coronary artery disease

for nursing faculty

1. REVIEW OF CARDIOVSCULAR SYS..

2. DEFINITION AND INTRO…. Coronary artery disease  ( CAD ), also known as  ischemic heart disease  ( IHD ), is the most common of the  cardiovascular diseases . Coronary artery disease (CAD) causes impaired blood flow in the arteries that supply blood to the heart. The most common cause of CAD is vascular injury with cholesterol plaque buildup in the arteries, known as  atherosclerosis . Reduced blood flow occurs when one or more of these arteries becomes partially or completely blocked.

3. Risk factors include Age.  Simply getting older increases your risk of damaged and narrowed arteries. Sex.  Men are generally at greater risk of coronary artery disease. However, the risk for women increases after menopause. Family history.  A family history of heart disease is associated with a higher risk of coronary artery disease, especially if a close relative developed heart disease at an early age. Smoking.  People who smoke have a significantly increased risk of heart disease. High blood pressure.  Uncontrolled high blood pressure can result in hardening and thickening of your arteries, narrowing the channel through which blood can flow.

4. RISK FACTORS High blood cholesterol levels.  High levels of cholesterol in your blood can increase the risk of formation of plaque and atherosclerosis.  Diabetes.  Diabetes is associated with an increased risk of coronary artery disease. Type 2 diabetes and coronary artery disease share similar risk factors, such as obesity and high blood pressure. Overweight or obesity.  Excess weight typically worsens other risk factors. Physical inactivity.  Lack of exercise also is associated with coronary artery disease and some of its risk factors, as well.

5. RISK FACTORS…. High stress.  Unrelieved stress in your life may damage your arteries as well as worsen other risk factors for coronary artery disease. Unhealthy diet.  Eating too much food that has high amounts of saturated fat, trans fat, salt and sugar can increase your risk of coronary artery disease. Sleep apnea.  This disorder causes you to repeatedly stop and start breathing while you're sleeping. Sudden drops in blood oxygen levels that occur during sleep apnea increase blood pressure and strain the cardiovascular system, possibly leading to coronary artery disease.

6. CONT… Preeclampsia.  This condition that can develop in women during pregnancy causes high blood pressure and a higher amount of protein in urine. It can lead to a higher risk of heart disease later in life. Alcohol use.  Heavy alcohol use can lead to heart muscle damage. It can also worsen other risk factors of coronary artery disease. Autoimmune diseases.  Conditions such as rheumatoid arthritis and lupus (and other inflammatory rheumatologic conditions) have an increased risk of atherosclerosis.

7. Clinical sign chest pain heaviness tightness burning squeezing pain in the  arms  or  shoulders shortness of breath sweating dizziness

8. Clinical sign nausea vomiting back pain jaw pain shortness of breath without feeling chest pain

9. DIAGNOSTIC MEASURE Histroy collection & physical examination ECG Echocardiogram Heart CT scan Coronary angiography Exercise ECG –  Stress test

10. MEDICAL MANG.. Medication Statins , which reduce cholesterol, reduce the risk of coronary artery disease Nitroglycerin Calcium channel blockers and/or beta-blockers Antiplatelet drugs  such as  aspirin

11. Surgical management… Balloon angioplasty :  to widen blocked arteries and smoosh down the plaque buildup, usually performed with insertion of a stent to help keep the lumen open after the procedure Coronary artery bypass graft surgery :  to restore blood flow to the heart in open chest surgery

12. Nursing management… Assess for chest pain : focus on the location, severity, intensity, duration and onset. Precipitating factors ; exercises, stress and smoking. Measures attempted, to control pain for example, lying Assess for other symptoms ; in digestion, heartburn, nausea, abdominal pain Assess for risk factors for CAD; positive family

13. Physical exam Assessing for the following ; Posture indicating chest pain e.g. rubbing chest, leaning forward. Changes in vital signs ; tachycardia, bradycardia , hypertension or hypotension Dyspnea , crackles, dsyrhythmia . Levels of consciousness Vomiting Decline in urine output.

14. Nursing diagnosis… Altered breathing pattern related to imbalance between myocardial oxygen supply and demand as evidenced by an increase in respiratory rate. Goal The patient will have normal respirations Intervention Nurse the patient in a high fowler’s position to allow Administer oxygen therapy, 4-6litres/minute to supplement oxygen supply. Discontinue oxygen therapy if oxygen saturation is greater than 90%.

15. Cont.. Activity intolerance related to dyspnea as evidenced by inability to perform some of ADLs Goal Patient will tolerate gradually with increasing levels of activities. Intervention Promote , encourage and provide activities of daily living.

16. Cont… Anxiety related to unknown outcome of the disease as evidenced by patient repetitive question. Goal Patient will experience manageable level of anxiety . Interventions Provide calm environment. Explain every procedure to the patient. Keep family members informed of the disease process.