Coronary artery disease is caused by atherosclerosis which narrows the coronary arteries and reduces blood flow to the heart. Risk factors include older age, male gender, family history, diabetes, hypertension, smoking, obesity, and stress. Symptoms include chest pain called angina that is usually brought on by exertion and relieved by rest. Treatment involves medications to open arteries and reduce risk factors, as well as lifestyle changes and cardiac rehabilitation. Nursing care focuses on monitoring for complications, administering medications, maintaining IV access, and providing education to the patient.

1. Coronary artery disease
A blood vessel disorder that is included in
atherosclerosis

2. cause
• Atherosclerosis ; characterized by focal deposit of
cholesterol and lipids within the arterial wall

3. Predisposing factors
• Age and gender
• Occurs in men between 35 to 45 years age
• After the age of 65 incidence of women and men
equalizes
• heredity
• Genetic pre-disposition but actual mechanism is
unknown

4. • Diabetes; 2-3 times more in diabetes ;
• maybe due to circulating insulin helps to form
atheroma and damaged arterial intima and insulin
modifies lipid metabolisms
• Hypertension
• Smoking and tobacco use (nicotine)
• Sedentary lifestyle

5. • Obesity
• Stress and behavior pattern

6. Major clinical manifestations
• Angina pectoris
• Myocardial infarction
• Hidden cardiac death

7. Angina pectoris
• pain (angina) in the chest (pectoris)
• ANGINA PECTORIS is defined as transient chest pain
caused by myocardial ischaemia
• Usually lasts for 3-5 minutes
• commonly subsides when the precipitating factor
(usually exertion) is relieved

8. Etiology
• Myocardial ischaemia develops when the demand
for myocardial oxygen exceeds the ability of the
coronary arteries to supply it.
• Primary reasons for insufficient blood flow is
narrowing of coronary arteries by atherosclerosis
• Extracardiac factors may precipitate myocardial
ischaemia and anginal pain

9. • Physical exertion
• Strong emotions
• Consumption of heavy meal
• Temperature extremes
• Cigarette smoking
• Sexual activity
• Stimulants such as cocaine

10. Pathophysiology
• Coronary artery disease refers to the development
and progression of plague accumulation in
coronary arteries.
• This process has three stages along; stable angina,
unstable angina and myocardial infarction

11. Clinical manifestation
• The following may occur with stable angina,
unstable angina and acute MI
• Chest pain or anginal equivalent(jaw pain, left arm
pain
• Non-verbal indicators of pain: clutch, rub, stroke on
the chest
• Increase or decrease in heart rate,
• dysrhythmias,

12. • Increase or a decrease in blood pressure
• Angina that occurs with predictable level of
exertion (stable angina)
• Angina not necessarily associated with activity and
ST depression (ECG)

13. In addition to unique features of
myocardial infarction
• Angina not relieved by rest or nitroglycerin therapy
• Associated with symptoms: dizziness, dyspnoea,
nausea, vomiting, feeling of impending doom
• Altered neurological status, if decreased cardiac
output
• Rales if decreased contractility creates left
ventricular function

14. • Presence of s3 (heard early in diastole)
• s4 (occurs late in diastole) gallop
• Diminished pulses
• Pallor
• ECG ST elevation
• Elevated ESR

15. Treatment Guidelines for acute
Myocardial infarction
• Use rapid transport to hospital
• Obtain 12 –lead electrocardiogram to be read
within 10 minutes
• Obtain laboratory blood specimens of cardiac
biomarkers including troponin
• Obtain other diagnostics to clarify the diagnosis
• Begin routine medical interventions

16. • Supplemental oxygen
• Nitroglycerin
• Morphine to reduce pain and anxiety also reduces
preload and afterload hence decreasing work of the
heart
• Aspirin 162-325mg to prevent clot formation
• Beta –blocker incase of dysrhythmias , within 24hrs
• Angiotensin-converting enzyme inhibitor within 24
hours prevent conversion of angiotensin 1 to
angiotensin 11
• Anticoagulation with heparin and platelet inhibitors

17. • Evaluate for indications for re-perfusion therapy
• Percutaneous coronary intervention
• Thrombolytic (fibrinolytic) therapy –alteplase
(activase) to dissolve thrombus
• Continue therapy as indicated
• Iv heparin, low molecular weight heparin-
bivalirudin, fondaparinux
• Clopidogrel (Plavix)

18. • Glycoprotein 11b/111a inhibitor
• Bed rest for a minimum of 12-24hours

19. Pt monitoring
• Blood pressure
• Urine output
• Serum sodium, potassium and cretinine levels

20. Cardiac rehabilitation
• Reassure the pt as CAD is a lifelong disease
• Advise on recommended activity which should
depend on; pt’s age,
• condition before the cardiac event,
• the extent of the disease
• the course of hospital stay
• the development of any complications

21. Nursing care
• Pt’s systemic assessment- take hx on S&S
• To include; chest pain or discomfort, difficulty
breathing, palpitations, unusual fatigue, faintness
(syncope)
• A focused physical assessment to detect
complications and detect any change in pt status
• Two iv lines are placed for administering emergency
medications

22. • Iv lines are changed to saline lock to maintain IV
access

23. Assignment
• Draw a nursing care plan for this patient

24. Potential complications
• Acute pulmonary edema
• Heart failure
• Cardiogenic shock
• Dysrhythmias and cardiac arrest
• Pericardial effusion
• Cardiac tamponade