Definition, causes, clinical manifestation, pathophysiology and collaborative care

1. CORONARY ARTERY DISEASE (CAD)
Prepared by:
Mrs. Safoora Qureshi
Nursing Instructor
PIMS, Islamabad

2. Corronary Circulation
• Left Coronary artery
• Left Circumflex artery
• Left Anterior descending artery
• Left marginal artery
• Left diagonal artery
• Supply the left atrium, left ventricle
and interventricular septum
• Right coronary artery
• Right marginal artery
• Posterior interventricular artery
• Supply the right atrium, right ventricle
posterior wall of left ventricle,
intraventricular septum, AV node and
bundle of His

3. Coronary artery Diseases (ACD)
• CAD is a type of blood vessel disorder that is included in the
general category of atherosclerosis
• Atherosclerosis is derived from two Greek words;
• Athere, mean fatty mush
• skleros, mean hard
• CAD is caused by plaque buildup in the wall of the
Coronary arteries that supply blood to the heart
• Plaque buildup of cholesterol deposits

4. Pathophysiology
• Involves two mechanisms
1. Atherosclerosis
2. Collateral circulation
Atherosclerosis
• Is the narrowing and hardening of arteries by building up of plaque
 Developmental stages Atherosclerosis:
• Fatty streak; lipid-filled smooth muscle cell streak
• Fibrous plaque; progressive changes in the epithelial lining of artery
• Complicated lesion; instable plaque and embolization, may block blood
vessels

5. Atherosclerosis

6. Collateral Circulation:
• Some arterial connections, termed as collateral circulation
• The growth and extend of collateral circulation based on
1. Angiogenesis: Inherited predisposition to develop new blood vessels
2. Chronic ischemia: plaque occlude the normal flow of blood through
coronary arteries, leads chronic Ischemia
Slow onset of Ischemia
• increases the development of collateral circulation
• myocardium may still receive adequate amount of blood and oxygen
Rapid-onset of Ischemia
• CAD or coronary spasm, result inadequate development of collateral circulation,
• A diminished arterial flow results severe ischemia or infarction

7. Collateral Circulation

8. Atherosclerotic Artery

9. Risk factors
• Nonmodifiable risk factors:
• Age, sex, ethnicity, family history genetic predisposition
• Modifiable factors:
• Serum lipid; elevated level of triglycerides, and LDL, decreased HDL
• Hypertension; > 140/90mmHg
• Tobacco use
• Physical inactivity
• Obesity
• Contributing factors:
• Diabetes, psychological status, hypertention

10. Diagnosis
• History
• Physical Examination
• Electrocardiogram (ECG or EKG).
• Echocardiogram.
• Exercise stress test.
• Angiography
• Heart (cardiac) CT scan.
• show calcium deposits and blockages in the heart arteries

11. Medical Treatment
• Cholesterol lowering drugs. .
• include statins, niacin, fibrates and bile acid sequestrant
• Aspirin.
• prevent blood clots. Daily low-dose aspirin therapy ma prevent heart attack
• Beta blockers.
• Slow the heart rate
• Lower the blood pressure.
• Reduce the risk of future attacks
• Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II
receptor blockers (ARBs).
• These medicines lower blood pressure
• Nitroglycerin.
• Widens the heart arteries
• Relieve chest pain.

12. Surgical Treatment
• Involves
• Invasive procedure
• Open heart Surgery
Coronary angioplasty
• Stent placement
• PCI
Coronary bypass surgery:
• Is created by grafting a piece of a healthy vein from else where
in the body and attaching it above or blew the blocked are of a artery

13. • Angioplasty and stent placement • Coronary Bypass

14. Lifestyle and home remedies
• No smoke.
• Nicotine tightens blood vessels and forces the
• Control blood pressure
• Check your blood sugar.
• Manage cholesterol
• Avoid or limit alcohol.
• Get moving
• Eat heart-healthy foods
• Maintain a healthy weight
• Manage stress
• Get recommended vaccines
• Follow-up:

15. Remedies
• Fish and fish oil:
• are the most effective sources of omega-3 fatty acids.
• Fish oil supplements may offer benefit evidence is
• Other oils:
• Alpha-linolenic acid (ALA) can also be found in canola oil, soybeans
and soybean oil.
• Fibers:
• Barley
• Oats
• Garlic
• Salads
• Leafy vegetables

16. Nursing Management
• Nursing Diagnosis
• In effective tissue perfusion related to decreased blood flow as evidence by
rest pain, diminished or absent peripheral pulse, pallor
• Risk for impaired skin integrity related to decreased peripheral circulation
• Activity intolerance related to imbalance b/w oxygen supply and demand

17. Interventions Rationales
Circulatory care
• Observe for peripheral
circulatory status
• Monitor degree of discomfort,
pain while resting
• Provide warmth
• Encourage mobility /exercise
• Check peripheral pulse, edema,
capillary refill, color, temp,
• Indicators of worsen peripheral
circulation
• To promote vasodilation and
increase circulation
• To enhance utilization of oxygen
in tissue and decrease ischemic
pain

18. continue
• Ensure adequate intake of
nutrients and fluid
• Prevent the factors such as
smoking, restricted clothing,
exposure to cold, and crossing of
legs and feet
• Administer antiplatelets and
anticoagulant medication as per
order
• Check and record oxygen
saturation of affected area
• To promote skin integrity
• To prevent interference with
peripheral circulation and
decreased ischemic pain
• To promote circulation and pain
free walk
• To correct tissue hypoxia earliear

19. Conti---
Circulatory precautions:
• Protection from injury of affected
area
Skin Care:
• Apply skin lotions to affected areas
• Maintain adequate hydration
Promote exercise
• Instruct about
• desired frequency, duration and
intensity of exercise program
• proper warm-up and cool-down
• Assist individual to develop an
appropriate exercise program
• To promote circulation, skin integrity
and healing process
• To keep the skin moist/ avoid cracking
• To prevent skin damage
• To promote tissue perfusion, and body
tolerance for activities
• To prevent injury
• To meat need and prevent injury