Atherosclerosis - Support Groups

Though atherosclerosis in and of itself is a relatively manageable disease given the right interventions, it is a disease nonetheless, and can lead to further complications such as cardiovascular disease. As a result, many related support groups focus on cardiovascular disease as opposed to solely focusing on atherosclerosis. Upon having been diagnosed, individuals may feel vulnerable, helpless or even clueless as to how they can improve their health.  It is in these moments that support is imperative.  Support from doctors and nurses is helpful, but people need backup from their family, community and peers, which oftentimes comes in the form of support groups.

One such support group, Mended Care, reaches out to patients with cardiovascular diseases.  They offer emotional support and care to those going through tough times.  Extending their care to all, they are present in the form of in-hospital visits, community support groups and education workshops.

Other similar support groups include the FH Foundation, WomenHeart, Mended Little Hearts, and Sisters by Heart.  While the FH foundation is widely focused and includes all patients as well as health care providers, the other mentioned support groups focus on specific demographic groups such as women and children.

WomenHeart is a group that supports women nationally through encouragement, teaching them various ways to cope, and promoting communication within their families and with their physicians. They provide various options of communication, including in-person meetings, email, and telephone.

Mended Little Hearts and Sisters by Heart are support groups that focus uniting parents of children with heart disease.  They deeply encourage peer communication and support, and work to help families obtain the resources they require during these times.

https://www.cardiosmart.org/Heart-Conditions/Atherosclerosis/Getting-Support

Nursing Care for Individuals with Atherosclerosis

As was mentioned previously, one of the most important interventions a nurse can provide for a patient is the promotion of self-care.  Self-care can only begin when the patient is aware and knowledgeable of the different risk factors and stages of progression of this disease.

Due to today's common use of technology, a beneficial and efficient form of obtaining information is provided through mobile applications such as Eureka.in - Atherosclerosis, Cure for Atherosclerosis, Tactio, and WebMD. While some of these apps are simply informational based, others serve as a means of improving and tracking atherosclerotic related factors such as cholesterol and weight.  WebMD is a particularly helpful app because it is a reliable source of information that is not limited solely to atherosclerosis, but covers a multiple of other diseases and health problems as well.

Though there are only a handful of apps mentioned above, there are many more apps that can work toward informing users and helping individuals track, manage and prevent this disease.

However, even though these apps may contain a lot of information, it is important to confirm that patients are getting the critical facts.  It is difficult to determine whether or not each app contains the must-knows. As a result, one on one patient education is necessary as the initial step.  After having taught the patient directly, the apps can then be suggested for for additional or backup information.

Dietary Treatment for Atherosclerosis

While there are several means of treatment for atherosclerosis, the healthiest means is indisputably an altered diet.  Key aspects of a healthy diet include a high intake of fruits, vegetables and whole grains, avoiding trans fat and limiting saturated fat, eating large varieties of proteinaceous foods, and limiting both cholesterol and salt.

WebMD suggests a number of ways to change eating habits into "heart-healthy diets." One such suggestion is the consumption of fish. Given that fish are a good source of protein and other necessary nutrients, this article recommends salmon, tuna and mackerel which provide Omega-3 fatty acids.

Another important aspect of a heart-healthy diet includes completely eliminating trans fat.  Trans fat is detrimental to one's health because it raises LDL cholesterol which contributes largely to  plaque build up within the arteries.  Some examples of food that contain trans fat include: pizza, fast food, margarine sticks, coffee creamer, and others.   It is also recommended to limit saturated fat to less than 10 percent of caloric intake.  Checking the food labels for the amount of saturated fat is a good tip to know and control just how much is being consumed with each meal.  Foods high in saturated fat include sausages, butter, cream, cheese, cakes and biscuits and creams. Conversely, it is good to eat small amounts of unsaturated fat, as it will help increase the level of HDL cholesterol (good cholesterol), and work to reduce blockage in the arteries.  Examples of foods containing unsaturated fat include: fish, avocados, and nuts or seeds.  Because cholesterol plays a large role in atherosclerosis, it is imperative to refrain from going above 300 milligrams beyond the specified limit per day.

