Atherosclerosis is a disease of large and medium sized muscular arteries and is characterized by:- • Endothelial dysfunction, • Vascular inflammation and • The build-up of lipids, cholesterol, calcium and cellular debris within the intima of the vessel wall.

1. By Pinky Rathee
M.Sc Nursing
ATHEROSCLEROSIS

2. ATHEROSCLEROSIS IS A DISEASE OF LARGE
OF LARGE & MEDIUM
SIZED MUSCULAR
ARTERIES AND IS
CHARACTERIZED BY-
ENDOTHELIAL DYSFUNCTION,
VASCULAR INFLAMMATION, AND
DEFINITION:-

3. CONT..
THE BUILDUP OF LIPIDS, CHOLESTEROL,
CALCIUM AND CELLULAR DEBRIS WITHIN
THE INTIMA OF THE VESSELS WALL.

4. RISK FACTORS:-
MAJOR RISKS LESSOR OR UNCERTAIN
RISKS
NONMODIFIABLE • OBESITY
• INCREASING AGE • PHYSICAL INACTIVITY
• GENDER • STRESS
• FAMILY HISTORY • HIGH CARBOHYDRATE INTAKE
• GENETIC ABNORMALITIES • LIPOPROTEIN
MODIFIABLE • HARDENED (TRANS) UNSATURATED
FAT
• HYPERLIPIDEMIA
• HYPERTENSION
• CIGARETTE SMOKING
• DIABETES MELLITUS

5. MAJOR RISK FACTORS

6. INCREASING
AGE AND
GENDER
 BETWEEN
AGES 40 AND
60.
 INCIDENCE IS
MORE IN MEN.
 AFTER
MENOPAUSE
IN WOMEN.

7. GENETICS ABNORMALITIES:-
 DERANGEMENTS IN
LIPOPROTEIN
METABOLISM.
 SUCH AS HYPER-
CHOLESTEROLEMIA
RESULTS IN
EXCESSIVELY HIGH
BLOOD LIPID
LEVELS.

8. HYPERLIPIDEMIA:-
 LOW DENSITY
LIPOPROTEIN (BAD
CHOLESTROL).
 HIGH DENSITY
LIPOPROTEIN
(GOOD
CHOLESTROL).

9. .
HYPERTENSION:-
INCREASES RISK
BY 60%.
AND
DIABETES
MELLITUS:-
CIGARETTE
SMOKING:-

10. PATHOPHYSIOLOGY

11. TYPICAL ANGINA
CHRONIC
ISCHEMIC HEART
DISEASES
MYOCARDIAL
INFARCTION
CLINICAL MANIFESTATIONS:-

12. • SYMPTOMATIC
ATHEROSCLEROTIC
DISEASE MOST OFTEN
INVOLVES THE ARTERIES
SUPPLYING THE HEART,
BRAIN, KIDNEYS &
LOWER EXTREMITIES.
• MYOCARDIAL INFACTION,
CEREBRAL INFARCTION,
AORTIC ANEURYSMS &
PERPHERAL VASCULAR
DISEASE (GANGRENE OF
LEGS) ARE THE MAJOR
CONSEQUENCES OF
ATHEROSCLEROSIS.
.

13. TESTS AND DIAGNOSIS:-
PHYSICAL EXAMINATION INCLUDES:-
WEAK PULSE BELOW NARROWED AREA OF
ARTERY.
DECREASED B.P. IN AFFECTED AREA.
BRUITS SOUNDS OVER ARTERIES(HEARD
WITH STETHOSCOPE).
POOR WOUND HEALING IN THE AREA
WHERE BLOOD FLOW IS RESTRICTED.

14.  BLOOD TESTS.
 DOPPLER ULTRASOUND.
 ANKLE-BRACHIAL INDEX.
 ELECTRON BEAM COMPUTED
TOMOGRAPHY
 ANGIOGRAPHY.
 ELECTROCARDIOGRAPHY (ECG)
 ECHO-CARDIOGRAPHIC STRESS
TEST.
TESTS AND DIAGNOSIS:-

15. 1.CHOLESTEROL
MEDICINES – STATINS
AND FIBRATES.
2. ANTI-PLATELET-
ASPIRIN.
3. ANTICOAGULANTS- HEPARIN, WARFARIN.
4. ANTIHYPERTENSIVE- BETA BLOCKERS, ACE
(ANGIOTENSIN CONVERTING ENZYME)
INHIBITORS AND CALCIUM CHANNEL BLOCKERS.
MEDICAL MANAGEMENT:-

16. ANGIOGRAPHY
 INSERTS A LONG,
THIN TUBE.
 WIRE WITH
DEFLATED
BALLOON IS THEN
INFLATED,
COMPRESSING
THEDEPOSITS
AGAINST WALLS.
 STENT IS LEFT.
SURGICAL MANAGEMENT:-

17. FATTY DEPOSITS
SURGICALLY
REMOVED FROM
THE WALLS OF
NARROWED
ARTERY.
SUCH AS CAROTID
ENDARTERACTOMY.
ENDARTERECTOMY

18.  GRAFT ISCREATED
USING A VESSEL
FROM ANOTHER
PART OF BODY OR A
TUBE OF
SYNTHETIC FABRIC
IS CREATED.
 ALLOWS BLOOD TO
FLOW AROUND
THEBOCKED OR
NARROWED
ARTERY.
BYPASS SURGERY

19. CLOT
DISSOLVING
DRUG INTO
ARTERY AT
THE POINT
OF THE CLOT
TO BREAK IT
UP.
THROMBOLYTIC THERAPY:-

20. PREVENTION
LIFESTYLE AND HOME REMEDIES

21. REDUCE RISK FACTORS BY-
• ASSESSMENT, SCREENING &
EDUCATION.
• LOWERING DIET INTAKE OF FAT,
CHOLESTROL, EXERCISING, CONTROLLING
DIABETES & HTN, KEEPING BODY WEIGHT
NEAR IDEAL LEVEL, CEASING SMOKING.
NURSING MANAGEMENT:-

22. CONT..
• STRENGTH REDUCTION TECHNIQUES:-
PROGRESSIVE MUSCLE RELAXATION
GUIDED IMAGERY.
• HORMONAL THERAPY FOR MENOPAUSAL
WOMEN.

23. RESTORE BLOOD SUPPLY:-
• ANTI-PLATELETIC MEDICATIONS.
• ANTI-COAGULANTS –HEPARIN.
• CALCIUM CHANNEL BLOCKERS OR
NITRATES FOR DECREASED CORONARY
SPASM.
• MONITOR PULSE, ECG, ST SEGMENT
MONITORING TO DETECT ISCHEMIA.

24. FOR STENT:-
• CLOSE MONITORING OF ANTICOAGULANT
STATUS.
• ONGOING ASSESSMENT FOR BLEEDING.
• LIMIT MOVEMENT TILL SHEATH IS
REMOVED.
• KEEP HEAD BELOW 30 DEGREE TO
PREVENT HEMATOMAAND BLEEDING AT
SITE.

25. THANK YOU