Blood Supply to The Heart Arteriosclerosis

 Arteriosclerosis is the most

2 coronary arteries branch from the main common disease of the arteries; the
aorta just above the aortic valve. "No larger term means "hardening of the
than drinking straws, they divide and arteries".
encircle the heart to cover its surface with a  It is the diffuse process whereby
lacy network that reminded physicians of a the muscle fibers and the
slightly crooked crown (coronary comes endothelial lining of the walls of
from the Latin coronarius, belonging to a small arteries and arterioles become
crown or wreath). They carry out about 130 thickened.
gallons of blood through the heart muscle
daily." (Clark, 119) 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.

Coronary Artery Disease

 Coronary artery disease is one of
the most common and serious
effects of aging. Fatty deposits
build up in blood vessel walls and
narrow the passageway for the
movement of blood. The resulting
condition, called atherosclerosis
often leads to eventual blockage of
the coronary arteries and a "heart
attack". Atherosclerosis Affecting Coronary Artery
Atherosclerosis Affecting Cerebral Artery d) In the advanced stages of
atherosclerosis, calcified scar tissue
will form. If the endothelium is
damaged and collagen is exposed,
platelets stick to the damaged area
and a blood clot (thrombus) form.
If blood flow in the coronary blood
vessel is stopped, a heart attack is
the result.

Clinical manifestations
The clinical signs and symptoms resulting
from atherosclerosis depend on the organ or
tissue affected. The consequences of
Risk factors: atherosclerosis are:
Modifiable risk factors  Myocardial infarction ischemic
 Nicotine use (i.e., Tobacco heart disease (IHD)
smoking, chewing)  Cardiovascular accident (Transient
 Diet (contributing to ischemic attack or stroke).
hyperlipidimia)  Subarachnoid hemorrhage may
 Hypertension result.
 Diabetes  Peripheral arterial diseases.
 Stress  Aneurysms.
 Sedentary life style.
Non modifiable risk factors Signs and Symptoms
 Age  None: This is referred to as silent
 Gender Blood to your heart may be
 Family history restricted due to CAD, but you
don't feel any effects.
Pathophysiology  Chest pain: If your coronary
a) The normal arterial wall consists of arteries can't supply enough blood
smooth, muscle and connective to meet the oxygen demands of
tissue with an endothelial cell your heart, the result may be chest
lining. pain called angina.
b) in early stages, excess LDL-  Shortness of breath: Some people
cholesterol accumulates between may not be aware they have CAD
the endothelium and connective until they develop symptoms of
tissue. There, it is oxidized and congestive heart failure-extreme
phagocytosed. The macrophages fatigue with exertion, shortness of
produce paracrine that attract breath and swelling in their feet and
smooth muscle cells. At this stage, ankles.
the lesion is called a fatty streak.  Heart attack: Results when an
c) As cholesterol accumulates, fibrous artery to your heart muscle
scar tissues forms around it. becomes completely blocked and
Migrating smooth muscle cells the party of your heart muscles fed
divide, thickening the arterial wall by that artery dies.
and narrowing the lumen of the
artery. This stage is known as a
fibrous plaque. Myocardial Infarction
 Ejection fraction (EF): determines
how well your heart pumps with
each beat.
Diagnostic investigations:
1. Blood test: Lipid profile
2. ECG.
3. Chest X-ray.
4. Echocardiogram.
5. Ankle/brachial Pressure Index.
6. Angiography.
7. Stress testing.

Ankle Brachial Pressure Index

Stroke The Ankle Brachial Index (ABI) is the ratio

of the blood pressure in the lower legs to
the blood pressure in the arms. Compared
to the arm, lower blood pressure in the leg
is an indication of blocked arteries
(peripheral vascular disease or PVD). The
ABI is calculated by dividing the systolic
blood pressure at the ankle by the systolic
blood pressures in the arm.
P Leg
ABPI Leg =
P Arm
Pleg is the systolic blood pressure of dorsalis pedis or posterior tibial arteries
PArm is the highest of the left and right arm brachial systolic blood pressure