Research has shown that eating about 2,000 mg of sterols and stanols each day can reduce the levels of LDL cholesterol by about 10%.  As a result, the risk of heart disease can decrease by as much as 25%. Sterols and stanols can be found in fruits, vegetables, nuts, seeds, cereals, legumes and both olive and vegetable oils.

Finally, it is important cut back on sodium.  It is easy to consume too much of it, but limiting consumption of this element can help individuals control their blood pressure.  The daily recommended intake for those monitoring atherosclerosis is less than 6 grams per day.  

http://www.webmd.com/heart-disease/guide/heart-healthy-diet
http://www.nhs.uk/Conditions/Atherosclerosis/Pages/Prevention.aspx

Nursing Care for Atherosclerosis

Creating a plan of care for a patient with atherosclerosis is highly dependent on patient education.  Because atherosclerosis is a disease that cannot truly be determined until fatalities such as myocardial infarctions and strokes occur, a large role of the nurse is informing patients of the many risk factors, and how a change of lifestyle can help prevent atherosclerosis.  Consequently, the primary patient outcome in the case of atherosclerosis is to inform the patient on ways to prevent or slow the progression of the disease.  For instance, teaching them that living an overall healthier life  such as eating a healthier diet, participating in physical activities frequently, and refraining from tobacco, can help decrease risk for atherosclerosis, and are number one preventative measures.

Further, it is important to make patients aware of what signs and symptoms to look for. Such signs and symptoms could include a sudden or gradual onset of pain in the lower back, groin, abdomen or chest, a bluish hue or coolness of the lower extremities, increased weakness and fatigue, and a decreased urine output.

A nursing plan of care for this disease also depends on the location affected. If someone does not yet know whether or not they have atherosclerosis, this is not helpful, but for a patient who has already been diagnosed, the nurse can be more specific in the treatments necessary as well as patient education.

Simply being aware of how to work toward preventing atherosclerosis and knowing what signs and symptoms to identify
can drastically improve an individual' chances toward prevention and early detection.

The website below is very helpful in outlining the measures taken by the nurse, and does well in addressing elements to assess, trigger factors to identify, causes, risk factors, and treatment.

http://www.nanda-books.com/2012/10/nursing-care-plan-for-atherosclerosis.html   

Atherosclerosis Treament

Progression and regression of existing plaque in the arteries can be treated via the modification of atherosclerotic risk factors.  Treatment for atherosclerosis occurs primarily through healthy life-style changes such as diet, physical activity and relinquishing smoking.  Other more clinically oriented options include medicine, medical procedures, and surgery.  Because atherosclerosis is so difficult to detect prematurely--aside from having already lived a healthy lifestyle--treatment for atherosclerotic treatments do not vary immensely from stage to stage within the disease.

Healthy eating is essential for preventing or treating further cases of atherosclerosis.  While there are many elements to healthy eating, atherosclerosis-specific diets should contain low levels of saturated fat, no trans fat, a higher consumption of fruits and vegetables and fibers, as well as a moderate intake of alcohol.  Further, if an individual has been diagnosed with hypertension, their doctor may recommend Dietary Approaches to Stop Hypertension (DASH).  This diet focuses on the consumption of fruits, vegetables and whole grains.  Conversely, it suggests avoiding foods high in fat, cholesterol and sodium.

Other important aspects to healthy living, especially in regards to treating atherosclerosis, is physical activity and refraining from smoking.  At least thirty minutes of aerobic exercise each day can lower risk factors of atherosclerosis such as LDL cholesterol, high blood pressure, and excess weight.
Further, beyond diet and exercise, it is important to refrain from smoking.  Smoking damages blood vessels and can increase risk for this disease.  Quitting smoking and avoiding second hand smoke can lower an individual's risk of forming blood clots and help reverse heart and blood vessel damage immediately.

