This document provides an overview of the management of patients with coronary vascular disorders. It discusses the pathophysiology of atherosclerosis and risk factors for coronary artery disease. Types of angina, acute coronary syndrome, myocardial infarction, and diagnostic testing are described. Both non-invasive and invasive treatment options are covered, including lifestyle changes, medications, percutaneous coronary interventions like angioplasty and stenting, and coronary artery bypass graft surgery. Post-procedure complications are also mentioned.

1. Management of patient with
coronary vascular disorders
Mrs. Samia Almusalhi

2. objectives
1. Patho, ss assessment, diagnosis, risk
factor prevention medical and nursing
management
2. Athero, angina and MI and acute
coronary syndrome
3. Types of angina
4. Identify invasive coronary artery
procedure

3. Acute coronary syndrome
• Includes all heart disease.

4. atherosclerosis
• It is abnormal
Accumulation of fats or
lipids in the arterial of
blood vessels.

5. atherosclerosis
• Patho: fats deposits in intima
(inner layer of blood vessels), ----
monocytes (macrophages)
migrate to the site--- it release
substance that attracts platelets
and initiating clotting----- smooth
cells of blood vessels proliferate
and for fibrous cape called “
atherosclerosis” or “plaque”– it
narrows the blood vessels
causing less blood flow.

6. S&S
• Ischemia
• Angina (chest pain)
• MI

7. Risk factor
-Non modifiable:
• Family history
• Increased age
• Gender (male more)
• Race (more with african americans)
-Modifiable:
Hyperlipidemia, smoking, DM, obesity,
physical inactivity.

8. Prevention
1. Controlling cholesterol abnormalities:
checking lipid profile p 759,
• Dietary measures: high in vegetables and
fruits and less of meat, high fiber reduce
fiber diet,
• Physical activity: it reduce LDL
• Medication: as Atrovastatin and
simvastatin.

9. Cont’ prevention
2. Promoting cessation of tobacco: it affect
endothelium leads to thrombus formation
3. Managing HTN: elevated BP leads to
stiffness of blood vessels walls,
4. Controlling DM:

10. Coronary artery

11. Angina pectoris
• Pain or pressure in the anterior chest.
• Patho: when there is increased demand
of O2 by cardiac muscle to meet its
continous work----- and there is
obstruction because of atherosclerosis---
blood flow will be affected----- ischemia
result------- chest pain starts which is
called angina pertoris

12. Factors causing angina pain:
• Physical exertion
• Exposure to cold
• Eating heavy meals
• Stress
 unstable angina is not associated with
pervious factors (at rest even)

13. Angina pectoris
• S&S: severe chest pain
under the sternum impending
to death not relieved by rest
• Chest tightness
• Weakness and numbness in the arms
• Shortness with breathing
• Diaphoresis
• dizziness
• Stable angina relieved with rest or with
nitroglycerides.

14. diagnosis
• Ask the patient: site of pain, if it is
radiated, how is the pain, when did it
begin, how long it last, what helps to
release it, any other symptoms associated
with it.
• St wave inversion (ischemia)
• Cardiac biomakers testing (CK mb,
Troponin)
• Exercise or stress test (treadmill)

16. Medical management
1. Pharmacological therapy:
• Nitroglycerin: vasodilator
• Beta-adrenegic blocking agent
To reduce cardiac contractility
• Calcium channel blocking agent:
To slow HR, decrease strength
Of contraction

17. • Antiplatelet and anticoagulant medication:
Prevent platelet aggregation and thrombus
formation.
e.g: Aspirin and Heparin or Glycoprotien

18. 2.Oxygen Administration
• Start O2 even if saturation is highat the
onset of pain
• Monitor oxygen level
• Assess skin color, mucous membrane
(central and peripheral cyanosis)
• Folwler position

19. • Assess level of pain continuously
• Perform repeated ECG to assess ST
segment
• Measure vital signs every 15 minutes or
half hour with pain level

20. • Reduce patient anxiety
• Home care related to ( diet, avoid vigorous
exercise like stairs, stress management,
follow up appointment, balance rest with
activity, stop smoking, take sublingual
medication once they feel pain, keep it
with him or her all the time and not to stop
medication by themselves, ,,,,,,,

21. MI
• It myocardial ischemia
Result in death of tissues.
• It is called coronary
occlusion, heart attack but proffered to be
called MI.
• In MI there is complete occlusion of
coronary artery leading to imbalance
between demand and supply------ischemia
----infacrtio or tissue death occure.

22. MI (S&S(
• Severe chest pain
• Shortness of breathing
• Indigestion
• Nausea and anxiety
• Cool, pale skin

23. Diagnostic finding
• ECG

24. Diagnostic finding
• Cardiac biomarkers (cardiac enzyme( CK
Mb and myoglobin which not specific to
heart and Troponin
SGOT (serum glutamic oxaloacetic
transaminase( or aspertate
aminotransferase (AST)
• 2. Physical examination
• 3. Patient history: of pain and previous
attach and family history.
• 4. ECG changes

25. Treatment guideline for acute MI
• Chart 27-7 page 744:
Transfere to hospital, ECG, blood test,
Aspirine, IV heparine,
• MONA treatment
• Careful for side effect of morphin

26. Types of Angina:
• Stable angina: occurs on exertion and
relieved by rest
• Unstable angina: pre-infarction angina is
not relieved by rest, it increase in
frequency caused by spasm in coronary
• Varient angina (Prinzmetal’s(: pain at rest
with reversible st segment elevation
caused by coronary artery vasospasm
• Silent ischemia: no pain ECG changes
with stress test.

27. Invasive coronary artery procedure
1. Percutanious transluminal coronary
angioplasty (PTCA(:
Is balloon tipped catheter is used to open
blocked coronary artery and for blocked
CABAG. It compress the atheroma thus
improves blood
flow.

28. Coronary artery stent
• After PTCA the area may close off partially
or completely, and the intima of this place
has been injured and it might stimulate
inflammatory process leading to
vasoconstriction and clot formation so-----
stent is placed there. Figure 28-8

29. atherectomy
• Is removal of atheroma by cutting or
grinding by a catheter.
• It could be used with PTCA

30. brachytherapy
• Involves gamma or beta-radiation by
catheter to destroy atheroma.

31. Surgical procedure: coronary artery
revascularization
• It is called CABG
1.Traditional Coronary Artery Bypass Graft:
2.Alternative coronary artery bypass graft
technique:

32. Traditional Coronary Artery Bypass
Graft:
• The surgeon will do incision
sternum and connects patient
to cardiopulmonary bypass
(CPB), next the blood vessels
as saphenous vein is grafted
distal to the coronary artery
lesion (bypassing the
obstruction) then the incision
isclosed and patient is
admitted

33. Traditional Coronary Artery
Bypass Graft:

34. Alternative coronary artery bypass
graft technique
• It is Off Pump CABG involves median
sternotomy incision but without CPB
(cardiopulmonary bypass). Beta
adrenergic block used to slow HR, then
anastomosis of the bypass graft into the
coronary artery while the heart continues
to beat. p781

35. complication
• Bleeding, HTN, Hypovolemia,,,,,,,,,,,

36. Thank You