Factors affecting blood

flow
Poiseuille’s Law
Poiseuille’s law describes the flow of a fluid
through a cylindrical pipe. It is particularly useful
for understanding blood flow through blood
vessels. The law is given by:
 where:
• ( Q ) is the volumetric flow rate,
• ( r ) is the radius of the vessel,
• ( \Delta P ) is the pressure difference between the two ends
of the vessel,
• ( \eta ) is the viscosity of the blood,
• ( L ) is the length of the vessel.
Factors affecting blood
flow
Laplace’s Law
Laplace’s law relates to the tension in the
walls of a cylindrical vessel and is given by:
T=Pr​/2
where:
• ( T ) is the wall tension,
• ( P ) is the internal pressure,
• ( r ) is the radius of the vessel.
Atherosclerosis
Hardening of the arteries, also called
atherosclerosis, is a common disorder. It occurs
when fat, cholesterol, and other substances
build up in the walls of arteries and form hard
structures called plaques.
Over time, these plaques can block the arteries
and cause problems throughout the body.
When atherosclerosis affects the coronary
artery, it can lead to coronary heart disease and
eventually, myocardial infarction otherwise
known as heart attack.
Etiology
For many people, high cholesterol levels are the
result of an unhealthy lifestyle -- most commonly,
eating a diet that is high in fat. Other risk factors
are heavy alcohol use, lack of exercise, and being
overweight.
Other risk factors for hardening of the arteries are:
Diabetes
Family history of hardening of the arteries
High cholesterol diet. Sedentary lifestyle
High blood pressure
Smoking
Pathophysiology
Hardening of the arteries is a process that often
occurs with aging. As you grow older, plaque
buildup narrows your arteries and makes them
stiffer. These changes make it harder for blood to
flow through them.
Clots may form in these narrowed arteries and block
blood flow. Pieces of plaque can also break off and
move to smaller blood vessels, blocking them.
Either way, the blockage starves tissues of blood
and oxygen, which can result in damage or tissue
death. This is a common cause of heart attack and
stroke.
Low-density lipoprotein (LDL) contributes to this
process in several ways:
[Link] Deposition: When LDL levels are high,
excess cholesterol is deposited in the walls of
arteries. This leads to the formation of fatty streaks,
which are the earliest signs of atherosclerosis.
[Link] and Inflammation: LDL particles can
become oxidized, which makes them more likely to be
taken up by macrophages (a type of white blood
cell). These macrophages turn into foam cells, which
accumulate and form the core of atherosclerotic plaques.
[Link] Formation: Over time, these foam cells, along
with other cellular debris, form plaques. These plaques
can grow and eventually restrict blood flow, leading to
conditions such as coronary artery disease, heart
attacks, and strokes
Symptoms
Hardening of the arteries does not cause
symptoms until blood flow to part of the body
becomes slowed or blocked.
If the arteries to the heart become narrow, blood
flow to the heart can slow down or stop. This can
cause chest pain (stable angina), shortness of
breath, and other symptoms.
Narrowed or blocked arteries may also cause
problems and symptoms in your intestines,
kidneys, legs, and brain.
Diagnosis
Physical exam
 Blood tests – to measure cholesterol levels by total lipid
profile (fasting for 10 to 12 hours), lipoprotein blood test
(non-fasting), and glucose testing
A number of imaging tests may be used to see how
well blood moves through your arteries.
Doppler tests use ultrasound or sound waves.
Magnetic resonance arteriography (MRA) is a
special type of MRI scan
Special CT scans called CT angiography
Arteriograms or angiography use x-rays to see
inside the arteries.
A Doppler ultrasound is a test that uses high
frequency sound waves (ultrasound) to
measure the amount of blood flow through
your arteries and veins, usually those that
supply blood to your arms and legs. Vascular
flow studies, also known as blood
flow studies, can detect abnormal flow within
an artery or blood vessel
• Electrocardiogram (ECG)
• Echocardiogram – utilizes sound waves to
create images of the heart
Treatment
Lifestyle changes: Reducing the lifestyle risk
factors that lead to atherosclerosis will slow or
stop the process. That means a healthy diet,
exercise, and no smoking. These lifestyle changes
won't remove blockages, but they’re proven to
lower the risk of heart attacks and strokes.
