CORONA-RY ARTERY DISEASE

1. PRESENTED BY
Monika Devi
M.S.c( N)
HCN, SRHU
Coronary Artery Disease

2. CORONARY ARTERY DISEASE
PLAGUE FORMATION

3. CORONARY ARTERY DISEASE
Definition
CAD refers to narrowing of the coronary artery The
blood vessels that supply oxygen and blood to the
heart it is also known as CAD.
 it is a major cause of illness and death.

4. CAUSES
Is a combination of genetic and lifestyle factors. These are
called risk factor.
NON modifiable causes.
Age
Gender more than 55 years.
Males and in female are more after menopause have
high risk of CAD.
Heredity.
Ethnicity :People of African or Asian are of high risk.

5. CONT…
Modifiable factor
Smoking
Diabetes
Excess body weight, especially around waist
High blood pressure
Abnormal blood cholestrol levels
Lack of regular exercise
Excessive stress level
Depression

6. Sign And Symptoms
 CAD usually have no symptoms for severals years
during its early stages, eventually the disease progresses
untill the symptoms of angina or heart attack occur.
These symptoms can be experience during activity or
rest.
 Chest pain, or a feeling of heaviness in the chest
 Pain in arm , neck or jaw

7. CONT…
 Shortness of breath
 Sweating
 Nausea
 Heart palpitations (irregular heart beat)
 Loss of consciousness
 In women early sign include :-
 fatigue
Sleep disturbance
SOB
Indigestion
Chest discomfort
anxiety

8. Diagnosis
 ECG :-Tto identify problem with heart rhythm or sign of a
heart attack.
 TMT (treadmill test):- To measure how will the heart
functions when challenged to work harder(during exercise)
then normal.
 Nuclear perfusion imaging :- To identify the area of the
heart that are receiving less blood.

9. CONT…
 Echocardiogram :- to determined volume of blood
pumped by heart
 CT coronary angiography:- to identify the blockage in
the arteries in the heart
 Cardiac catheterization :- to identify the blocked or
restricted arteries
 Blood test
 complete hemogram :- increase TLC count
suggestive of infection
 Cardiac marker :- tropinin I , CPK-MB

10. MANAGEMENT
Management
Includes medical procedure and medication, life style
modification , diet , and exercise regularly.
Medication Include
 Statins :-
lipid lowering agents decrease the cause of developing
cardiovascular disease
 Beta blockers:-
To reduce blood pressure and heart rate.

11. CONT…
 Nitroglycerine patches, sprays, tablets :-
To control chest pain by reducing the heart’s demand
for blood by widening the coronary arteries.
 Angiotensin- converting enzymes ACE inhibitors :-
To lower the blood pressure and help to slow or stop the
progression of CHD.

12. CONT..
 Calcium Channel Blockers :-
To widen the coronary arteries, allowing greater
blood flow to the heart and reduce hypertension.

13. Surgical management
Surgery can be open or replaced arteries it the blood
vessels become very narrow or if symptoms are not
responding to medications.
 Laser surgery :-
this involves making several tiny holes in the heart
muscles which encourage the formation of new blood
vessels

14. CONT..
 Coronary bypass surgery :-
The surgeon use a blood vessels from another part of the
body to create a graft that can bypass the blocked artery.
The graft may come from the leg or an inner chest wall
artery.

15. CONT…
 Angioplasty and stent placement :-
A catheter is inserted into the narrowed part of the artery.
A deflated ballon is passed through the catheter to The
affected area. When the ballon is inflated it compresses
the fatty deposits against the artery walls. A stent or mess
tube , may be left in the artery help to keep it open.

16. Nursing management
Nursing assessment
Heath history:
Assess for chest pain, focus on the location, severity, intensity,
duration and onset.
Precepitating factor: exercise stress and smoking.
Measure attempted to control pain for examples lying down,
eating and drinking , using of antacids.
Assess for other symptoms : in digestion , heartburn, nausea,
abdominal pain

17. CONT…
Physical examination
Assessing for the following
Posture indicating chest pain examples rubbing chest, leaning
forward.
Changes in vital sign
Dyspnea, crackles, dysrhythmias.
Level of conciousness
vommiting

18. Nursing diagnosis
1. Altered breathing pattern related to imbalance between
myocardial oxygen supply and demand as evidence by an
increase in respiratory rate.
Goal
The patient will have normal respirations.
Nursing intervention
 Assess the pattern and rhythm of breathing
 Check spo2 level
 Place the patient in semi fowler position
 Administer oxygen therapy
 Give medication as prescribed

19. CONT…
2. Chest pain related to inflammatory response of the
arteries as evidence by patient rubbing the chest.
Goal
To relieve pain
Intervention
 Place the patient in a position which he / she feeling
comfortable
 Administer prescribed analgesics

20. CONT…
3. Activity intolerance related to dyspnea as evidence by
inability to perform some activity of daily living.
Goal
patient will tolerate gradually with increasing levels of
activities
Interventions
 Promote, encourage and provide activities of daily
living.

21. Prevention
 Controlling blood cholesterol levels , reduce the risk
of CHD.
 Restricted alcohol intake
 Avoiding tobacco
 Being physically active
 Consuming health diet ( avoid fast food, food with
added preservatives)
 Limiting sugar and salt.

22. Complication of CAD
 Heart failure
 Dysarrthymia
 Pericarditis
 Cardiogenic shock
 Cardiomegaly

23. THANKS