Coronary Artery DiseasePresented by: Dave Jay S. Manriquez RN.

Overview

Coronary artery disease (also called CAD) is the most common type of heart disease. It is also the leading cause of death for both men and women in the United States.

It occurs when fatty deposits called plaque build up inside the coronary arteries. The coronary arteries wrap around the heart and supply it with blood and oxygen. When plaque builds up, it narrows the arteries and reduces the amount of blood that gets to your heart.

What causes CAD? Research shows that the exact etiology of CAD is unknown.

However, numerous contributing risk factors have been identified. It starts when certain factors damage the inner layers of the coronary arteries. It is classified as modifiable & non-modifiable.

Non- modifiable

Age

Sex

Family Hx

Ethnic background

Modifiable

Smoking

High amounts of certain fats and cholesterol in the blood

Physical inactivity Stress (release of Catecholamine) High amounts of sugar in the blood due to

insulin resistance or diabetes When damage occurs, your body starts a healing

process. Excess fatty tissues release compounds that promote this process. This healing causes plaque to build up where the arteries are damaged.

The buildup of plaque in the coronary arteries may start in childhood. Over time, plaque can narrow or completely block some of your coronary arteries. This reduces the flow of oxygen-rich blood to your heart muscle.

Plaque also can crack, which causes blood cells called platelets (PLATE-lets) to clump together and form blood clots at the site of the cracks. This narrows the arteries more and worsens angina or causes a heart attack

Plaque

A Narrowing or obstruction of the coronary arteries resulting from atherosclerosis. An accumulation of fatty plaques made of lipids in the arteries

Causes a decrease perfusion of myocardial tissue and inadequate myocardial oxygen supply

Atherosclerosis

Angina

I have chest pain!

CHF

Inability of the heart to do its job

Myocardial Infarction

Death

It’s my time!

Signs & Symptoms

Findings may be normal during asymptomatic periods

Chest pain - due to lack of oxygenPalpitationsDyspneaSyncopeCough of hemoptysisExcessive fatigue

Symptoms occurs when the coronary artery is occluded to the point that inadequate blood supply to the muscle occurs causing ischemia.

Coronary artery narrowing is significant if the lumen diameter of the left main artery is reduced at least 50% or if any major branch is reduced at least 75%

Lab test / Dx

ECGa. When blood flow is reduced and ischemia occurs, ST segment depression or T-wave inversion is noted; the ST segment returns to normal when the blood flow returns.

Cardiac Catheterizationa. Provide the most definitive source for

diagnosisb. Would show the presence of atherosclerotic

lesions Blood lipid levels

a. Blood lipid levels may be elevatedb. Cholesterol-lowering medications may be

prescribed to reduce the development of atherosclerotic plaques

Treatment

The goal of treatment is to alter the atherosclerotic progression

Diet Therapy

The aim is to decrease the serum cholesterol and triglyceride levels.

Low-fat, low-cholesterol

Drug Therapy

Antilipemics - cholestyramine, clofibrate, gemfibrizil, lovastatin

NitratesCalcium Channel BlockerBeta-blockers

Surgical Procedures

Percutaneous Transluminal Coronary Angioplasty

PTCA

Compress the plaque against the walls of the artery and dilate the vessel

Percutaneous Coronary Intervention

Thrombus material (in a cup, upper left corner) removed from a coronary artery during a percutaneous coronary intervention to abort a myocardial infarction. Five pieces of thrombus are shown (arrow heads).

Stent

Vascular stent to prevent the artery from closing and prevent restenosis

Coronary Artery Bypass Graft

To improve blood flow to the myocardial tissue that are at risk for ischemia or infarction as a result of the occluded artery.

Nursing Considerations Instruct the client regarding the purpose of

diagnostic medical & surgical procedures and the pre- & post procedure expectations.

Assist the client to identify risk factors that can be modified, and set goals that will promote change in lifestyle to reduce the impact of risk factors.

Instruct client regarding a low-calorie, low-sodium, low-cholesterol, low-fat diet with a increase in dietary fiber. Stress that dietary changes are not temporary and must be maintained for life.

Provide community resources to client regarding exercise, smoking cessation and stress reduction.

Nursing Diagnosis

Altered (cardiopulmonary) tissue perfusion related to imbalance myocardial oxygen supply as evidence by chest pain & shortness of breath.