Atherosclerosis V1.0

Atherosclerosis V1.0

1. S/S

   • Coronary Arteries
     • Angina
     • Shortness of Breath
     • Arrhythmias
     • Fatigue
     • Lack of Energy
   • Carotid Arteries
     • Sudden Weakness
     • Paralysis
     • Confusion
     • Lost of Consciouness
     • Headache
     • Dizziness
   • Peripheral Arteries
     • Numbness
     • Pain
     • Infections
   • Renal Arteries
     • Change in Urination
     • Loss of Appetite
     • Nausea
     • Swollen Extremities

2. Treatment

   • Pharmacology
     • Statins
       • Pravastatin
       • Atorvastatin
       • Rosuvastatin
     • Antiplatelets
       • Aspirin
       • Clopidogrel
       • Dipyridamole
     • Anti-inflammatories
       • Canakinuma
       • Colchicine
     • Anti-hypertensives
       • CCB
       • Beta Blockers
       • ACE Inhibitors
       • Diuretics
   • Surgery
     • Angioplasty/ Stenting
     • Coronary Artery Bypass Surgery
     • Carotid Endarterectomy
   • Complementary/ Alternative Therapy to Lower Cholesterol
     • Supplements
       • Niacin
       • Omega 3
       • Milk Thistle
       • Coenzyme Q10
     • Foods
       • Garlic
       • Soy
       • Fish (Salmon, Mackerel, & Sardines)
       • Fibre (Oat Bran, Fruits, & Beans)

3. Etiology and Pathology

   • Arteriosclerosis includes
     • Monckeberg sclerosis
     • Arteriolar sclerosis
     • Atherosclerosis, the most common of the three type
       • Atherosclerosis is the pathological origin for most arterial disease in the several countries.
       • Most often develops in medium and large arteries such as carotid
         • Occlusion of coronary arteries
           • Myocardial ischemia and myocardial infarction
             • Death
           • Thrombosis formation
             • Stroke
               • Death
             • Affect organs or the peripheral vascular system
               • Lower extremities are affected, called atherosclerosis obliterans
           • Pain with activity
             • As occlusion worsens, potential for pain at rest
           • Ulceration
       • The endothelial surface of artery is damaged
         • Inflammatory response and increased vessel permeability
           • Low density lipids breach vessel wall
             • Leukocytes drawn to the site and oxidize the lipids, further damaging the vessel walls
           • Platelets collect at site of injury and are activated
             • Produce platelet derived growth factor which promotes smooth muscle cell growth
               • Smooth muscle cells are drawn to the area and begin to reproduce
                 • Plaque is formed
                   • Smooth muscle cells
                   • Lipoproteins
                   • Inflammatory debris
                   • Plaque enlarges and artery gets more occluded
                     • Plaque may rupture and form thrombus
         • Potential causes and risk factors
           • Modifiable
             • Smoking
             • Elevated blood pressure
             • Glucose intolerance and diabetes
             • Elevated cholesterol and low density lipids
             • Inactivity
             • Obesity
             • Weight changes
             • High stress
           • Non-modifiable
             • Age
             • Gender
             • Ethnicity
             • Genetics
   • (Loftsgaarden, 2013).

4. Health Promotion and Prevention

   • Modifying risk factors
     • Becoming physically active
     • Cessation of smoking, leaving smoke friendly environments
     • Address and control hypertension
     • Change in diet
       • Reduce low density lipid and cholesterol intake
       • Increase high density lipid intake
       • Reducing sugar intake
     • Managing diabetes
     • Losing weight if obese
     • Create healthy stress coping habits
   • Patient education
     • Educate patient about both non-modifiable and modifiable risk factors
     • Explain benefits of change
     • Refer to resources such as Canadian Heart and Stroke foundation
   • (Loftsgaarden, 2013; Comrie, 2014)
   • Monitor blood fat through blood tests
     • Cholesterol should be below 5.2 mmol/L
     • Triglycerides should below 2.2 mmol/L
     • Total cholesterol to high density lipids should be 6.0 or less
   • Refer to different programs and services as needed
     • Smoking cessation
     • Stress management program
     • Dietitian or nutritionist
   • Low daily dose of aspirin in consultation with physician

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