Cigarette
smoke has long been considered the main cause for heart
disease. ... Ultimately, this cellular migration ( Cell migration is
a central process in the development and maintenance of
multicellular organisms. ) and invasion process gives rise to the
formation of vessel-clogging ( block ) fatty deposits known as
plaque

10. HTN
 high blood pressure are more likely to develop
coronary artery disease, because high blood
pressure puts added force against the artery walls. Over
time, this extra pressure can damage the arteries, making
them more vulnerable to the narrowing and plaque
buildup associated with atherosclerosis.

11. DM
 Prolonged exposure to hyperglycemia is now
recognized a major factor in the pathogenesis of
atherosclerosis in diabetes.

12. STRESS
 stress is triggered by perturbations in ER (Endoplasmic
reticulum ) function such as those caused by protein mis
folding or by increases in protein secretion

13. SEDENTARY LIFESTYLE
 A sedentary lifestyle is a type of lifestyle with little or
no physical activity. A person living a sedentary
lifestyle is often sitting or lying, while reading, socializing,
watching television, playing video games, or using a
mobile phone/computer for much of the day.

14. TERMS
 Arteriosclerosis is a general term describing any hardening
(and loss of elasticity) of medium or large arteries
 Arteriolosclerosis is any hardening (and loss of elasticity)
of arterioles (small arteries);
 Atherosclerosis is a hardening of an artery specifically due
to an atheromatous plaque.
 Atherogenic is used for substances or processes that cause
atherosclerosis.
 Atherogenesis is the developmental process of
atheromatous plaques

15. Causes
Atherosclerosis starts with damage or injury to the inner
layer of an artery. The damage may be caused by:
 High blood pressure
 High cholesterol
 An irritant, such as nicotine
 Certain diseases, such as diabetes

16. Pathophysiology
Due to etiological factors
Deposition of lipid and fatty streaks in the
intima of atrial wall
Which lead to inflammatory response started
T-lymphocytes and monocytes in filtrate the
area to ingest the liquid and then die.

17.  Causes smooth muscle cells with in the vesscles
to proliferate
 From of fibrous cap over that fatty core or plug

 Which lead to narrowing and obstruction of blood
flow
 Then lead to arthrosclerosis

18. Response-to-injury hypothesis
 The following are the
steps involved in the
hypothesis:
1. Chronic endothelial
injury
2. Accumulation of
lipoproteins
3. Monocyte adhesion to
the endothelium
4. SMC proliferations
and ECM production
5. factor release
6. platelet adhesion

20. Micrograph of an artery that supplies the heart With
significant atherosclerosis and marked luminal narrowing

21. Symptoms
 Atherosclerosis develops gradually, typically begins in
early adolescence, and is usually found in most major
arteries. There are usually no atherosclerosis symptoms
until an artery is so narrowed or clogged that it can't
supply adequate blood to your organs and tissues.
Sometimes a blood clot completely obstructs blood flow,
or even breaks apart and causes blood clots that can
trigger a heart attack or stroke.

23.  Stroke — A blood clot (thrombus) may form inside a
brain artery that has been narrowed by atherosclerosis.
Once this thrombus forms, it cuts off the blood supply to
part of the brain, causing a thrombotic stroke.

24.  Abdominal angina and bowel infarction — When
atherosclerosis narrows arteries that supply blood to the
intestines, it causes a form of abdominal pain called
abdominal angina. Complete, sudden blockage of
intestinal blood supply can cause a bowel infarction.

25. Symptoms
Atherosclerosis symptoms depend on which arteries are
affected. For example:
 Atherosclerosis in heart arteries, have symptoms
similar to those of a heart attack, such as chest pain
(angina).
 Atherosclerosis in the arteries leading to brain, have
symptoms such as sudden numbness or weakness in your
arms or legs, difficulty speaking or slurred speech, or
drooping muscles in your face.
 Atherosclerosis in the arteries in arms and legs,
produces decreased blood flow is called peripheral artery
occlusive disease (PAOD).have symptoms such as leg pain
when walking
 Sometimes atherosclerosis causes erectile dysfunction in
men.

26.  common symptoms include:
 chest pain or angina.
 pain in your leg, arm, and anywhere else that has a
blocked artery.
 shortness of breath.
 fatigue.
 confusion, which occurs if the blockage affects
circulation to your brain.
 muscle weakness in your legs from lack of circulation.

27. Symptoms

28. Symptoms

29. chest x-ray, a
CT (computed tomography)
Angiogram
Echocardiogram
Exercise stress test

30. Atherosclerosis is a disease in which plaque builds up on the insides
of your arteries.

31. ANGIOGRAM
To prepare for imagining, a very small tube (catheter) is inserted
into a blood vessel in either the patient's groin or arm. The tip of the
tube is positioned at the beginning of the arteries supplying the
heart, and a special fluid or dye is injected.
This special fluid is visible by X-ray, which details the narrowing,
occlusions, and other abnormalities of specific arteries. These
images obtained are called angiograms.

32. ECHOCARDIOGRAPHY is a test that uses sound
waves to produce live images of your heart
EXERCISE STRESS TEST usually involves walking
on treadmill or riding a stationary bike while your heart rhythm,
blood pressure and breathing are monitored. Your doctor may
recommend an exercise stress test if he or she suspects you have
coronary artery disease or an irregular heart rhythm

33. Depending on the results of the physical exam, doctors may
suggest one or more diagnostic tests, including:
Blood tests.
Doppler ultrasound
Ankle-brachial index.
Other imaging tests.
Angiogram.
Electrocardiogram (ECG).

