This is a topic from cardiovascular system which includes definition, risk factors, pathophysiology, clinical menifestation, diagnostic evaluation and management

1. DEPARTMENT OF
MEDICAL SURGICAL
NURSING
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2. At the end of this lecture the students should be able
to:-----
1. Define CAD.
2. Enumerate the risk factors of CAD.
3. Describe the pathophysiology of CAD.
4. Enlist the clinical manifestations of CAD.
5. Enumerate diagnostic evaluation of CAD.
6. Explain the management of CAD.
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Learning Objectives

3. DEFINITION
Coronary atherosclerosis is characterized by
abnormal accumulation of lipid or fatty
substances & fibrous tissues in the vessel
walls. These substances block or narrow the
blood vessels, reducing blood flow to the
myocardium & resulting in coronary artery
disease.
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4. RISK FACTORS
MODIFIABLE FACTORS:---
1. Cigarette smoking.
2. Elevated lipid level in blood.
3. Elevated blood pressure.
4. Hyperglycemia.
5. Obesity.
6. Physical inactivity.
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5. Ct--RISK FACTORS
7. Use of oral contraceptives.
8. Infection (gingivitis).
9. Behavior pattern (stress, aggressiveness,
hostility).
10.Geography. (Higher incidence in
industrialized regions).
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6. Ct--RISK FACTORS
NON MODIFIABLE FACTORS: ----
1. Positive family history.
2. Age, (35 – 55years).
3. Gender, (more common in men).
4. Race, (African Americans).
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7. PATHOPHYSIOLOGY
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1) Accumulation of fat deposit on intimal layer of blood
vessel.
2) Inflammatory process.
3) Fiber tissue Formation
4) occlusion of blood vessels
5) Decreased blood supply to myocardium.

8. Ct--PATHOPHYSIOLOGY
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6) ischemia.
7) Necrosis of myocardial muscles.
C.A.D.

9. CLINICAL MANIFESTATIONS
1. Chest pain.
2. Weakness or numbness in arms, wrist &
hands.
3. Dyspneoa.
4. Diaphoresis.
5. Fatigue.
6. Palpitation
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10. Ct--CLINICAL MANIFESTATIONS
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7. Nausea & vomiting.
8. ECG changes.
9. Ventricular aneurysms.
10.Dysrhythmias, sudden death.
11.Hyperlipidemia.

11. DIAGNOSTIC EVALUATION
1. History taking.
2. Physical examination.
3. Blood investigations.
4. Urine analysis.
5. Chest X-ray.
6. E.C.G.
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12. Ct--DIAGNOSTIC EVALUATION
7. 2D – ECHO.
8. Angiography.
9. Tread mill test (TMT).
10.Positron Emission Tomography, (P.E.T.).
11.Nuclear Imaging Studies.
12.C.T.-Scan.
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13. MEDICAL:
1. To control cholesterol level.
- Nicotinic acid.
- Fibric acid.
- Bile acid.
2. Anti hypertensive drugs, nitroglycerine, beta
adrenergic blockers, calcium channel blockers,
ACE inhibitors.
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MANAGEMENT

14. Ct--MANAGEMENT
4. Antiplatelet, e.g. aspirin, clopidugre.
5. Anticoagulants, (Heparin).
6. Sedative analgesics, (Morphine
sulphate – IV.)
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16. SURGICAL:
Coronary revascularization:
1. P.T.C.A. (Percutaneous Transluminal
Coronary Angioplasty).
2. C.A.B.G. (Coronary Artery Bypass Graft
Surgery).
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Ct--MANAGEMENT

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20. NURSING:
Assessment.
Nursing diagnosis:
1. Acute pain related to hypoxia due to coronary
artery obstruction.
2. Ineffective tissue perfusion (cardiac) related
to cardiac injury.
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Ct--MANAGEMENT

21. 3. Anxiety related to disease condition.
4. Activity intolerance related to fatigue
secondary to decreased cardiac output.
5. Ineffective therapeutic regimen
management related to lack of knowledge
of disease process.
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Ct-- Nursing diagnosis

22. Summary
1. Definition of CAD.
2. Risk factors of CAD.
3. Pathophysiology of CAD.
4. Clinical manifestations of CAD.
5. Diagnostic evaluation of CAD.
6. Management of CAD-
– Medical
– Surgical
– nursing 22

23. BIBLIOGRAPHY
• Lewis, S.M., Dirkse, S.R., Heitkemper, M.M., &
Bucher, L. (2010). Medical-Surgical Nursing:
Assessment and Management of Clinical
Problems (7th ed.). St. Louis: Mosby.
• Black, J.M. & Hawks, J.H. (2009). Medical-Surgical
Nursing: Clinical Management for Positive
Outcomes (8th ed.). Philadelphia:
Elsevier/Saunders.
• Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever,
K.H. (2010). Brunner & Suddarth’s Textbook of
Medical-Surgical Nursing (12th ed.). Philadelphia:
Lippincott Williams & Wilkins
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