Arteriosclerosis means “hardening of the arteries” and is a general term describing three diseases:
1. Atherosclerosis, in which there is a proliferation of smooth muscle cells and accumulation of lipids in the intima of the large and middle-sized muscular arteries.
2. Medical calcific sclerosis, or Mönckeberg's sclerosis, in which there is an accumulation of calcium in the media of medium-sized arteries.
3. Arteriolar sclerosis, in which there is thickening of the walls and narrowing of the lumen of the small arteries and arterioles, leading to reduced or blocked blood flow and which is often associated with hypertension.
Caused & Why
Repeated injury to the artery wall --> Immune system involvement or direct
toxicity allows materials to deposit on the artery’s inner lining.
High cholesterol High --> levels of cholesterol in the blood injure the artery’s lining, causing an
inflammatory response, allowing cholesterol and other fatty materials to deposit.
Infection due to bacteria or virus --> Damages the lining of the artery’s wall,
encouraging deposits to form.
Atheromas (patchy deposits of fatty material) --> Form where the arteries branch because
of fatty material) the artery’s wall is injured from constant turbulent blood flow.
There are many risk factors associated with atherosclerosis including:
Smoking --> It will decrease high-density lipoprotein (HDL), the good stuff,
and increases the bad stuff, low-density lipoprotein (LDL).
High cholesterol --> risk of heart attack increases when the HDL and
LDL are out of whack.
High blood pressure --> uncontrolled high blood pressure can lead to
heart attack or stroke.
Diabetes mellitus --> the risk for developing atherosclerosis is 2 to 6 times
higher in diabetics because sugar deposits just like fat.
Obesity --> abdominal (truncal) obesity increases the risk for diabetes,
hypertension, and coronary artery disease (CAD).
Physical inactivity --> leads to obesity, high blood pressure, and CAD.
High blood levels of homocysteine --> homocysteine (an amino acid)
may directly injure the lining of the arteries, making the formation of
atheromas more likely.
Signs & symptoms
High blood pressure --> Atheromas grow, causing narrowing of the arteries and calcium accumulation in the arteries.
Decreased peripheral pulses --> Decreased elasticity of the arteries and the narrowed lumen contribute to decreased peripheral circulation.
Angina --> Arteries that supply the heart are narrowed.
Leg cramps (intermittent claudication) --> Narrowing of arteries in the legs.
Stroke --> Blockage of the arteries supplying the brain.
Heart attack --> Arteries supplying the heart are blocked.
Kidney failure --> Arteries supplying one or both kidneys become narrowed or blocked.
Malignant hypertension --> Dangerously high blood pressure caused by narrowing of the arteries.
Tests:
Blood pressure --> monitors hypertension.
Lipid profile --> cholesterol below 200 mg/dL is desired.
Coronary angiography --> shows location and degree of coronary artery stenosis or obstruction, circulation, and condition of the artery beyond the narrowing.
Electrocardiography --> evaluates damaged heart muscle and if there is adequate blood supply.
Cardiac catheterization --> confirms presence of hardening of arteries.
Intravascular ultrasound --> views the inside walls of the arteries.
Nuclear imaging --> dye shows area of blockage.
Exercise stress test --> determines if angiography or coronary artery bypass surgery (CABS) is needed.
Holter monitor --> detects silent ischemia and angina.
Treatements:
Lifestyle modifications: low-fat, low-sodium, high-fiber diet; decreased
alcohol intake; smoking cessation; weight loss program; exercise program.
Nitrates: decrease cardiac pain caused by angina by vasodilating the
coronary arteries, therefore supplying more blood to actual heart muscle.
Antihypertensives: lower blood pressure.
Anticoagulants: prevent blood clots.
Percutaneous transluminal coronary angioplasty (PTCA): balloon compresses fatty plaque or blockage against vessel wall to widen diameter of blood vessel and increase blood flow.
Balloon angioplasty with stenting: stent expands to the size of the artery and holds it open.
Calcium-channel blockers: lower blood pressure.
Angiotensin-converting enzyme (ACE) inhibitors: widen bloods vessels, lower blood pressure.
Beta blocker: reduce blood pressure and improve circulation.
Antiplatelets: prevent platetelets from sticking together and blocking vessels.
What can harm my client?
Stroke.
Heart attack.
Kidney failure.
Malignant hypertension.
Peripheral artery disease.
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