Coronary Artery Disease and Acute Coronary Syndrome


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Coronary Artery Disease and Acute Coronary Syndrome

  1. 1. Life University AssignmentSubject: Adult Nursing II Professor: Sek Sophon
  2. 2. Coronary Artery Diseaseand Acute Coronary Syndrome Professor: Sek Sophon Presented by: 1. Cheng Chanmara 2. Chea Linna 3. Mek Sophy 4. Sopha Sokny 5. Say Chantha 6. Sorm Chanthy 7. Tang Sareth 8. Chou Nimol 9. Sy Sreythin
  3. 3. Learning Objectives: Describe the etiology and pathophysiology of coronary artery disease, angina, and acute coronary syndrome. Identify risk factors for coronary artery disease and the nursing role in the promotion of therapeutic lifestyle change in patients at risk. Describe clinical manifestations, and collaborative care and nursing management of the patients with coronary artery disease and chronic stable angina. 3
  4. 4. Learning Objectives: (cont.)Describe the clinical manifestations, complications, diagnosis, and collaborative care of the patient with acute coronary syndrome.Describe the pathophysiology of myocardial infarction.Identify commonly used drug therapy in treating patients with coronary artery disease and acute coronary syndrome. 4
  5. 5. Learning Objectives: (cont.)Identify key issues to include in the rehabilitation of patients recovering from acute coronary syndrome and coronary revascularization procedures.Describe the collaborative care of patients who are at risk for or have experienced sudden cardiac death. 5
  6. 6. Coronary Artery Disease 6
  7. 7. Description Coronary artery disease (CAD; also calledatherosclerotic heart disease) is a type of bloodvessel disorder that is included in the generalcategory of atherosclerosis (hardening of thearteries). 7
  8. 8. Description (cont.) It occurs when fatty depositscalled plaque build up inside thecoronary arteries. The coronaryarteries wrap around the heartand supply it with blood andoxygen. When plaque builds up,it narrows the arteries andreduces the amount of blood thatgets to your heart. 8
  9. 9. EtiologyCause of coronary artery narrowing are: Atherosclerosis Thrombosis Spasm Coronary dissection Aneurysm formation 9
  10. 10. Pathophysiology Progression of Atherosclerosis:1. Fatty streak:  Injury to intimal endothelium  Lipid deposits  No obstruction 10
  11. 11. 1. Fibrous plaque:*Plaque and thrombus formation  Protrusion into arterial lumen  Proliferation of smooth muscle cells  Irreversible progression 11
  12. 12. 1. Complicate lesion:*Total occlusion  Plaque calcification  Plaque rupture  Thrombus formation 12
  13. 13. By total occlusion it can lead to: Ischemia Myocardial infarction Sudden death 13
  14. 14. Collateral circulationAn area of tissue or an organ has different pathways for blood to reach it. This is often as a result of anastamoses.Branches formed between adjacent blood vessels.Collaterals increase in the presence of chronic ischemia. 14
  15. 15. When occlusion occurs slowly over a long period, there is a greater chance of adequate collateral circulation developing. 15
  16. 16. Risk Factors for Coronary Artery Disease Risk factors can be divided: Non- modifiable Age Sex Family Hx Ethnic background 16
  17. 17. Risk Factors for Coronary Artery DiseaseModifiable risk factors: Elevated serum lipids Hypertension Smoking Obesity Physical inactivity Diabetes mellitus Stressful lifestyle 17
  18. 18. Clinical expression of coronary disease Unstable MI anginaStable Coronary HeartAngina failure Disease Prinzmetal’s Sudden Angina death 18
  19. 19. AnginaResults when the lack of oxygen supply is temporary and reversibleTypes of Angina Chronic Stable Angina Unstable Angina Prinzmetal’s Angina 19
  20. 20. Chronic Stable AnginaIs the most common angina type.It can also be referred to as exertional angina, emotional stress, cold weather, and large meal.With rest, the angina attack symptoms generally improve. 20
  21. 21. Unstable AnginaIs the second most common angina type.This is a dangerous condition that requires emergency treatment.Can occur without physical exertion and is not relieved by rest or medicine.The condition is caused by blood clots that partially or totally block a coronary artery. 21
  22. 22. Prinzmetal’s AnginaAlso called Variant angina.Is a rare angina type.Caused by a spasm in a coronary artery. 22
  23. 23. Clinical Manifestations AnginaChest pain or discomfort (due to ischemia) A strange feeling, pressure, or ache in the chest Constrictive, squeezing, heaving, choking, or suffocating sensation Indigestion, burning 23
  24. 24. Location of Chest Pain 24
  25. 25. Treatment for stable anginaThe two general approaches to treat are: Invasive therapy Bypass surgery Coronary angioplasty Stents Non-invasive therapy (medical therapies) 25
  26. 26. Bypass Surgery Bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. It improve the blood supply to the coronary circulation supplying the myocardium. 26
  27. 27. Coronary AngioplastyCoronary angioplasty is a procedure used to open blocked or narrowed coronary arteries.The procedure improves blood flow to the heart muscle. 27
  28. 28. StentVascular stent to prevent the artery from closing and prevent restenosis 28
  29. 29. Watch a video 29