If atherosclerosis has progressed significantly, more immediate or extreme means of treatment may be necessary.  Often times drugs are prescribed if someone has coronary heart disease, peripheral arterial disease, or high LDL levels.  Medication can also be prescribed to help lower blood pressure and blood sugar levels, or prevent blood clots and inflammation. Even still, there are quicker--yet more invasive--means of treating severe buildup of plaque in the arteries. For example, Percutaneous coronary intervention (PCI), or coronary angioplasty, is a procedure that opens a blocked coronary artery.  This procedure allows better blood-flow to the heart, preventing a heart attack.  Occasionally, a stent is placed in the artery for long-term effect.  Another type of surgical intervention includes coronary artery bypass grafting (CABG).  This surgery will form a bypass that will go around narrowed coronary arteries by using arteries from other areas of the body.  Again, this allows for better blood flow, and hence better oxygen supply to the heart.  Similar approaches are used in arteries leading to the brain as well as peripheral arteries.

Treatment for atherosclerosis can be difficult and may take time.  However, these methods can improve endothelial function, reduce inflammation, prevent blood clotting and decrease risk for further plaque build-up, overall decreasing chances for fatalities.

http://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis/treatment
http://www.merckmanuals.com/professional/cardiovascular-disorders/arteriosclerosis/atherosclerosis

Signs and Symptoms of Atherosclerosis

Atherosclerosis, latent in its nature, is a disease difficult to diagnose due to its general lack of overt signs and symptoms.  Because the progression of this disease occurs hidden within the lumen of the body's arteries, people do not regularly check for this disease until severe damage, such as a myocardial infarction or stroke occurs.  As a result, many people do not realize they have atherosclerosis until such medical emergencies take place.

However, while this disease has a relatively small number of signs to look for, there are a few key identifiers, that might indicate the presence of atherosclerosis. Yet, it is important to remember that each sign and symptom is different according to the affected artery. One symptom that many people experience in relation to coronary arteries is angina.  Angina is a pain or discomfort that takes place in the chest when the heart is not receiving an adequate amount of blood.  Someone experiencing this symptom may feel a tight pressure in the pleural cavity.  This pressure can also extend through one's shoulders, arms, neck, jaw or back, and can be triggered by emotional stress and physical activity, or relieved with rest.  Additional symptoms of coronary heart disease (CHD) include shortness of breath and arrhythmia.

Another primary location for atherosclerosis is the carotid arteries.  Blockage of these arteries prevents the flow of oxygen-rich blood to the brain and can cause a stroke. Symptoms and signs of carotid artery disease include sudden weakness, paralysis or numbness in one half of the body, confusion, trouble speaking and understanding, dizziness, loss of balance and coordination, as well as difficulty breathing.

Finally, plaque buildup can occur in the peripheral and renal arteries.  Peripheral arteries are the arteries leading to legs, arms and pelvis. Numbness and pain are the primary symptoms of peripheral arterial disease, and while blockage of these arteries is not as severe, understanding the symptoms is important nonetheless.  Blockage to the renal arteries can result in chronic kidney disease which can lead to decreased kidney function.  Initially, there is no way to determine whether or not someone has chronic kidney disease.  However, with time people see changes in their urination patterns, loss of appetite, nausea and swelling in the hands or feet.

http://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/basics/symptoms/con-20026972

Diagnosis of Atherosclerosis

Atherosclerosis is a silent disease that progresses slowly, not fully showing signs until about the 5^th decade of life.  Over time as the plaque builds, its potential for harm gradually increases and reaches its full potential when a thrombus is formed or the lumen of an artery is completely blocked. Yet, regardless of its tendency to progress slowly, given its numerous risk factors, it is important to stay up to date and be assessed frequently for any signs indicating atherosclerosis.  

Typically, a diagnosis is formed based on medical and family history, physical exams and test results. After having visited a primary care doctor, specialists such as cardiologists, vascular specialists or neurologists might be recommended in order to diagnose specific issues that may be associated with atherosclerosis.  

During a general physical exam, the doctor will listen to the arteries to determine abnormal sounds. In this case, they are listening for a sound called bruit.  This sound indicates inadequate blood flow which could be a result of plaque buildup.  The presence of a blocked artery can also be determined via the pulse.  A weak pulse, such as in the leg or foot, is a possible indication that there is a blocked artery.  Atherosclerosis can also be determined through specific diagnostic tests.  Such tests include blood tests, an electrocardiogram (EKG), chest X Rays, the ankle/brachial index, computed tomography scans, stress testing and angiography.  Many of these tests either allow a clearer view of plaque buildup within arteries, or assess the heart for abnormal blood flow.  Below is a short summary describing how each of the above tests are used in diagnosing atherosclerosis.  

