CORONARY ARTERY DISEASES AND MEDICATIONS

1. CORONARY ARTERY
DISEASES

2. Disturbances in O2 Transport Mechanism
• Infectious Disorders
– Pericarditis, Myocarditis, Endocarditis, RHD
• Coronary Artery Disease
–Atherosclerosis
–Angina pectoris
–Myocardial infarction
• Congestive Heart Failure
• Pulmonary edema
• Arrythmias

4. Coronary Artery Disease

5. Coronary Artery Disease
• Arteriosclerosis
– Thickening or hardening
of the arterial wall
• Atherosclerosis
– A type of arteriosclerosis
caused by formation of
PLAQUE (chiefly
composed of cholesterol)
– Leading contributor to
coronary artery and
cerebrovascular disease

6. Coronary Artery Disease
• Pathophysiology
(atherosclerosis): UNKNOWN
– Vascular damage (cause
inflammation)
– Fatty streak development
(intimal layer)
– Plaque (partial or complete occlusion
of blood flow)
– Complications
• Calcifications
• Ulceration
• Thrombosis

8. Coronary Artery Disease
• Assessment:
– BP (hypertension)
– Elevated cholesterol &
triglycerides
– Elevated homocysteine (risk
if level > 15mmol/L)
• Blocks the production of nitric
oxide on the endothelium
making cell wall less elastic &
permitting plaque to build up
• Diet: B-complex vitamin rich
diet (folic acid) - homocysteine
– Presence of abdominal obesity
– Elevated FBS

9. Coronary Artery
Disease
• Interventions:
– Cholesterol
screening
– Diet
–Smoking
cessation
– Exercise
– Drug therapy
• HMG-CoA
reductase
inhibitors

10. In combination with other substances,
LDLs can lead to plaque formation,
greatly increasing the chances
for myocardial infarction and stroke.
HDLs work to remove harmful LDLs
from the blood, thereby preventing
fatty buildup and formation
of plaque in arterial walls.

11. Coronary Artery Disease
• The American Heart Association (AHA) now
suggest the term ACUTE CORONARY
SYNDROME to describe any group of clinical
symptoms compatible with acute myocardial
ischemia
– Ischemia –
– Atherosclerosis  ischemia
insufficient blood supply
ANGINA PECTORIS
Myocardial Infarction
O2

12. Coronary Artery Disease
• Angina Pectoris
– “Chest pain” of
cardiac origin
– Most common
clinical
manifestation of
myocardial ischemia
– Myocardial ischemia
causes chemical and
mechanical
stimulation of
sensory afferent
nerve endings in the
coronary vessels and
myocardium

13. Types of Angina:
Stable -75% coronary occlusion
that accompanies
exertion
-Elevated HR or BP
-Eating a large meal
-Chest pain (15mins or
less) and may radiate
-Similar pain severity,
frequency & duration
with each episode
Unstable -Progressive worsening
of stable angina with
>90% coronary
occlusion
- Chest pain of
increased frequency,
severity & duration
poorly relieved by rest
or oral nitrates
Variant
(Prinzmetal’s)
-Arterial spasm in
normal or diseased
coronary artery
-chest pain that occurs
at rest (usually bet. 12
& 8am), sporadic over
3-6 mos & diminishes
over time (ECG: ST –
elevation)
CAUSE SYMPTOMS

14. Coronary Artery Disease
• What is the most serious acute coronary
syndrome??? Subendocardial MI
Transmural MI

15. Myocardial Infarction
• Etiology & Genetic Risk:
– PRIMARY FACTOR: Atherosclerosis
– Nonmodifiable risk factors
– Modifiable risk factors
• Elevated serum cholesterol levels
• CIGARETTE SMOKING!!!
• Hypertension
• Impaired glucose tolerance
• Obesity
• Physical inactivity
• Stress

16. Myocardial Infarction
• Physical assessment/ Clinical Manifestations:

17. Myocardial Infarction
Interventions:
• Pain management: MONA
– Morphine
• 2- to 10-mg IV q 5-15 minutes
• AE: respiratory depression, hypotension, bradycardia,
severe vomiting
• Antidote: Naloxone (Narcan) 0.2 – 0.8 mg IV
– Oxygen: 2-4L/min by nasal cannula
– Nitroglycerin
– Aspirin
• Positioning – semifowler’s
• Provide a quiet & calm environment

18. Medications
• Nitrates
– Nitroglycerine, Isosorbide dinitrate (Isordil),
Isosorbide mononitrate (Imdur)
• Beta Blockers
• Calcium Channel Blockers
• Thrombolytics/ Fibrinolytics

19. Coronary Artery Disease

20. Coronary Artery Disease