  30. 30. 30
  31. 31. Medical therapiesThree categories of drugs are commonly used: Nitrates Beta blockers Calcium channel blockers 31
  32. 32. Nursing and Collaborative Management Coronary artery diseaseHealth Promotion Identification of high-risk persons Management of high-risk persons Risk factor modification Physical fitness Health education in schools Nutrition (weight control, ↓ fat, ↓ cholesterol intake) Cholesterol-lowering medications 32
  33. 33. Acute Coronary SyndromeAcute coronary syndromes result from acute obstruction of a coronary artery. 33
  34. 34. Etiology and PathophysiologyIt occurs when an atherosclerotic plaque ruptures, fissures or ulcerates and precipitates thrombus formation.Alternatively thrombus may break off from a ruptured plaque and occlude smaller vessels like coronary arteries. 34
  35. 35. Manifestation of Acute coronary syndrome Acute coronary syndrome (ACS) is usually involving with one between:  Myocardial infarction  Unstable angina 35
  36. 36. Myocardial InfarctionMyocardial infarction occurs as a result of sustained ischemia, causing irreversible cells death (necrosis). 36
  37. 37. Clinical manifestation of MITachycardia or bradycardiaNormotension or hypotensionTachypneaPulmonary edema, cracklesAir hunger, orthopneaFrothy sputumRestlessness, confusion, anxiety. 37
  38. 38. Complication of MIDysrhythmiasHeart failureCardiogenic shockPapillary muscle dysfunctionVentricular aneurysmPericarditis 38
  39. 39. DIAGNOSISElectrocardiogramSerum Cardiac MarkerCoronary Angiography 39
  40. 40. Collaborative Care Medical ManagementPercutaneous transluminal coronary angioplasty (PTCA)Pain control: (MONA) Morphine Oxygen Nitroglycerin Aspirin 40
  41. 41. Medical management (cont.)Nutritional therapy: Initially patient may be NPO except for sip of water until stable. Low salt Low saturated fat Low cholesterol dietCoronary surgical revascularization Bypass surgery 41
  42. 42. Nursing management Chronic stable angina and Acute coronary syndromeNursing Assessment Subjective data: Past health history of CAD, angina, MI, CHF, hypertension, diabetes, anemia, hyperlipidemia, lung disease, aortic stenosis Medications: use of aspirin, nitrate, cholesterol lowering drug, antihypertension, and vitamin 42
  43. 43. Objective data: General: anxiety, fear, restlessness. Integumentary: cool, clammy, pale skin Cardiovascular: tachycardia or bradycardia, BP 43
  44. 44. Nursing Diagnosis: Acute pain related to myocardial ischemia, radiation of pain to the neck and arms. Ineffective tissue perfusion (cardiac) related to myocardial injury. Anxiety related to perceived threat of death, pain, possible lifestyle changes as evidenced by restlessness. 44
  45. 45. Planning: Relief of pain Preservation of myocardium Immediate and appropriate treatment Effective coping with illness associated anxiety Participation in a rehabilitation plan Reduction of risk factors 45
  46. 46.  Nursing Implementation: Chronic stable angina Health Promotion: we have to control and change some behavior such as Hypertension Elevated serum lipids Tobacco use Physical inactivity Stressful lifestyle Obesity Diabetes 46
  47. 47. Acute Intervention: If angina attack occurs nurse should Administration of supplemental oxygen Determination of vital signs 12-leads ECG Pain relief first with Nitrate Auscultation of heart sounds Comfortable positioning of the patient. 47
  48. 48. Ambulatory and Home Care: The patient should be provided information regarding CAD, angina, precipitation factors for angina, risk factor reduction, and medications. Patient teaching can be handle in a variety of ways. 48
  49. 49.  Nursing Implementation: Acute coronary syndrome  Acute Intervention include: Pain assessment and relief Physiologic monitoring Promotion of rest and comfort Alleviation of stress and anxiety Understanding patient’s emotional and behavioral reaction  Ambulatory and Home Care: Cardiac Rehabilitation 49
  50. 50. Evaluation The expected outcomes that the patient will Relief of pain Preservation of myocardium Immediate and appropriate treatment Effective coping with illness associated anxiety Participation in a rehabilitation plan Reduction of risk factors 50
  51. 51. Sudden cardiac deathAlso called sudden cardiac arrest.Is an unexpected death due to cardiac condition 51
  52. 52. Etiology and PathophysiologyIn SCD there is an abrupt disruption in cardiac function, producing an abrupt loss of cardiac output and cerebral blood flow.Occurring in a short time period (generally within 1 h of symptom onset)CAD is most common cause of SCD. 52
  53. 53. Nursing and Collaborative Management Serial analysis of cardiac markers and ECGs must be obtain and the patient must be treated The most common approach to preventing a recurrent is the use of implantable cardioverter-difibrillator. The nurse should attuned to the specific needs of the patient and the family and teach them accordingly while providing emotional support. 53
  54. 54. References Medical Surgical Nursing Volume 1 (Seventh Edition) syndrome/DS01061/DSECTION=causes overview id=724 surgery 54
  55. 55.  se/a/medrx_angina.htm types.html Angiography.htm disease-coronary-artery-disease 55
  56. 56. Thanks You! 56