Blood tests: blood test can show levels of fats, cholesterol, sugar and protein. Abnormal results may indicate a possibility for atherosclerosis.

EKG: EKG’s can monitor and record the heart’s electrical activity and whether its rate and rhythm are normal or irregular. This type of test can show signs of heart damage that result from cardiovascular heart disease or signs of a previous or current heart attack.

Chest X Ray: similar to the EKG, the chest X Ray can show signs of heart failure by taking pictures of the organs inside the chest (ie: heart, lungs, blood vessels)

Ankle/brachial index: the ankle/brachial index compares the blood pressures of the posterior tibial artery and the brachial artery to determine the adequacy of blood flow in contiguous areas.

Computed tomography scan: this test creates pictures of the heart, brain or other parts of the body to illustrate hardening and/or narrowing of more prominent arteries.

Stress testing: in stress testing, through exercise or medication, the heart is made to work harder.  As it does so, it requires more oxygen and blood. Pictures of the heart are taken during and after exercise. When there is a presence of plaque in the arteries, certain parts of the heart don’t receive the blood flow it requires, which is shown in the pictures.

Angiography: an angiography is a test that uses dye and X rays to help view the inside of the arteries.  This allows a clear view of how much plaque is progressively building up.

http://www.mayoclinic.org/diseases-conditions/arteriosclerosis-atherosclerosis/basics/tests-diagnosis/con-20026972

http://www.merckmanuals.com/professional/cardiovascular-disorders/arteriosclerosis/atherosclerosis

The Pathophysiology of Atherosclerosis

Pathophysiology

Atherosclerosis is a disease characterized by the buildup of fatty streaks within the arterial tree.  This disease sets its roots when an accumulation of atherosclerotic plaque, primarily consisting of lipids, inflammatory and smooth muscle cells, and the matrix of connective tissue, forms.  Ironically, this disease begins to form when the body sends an inflammatory response to injury or destruction of the endothelial layer of the artery.  While atherosclerosis can develop in any area within the arterial tree, certain areas are more prevalent.  For instance, in areas where the arterial tree branches, endothelial dysfunction is likely, which in turn, stops endothelial production of nitric oxide.  Nitric oxide is a vasodilator and anti-inflammatory molecule that plays a large role in maintaining the tone of the endothelium of arteries.

 Further, in areas of a diminished blood flow, the endothelial cells are less likely to produce adhesion molecules; these molecules are tasked with finding and binding inflammatory cells, so when they aren’t present, inflammation is more likely to occur.  Certain risk factors are also known for inhibiting nitric oxide production, as well as stimulating the production of certain molecules, cytokines, proteins and other elements that are detrimental to the arteries.  Essentially, this will result in the endothelial binding of monocytes and T cells.  As these cells flow into the subendothelial space, a local vascular inflammatory response is at stake.  Eventually, the monocytes in the endothelium are transformed into macrophages.  Passing lipids such as low-density lipoproteins (LDL), bind to the endothelial cells and are oxidized.  Oxidation of these lipids and macrophages produce foam cells, resulting in the initial stages of atherosclerosis.

As atherosclerosis develops, the plaque can be either stable or unstable.  On one hand, stable plaque can disappear, remain static, or continue to grow until occlusion or stenosis occurs.  On the other hand, unstable plaque increases chances for thrombosis which can lead to infarction. 

Unstable plaque is formed when the integrity of a layer of fibrous connective tissue called the fibrous cap, is tested.  Certain enzymes are activated by macrophages in the plaque and will eventually consume the fibrous cap, ultimately weakening its structure and causing a rupture. Ensuing the rupture, plaque roams freely in the blood stream, and thrombosis is likely.  

Risk Factors

There are many risk factors for atherosclerosis: many of these factors tend to demonstrate association with the metabolic syndrome.  Certain related factors with metabolic syndrome include abdominal obesity, atherogenic dyslipidemia, hypertension, insulin resistance, aprothrombotic state and a proinflammatory state.  However, there are many other factors that can and do play a role in atherosclerosis.  Below is a link that lists and describes many issues and diseases as they relate to atherosclerosis.

http://www.merckmanuals.com/professional/cardiovascular-disorders/arteriosclerosis/atherosclerosis

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The Epidemiology of Atherosclerosis

Atherosclerosis, while undeniably present in many people, is a difficult disease to identify due to the fact that it is generally asymptomatic. It is not until the danger is said and done that most people realize what is transpiring within their bodies and can begin the process of recovery and preventative measures.

