NUR 333 Blood Vessel Diseases

• NUR 333 is a Medical Nursing course

Blood Vessel Diseases

• The course covers various blood vessel diseases

Conditions Discussed

• Arteriosclerosis
• Atherosclerosis
• Aneurysm
• Raynaud's disease
• Varicose veins
• Buerger's disease
• Deep vein thrombosis

Arteriosclerosis Introduction

• It is characterized by the thickening and hardening of artery walls, leading to loss of elasticity
• Is a progressive process, restricting blood flow to tissues and organs

A&P Review

• Arteries carry blood under high pressure
• Arteries have a thick muscle layer for contraction and relaxation, facilitating circulation
• Arteriosclerosis impairs the ability of arteries
• Smaller arteries are mostly affected

Risk Factors

• High cholesterol and triglyceride levels
• High blood pressure
• Smoking
• Diabetes
• Obesity
• Eating saturated fats

Pathophysiology

• Arteriosclerosis can begin with damage to the intima
• The intima of the arterial wall fills up with cellular wastes deposition
• Deposited substances stiffen arterial vessels, thicken arterial walls, and cause the disease to be degenerative

Clinical Manifestations

• Affecting cerebral or ophthalmic vessels may result in sudden weakness, facial/lower limb numbness, confusion, or speech/vision problems
• When coronary vessels are affected, chest pain may occur
• Affecting arteries in arms and legs can cause peripheral artery disease symptoms, like leg pain during walking

Diagnosis

• Review of clinical manifestations
• Physical examination
• Stress test
• EKG

Treatment

• Medical therapy prevents arteriosclerosis for underlying conditions
• Treatment includes medications for high cholesterol, such as statins and cholesterol absorption inhibitors
• Medications for Hypertension, such as ACE inhibitors, angiotensin II receptor blockers - Antiplatelet medications
• Lifestyle changes, such as increase exercise, quit smoking, and alcohol

Atherosclerosis Introduction

• It is characterized by intimal lesions, such as atheroma or atherosclerotic plaque
• Plaque narrows or closes the vessel, impeding blood flow
• Plaque rupture can cause sudden occlusion

Risk Factors

• Genetic abnormalities
• Family history
• Increasing age
• Male gender
• Modifiable risk factors include hyperlipidemia
• Hypertension
• Cigarette smoking
• Diabetes
• Obesity
• Unhealthy diet

Pathogenesis

• It arises from the response-to-injury hypothesis
• Injury to the endothelial lining increases permeability
• Accumulation of lipoproteins in vessel wall
• Platelet adhesion
• Monocyte adhesion to endothelium, migration into intima, and differentiation to macrophages and foam cells
• Lipid accumulation within macrophages leads to inflammatory cytokines release
• Recruitment of smooth muscle cells
• Smooth muscle cell proliferation and extracellular matrix production

Clinical Manifestations

• Clinical manifestations depend on vessel location

Diagnosis

• Physical examination
• Angiography
• Stress testing
• Intravascular ultrasound
• Lipoprotein subclass analysis, HbA1c, hs-CRP, and homocysteine

Management

• Requires vascular bypass surgery to re-establish blood flow around the diseased artery segment
• Angioplasty with/without stenting reopens narrowed arteries and improves blood flow

Prevention

• Getting regular exercise
• Following a healthful diet
• Maintaining a healthy weight
• Cessation of tobacco use
• Cessation of alcohol use

Aneurysm Introduction

• It is an outward bulging in a vessel caused by a weak spot on the vessel wall
• Can be hereditary or acquired
• Carries a rupture risk, leading to uncontrolled bleeding
• Is dangerous when occurring in the Circle of Willis in the brain, or in the thoracic and abdominal aorta
• It can arise in the heart following a heart attack, including ventricular and atrial septal aneurysms
• Congenital atrial septal aneurysms are a rare heart defect

Aetiology

• Bacteria gain access into circulation from the mouth, skin, intestines, respiratory system, or urinary tract

Classification According to Location

• Arterial and venous aneurysm
• Arterial cases are more common
• The heart: includes coronary artery aneurysms and ventricular aneurysms
• The aorta: thoracic aortic aneurysms and abdominal aortic aneurysms
• The brain: cerebral aneurysms, berry aneurysms, and Charcot–Bouchard aneurysms
• The legs: popliteal artery aneurysm
• The kidney: renal artery aneurysms and intraparenchymal aneurysms
• Capillaries: capillary aneurysms
• Large vessels such as external and internal jugular veins

Risk Factors

• Congenital aneurysm
• Hypertension
• Atherosclerosis
• Trauma
• STIs like syphilis if untreated, weakens the aorta wall
• Polycystic kidney disease increases the risk of cerebral aneurysm

Clinical Manifestations of Cerebral Aneurysm

• If not ruptured symptoms include fatigue, loss of perception/balance, speech problems, double vision
• If it ruptures symptoms include severe headaches, vision loss, neck pain/stiffness, and pain above or behind the eyes

Clinical Manifestations of Abdominal Aneurysm

• Abdominal aneurysms are usually asymptomatic, but in rare cases cause lower back pain or lower limb ischemia

Clinical Manifestations of Renal Aneurysm

• Flank pain and tenderness
• Hypertension
• Hematuria
• Signs of hypovolemic shock

Diagnosis

• Physical examination
• X-rays
• Ultrasound scans
• CT scans
• MRI
• Digital subtraction angiograms
• Examination of cerebrospinal fluid

Treatment

• Medications to reduce blood pressure
• Surgery may be required, for example: bypass graft, clipping, and stent application

Complications

• Blood clots within the aneurysm
• Compression of nearby nerves
• Dissecting aneurysm
• Stroke
• Epilepsy
• Paralysis
• Congestive heart failure
• Myocardial infarction
• Kidney failure