Coronary artery disease

1. REGENCY INSTITUTE OF NURSING
TOPIC- CORONARY ARTERY DISEASE
BY- SHREYA YADAV
NURSING TUTOR
MEDICAL SURGICAL
NURSING

2. DEFINITION
 Coronary artery disease is the narrowing or blockage of the
coronary arteries, usually caused by atherosclerosis.
 CAD is a progressive disease process characterized by
narrowing or blockage of coronary artery resulting in
decreased blood flow to the heart muscle.

3. RISK FACTOR
MODIFIABLE RISK FACTORS:
 Tobacco use
 High blood cholesterol or triglyceride levels
 Lack of exercise
 Obesity
 Stress
 Use of oral contraceptive
 Infection
 Hypertension
NONMODIFIABLE RISK FACTORS:
 Family history of heart disease
 Age (45-55)

4.  Gender
CLINICAL MANIFESTATION:
 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

5.  Decreased urine output.
 Nausea And Vomiting
 Skin- Cool, Clammy ,Diaphoretic , And Pale Appearance
On Skin.
DIAGNOSTIC EVALUATION:
History collection
Physical examination
Stress test

6. Chest x ray

7. ECG

8. Echocardiogram

9. Cardiac Catheterization

10. MANAGEMENT
MEDICAL MANAGEMENT
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

11. Anti-hypertensive drugs
 Methyldopa, Sodium nitroprusside, Amlodipine.
ACE inhibitor
 Captopril, Enolapril
SURGICAL MANAGEMENT
• Percutaneous transluminal coronary angioplasty(PTCA).
• Coronary artery bypass graft surgery(DCA).
• Intra coronary stent.
NURSING MANAGEMENT
• Assess pain
• Assess vital sign
• Ensure bed rest
• Continuous cardiac monitoring

12. Angina Pectoris
Angina pectoris is a sudden attacks of chest pain or
discomfort caused by deficient oxygenation of the heart
muscles usually due to impaired blood flow to the heart

14. Modifiable risk factor:
 Tobacco use
 High blood cholesterol or triglyceride levels
 Lack of exercise
 Obesity
 Stress
NON MODIFIABLE RISK FACTORS:
 Family history of heart disease
 Age
 Gender

15. CLINICAL MANIFESTATION:
Sensation of chest pain.
Ischemia- Ischemia is a restriction in blood supply to
tissues, causing a shortage of oxygen that is needed for
cellular.
Low cardiac output
Decrease pulse rate.
BP may be elevated because of sympathetic stimulation or
decreased BP because of decreased contractility.
Myocardial infarction
Diaphoresis –excessive sweating
ECG changes – ST segment and T wave changes

16.  Pulmonary edema
 Chest heaviness
 Dyspnea- difficulity of breathing
 Fatigue
 Gastrointestinal- Nausea And Vomiting
 Skin- Cool, Clammy ,Diaphoretic , And Pale Appearance On
Skin
DIAGNOSTIC EVALUATION:
• History collection
• Stress test
• Electrocardiogram(ECG)
• Echocardiogram
• Angiogram

17. MANAGEMENT
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

18. Atheriosclerosis
Atherosclerosis is the most
common disease of the
arteries; the term means
“hardening of the arteries. It
is the diffuse process
whereby the muscle fibers
and the endothelial lining of
the walls of small arteries
and arterioles become
thickened.

19. Risk Factor-
 High blood pressure
 High cholesterol
 High triglycerides, a type of fat (lipid) in your blood
 Smoking and other sources of tobacco
 Insulin resistance, obesity or diabetes
 A family history of early heart disease
 Lack of exercise

20. CLINICAL MANIFESTATION-
 Pain is the first symptom that occurs
 Pain generally occurs in the affected extremity in conjunction
w/sustained activity. This is due to the demand of the tissue
exceeding the available blood supply.
 Heart failure
 Increased cardiac enzyme level
 Sudden cardiac death
 Dyspnea
 Inadequate cardiac output
 Ischemia of heart muscles
 Difficulty in speaking
 Arrythmias
 Palpitation
 Diaphoresis
 Myocardial infraction

21.  Diagnostic Evaluation-
 History collection – The family history, nutritional
history and personal history should be collected from
the patient.
 Physical examination
 Blood studies
 Electrocardiogram (ECG)
 Angiogram
 CT-Scan

22. MANAGEMENT-
Pharmacological management-
 Anti-platelet medications. Such as aspirin(75-100mg,orally).
 Beta blocker medications Eg: propanolol (20-40 mg).
 Angiotensin-converting enzyme (ACE) inhibitors.. Eg:
captopril(25 mg orally) ramipril(20mg orally).
 Calcium channel blockers. Eg: verapamil amlodipin (5-20 mg
IV).
Surgical Management:
 Coronary Artery Bypass Surgery. (CABG)
 Thrombectomy
 Embolectomy

23. MYOCARDIAL INFRACTION
Myocardial Infarction is defined as a disease caused by
reduced blood flow in a coronary artery due to
atherosclerosis & occlusion of an artery an embolus or
thrombus.

