Cornell Notes Topic/Objective: Cardiac

Disease: Arteriosclerosis & Atheroscleroris

Name: Ben
Page(s):

Disease Process/Overview:
Arteriosclerosis thickening or hardening of the arterial wall often associated with aging
Atherosclerosis type of arteriosclerosis involving the formation of plaque within the arterial wall
(usually affects the larger arteries)

Questions:

Notes:
Etiology:
Factors related to atherosclerosis include:
1.
2.
3.
4.

Obesity
Lack of exercise
Smoking
Stress

Interventions:

Atherosclerosis

1.
2.
3.
4.
5.
6.

Evaluation of total serum cholesterol levels and lifestyle changes

Nutritional therapy
Smoking cessation
Exercise
National Cholesterol Education Program (NCEP)
Therapeutic Lifestyle Change (TLC) diet

Drug Therapy:
1.
2.
3.
4.
5.

HMG-CoA reductase inhibitors (statins)

Fibrinic acids
Zetia
Omacar
Statins: Crestor, Lipitor

Peripheral Vascular Disease:

Peripheral
Atherosclerosis

1. Atherosclerotic and Arteriosclerotic changes occur in and impair

circulation to lower extremities
2. Usually affect persons in 60s and 70s, males more than females
Risk factors: similar to those for atherosclerosis and CHD

Peripheral Arterial
Disease

Disorders that alter the natural flow of blood through the arteries and veins of
the peripheral circulation
May affect:
1.
2.
3.
4.
5.
6.

Aorta (lower)
Iliac
Femoral
Popliteal
Tibial
Dorsalis pedis artery

Pathophysiology:
1. Lesions involve intimal and medial layers of arteries and develop in
large and medium sized arteries

Abdominal aorta and iliac arteries (30% of clients)

Femoral and popliteal arteries (80-90% of clients)
More distal arteries (40-50% fo clients)

-Plaque tends to form at arterial bifurcations; client develops collateral

circulation but is insufficient to meet increased metabolic demands during
exercise

Manifestations:
1. Classic symptoms of PAD intermittent claudication

Ischemic muscle ache or pain that is precipitated by a constant level of

exercise

Resolves within 10min or less with rest

Reproducible
2. Paresthesia:

Shooting or burning pain in extremity

Produces loss of pressure and deep pain sensations
Injuries often go unnoticed by patient
3.
4.
5.
6.
7.

Thin, shiny, and taut skin

Loss of hair on the lower legs
Diminished or absent pedal, popliteal, or femoral pulses
Pallor
Reactive hyperemia irritated area that lies over arterial supply and
artery is effected
8. Nonhealing arterial ulcers and gangrene are most serious complications
9. May result in amputation if blood flow is not adequately restored or if
severe infection occurs
Diagnostics:
1. Doppler ultrasound

Segmental blood pressure (how far is the blood traveling in the

periphery?
2. Ankle-brachial index (ABI)

Done using a handheld Doppler

3. Duplex imaging

Bidirectional, color Doppler; perfusion

4. Angiography determine where blockage is at
5. Magnetic resonance angiography (MRA)

Use contrast
NOT MRI

Risk Factor Modification:

1.
2.
3.
4.
5.

Smoking cessation
Aggressive treatment of hyperlipidemia
Hypertension and diabetes mellitus
Blood pressure maintained <130/80mmHg
Hemoglobin A1C <7.0% for diabetics

want to keep things controlled

Drug Therapy: Antiplatelet agents
1. Aspirin
2. Ticlopidine (Ticlid)
3. Clopidogrel (Plavix)
Make platelets slippery so they slide through
Drug Therapy: Treatment of intermittent claudication
1. Pentoxifylline (Trental)

Increased erythrocyte flexibility

Decreased blood viscosity
2. Cilostazol (Pletal)

Increased vasodilation
Increased Walking distance
Exercise Therapy:
1. Exercise improves oxygen extraction in the legs and skeletal
metabolism
2. Walking is the most effective exercise for individuals with claudication

30-60mins daily
Nutritional therapy:

1. Dietary cholesterol <200mg/day

2. Decreased intake of saturated fat
3. Soy products can be used in place of animal protein

Complementary/Alternative Therapies:
1. Ginkgo biloba

Effective in increasing walking distance for patients with intermittent

claudication
2. Folate, vitamin B6, cobalamin (B12)

Lowers homocysteine levels

What other medications are they on? Check with physician or
pharmacist for interactions

Summary: