Coronary artery disease (CAD) is caused by the narrowing or blockage of coronary arteries, primarily due to atherosclerosis, which has seen increasing incidence in India. Risk factors include modifiable aspects like high cholesterol and smoking, as well as nonmodifiable factors such as age and family history. Management options range from lifestyle changes and pharmacological treatments to surgical interventions like angioplasty and bypass surgery.

1. CORONARY ARTERY DISEASE
PRESENTED BY
MR.ABHAY RAJPOOT
M.SC.NURSING FINAL YEAR

2. DEFINITION
Coronary artery disease is the narrowing or blockage of the coronary
arteries, usually caused by atherosclerosis.

3. INCIDENCE:
Cardiovascular diseases, especially coronary heart disease (CHD),
are epidemic in India. The Registrar General of India reported
that CHD led to 17% of total deaths and 26% of adult deaths in 2001-
2003, which increased to 23% of total and 32% of adult deaths in
2010-2013.

4. RISK FACTORS:
MODIFIABLE RISK FACTORS:
 Tobacco use
 High blood cholesterol or triglyceride levels
 Lack of exercise
 Obesity
 Stress
NONMODIFIABLE RISK FACTORS:
 Family history of heart disease
 Older age
 Diabetes
 High blood pressure

5. CAUSES
Development of atherosclerosis;
Coronary artery disease is thought to begin with damage or injury to
the inner layer of a coronary artery, sometimes as early as childhood.
The damage may be caused by various factors, including:
 Smoking
 High blood pressure
 High cholesterol
 Diabetes or insulin resistance
 Sedentary lifestyle

6. PATHOPHYSIOLOGY:

7. SYMPTOMS:
CARDIOVASCULAR-
 Angina pectoris
 Ischemia
 Low cardiac output-
 Bradycardia (Decrease pulse rate)
 Hypertension
 Myocardial infarction-
 Diaphoresis –excessive sweating
 ECG changes – ST segment and T wave changes, also show
tachycardia, bradcardia, or dysrhythimas.
 Dysarrithmias

8. Conti….
RESPIRATORY-
 Dyspnea-Shortness of breath.
 Pulmonary edema
 Chest heaviness
 Fatigue

9. Conti….
 Genitourinary-Decreased Urinary Output May Indicate Cardiogenic
Shock.
 Gastrointestinal- Nausea And Vomiting
 Skin- Cool, Clammy ,Diaphoretic , And Pale Appearance On Skin

10. DIAGNOSTIC EVALUATION
 Physical Examination
 History collection
 Stress test

11. Chest X-ray.

12. Electrocardiogram (ECG).

13. Echocardiogram

14. Cardiac catheterization (angiogram).

16. COMPLICATIONS:
 Chest pain (angina)
 Heart attack
 Heart failure
 Abnormal heart rhythm (arrhythmia)

17. PREVENTION:
 Quit smoking
 Control conditions such as high blood pressure, high cholesterol
and diabetes
 Stay physically active
 Eat a low-fat, low-salt diet that's rich in fruits, vegetables and
whole grains
 Maintain a healthy weight
 Reduce and manage stress

18. MEDICAL MANAGEMENT:
Various drugs can be used to treat coronary artery disease, including:
 Vasodilators (These drugs acts as blood vessel dilator):
• Nitrates
 Beta-Blockers (Decrease work load in heart):
• Propranolol 20-40 mg
 Calcium channel blocker (They improve coronary blood flow):
• Nifedipine
• Verapamil

19. CONTI….
 Anticoagulant Drugs:
 Heparin
 Opiate Analgesic (For reduce pain)
 Morphine sulphate
 Thrombolytic Drugs:
 Streptokinase,Urokinase

20. ANTIHYPERTENSIVE MEDICINES-
 Methydopa- This medication is used alone or with other medications
to treat high blood pressure (hypertension). Lowering high blood
pressure helps prevent strokes, heart attacks, and kidney problems.
Methyldopa works by relaxing blood vessels so blood can flow more
easily.
 Sodium nitroprusside- It is used for lowering the blood pressure.
 Amlodipine- Amlodipine is used with or without other medications
to treat high blood pressure. Lowering high blood pressure helps
prevent strokes, heart attacks, and kidney problems. Dose-10 mg,20
mg.

21. SURGICAL MANAGEMENT
 Angioplasty and stent placement (percutaneous coronary revascularization):

22. Coronary artery bypass surgery:

23. NURSING MANAGEMENT
 Instruct the client regarding the purpose of diagnostic medical &
surgical procedures and the pre- & post procedure expectations.
 Assist the client to identify risk factors that can be modified, and set
goals that will promote change in lifestyle to reduce the impact of risk
factors.
 Instruct client regarding a low-calorie, low-sodium, low-cholesterol,
low-fat diet with a increase in dietary fiber. Stress that dietary changes
are not temporary and must be maintained for life.
 Provide community resources to client regarding exercise, smoking
cessation and stress reduction.

24. NURSING DIAGNOSIS
 Impaired gas exchange related to decreased blood flow as evidenced by
breathlessness
 Acute pain related to disease condition as evidenced by patient
verbalization
 Impaired physical mobility related to weakness as evidenced by patient
is unable to perform daily activity.
 Imbalanced nutrition less than body requirement related to less intake of
food as evidenced by weight loss

25. RESEARCH STUDY
A new study has found that the heart’s small left ventricle with thick
walls, can be the strongest predictor of morphologic remodeling, which is
most likely to be considered a first step towards heart failure in patients
with ischemic heart disease. According to study coordinators Frank
Rademakers and Jan D’Hooge, the results of the DOPPLER-CIP
(Determining Optimal non-invasive Parameters for the Prediction of Left
ventricular morphologic and functional Remodeling in Chronic Ischemic
Patients).

26. Summary

27. CONCLUSION
Drug-eluting stents — a less-invasive alternative to bypass surgery — are as
effective as surgery for many patients with a blockage in the left main
coronary artery, a study has found. Coronary artery bypass graft (CABG)
surgery has long been considered the definitive treatment for patients with
left main coronary artery disease (LMCAD), in which the artery that supplies
oxygen-rich blood to most of the heart muscles is clogged with
atherosclerotic plaque. However, stents, which are placed into the diseased
artery via a catheter that is inserted through a small opening in a blood vessel
in the groin, arm, or neck, are a less-invasive treatment option for many
people with coronary artery disease.

28. Assignment
Difference BETWEEN angiography and angioplasty

29. BIBLIOGRAPHY:
 Black M. joyce, Hwks hokanson jane,medical surgical nursing.8th edition. volume 2.
New delhi ;Reed elsevier india private limited:2009.p1411-1426.
 Suddarth’s and brunner, Hinkle L.Janice, Cheever H.Kerry. text book of medical
surgical nursing.13th edition . volume 1.New delhi: wolters kluwer india Pvt ltd
;2014.p729-759.
 Chugh N S . text book of medical surgical nursing .volume 1.delhi;avichal publisher
company:2013.p303-310.
 https://www.webmd.com/heart-disease/guide/heart-disease-coronary-artery-disease#1
 http://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-
disease/coronary-artery-disease
 https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease
 https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease
 https://my.clevelandclinic.org/health/diseases/16898-coronary-artery-disease