ARTERIOSCLEROSIS AND ATHEROSCLEROSIS

Definition of Arteriosclerosis and atherosclerosis

Arteriosclerosis is an arterial disease manifested by loss of elasticity and hardening of blood vessel wall. Commonly known as “hardening of blood vessels”

Atherosclerosis is the formation of atheromas ( patchy lipoidal degenerationof the intima). Lesions or plaques form throughout the arterial wall, reducing the size of the vessel and limiting the flow of blood.

Types of Atherosclerotic lesion

a)      Fatty streaks

b)      Fibrous plaques

Predisposing factors include:

·         Heredity,

·          age,

·         Male gender,

·          Cigarette smoking,

·         Hypertension,

·          Elevated blood cholesterol levels,

·         Diabetes mellitus,

·         Obesity,

·         Physical inactivity and stress.

Pathophysiology

 The condition starts slowly; aging is one of the denominator. As cells within arterial tissue layers degenerate, calcium is deposited within the cytoplasm. The calcium causes the arteries to become arteriosclerotic (less elastic). When the left ventricle contracts sending oxygenated blood from the heart, the rigid vessels fail to stretch. This potentially reduces the volume of oxygenated blood that can be delivered to organs at times when they may most need it.

Signs and symptoms

Affects vascular system or one segment of the vascular tree.

 Symptoms are based on affected area:

1.      Brain

¨      Transient ischemic Attacks (TIA)

 Is when atherosclerosis narrows brain arteries, it can cause headache; dizziness or confusion; weakness or paralysis on one side of the body; sudden, severe numbness in any part of the body; visual disturbance, including sudden loss of vision; difficulty walking, including staggering or veering; coordination problems in the arms and hands; and slurred speech or inability to speak.  Symptoms disappear in less than 24 hours.

¨      Cerebral Vascular Accident (CVA)

¨      Visual disturbances

2. Heart

¨      Angina,

¨      Myocardial infarction

¨      Congestive Heart failure

3.Gastrointestinal tract

¨      Aortic aneurism

¨      Mesenteric ischemic- abdominal pain 15 to 30 minutes after meal, unintentional weight loss, lower back pain

4. Kidneys- renal insufficiency, poorly controlled hypertension

5. Extremities- pain in legs associated with exercise (intermittent claudication)

     Rest pain, tissue loss

     Decreased or absent pulses   

Diagnosis

1. CT scan

2. Arteriography of involved area

3. ECG

4. MRI/MRA

5. Noninvasive testing of the vascular system

-Duplex studies

-Sequential Doppler studies

-Pulse volume resistance

-Ankle-brachial index

Medical management

¨      Modification of risk factors is important

¨      Anticoagulants may be given

¨      Antiplatelet therapy,

¨      Lipid lowering argents

¨      Antihypertensive drugs are important

¨      Specific treatment may be given if the patient has angina, occlusive arterial disease

¨      Vascular rehabilitation/ exercises

Surgical management

·         Endovascular procedures:

-Percutaneous transluminal angioplasty( PTA)

-Endovascular grafting- placement of prosthetic graft via a transluminal approach.

-Rotational artherectomy –high speed rotary cutter that removes lesions by abrading plaque.

-Laser angioplasty-amplified light waves are transmitted by fiberoptic catheters.

·         Surgical revascularization of affected vessels

Embolectomy-removal of blood clot from the artery.

Endarterectomy- removal of atherosclerotic plaque from an artery.

Thrombolectomy- removal of thrombus from the artery.

Bypass- use of grafting, either vein graft or prosthetic material.

Nursing Management

·         Assess the patient for any chest pain give drugs to dilate the vessels.

·         Give oxygen to the client when ever needed.

·         Monitor vital signs to detect any deviation from normal

·         Pre operative is done for a client with unrelieved chest pain      

·         Assess patient mental status since cerebral emboli can occur

·         Distal pulses are assessed

·         Adequate urine output is monitored.

·         Mild analgesics are administered for discomfort.

·         Monitoring vital signs regularly

·         Encourage patient to reduce cholesterol intake

·         Adequate control of diabetes is important.

·         Encourage active life style to promote cardiovascular health.

·         Reassure the patient in order to reduce stress.

·         If patient has been smoking explain the risks so that to stop it.

Prevention

¨      Regular exercise - Walking is great!

¨      Control blood pressure

¨      Control serum cholesterol and triglyceride levels

¨      Do NOT smoke

¨      Eat a heart healthy diet of fresh fruits and vegetables, low fat foods, and lean meats

Complications

¨      Brain- long and or short term disabilities

¨      Angina

¨      Myocardial infarction

¨      Lower extremities- intermittent claudication

                            -Non healing ulcers

                           -Gangrene

                             Amputation