1. Coronary Artery Disease Presented by: Marissa V. Dacumos Batch 17

2. Overview
Coronary artery disease (also called CAD) is the most common type of heart disease. It is also the leading cause of death for both men and women in the United States.
It occurs when fatty deposits called plaque build up inside the coronary arteries. The coronary arteries wrap around the heart and supply it with blood and oxygen. When plaque builds up, it narrows the arteries and reduces the amount of blood that gets to your heart.

3. What causes CAD?
Research shows that the exact etiology of CAD is unknown. However, numerous contributing risk factors have been identified. It starts when certain factors damage the inner layers of the coronary arteries. It is classified as modifiable & non- modifiable.
Non- modifiable
Age
Sex
Family Hx
Ethnic background

4. Modifiable
Smoking
High amounts of certain fats and cholesterol in the blood
Physical inactivity
Stress (release of Catecholamine)
High amounts of sugar in the blood due to insulin resistance or diabetes
When damage occurs, your body starts a healing process. Excess fatty tissues release compounds that promote this process. This healing causes plaque to build up where the arteries are damaged.

5. The buildup of plaque in the coronary arteries may start in childhood
The buildup of plaque in the coronary arteries may start in childhood. Over time, plaque can narrow or completely block some of your coronary arteries. This reduces the flow of oxygen-rich blood to your heart muscle.
Plaque also can crack, which causes blood cells called platelets (PLATE-lets) to clump together and form blood clots at the site of the cracks. This narrows the arteries more and worsens angina or causes a heart attack

6. Plaque

7. A Narrowing or obstruction of the coronary arteries resulting from atherosclerosis. An accumulation of fatty plaques made of lipids in the arteries
Causes a decrease perfusion of myocardial tissue and inadequate myocardial oxygen supply

8. Atherosclerosis

9. It Leads to …
HTN

10. Angina
I have chest pain!

11. CHF
Inability of the heart to do its job

12. Myocardial Infarction

13. Death
It’s my time!

14. Signs & Symptoms Findings may be normal during asymptomatic periods
Chest pain - due to lack of oxygen
Palpitations
Dyspnea
Syncope
Cough of hemoptysis
Excessive fatigue

15. Symptoms occurs when the coronary artery is occluded to the point that inadequate blood supply to the muscle occurs causing ischemia.
Coronary artery narrowing is significant if the lumen diameter of the left main artery is reduced at least 50% or if any major branch is reduced at least 75%

16. Lab test / Dx
ECG
a. When blood flow is reduced and ischemia occurs, ST segment depression or T-wave inversion is noted; the ST segment returns to normal when the blood flow returns.

17. Cardiac Catheterization
Provide the most definitive source for diagnosis
Would show the presence of atherosclerotic lesions
Blood lipid levels
Blood lipid levels may be elevated
Cholesterol-lowering medications may be prescribed to reduce the development of atherosclerotic plaques

18. Treatment
The goal of treatment is to alter the atherosclerotic progression

19. Diet Therapy
The aim is to decrease the serum cholesterol and triglyceride levels.
Low-fat, low-cholesterol

20. Drug Therapy
Antilipemics - cholestyramine, clofibrate, gemfibrizil, lovastatin
Nitrates
Calcium Channel Blocker
Beta-blockers

21. Surgical Procedures
Percutaneous Transluminal Coronary Angioplasty

22. PTCA
Compress the plaque against the walls of the artery and dilate the vessel

23. Percutaneous Coronary Intervention
Thrombus material (in a cup, upper left corner) removed from a coronary artery during a percutaneous coronary intervention to abort a myocardial infarction. Five pieces of thrombus are shown (arrow heads).

24. Stent
Vascular stent to prevent the artery from closing and prevent restenosis

25. Coronary Artery Bypass Graft
To improve blood flow to the myocardial tissue that are at risk for ischemia or infarction as a result of the occluded artery.

26. Nursing Considerations
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.

27. Nursing Diagnosis
Altered (cardiopulmonary) tissue perfusion related to imbalance myocardial oxygen supply as evidence by chest pain & shortness of breath.