Coronary Artery Disease presentation

TOPIC
ON
“Coronary artery Disease ”
Presented By:
Mr. Manjunath. M. Beth.
M. Sc. (N)
ASSO-PROFESSOR
H.O.D OF Med-Sur-Nsg
MBNC

•CAD is also known as
CHD = Coronary Heart Disease
ASHD = Arterio Scleratic Heart disease
CVHD = Cardio- Vascular Heart disease
IHD = Ischemic Heart Disease
• It is the No. 1 killer disease in worldwide, affecting more
peoples. So it is one of the leading cause for death.
• Heart disease is a result of plaque buildup in the arteries,
which blocks blood flow and heightens the risk for heart
attack and stroke.
• 50% of all cardiac deaths result from CAD.
INTRODUCTION
Presented By : Mr. Manjunath. M. Beth (Asso-pr) Dept: Med-Sur-Nsg

• The major disorders that result from insufficient
blood supply to the myocardium are
Angina pectoris
CHF {Congestive Heart Failure}
MI {Myocardial Infraction}
• It is a type of blood vessel disorder that is included
in the general category of “arthrosclerosis”.
Arthero = “fatty flush”
sclerosis = “Hard”
Arthrosclerosis = Hardening of Arteries
Presented By : Mr. Manjunath. M. Beth (Lecturer) Dept: Med-Sur-Nsg

DEFINITION
• “CAD is a narrowing of the small blood vessels
that supply blood and oxygen to the heart”.
OR
“CAD is the result of the accumulation of atheromatous
plaques [this plaque is made up of fat,
cholesterol etc.] within the walls of the coronary arteries that
supply the myocardium (the muscle of theheart) with oxygen
and nutrients”.

• “CAD occurs when the coronary arteries that
supply the heart muscle become blocked”
OR

Coronary Heart Disease
• Plaque
The build-up of lipid/cholesterol in the artery
wall forms as a response to injury to the
endothelium in the artery wall.

Affected sites of Arteries
• Cerebral Arteries
• Carotid Arteries
• Aorta
• Coronary Arteries
• Renal Arteries
• Iliac Arteries
• Femoral Arteries
• Tibial Arteries

Partially Blocked
TYPES
Angina Pectoris
Heart attack /
myocardial Infraction
Fully Blocked
OR OR

Risk Factors for Coronary Artery
Disease
•Non-modifiable1
•Modifiable2

Non-Modifiable Risk Factors
 Family History
– Twice the risk of MI if one first-degree relative with MI
– Triple the risk of MI if 2+ first-degree relatives with MI
– Risk is strongest if MI occurred at age 55 or less
 Advancing Age
– Risk of CAD Increases as we get older
 Gender
– Men are at risk at an earlier age than women
– Women’s risk of heart disease increases after menopause
and soon equals men’s

 Race: Negroes
 Genes: close relatives or parents

Modifiable Risk Factors
 Tobacco Smoking
 Dyslipidemia
 Hypertension
 Obesity
 Sedentary Lifestyle
 Diabetes
 Emerging Risk Factors

Abnormal Blood Lipids
• Increased LDL Cholesterol
(low density lipoprotein)
• Decreased HDL Cholesterol
(high density lipoprotein)
• Goal:
– The goal is a LDL-C level of 100 mg/dL
Cholesterol and the CHD Patient

Blood Lipids and Lipoproteins
• HDL-C IS INCREASED:
– Exercise
– loss of weight and
– moderate consumption of ETOH.
• HDL-C IS LOWERED:
– Obesity
– Inactivity
– cigarette smoking
– some oral contraceptives
– Steroids
– Hyper tri-glyceridemia &
– some genetic factors.

Dyslipidemia
 2 main types of lipids:
– Cholesterol
– Triglycerides (TGs)
 Lipids are an essential component of healthy body functioning,
including:
– Structural component of cell walls
– Hormones
– Energy source
 Much research to support the link between abnormal serum lipid
levels and CAD
 LDL =  risk of CAD
 HDL =  risk of CAD
 TGs =  risk of CAD

SL.NO Blood Lipid Classification
1 Cholesterol:
<200 mg/dl
200-239 mg/dl
>240 mg/dl
Desirable
Borderline high-risk
High-risk
2 HDL Cholesterol
<40 mg/dl
>60 mgl/dl
Low
High, negates one risk factor
3 LDL Cholesterol
<100 mg/dl
100 – 129 mg/dl
130-159 mg/dL
>160 mg/dl
Desirable
Above optimal
Borderline High
High Risk

ETIOLOGY
• Hardening of the arteries / Atherosclerosis
• Hereditary
• Sex
• Age & Race
• Smoking
• Obesity
• Diabetes
• Stress
• Alcoholism
• Emotions
• Diet

