Coronary atherosclerosis /CAD is characterized by accumulation of fatty deposits along the inner most layer of the coronary arteries. The topic coronary atherosclerosis is summarized by introduction, definition, etiology, risk factors, clinical manifestation, pathophysiology, diagnostic evaluation, complications, preventions, management, nursing diagnosis.

2. PRESENTED BY:-
JITENDRA KUMAR DAS
MSC NURSIBG 1ST YEAR
COLLAGE OF NURSING,
VIMSAR, BURLA, SAMBALPUR

3.  The main function of heart is pumps blood through a
system of blood vessels, called the circulatory
system.
 There are three main types of blood vessels-
 Arteries- carry oxygen and nutrients with blood to
the body’s tissues.
 Veins-take oxygen poor or deoxygenated blood to
the heart from body’s tissues.
 Capillaries-these are thin and small blood vessels of
arteries and veins.
 The blood vessels connected to the heart are:- aorta,
superior vena cava, inferior vena cava, pulmonary
artery, pulmonary vein and the coronary arteries.

4.  Coronary
arteries:- these
are the arteries
which transports
blood into and
out of the cardiac
muscle and
provide oxygen,
nutrients to the
heart.
 There are left and
right coronary
arteries which
are originated
from aorta.

5.  Due to the abnormal
accumulation of the
lipid or fatty
substance in the
coronary arteries, the
blood flow to the
heart is reduced and
leads to heart disease
like coronary
atherosclerosis/coro
nary artery disease.
 Atherosclerosis:-is
an abnormal
accumulation of the
lipid or fatty
substances and
fibrous tissue in
vessel wall

6.  Arteriosclerosis:-is referred to as hardening of the
arteries.

7.  Coronary atherosclerosis /CAD is
characterized by accumulation of fatty
deposits along the inner most layer of the
coronary arteries.
 The enlarged lesion can cause a critical
narrowing of the coronary artery lumen,
resulting in a decrease in coronary blood
flow and an inadequate supply of
oxygen to the heart muscle.

8.  Damage, injury to the inner wall of coronary
artery and hardening of coronary artery by
accumulation of lipid or fatty substance.
 This damage or hardening of coronary artery
may be caused by various factors such as:-
 Smoking
 High blood pressure
 High cholesterol
 Diabetes
 Sedentary life style

9.  Modifiable risk factors:-
 High blood cholesterol level (hyper lipidemia)
 Cigarette smoking, tobacco use
 Hypertension
 Diabetes mellitus
 Physical inactivity
 Obesity
 stress
 Non modifiable risk factors:-
 Family history of coronary heart disease.
 Increasing age
 Gender

10.  Chest pain
 Inadequate cardiac out put
 Diaphoresis
 Palpitation
 Syncope
 Excessive fatigue
 Changes on the ecg
 Pain in the arm, neck, jaw
 Nausea
 Dysrhythmias
 Angina pectoris
 Myocardial infraction
 Congestive heart failure
 Sudden cardiac death

11. induced the early phase of coronary
atherosclerosis
Due to atherosclerosis the arteries lining becomes
hardened, stiffened and accumulates of calcium, fatty
lipids and abnormal inflammatory cells occurs
The smooth, elastic lining inside a coronary
artery develops atheriosclerosis
Due to etiological factors

12. consequently, a reduced blood flow results in a
more sever ischemia or infraction
when plaque blocks the normal flow of blood through a
coronary artery and the resulting ischemia is cronic, increased
collateral circulation develops
leads to plaque formation

14.  Electrocardiogram (ECG)
 Treadmill testing
 Nuclear perfusion imaging
 CT coronary angiography
 Echocardiogram
 Positron emission tomography
(PET)
 Bloods test

15.  Chest pain
 Irregular heart beat
 Limited blood flow to vital organs,
and hands and legs, thus affecting
the efficient functioning of the
different parts of the body.
 Heart attack
 Heart failure
 Sudden death

16.  Regular check up (blood test)
 Aim for healthy weight
 Avoid cigarette smoking
 Limit alcohol intake
 Eat smart avoid fat
 Exercise regularly
 Manage the stress level

17.  Medical management:-
 Non pharmacologic intervention:-
 Lifestyle modification
 Stop smoking and tobacco taking
 Daily and regular exercise
 A healthy diet lowing cholesterol, fat
and sugar and high fiber diet
 Weight control

18.  Pharmacological intervention:-
 Antiplatelets and anticoagulant:- ex-
aspirin and clopidogre, ticlopidine
and heparin
 Antiangianal agent:-ex- calcium
channel blocker, nitrates and B-
blocker
 lipid lowering drug:-ex- stafins and
clofibrate

19.  PTCA (Percutaneous transluminal coronary
angioplasty):-compress the plaque against the
wall of the artery and dilate the vessel.

