Arteriosclerosis and atherosclerosis are diseases that cause hardening and narrowing of arteries. Arteriosclerosis is thickening of arterial walls while atherosclerosis involves plaque buildup within artery walls from accumulation of lipids, calcium, and other substances. Major risk factors for atherosclerosis include age, smoking, diet, hypertension, diabetes, and stress. The formation of fatty streaks and plaques within artery walls can progress over decades and lead to complications when plaques rupture and form blood clots. Prevention focuses on lifestyle modifications like quitting smoking, regular exercise, healthy diet, weight control, and stress management.

1. RATHEESH.R.L
ATHEROSCLERO
SIS

3. NORMAL ARTERY DISEASED ARTERY

4. 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

5. 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.

7. 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.

8. ATHEROSCLEROSIS AFFECTING CORONARY
ARTERY

9. ATHEROSCLEROSIS AFFECTING CORONARY
ARTERY

10. ATHEROSCLEROSIS AFFECTING CEREBRAL
ARTERY

11. RISK FACTORS:
 Modifiable risk factors
Nicotine use (i.e., Tobacco smoking,
chewing)
Diet (contributing to hyperlipidimia)
Hypertension
Diabetes
Stress
Sedentary life style.

12.  Non modifiable risk factors
Age
Gender
Family history

13. PATHOPHYSIOLOGY

15. NORMAL ARTERIAL WALL
 The normal arterial wall consist of smooth
muscles and connective tissue with an
endothelial covering.

16. 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.

17. 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.

18.  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.

19. 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.

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

21. CLINICAL MANIFESTATIONS
 Chest pain
 Ischemia of heart muscles
 Inadequate cardiac output
 Dyspnea
 Sudden cardiac death
 Increased cardiac enzyme level
 Heart failure

22.  MI
 Diaphoresis
 Palpitation
 Arrythmias
 Difficulty in speaking

23. DIAGNOSIS
1. 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)

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

25. 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.

26. 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.

27. 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.

28. 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.

29.  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.

30. 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.

31. MANAGEMENT
 LIFE STYLE MODIFICATIONS
 PHARMACOLOGICAL MANGEMENT
 SURGICAL MANAGEMENT

32. 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.

33.  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.

34.  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

35. 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.

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

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

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

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

40. 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.

41.  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.

42.  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.

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

44.  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.

46. 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.

47.  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.

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

49. 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.