Presented By Mr. Akash N Bhagwat, Associate professor in MMNC, Yavatmal

3. INTRODUCTION &
DEFINITION
The most common heart disease in the
India is atherosclerosis, which is an
abnormal accumulation of lipid, or fatty
substances and fibrous tissue in the vessel
wall. These substances create blockages or
narrow the vessel in a way that reduces
blood flow to the myocardium.

4. CONTI….
Studies (Mr. Mehta 1998) indicate that
atherosclerosis involves a repetitious
inflammatory response resulting arterial
wall injury and an alteration in the
biophysical properties of the arterial walls.

5. INCIDENCE OF C.A.
In India, studies have reported increasing
coronary atherosclerosis and coronary artery
disease over the last 60 years from 1% to 10%
in urban population and 1% to 6% in rural
population.
The coronary artery disease is most common in
India, it also increased to 24 million cases in
2016 and 18% death occurs by the CAD.

6. RISK FACTORS OF C.A.
The risk factors are classified in to two parts first
is an modified risk factors and non-modified risk
factors.
The modified risk factors include the
Hyperlipidemia, cigarettes smoking and tobacco,
hypertension, diabetes, unhealthy and oily diet,
unhealthy life styles, obesity, and low physical
activities.

7. CONTI….
The non-modified risk factors include the
family history of CAD, increasing age
(more than 45 years in male and 55 in
female), gender ( men develop CAD at an
earlier age than women), Race ( higher
incidence of CAD in African and
American.

8. PATHOPHYSIOLOGY OF C.A.
The inflammatory response involved with the
development of atherosclerosis begins with
injury to Vascular Endothelium (The
endothelium is an thinnest membrane that inside
the heart & blood vessels) and progresses over
many years.
The injury may be initiated by the smoking,
hypertension, hyperlipidemia, and other risk
factors.
The endothelium undergoes biochemical
changes and stop producing normal

9. CONTI….
Some of the lipids is deposited on the arterial wall,
resulting formation of the fatty cells in artery.
The reason why some fatty cells continue to develop is
unknown, although genetic, environmental &
nutritional factors are involved.
The activated macrophages also release biochemical
substance that can further damage the endothelium by
contributing to the oxidation of LDL (low density
lipoprotein.)
The oxidized LDL is toxic to the endothelial cells
resulting the progression of the atherosclerotic process.

10. CONTI….
Oxidation of LDL & proliferation of the smooth
muscles resulting inflammatory infiltrate (Deposition of
fat), this deposition called as Atheromas or Plaques.
This atheromas and plaques protruded into the lumen of
the vessels resulting the narrowing and obstructing the
blood flow in coronary artery, and its called as coronary
atherosclerosis.
Due to excessive deposition of fatty cells resulting the
rupture of the plaques. A ruptured plaques attracts the
platelets causing the thrombus formation.

11. CONTI….
A thrombus may obstruct blood flow leading to
acute coronary syndrome, which may resulting
the myocardial infarction.

12. CLINICAL MANIFESTATION
CAD produces symptoms and complication according
to the location and narrowing of the artery, thrombus
formation and obstruction of blood flow to
myocardium.
The impediment (Insufficient) to blood flow is usually
progressive, causing inadequate blood supply to the
cardiac muscles. This condition is known as
“Myocardial ischemia.”
The most common manifestation of myocardial
ischemia is the often of chest pain. Patient with
myocardial ischemia may admitted to an emergency
department with variety of symptoms other than chest

13. CONTI....
The patient complaint of epigastric distress and
pain in the jaw & left arm. patient who are older
or have a history of diabetes or heart failure may
reported shortness of breath. Many women have
been found to have atypical symptoms including
indigestion, nausea, palpitation and numbness
on the left arm.
The Prodromal symptoms may occur. (Angina a
few hours in a day).

14. DIAGNOSTIC EVALUATION
The complete family history of the cardiac
diseases including the heart failure, CAD and
atherosclerosis.
Complete physical examination of patient
including heart sound, heart rhythm, heart beats,
cardiac output and blood pressure.
A 12 leads electrocardiogram to evaluation
indicative ischemia, T-wave, ST-segment and
development of abnormal Q-wave.

15. CONTI....
The laboratory studies are performed; these
generally including the cholesterol & LDL level
in blood. The normal level of cholesterol in
blood less than 200 milligram per decilitre. The
LDL level in blood is less than 100 mg per dl.
The angiography is performed to evaluate the
blockage of coronary artery.