DUE TO ETIOLOGICAL FACTORS
Inside the coronary artery develops a atherosclerosis over smooth & elastic
lining
TYPE I : Intimal thickening (adaptive thickening of smooth muscles )
TYPE II : Formation of lesion due to production of Macrophage foam cells
TYPE III : Pre-Atheroma formation due to adhesions of small pools of
extracellular lipids
TYPE IV : Atheroma formed by core of extracellular lipids
TYPE V : Multiple lipid core with fibrotic layer forms a fibro-Atheroma
TYPE VI : formation of complicated lesions like thrombus formation, fissuring
of artery & hematoma
Greater degree of occlusion
CORONARYARTERY DISEASE

Progression of Atherosclerosis
Intima
Media
Core of
extracellular
lipid
Fibrous
thickening
Thrombus
fissure &
hemtoma
Type VI
(Complicated lesion)
Type V
(Fibroatheroma)
Type IV
(Atheroma)
Type III (Preatheroma)Type II (Lesion)
Coronary artery at
lesion-prone location
Small pools of
extracellular
lipid
Macrophage
foam cells
Adaptive
thickening
(smooth muscle)
Adapted from Stary in Fuster et al (eds). Atherosclerosis and Coronary Artery Disease 1996.Presented By : Mr. Manjunath. M. Beth (Lecturer) Dept: Med-Sur-Nsg

SIGNS & SYMPTOMS
• Angina pectoris or chest pain.
• Shortness of breath
• Palpitations (irregular heart beats, skipped beats, or a "flip-
flop" feeling in your chest)
• Weakness
• dizziness
• Nausea & vomiting
• Sweating
• Dyspnea, Sudden heart attack/death, pulmonary edema,
chronic coronary ischemia
• Discomfort, spasm of arteries

VIDEO

Diagnostic evaluation
• Performing a physical exam.
• Performing diagnostic tests, including an
electrocardiogram (ECG or EKG),
• CT scans
• Exercise stress test
• Nuclear stress test
• MRA (magnetic resonance angiography)
• Lipid profile
• Uric acid
• Cardiac enzymes
• TMT (trade mill test)

• Echocardiogram stress test
• Electron-beam computed tomography (EBCT) to
look for calcium in the lining of the arteries -- the
more calcium, the higher your chance for CHD.
• CT ANGIOGRAPHY
• Electron beam computed tomography (EBCT)

COMPLICATIONS
Atherosclerosis can cause disease in many parts of
the body
• Cerebral Stroke
• Aneurysm
• Angina pectoris
• MI
• Hypertension
• Peripheral vascular
Disease

MEDICAL MANAGEMENT
• If patient having angina/chest pain and have been
prescribed nitroglycerin, call your doctor or have someone
take you to the nearest emergency room if pain persists
after taking two doses (taken at five-minute intervals) or
after 15 minutes.
• Emergency personnel may tell you to chew an aspirin to
help break up a possible blood clot, if there is not a
medical reason for you to avoid aspirin.
• Other medications like
• Nitrates,
• calcium channel antagonists,
• ACE-inhibitors
• Statins

• imipramine (for analgesia),
• aminophylline,
• Hormone replacement therapy (estrogen)
• Anti-platelet therapy
• Recent research efforts focus on new angiogenic treatment
modalities (angiogenesis) and various (adult) stem
cell therapies.

Treatment in CHD Patients
LDL-C Levels Diet & Life
Habits
Drug Therapy
<100 mg/dL Yes No
100-129 mg/dL Yes Clinical Judgment
>130 mg/dL Yes Yes

SURGICAL TRETMENT
• Coronary angiography -- an invasive test that evaluates the
heart arteries under x-ray
• cardiac catheterization
• Angioplasty and stent placement, called percutaneous
coronary interventions (PCIs)
• Coronary artery bypass surgery
• Minimally invasive heart surgery
• Intravascular ultrasound
• Angiogenesis.
[This involves giving substances, such as stem cells and other genetic material,
through the vein or directly into damaged heart tissue to trigger the growth of
new blood vessels to bypass the clogged ones]

• EECP (Enhanced External Counter pulsation)
 Patients who have chronic angina but are not helped by
nitrate medications or who do not qualify for various
surgeries and procedures may find relief with EECP.
 The EECP is a outpatient procedure
 EECP it involves using treatment cuffs placed on the
legs that inflate and deflate, increasing the blood
supply that feeds coronary arteries.

NURSING MANGEMENT
Teach about
• How to Make lifestyle changes
• Taking medications
• Consult cardiologist for regular checkups.
• Reduce risk factors.
• Avoid high-cholesterol foods and adopt a low-fat, low-salt
diet.
• Keep blood sugar in control if patient having diabetes.
• Exercise more to maintain a healthy weight but according
to physician order.

– Weight Loss
– Increased physical activity
– Smoking cessation
– Management of Diabetes
– Restricted alcohol use
– Advice to take α-Omega-3 Fatty Acids
[which Helps to thin blood and prevent blood platelets
from clotting and sticking to artery walls]

Expectations (prognosis)
• Everyone recovers differently.
• Some people can maintain a healthy life by
changing their diet, stopping smoking, and taking
medications exactly as the doctor prescribes.
• Others may need medical procedures such as
angioplasty or surgery.
• Although everyone is different, early detection of
CHD generally results in a better outcome.

Coronary Artery Disease presentation

Coronary Artery Disease presentation

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