1. Problems With Oxygen
Transport
Arteriosclerosis
and
Atherosclerosis

2. LIPIDS = FATS
TRIGLYCERIDES
PHOSOPHOLIPIDS
STEROIDS

3. CHOLESTEROL
Wax like substance
Structural component of
cell membranes
Hormones, Vit D, Bile Acids
Produced in Liver

4. COMPLEXES
Lipoproteins
LDL
HDL
VLDL

5. Serum Lipids
 HDL
 High density lipids
 “good cholesterol”
 Protective effect against
atherosclerosis
 LDL
 Low density lipids
 “bad cholesterol”
 Increased incidence of
atherosclerosis

6. Serum Lipids
 VLDL
 Very low density lipids
 Transport triglycerides
 Increase risk of premature
atherosclerosis
 TRIGLYCERIDES
 Stored body fat

7. Arteriosclerosis
 Hardening and  of elasticity
of arterial walls
Most common arterial
disease
Normal aging process
Hypertension
Diabetes

8. 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

9. Normal and
atherosclerotic arteries

10. ETIOLOGY
 AGE & SEX
 GENETICS
 PRE EXISTING CONDITIONS
 SMOKING
 DIET
 EXERCISE OR LIFE STYLE

11. ATHEROSCLEROTIC LESIONS
 Fatty streak
 Raised fibrous plaque
 Atheroma - irreversible

12. Commonly Affected Sites
Coronary arteries
Vascular bifurcations or
branch areas
Abdominal aorta
Iliac arteries
Femoral arteries

13. Progression of
Atherosclerosis

14. 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

15. RISK FACTORS
 HIGH SERUM LIPIDS
 SMOKING
 OBESITY - LIFESTYLE
 PRE EXISTING CONDITIONS
HTN
DIABETES
ATHEROSCLEROSIS

16. SERUM LIPID STUDIES
WHAT DO MY
CHOLESTEROL LEVELS MEAN???
AMERICAN HEART ASSOCIATION
HANDOUT

17. MANAGEMENT
Dietary FATS
Saturated 
Polyunsaturated 
Monounsaturated 
Hydrogenated 

18. HX & NUTRITIONAL FACTS
 Calories vs. Fats
 Cooking recommendations
 Alcohol consumption
 Exercise

19. DRUG THERAPY
 Statins: Lipitor, Zocor
 HMG-COA Reductase Inhibitors:
Mevacor
 Bile acid sequestrants: Questran
 Nicotinic Acid: Niacin
 Fibric Acids: Atromid, Lopid

20. LET’S TAKE A LITTLE BREAK!!

21. CORONARY ARTERY DISEASE

22. CORONARY ARTERIES

23. ATHEROSCLEROTIC
PROCESS

24. FACTORS THAT  O2 SUPPLY
TO THE 
Vessel spasm
Tachycardia
Blood diseases
Bradycardia

25. FACTORS THAT  O2 DEMAND
ON THE
 Heart rate increase
  Contractibility
  Afterload
 Hypertrophy of Left
Ventricle

26. RISK FACTORS
 MODIFIABLE  UNMODIFIABLE
 CHOLESTEROL  AGE
LEVEL
 BP
 SEX
 SMOKING  RACE
 OBESITY  FAMILY HX
 NTG + VIAGRA  DIABETES
 ETOH
 HOMOCYSTEINE

27. RISK RATIO

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

30. ANGINA PECTORIS
 Stable Angina
 Unstable angina
 Silent Ischemia
 Variant or Prinzmetal’s
Angina

31. 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

32. 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

33. SILENT ISCHEMIA VARIANT ANGINA
 No pain  Arterial Spasms
 + ECG  No precipitating
 + Cardiac Enzymes factors
 Rare
 Occurs at rest

34. ASSESSMENT OF SXS
P = PRECIPITATES
 Q = QUALITY
 R = RADIATES
 S = SEVERITY and
SYMPTOMS
 T = TIMING

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

36. 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

37. LAB TESTS
 Cardiac Enzymes
 Lipid profiles
 CBC & Lytes
 NTG Test
 ECG
 Stress Tests
 Cardiac Scans (Thallium, MUGA, PET, LVEF)
 Echo (TEE)
 Cardiac Cath

38. PERCUTANEOUS TRANSLUMINAL
CORONARY ANGIOPLASTY

39. CORONARY ARTERY
STENT

40. Angiojet

41. CABG

42. NURSING
INTERVENTIONS
TEACH REFER

43. MEDICATIONS
 ASA
 NITRATES
 BETA ADRENERGIC BLOCKERS
 ACE INHIBITORS
 CALCIUM CHANNEL BLOCKERS
 ANGIOTENSIN II RECEPTOR BLOCKERS
 THROMBOLYTIC THERAPY

44. ETIOLOGY