16. PREVENTIVE MANAGEMENT OF C.A.
 Controlling cholesterol abnormalities:
The association of a high blood cholesterol level
with heart diseases is well established, and the
metabolism of fats is known to be an important
contributor to the development of heart diseases.
Controlling the cholesterol level in blood is
reduce the risk of the coronary and heart diseases

17. CONTI….
The American college of cardiology and American
heart Association(ACC & AHA) have been developed
the clinical practice guidelines on the treatment of
blood cholesterol to reduce the risk of cardiovascular
diseases in adults.
These guidelines address primary prevention and
secondary prevention. All the 20 years and older
should have a fasting lipids profile (total cholesterol,
HDL, LDL, triglycerides level) performed at least
once every 5 years.

18. CONTI….
 A patient who had an acute event of
Percutaneous coronary intervention(PCI) or
coronary artery bypass grafting requires
assessment of their LDL levels may be
immediately after acute event or procedure.
Subsequently, lipids should be monitored every
6 weeks until the desire level is achieved.

19. CONTI….
Dietary measures
Provide the recommendation of the therapeutic lifestyle
changes diet. The diet include low saturated fat and high
in soluble fibers.
Another diet recommended that promotes vegetables and
fish and restrict red meat.
The peoples who adopt strict vegetarian diets can
significantly reduce the blood lipids, blood glucose, body
mass index and blood pressure.
Nutrients contents of therapeutic lifestyle change diet
following are:

20. CONTI….
SR NO. NUTRIENTS RECOMMENDED DIET
1 Total calories Balance intake and expenditure to maintain
desirable weight.
2 Total fat 25 to 35 % of total calories
3 Saturated fat <7 % of calories
4 Polyunsaturated fat Up to 10% of total calories
5 Monounsaturated fat Up to 20% of total calories
6 Carbohydrates 50 to 60 % of total calories
7 Dietary fibers 20 to 30 g per day
8 Protein Approximately 15 % of total calories
9 Cholesterol <200 mg per day

21. CONTI….
Increasing the physical activity:
The management of elevated triglyceride and LDL
level focus on the weight reduction and increased
physical activity. Regular, moderate physical activity
increased the HDL level and reduces the triglyceride
level which is decreasing the risk of coronary and
cardiac diseases with mortality rate.
The cardiologist recommended the Aerobic physical
exercises at least 150 minutes per week or Vigorous-
intensity aerobic physical exercises at least 75 minutes
per weeks.

22. CONTI….
The Aerobic physical exercises is a form of the
physical exercise that combines with rhythm and
exercise including the stretching and strength
training.
Vigorous-intensity aerobic physical exercises is
form of the hardest physical exercise which is focus
on increasing the breathing rate and heart rate has
gone up to quite a bite (examples: cardio exercise
including Jogging and running, swimming laps,
climbing hills, playing single tennis and playing
basketball and football.)

23. CONTI….
MEDICATION
If the diet and exercise cannot normalized serum
cholesterol and LDL level, then medication can a
synergistic (Additional) effect with the prescribed diet
and control cholesterol level. Lipid lowering
medication can reduce the CAD mortality.
The various types of lipid-lowering agents affect the
lipid components somewhat differently; these type
include 3-hydroxy-3-methylglutaryl coenzyme
A (HMG-CoA) such as Atorvastatin and Simvastatin.

24. CONTI….
Fibric acid inhibitors such as Fenofibrate and
Gemfibrozil.
Bile acid sequestrants such as Cholestyramine and
Colestipol.
Cholesterol Absorption inhibitors such as Ezetimibe
Omega-3-Acid Ethyl Esters such as fish oil capsules.
(Note : The therapeutic effects and nursing
consideration of above drugs is including the
pharmacologic studies)

25. SURGICAL MANAGEMENT OF C.A.
Balloon Angioplasty:
If the patient have coronary artery diseases, the arteries
in your heart are narrowed or blocked by a plaque. The
balloon angioplasty is a surgical procedure to restore
the blood flow in coronary artery.
Patient have balloon angioplasty in a hospital. The
cardiologist inserting the thin tube through the blood
vessel in your arm groin up to involved site in coronary
artery. The tube has a tiny balloon on the end. When the
tube is placed, the doctor inflamed the balloon to push
the plaque outward against the wall of artery.

27. The Evidence Based Nursing Diagnosis is totally
based on the assessment of patient data and clinical
manifestations:
Decrease cardiac output related to insufficient blood
flow in coronary artery as evidenced by fatigue,
chest pain, and inability to do ADLs as normal.
Acute chest pain related to obstruction in coronary
blood flow as evidenced by pain scale and USG
analysis.
Activity intolerance related to acute chest pain and
weakness as evidenced by inability to do ADLs as
normal.

28. CONTI….
Hyperthermia related to infection as evidenced
by TPR monitoring.
Fear and anxiety related to hospitalization as
evidenced by anxiety scale.