CAD

CORONARY ARTERY DISEASE

1. CORONARY ARTERY DISEASE (CAD) SUDESHNA BANERJEE DUTTA LECTURER S.R.S.V.M B.SC NURSING COLLEGE

2. Definition It is the abnormal deposition of lipid or fatty substances and fibrous tissues in the lining of arterial blood vessel walls, called as plaques, which blocks or narrows the lumen and reduces blood supply to the myocardium causing injury to the arterial wall. There is deprivation of oxygen supply to the cells causing ischemia.

3. RISK FACTORS Modifiable risk factors: Hyperlipidemia Cigarette / bidi smoking Tobacco use Hypertension Diabetes mellitus Metabolic syndrome Obesity Physical inactivity and sedentary lifestyle Dietary intake(increased salt, using palm oil, unrefined oil for cooking, excessive intake of non vegetarian food) Mental stress

4. Non-modifiable risk factors are: Family history of CAD ( 1 st degree relatives) Increasing age 45 yrs and above, but it has now occurrence in young adults of age 20-40 years also. Gender ( males are more prone than females) Race ( higher incidence in African-Americans than in Asians)

5. PATHOPHYSIOLOGY Due to etiological factors Injury to the endothelial cell that lining the artery Inflammation and immune reactions Accumulation of lipids in the intima of arterial wall T lymphocytes and monocytes that becomes as macrophages, infiltrate the area to ingest the lipids and die there ( after ingestion macrophages can’t get removed from that area due to inflammation)

6. Formation of fibrous cap over the dead fatty core Protrusion of atheroma into the lumen of vessel (fatty material which forms deposition) Narrowing and obstruction If cap is thin the lipid core may grow causing it to rupture Hemorrhage into plaque allowing thrombus to devolop

7. Thrombus and atheromatous plaque obstructs the blood flow leading to ischaemia & further necrosis of cardiac myocytes Angina and other symptoms

8. SYMPTOMS: Chest pain (Angina pectoris) Diaphoresis Chest heaviness Dyspnea Fatigue Radiation of pain to the left arm and neck A burning sensation in the chest or upper abdomen Nausea

9. SIGNS: ECG changes Hypertension or hypotension Dysrythmias Elevated cardiac enzymes

10. Diagnostic tests History taking Physical examination ECG Laboratory routine blood tests Stress test (treadmill testing)

11. Stress test (treadmill test)

12. Medical management Statins , which reduce cholesterol, reduce risk of coronary disease Nitroglycerin Calcium channel blockers  and/or  beta-blockers Antiplatelet drugs such as  aspirin .

13. Surgical management CORONARY STENT

14. ANGIOPLASTY

15. CORONARY ARTERY BYPASS GRAFTING (CABG)

16. GENERAL MANAGEMENT MANAGING BP: BP should be monitored every 2 hourly & client should be encouraged to measure weight every month, limit salt intake, moderate alcohol intake. Antihypertensive medications have to be started if BP is > 140/90 mmHg; after 6 months of lifestyle modification.

17. SMOKING CESSATION : Patient should stop smoking & avoid passive smoking also. CONTROLLING CHOLESTEROL : Total LDL & HDL should be monitored anually for adults older than 20 years. Client should be encourage to exercise atleast 5times weekly for 30 minutes & to increase their physical activity in their daily life. CONTROL DIABETES : FBS should be maintained near normal level in clients with DM.