Though it is different from person to person, the process of atherosclerosis begins in childhood with the development of fatty streaks.  With age, these fatty streaks develop into plaque formations.  However, it is not until the fifth or sixth decades of life that the clinical manifestations of this condition become prevalent.

Atherosclerosis is a key player in cardiovascular disease, with about 36 percent of the United States’ population having been diagnosed. So while ASVD can be detrimental to all parts of the body, the true danger of this disease is present in the form of Coronary Artery Disease (CAD), an area-specific form of atherosclerosis.  About 14 million people experience CAD, and have undergone its related complications.  Notably, CAD continues to be the number one cause of death for individuals across the United States. 

Multiple factors are associated with the onset of CAD, some of which include race, sex and age.  For instance, CAD has appeared to affect African Americans and Asian Indians more drastically than Caucasians.  It has also been observed that men, opposed to women, lead the charts in CAD diagnoses.  However, age is indisputably the leading determinant of developing any form of atherosclerosis.  As was mentioned previously, the effects of this disease are not prominent until the latter half of one’s life.  Even so, it is important to note that while genetics and age may play a role in the acquisition of this disease, certain risk-factors such as hypertension, diet, tobacco, obesity and physical activity are contributing influences to the cause of ASVD.

While atherosclerosis is difficult to prematurely identify, being informed on the various facets of this disease could help contribute immensely to prevention tactics.  However, taking the time to be informed is just one step of a process; it is one step that must be followed by another. Step two…take action. Because living a healthy lifestyle is not just one step, it’s a journey. 

So start walking.

What is Atherosclerosis and How Does it Affect the Body?

Atherosclerosis, also known as Ateriosclerotic Vascular Disease (ASVD), is a disease that results when an excessive buildup of plaque forms and adheres to the lining of the body’s arteries.  As the plaque lingers, it begins to harden, causing these blood vessels to narrow and restrict blood flow from the heart to the body’s tissues and organs. This limited ability to receive oxygenated blood can cause serious cardiovascular complications such as strokes, myocardial infarctions and even death if not treated properly or in a timely manner.  

   

ASVD begins to form when the endothelium, a thin layer of cells lining the lumen of the artery, is damaged.  Damage to the endothelium can result from high blood pressure, smoking, or high cholesterol levels. The impaired layer allows LDL cholesterol to accumulate along the wall.  In response to this foreign buildup, the body sends white blood cells called macrophages to act as a defense system and rid the body of the cholesterol. However, what was initially meant as good can lead to bad.  Occasionally, some of the macrophages will remain in the damaged area, and as they conglomerate with the cholesterol, plaque begins to form.  The continual presence and flow of blood through the artery contributes other substances such as fat and calcium to the buildup.  While the limited flow of blood through the body is unsafe, the true danger occurs when a piece of plaque breaks away or when a thrombus forms.  If either of these blocks the artery, the flow of blood discontinues, significantly reducing the oxygen supply to the body.  Were this to occur in either of the two coronary arteries, the heart is deprived of oxygen and undergoes cardiac ischemia.  Prolonged, the tissues of the heart die and myocardial infarction occurs.  Further, the same idea is applied when the brain’s arteries are blocked, and the brain receives an insufficient supply of oxygen.  Without the essential oxygen, the brain tissue dies and a stroke ensues.   

While atherosclerosis might initially seem trivial, it has the potential to substantially affect your health. So the question is, will you let it?

For more information visit the link below:

http://www.webmd.com/heart-disease/what-is-atherosclerosis

“Atherosclerosis – 3D Animation || ABP ©.” YouTube. YouTube, n.d. Web. 04 Sept. 2015.

Rooke, Jennifer. Atherosclerosis. Digital image. Advanced Lifestyle Medicine. N.p., n.d. Web. 2 Sept. 2015.