24. Types of Myocardial infarction-
According to wall-
 Anterior wall MI- obstruction of left anterior descending
artery (LAD) results in anterior or septal wall MI
 Posterior wall MI – Obstruction of circumflex artery
results in posterior wall MI.
 Inferior wall MI- obstruction of the right coronary artery
results in inferior wall MI.
According to ECG
 ST-Elevated Myocardial infarction
 Non- ST Elevated Myocardial Infarction

25. RISK FACTORS
Non- Modifiable Risk Factors:
 Age(45-55)
 Gender
 Sex (Male)
 Genetics
Modifiable Risk Factors:
 Tobacco use
 High blood cholesterol or triglyceride levels
 Lack of exercise
 Obesity
 Stress
 Use of oral contraceptive
 Infection
 Hypertension

26. CLINICAL MANIFESTATION
 Chest pain characterized by
 heavy, vise like pain which radiates to shoulders and down the arms, usually the
left arms
 occur during rest and during exertion
 not relieved by rest long lasts longer than 30 min.
 No relief with nitrites
 Shortness of breath
 Pallor
 Cold clammy skin
 Diaphoresis
 Dizziness
 Light headedness
 Nausea
 Vomiting
 Fainting
 Shock
 Profuse sweating
 Fever after 48 hour of MI
 Pulse normal often rapid or irregular
 Anxiety

27. DIAGNOSTIC EVALUATION
 History collection
 Physical examination
 Electrocardiogram
 Echocardiogram
 Cardiac marker-
 Myoglobin-The myoglobin level starts to increase within 1 to 3 hours
and peaks within 12 hours after the onset of symptoms.
 Troponin- Troponin I and T are specific for cardiac muscle, an increase
in the level of troponin in the serum can be detected within a few hours
during acute MI.
 Creatine Kinase and Its Isoenzymes-There are three creatine kinase
(CK) isoenzymes: CK-MM (skeletal muscle), CK-MB (heart muscle),
and CK-BB (brain tissue).

28. MANAGEMENT-
MEDICAL MANAGEMENT-
Pharmacological management-
 Opiate Analgesic - Morphine (2.5-5.0mg, IV) - For sudden relief of
pain & anxiety.
 Aspirin (162-325mg,Orally)- for prevention of thrombus
extension, embolism, venous thrombosis
 Vasodilators- Nitrates (0.4 mg , sublingual)
 Anticoagulant- Heparin (5000 U,IV)
 Antihypertensive drugs-Methyldopa- (250 mg. orally), B- blocker-
Propanolol(20- 40 mg).

29. Non-pharmacological management-
 Avoiding tobacco smoking, eating a well-balanced diet that
is low in saturated fat and refined carbohydrates.
 Cessation of smoking should be given priority in risk-factor
reduction.
 Regular physical activity reduces the incidence of, and
fatality rate from, cardiovascular disease.
Surgical management-
 Coronary artery bypass graft surgery (CABG)
 (PTCA) percutaneous transluminal coronary angioplasty - a
small, flexible plastic tube, or catheter, with a "balloon" at the end
of it. When the tube is in place, it inflates to open the blood vessel.
 Atherectomy

30. NURSING MANAGEMENT:
- Assess vita sign of the patient.
- Assess for the chest pain where it radiates
- Advice to do not smoke and drink alcohol.
- Change the position to maintain blood circulation.
- Provide adequate bed rest.

31. NURSING DIAGNOSIS
 Acute Pain related to decreased/increased cardiac output as
evidenced by verbalization.
 Ineffective breathing pattern related to decreased blood
flow to pulmonary capillaries secondary to decreased
ventricular contractility as evidenced by vital sign.
 Impaired tissue perfusion related to decreased cardiac
output as evidence by vital sign.
 Fear and anxiety related to disease condition as evidence by
facial expression.
 Knowledge deficit related to prognosis and self care
management as evidence patient is asking more question.