Problems With Oxygen

Transport

Arteriosclerosis
and
Atherosclerosis
 LIPIDS = FATS

TRIGLYCERIDES
PHOSOPHOLIPIDS
STEROIDS
 CHOLESTEROL

Wax like substance

Structural component of
cell membranes
Hormones, Vit D, Bile Acids
Produced in Liver
 COMPLEXES

Lipoproteins
LDL
HDL
VLDL
Serum Lipids

 HDL
 High density lipids
 “good cholesterol”
 Protective effect against
atherosclerosis
 LDL
 Low density lipids
 “bad cholesterol”
 Increased incidence of
atherosclerosis
 Serum Lipids
 VLDL
 Very low density lipids
 Transport triglycerides
 Increase risk of premature
atherosclerosis

 TRIGLYCERIDES
 Stored body fat
 Arteriosclerosis

 Hardening and  of elasticity

of arterial walls
Most common arterial
disease
Normal aging process
Hypertension
Diabetes
 Atherosclerosis
 Formation of obstructive lipid deposits
Affectsarteries
Lipid metabolism disorder
Obstruction of blood flow organs
Underlying cause of CAD, MI,
CVA, aneurysms and arterial
vascular disease
Normal and
atherosclerotic arteries
 ETIOLOGY

 AGE & SEX

 GENETICS
 PRE EXISTING CONDITIONS
 SMOKING
 DIET
 EXERCISE OR LIFE STYLE
 ATHEROSCLEROTIC LESIONS

 Fatty streak
 Raised fibrous plaque
 Atheroma - irreversible
 Commonly Affected Sites

Coronary arteries
Vascular bifurcations or
branch areas
Abdominal aorta
Iliac arteries
Femoral arteries
Progression of
Atherosclerosis
 INCIDENCE &  RISK

 MALE vs FEMALE UNTIL MENOPAUSE

 BLACK vs WHITE IN MEN AND WOMEN
 FAMILY PREDISPOSITION
 HIGH SERUM LIPIDS
 SMOKING
 OBESITY - LIFESTYLE
 PRE EXISTING CONDITIONS
 RISK FACTORS

 HIGH SERUM LIPIDS

 SMOKING
 OBESITY - LIFESTYLE
 PRE EXISTING CONDITIONS
HTN
DIABETES
ATHEROSCLEROSIS
 SERUM LIPID STUDIES

WHAT DO MY
CHOLESTEROL LEVELS MEAN???

AMERICAN HEART ASSOCIATION

HANDOUT
MANAGEMENT

Dietary FATS
Saturated 
Polyunsaturated 
Monounsaturated 
Hydrogenated 
 HX & NUTRITIONAL FACTS

 Calories vs. Fats

 Cooking recommendations
 Alcohol consumption
 Exercise
 DRUG THERAPY

 Statins: Lipitor, Zocor

 HMG-COA Reductase Inhibitors:
Mevacor
 Bile acid sequestrants: Questran
 Nicotinic Acid: Niacin
 Fibric Acids: Atromid, Lopid
LET’S TAKE A LITTLE BREAK!!
CORONARY ARTERY DISEASE
CORONARY ARTERIES
ATHEROSCLEROTIC
PROCESS
 FACTORS THAT  O2 SUPPLY
TO THE 
Vessel spasm
Tachycardia
Blood diseases
Bradycardia
 FACTORS THAT  O2 DEMAND
ON THE

 Heart rate increase

  Contractibility
  Afterload
 Hypertrophy of Left
Ventricle
RISK FACTORS

 MODIFIABLE  UNMODIFIABLE
 CHOLESTEROL  AGE
LEVEL
 BP
 SEX
 SMOKING  RACE
 OBESITY  FAMILY HX
 NTG + VIAGRA  DIABETES
 ETOH
 HOMOCYSTEINE
RISK RATIO
 ANGINA PECTORIS

 Temporary imbalance
between O2 supply and
demand
 Symptom not a disease
itself
 Pain results from Lactic
Acid
ANGINA PECTORIS

 Stable Angina
 Unstable angina
 Silent Ischemia
 Variant or Prinzmetal’s
Angina
 STABLE ANGINA

 Precipitated by exertion
 Impaired blood delivery due to 75%
block
 Predictable pattern
 No change in symptoms over time
 Pain relieved by rest or NTG
 UNSTABLE ANGINA

 Occurs at rest or without  O2

demand
 Preinfacrtion Angina
 Can be > 90% blockage
 Extreme pain
 Last longer than 10 minutes and poor
relief from NTG or rest
 SILENT ISCHEMIA VARIANT ANGINA
 No pain  Arterial Spasms
 + ECG  No precipitating
 + Cardiac Enzymes factors
 Rare
 Occurs at rest
ASSESSMENT OF SXS
P = PRECIPITATES
 Q = QUALITY
 R = RADIATES
 S = SEVERITY and
SYMPTOMS
 T = TIMING
 Characteristics of angina

CHEST PAIN
 Different for men and women
 : squeezing, fullness or
pressure in the center of your
chest.
 : stabbing, pulsating, or sharp
 Characteristics of angina

 Vise squeezing chest

 Heavy weight placed on their chest
 Extend to the arm, especially the left arm,
neck, jaw, shoulder or back.
 Nausea, fatigue, shortness of breath,
anxiety, sweating or dizziness
 Crescendo effect – builds up and
gradually fades away
 LAB TESTS

 Cardiac Enzymes
 Lipid profiles
 CBC & Lytes
 NTG Test
 ECG
 Stress Tests
 Cardiac Scans (Thallium, MUGA, PET, LVEF)
 Echo (TEE)
 Cardiac Cath
PERCUTANEOUS TRANSLUMINAL
CORONARY ANGIOPLASTY
CORONARY ARTERY
STENT
Angiojet
CABG
NURSING
INTERVENTIONS
TEACH REFER
 MEDICATIONS

 ASA
 NITRATES
 BETA ADRENERGIC BLOCKERS
 ACE INHIBITORS
 CALCIUM CHANNEL BLOCKERS
 ANGIOTENSIN II RECEPTOR BLOCKERS
 THROMBOLYTIC THERAPY
ETIOLOGY