20.  VASCULAR STENT:-prevent the artery from
closing and prevent restenosis.

21.  CABG(coronary artery bypass grafting):-
recommended for patient with left main coronary
artery disease, triple or two vessel disease.

22.  ATHERECTOMY:-removing
atherosclerosis from blood vessel.
 Surgical revascularization of affected
artery:- BY-
 EMBOLECTOMY-removal of blood
clots from artery.
 THROMECTOMY-removal of thrombus
from the artery.
 ENDARTERECTOMY-removal of
atherosclerotic plaque from the artery.

23.  Instruct the patient regarding the
purpose of diagnostic medical and
surgical procedures and the pre and post
procedure expectations.
 Assist the patient to identify risk factors
that can be modified and set goals that
will promote changes in life style to
reduce the impact of risk factor.
 Instruct the patient to follow a low
calorie, low sodium, low cholesterol, low
fat and high fiber diet.

24.  Keep nitroglycerin available for
immediate use.
 Monitor blood pressure and heart rate
during the episodes.
 Patient when posted for coronary
angiogram or surgery explain the
procedure to the patient and relatives.
 Stress the patient to follow prescribed
drug regimen and regular follow ups.

25. 1.Acute pain related to decreased myocardial blood
flow as evidenced by reports of pain and distraction
behaviors.
 Nursing intervention:-
 Assess reports of pain in jaw, neck, shoulder, arm or
hand.
 Place patient at complete bed rest.
 Elevate head of bed if patient is short breath.
 Monitor heart rate and blood pressure.
 Maintain calm and comfortable environment.
 Provide supplementary oxygen as indicated.
 Administered antianginal medication as indicated

26. 2.Decreased cardiac output, by the heart to meet
metabolic demands of the body related to
alterations in rate /rhythms as evidenced by
reduced heart rate.
 Nursing intervention:-
 Monitor vital signs and cardiac rhythm.
 Asucultate breath sounds and heart sounds
listen for murmur.
 Provide adequate rest period.
 Encourage immediate reporting of pain for
prompt administration of medications.
 Administer supplemental oxygen as needed.

27. 3.Anxiety related to situational crises as
evidenced by increased tension.
 Nursing intervention:-
 Let patient know these are normal
reactions.
 Tell patient the medical regimen has
been designed to limit future attack and
increase cardiac stability.
 Administer sedatives, tranquilizers as
indicated.

28. 4.Knowledge deficiency related to lack of
exposure as evidenced by asking
questions about his disease condition
and request for information.
 Nursing intervention:-
 Discuss the pathophysiology of
condition.
 Review significance of cholesterol level.
 Explain importance of weight control.
 Demonstrate how to monitor own pulse
and blood pressure.

30.  The topic coronary atherosclerosis is
summarized by introduction, definition,
etiology, risk factors, clinical
manifestation, pathophysiology,
diagnostic evaluation, complications,
preventions, management, nursing
diagnosis.

31.  What is CAD, describe the
management of coronary
atherosclerosis with nursing
care plan?

32.  Coronary atherosclerosis is a chronic
heart disease. Chronic atherosclerosis
can be prevented by life style
modification and home remedies by
eating healthy low fat diet. It is a
preventable and treatable condition.

33.  Brunner and Suddarth’s.(2016), Text book of medical
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Williums and wilkins, page no.
 Javed Ansari and Davinden kaur.(2011), Text book of
medical surgical nursing volume-ii; 1st edition: publish
by pee vee, page no. 427-430
 Lewis.Bucher, Heitkempeer, Harding, Kwong.(2017),
Roberts medical surgical nursing, assessment and
management of clinical problems; 3rd south asia edition:
publish by RELX India pvt.ltd , new delhi; page no. 657-
666