34. Blood tests. Lab tests can detect increased levels of cholesterol
and blood sugar that may increase the risk of atherosclerosis.
Doppler ultrasound.
Uses a special ultrasound device (Doppler ultrasound) to measure
blood pressure at various points along arm or leg. These
measurements can help doctor gauge the degree of any blockages,
as well as the speed of blood flow in the arteries.
Ankle-brachial index. This test can tell if one have
atherosclerosis in the arteries in your legs and feet. Doctor may
compare the blood pressure in ankle with the blood pressure in the
arm. This is known as the ankle-brachial index. An abnormal
difference may indicate peripheral vascular disease, which is
usually caused by atherosclerosis.

35. Electrocardiogram (ECG). An electrocardiogram records
electrical signals as they travel through your heart. An ECG can
often reveal evidence of a previous heart attack or one that's in
progress. If signs and symptoms occur most often during exercise,
Angiogram. To better view blood flow through heart, brain, arms
or legs, doctor may inject a special dye into your arteries before an
X-ray. This is known as an angiogram. The dye outlines narrow
spots and blockages on the X-ray images.
Other imaging tests. doctor may use ultrasound, a computerized
tomography (CT) scan or a magnetic resonance angiogram (MRA)
to study the arteries. These tests can often show hardening and
narrowing of large arteries, as well as aneurysms and calcium
deposits in the artery walls.

36. PHARMACHOLOGICAL MANAGEMENT
 Fibrates to Reduce Triglycerides
 Fibrates are drugs that reduce triglyceride l here are two
fibrates used in the U.S.:
Gemifibrozil
(Lopid)
 fenofibrate

37.  Ezetimibe ) works by reducing absorption of cholesterol
in the intestines.

38. PHARMACHOLOGICAL MANAGEMENT
 controls the production of cholesterol in the liver.
Examples include:
 Lovastatin (Mevacor)
 Simvastatin (Zocor)
 Pravastatin (Pravachol)
 Fluvastatin (Lescol)
 Atorvastatin (Lipitor)
 Rosuvastatin (Crestor)

39.  Anti-platelet medications. Doctors 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.
 Anticoagulants. An anticoagulant, such as heparin or
warfarin (Coumadin), can help thin blood to prevent clots
from forming.
 Blood pressure medications. Medications to control blood
pressure — such as beta blockers, angiotensin-converting
enzyme (ACE) inhibitors and calcium channel blockers — can
help slow the progression of atherosclerosis

40. Tests and diagnosis
Doctors may find signs of narrowed, enlarged or hardened
arteries during a physical exam. These include:
 A weak or absent pulse below the narrowed area of the
artery
 Decreased blood pressure in an affected limb
 Whooshing sounds (bruits) over the arteries, heard with a
stethoscope
 Signs of a pulsating bulge (aneurysm) in the abdomen or
behind knee
 Evidence of poor wound healing in the area where blood
flow is restricted

41.  Angioplasty. In this procedure, your doctor inserts a
long, thin tube (catheter) into the blocked or narrowed
part of your artery. A wire with a deflated balloon is
passed through the catheter to the narrowed area. The
balloon is then inflated, compressing the deposits against
your artery walls. A mesh tube (stent) is usually left in
the artery to help keep the artery open. Angioplasty may
also be done with laser technology.
 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.
Surgical management

42.  Thrombolytic therapy. If you have an artery that's
blocked by a blood clot, your doctor may insert a clot-
dissolving drug into your artery at the point of the clot
to break it up.
 Bypass surgery. Your doctor may create 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.
Treatments and drugs

43. Lifestyle and home remedies
Lifestyle changes can help prevent or slow the progression of
atherosclerosis.
 Stop smoking.
 Exercise most days of the week.
 Eat healthy foods
 Manage stress
 manage the condition of high cholesterol, high blood
pressure, diabetes or other chronic disease

44. Prevention
 The same healthy lifestyle changes recommended to treat
atherosclerosis also help prevent it. You've heard it before —
stop smoking, eat healthy foods, exercise regularly, maintain a
healthy weight, drink less alcohol. Just remember to make
changes one step at a time, and keep in mind what lifestyle
changes are manageable for you in the long run.

45. COMPLICATION
The complications of atherosclerosis depend on the
location of the blocked arteries. For example:
 Coronary artery disease. When atherosclerosis
narrows the arteries close to your heart, you may
develop coronary artery disease, which can cause chest
pain (angina) or a heart attack.
 Carotid artery disease. When atherosclerosis
narrows the arteries close to your brain, you may
develop carotid artery disease, which can cause a
transient ischemic attack (TIA) or stroke.

46. Con…………
 Peripheral artery disease. When atherosclerosis
narrows the arteries in your arms or legs, you may
develop circulation problems in your arms and legs
called peripheral arterial disease.
 Aneurysms. Atherosclerosis can also cause
aneurysms, a serious complication that can occur
anywhere in your body. An aneurysm is a bulge in the
wall of your artery. Pain and throbbing in the area of
an aneurysm is a common symptom..

47. Conclusion
 Although atherosclerosis is considered a heart disease it
can happen in any part of the bodies.
 Atherosclerosis can be prevented by life style factor and
home remidies by eating healthy diet.
 Atherosclerosis is a preventable and treatable condition.

48. References:
 Harrison’s principle of internal medicine, 17th
edition.
 Robbins basic pathology, 8th
edition.
 www.wekiepedia.com/atherosclerosis
 www.mayoclinic.com/atherosclerois