Interpretation of Results
ABP Interpretati action Nature of
I on ulcer, if
Aneurysm valu present
e
Screening and Diagnosis Abo Abnormal Refer Venous
 Electrocardiogram ve Vessel routinel ulcer
 Stress test 1.2 hardening y
from PVO Use full
 Coronary angiography 1.0- Normal none compression
bandaging
1.2 range
0.9- Acceptable none
Other Tests Include 1.0
 Blood tests: used to evaluate 0.8- Some arterial Manage
kidney and thyroid function as well 0.9 disease risk
as to check cholesterol levels and factors
the presence of anemia. 0.5- Moderate Routine Moved
 Chest X-ray: shows the size of your 0.8 arterial speciali ulcers
heart and whether there is fluid disease st
referral Use seduce
buildup around the heart and lungs.
compressio
 Echocardiogram: shows a graphic n
outline of the heart's movement
 bandaging Treatment
Unde Severe Urgent Arterial
r arterial speciali ulcers 1) Stenting
0.5 disease st  a stent is introduced into a blood
referral No vessel on a balloon catheter and
compressio
advanced into the blocked area of
n
bandaging
the artery the balloon is then
used inflated and causes the stent to
expand until it fits the inner wall of
Medical management: the vessel, conforming to contours
 Anti-cholesterol medications: as needed the balloon is then
Example: Statins. (Atorvastatin, deflated and drawn back
lovastatin, Lovastatin). Tab  The stent stays in place
Atorvastatin10mg PO OD. permanently, holding the vessel
 Anti-platelet medications: Tab. open and improving the flow of
Aspirin 75mg PO OD., Tab. blood.
Clopidogrel 75mg PO OD.
 Thrombolytic therapy: Inj. 2) Angioplasty
Streptokinase.  a balloon catheter is passed through
 Beta blockers: E.g. Metaprolol, the guiding catheter to the area ne
Atenolol, propanolol. Tab. narrowing. A guide wire inside the
Metaprolol 12.5 mg PO OD. balloon catheter is then advanced
through the artery until the tip is
 Angiotensin-converting enzyme
beyond the narrowing
(ACE) inhibitors: E.g. enalapril.
Tab. Enalapril 2.5mg or 5mg,  the angioplasty catheter is moved
depending on the blood pressure, over the guide wire until the
balloon is within the narrowed
 Calcium channel blockers: E.g.
segment.
Tab. Amlodipine 2.5mg, 5mg or 10
mg dose can be adjusted according  balloon is inflated, compressing the
to the blood pressure. . plaque against the artery wall
 Diuretics:E.g. Tab. Frusemide  once plaque has been compressed
20mg and the artery has been sufficiently
opened, the balloon catheter will be
Surgical management: deflated and removed.

Angioplasty:
 A catheter is inserted into the
blocked or narrowed part of artery.
 A second catheter with a deflated
balloon on its tip is then passed
through the catheter to the
narrowed area. Endarterectomy:
 The balloon is then inflated,
compressing the deposits against
artery walls.
 A mesh tube (stent) is usually left
in the artery to help keep the artery
open.
  In some cases, fatty deposits must  Nurses need to explain the risk
be surgically removed from the factors related to atherosclerosis
walls of a narrowed artery. When and focus on life style changes
the procedure is done on arteries in  Nurses should educate patients
the neck (the carotid arteries), it's about the effect of smoking on the
known as carotid endarterectomy. arterial system.
 Encourage adherence of cholesterol
lowering medications and other
medications.
 Recommend follow up of patients
on statins to monitor required
lowering cholesterol.
 Accompany any prescription of
medication with dietary control.

Prevention
 Get regular medical checkups.
 Control blood pressure.
 Check cholesterol.
 Don't smoke.
Bypass surgery  Exercise regularly.
 A graft bypass using a vessel from  Maintain a healthy weight.
another part of your body or a tube  Eat a heart-healthy diet.
made of synthetic fabric. This
allows blood to flow around the Prognosis
blocked or narrowed artery  If arteriosclerosis is left untreated it
can be fatal by leading to a stroke
or heart attack (where the coronary
arteries are affected.)
 Especial caution is needed if a
patient is also diabetic because the
disease can progress very rapidly in
diabetic patients.

Nursing management
 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.