Coronary Artery Disease Presented 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.

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

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.

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

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

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!

I have chest pain!

CHF Inability of the heart to do its job

Inability of the heart to do its job

Myocardial Infarction

Death It’s my time!

It’s my time!

Signs & Symptoms Findings may be normal during asymptomatic periods Chest pain - due to lack of oxygen Palpitations Dyspnea Syncope Cough of hemoptysis Excessive fatigue

Findings may be normal during asymptomatic periods

Chest pain - due to lack of oxygen

Palpitations

Dyspnea

Syncope

Cough of hemoptysis

Excessive 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%

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 ECG a. 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.

ECG

a. 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 Catheterization Provide the most definitive source for diagnosis Would show the presence of atherosclerotic lesions Blood lipid levels Blood lipid levels may be elevated Cholesterol-lowering medications may be prescribed to reduce the development of atherosclerotic plaques

Cardiac Catheterization

Provide the most definitive source for diagnosis

Would show the presence of atherosclerotic lesions

Blood lipid levels

Blood lipid levels may be elevated

Cholesterol-lowering medications may be prescribed to reduce the development of atherosclerotic plaques

Treatment The goal of treatment is to alter the atherosclerotic progression

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

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

Low-fat, low-cholesterol

Drug Therapy Antilipemics - cholestyramine, clofibrate, gemfibrizil, lovastatin Nitrates Calcium Channel Blocker Beta-blockers

Antilipemics - cholestyramine, clofibrate, gemfibrizil, lovastatin

Nitrates

Calcium Channel Blocker

Beta-blockers

Surgical Procedures Percutaneous Transluminal Coronary Angioplasty

Percutaneous Transluminal Coronary Angioplasty

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

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).

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

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.

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.

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.

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