 A low cholesterol, low sugar diet to control cholesterol and
blood glucose levels is needed for a patient with
atherosclerosis. Foods rich in omega-3 fatty acids such as
fish, soybeans, and flaxseeds are recommended Smoking is
another risk factor of atherosclerosis and CAD. Increased
physical activity by doing at least 150 minutes of moderate
aerobic exercises will help promote an active lifestyle.
Medication:
Anti-cholesterol drugs (e.g. statins) – to reduce
the deposits on the arterial walls
• Blood thinning agents such as Aspirin – to reduce
the ability of the blood to clot, so that the blood
flows easier through the narrowed arteries.
• Nitrates – to relax the blood vessels.
• Beta blockers – to decrease the cardiac demand
for oxygen by means of lowering the heart rate
and blood pressure levels
• Calcium channel blockers – used in combination
with beta blockers
• Diuretics – to reduce blood pressure
Surgery.
• Coronary artery bypass surgery – creation of a
graft to reroute the blood flow away from the
diseased artery
• Fibrinolytic therapy – usage of a clot-
dissolving drug to dissolve the atheroma
• Endarterectomy – surgical removal of
atheroma from the narrowed arteries
Angiography or arteriography is a medical
imaging technique used to visualize the inside,
or lumen, of blood vessels and organs of the
body, with particular interest in the arteries,
veins, and the heart chambers.
A stent is a small mesh (net work) tube that's
used to treat narrow or weak arteries.
A stent is placed in an artery as part of a
procedure called percutaneous coronary
intervention (PCI), also known as coronary
angioplasty.
Nursing diagnosis
• Activity intolerance related to poor blood flow
to lower extremities.
•Ineffective health maintenance related to
smoking and lack of information about disease
management.
• Risk for impaired skin integrity related to
ischemic tissues of legs and feet.
• Risk for peripheral neurovascular dysfunction
related to impaired peripheral blood flow to
lower extremities.
Impaired Gas Exchange related to alveolar edema
secondary to atherosclerosis and increased ventricular
pressure as evidenced by difficulty in breathing, shortness
of breath, fatigue, and circumoral cyanosis.
Ineffective Breathing Pattern related to fatigue secondary
to atherosclerosis as evidenced by generalized weakness,
tachypnea, and pursed lip breathing.
Activity Intolerance related to imbalanced oxygen supply
and demand secondary to atherosclerosis as evidenced by
marked weakness, fatigue, and changes in vital signs
Acute Pain related to decreased myocardial blood flow as
evidenced by pain score of 10 out of 10, verbalization of
pressure-like/ squeezing chest pain (angina), guarding sign
on the chest, blood pressure level of 180/90, respiratory
rate of 29 bpm, and restlessness
Decreased cardiac output secondary to
increased vascular resistance as evidenced by
high blood pressure level of 170/89, fatigue
and inability to do ADLs as normal
Nursing interventions
Teach the patient the prescribed drug regimen.
 Evaluate the patient’s vital signs prior to and during activity especially if
the patient is on vasodilators, diuretics, or beta-blockers.
Asses vital signs.
Administer medication as ordered.
Give emotional support to the patient and his family.
Advice the patient to limit his/her activities in order to
reduce oxygen demand.
Teach the patient about behavior modification avoid
smoking, intake of fatty diet.
Teach the patient about complication of
atherosclerosis.
Take note and record the patient’s vital signs,
particularly the respiratory rate and oxygen
saturation.
Assist the patient to a comfortable position.
Consider putting the patient on semi-Fowler’s
position.
References
• Genest J, Libby P. Lipoprotein disorders and
cardiovascular disease. In: Bonow RO, Mann
DL, Zipes DP, Libby P, eds. Braunwald's Heart
Disease: A Textbook of Cardiovascular
Medicine. 9th ed. Philadelphia, Pa: Saunders
Elsevier; 2011:chap 47.
• Libby P. The vascular biology of atherosclerosis.
In: Bonow RO, Mann DL, Zipes DP, Libby P,
[Link]'s Heart Disease: A Textbook of
Cardiovascular Medicine. 9th ed. Philadelphia,
Pa: Saunders Elsevier; 2011:chap 43.