Coronary artery diseases.

Nursing care of patient with CAD.

1. Coronary artery disease Mr.Veerabhadra.B.Badiger Asst Professor Dept of Medical Surgical Nsg .

2. Coronary artery disease The coronary arteries are the blood vessels that supply the oxygenated blood to heart . Coronary artery disease is a condition characterized by the narrowing or blockage of the coronary arteries , usually caused by atherosclerosis. Atherosclerosis is the collection of cholesterol and fatty deposits (called plaques) inside the arteries.

3. These plaques can deposit in the arteries or damage the arteries, which limits or stops blood flow to the heart muscle .

4. Atherosclerosis

5. Causes for CAD Smoking High blood pressure High cholesterol Diabetes or insulin resistance Sedentary lifestyle Atherosclerosis

6. Risk Factors Modifiable risk factors Being overweight or obese Diabetes Unhealthy diet   , including a lot of food that has high saturated fat, trans fat, salt, and sugar Smoking or secondhand smoker Lack of physical activity High blood pressure and high cholesterol High stress

7. Non-modifiable risk factors Age ,  especially being older than 65 Race  . African Americans have a higher risk than people of other Gender .  Men have a greater risk of heart attack,  However, the risk for women increases after menopause Family history Continued….

8. Other possible risk factors Sleep apnea .  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. High-sensitivity C-reactive protein ( hs -CRP).   High  hs -CRP levels may be a risk factor for heart disease. High triglycerides.  High levels may raise the risk of coronary artery disease, especially for women.

9. Homocysteine .   Homocysteine is an amino acid body uses to make protein and to build and maintain tissue. But high levels of homocysteine may increase risk of coronary artery disease. Preeclampsia.  Occurs 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

10. Autoimmune diseases.  People who have conditions such as rheumatoid arthritis and lupus (and other inflammatory conditions) have an increased risk of atherosclerosis. Alcohol use.  Heavy alcohol use can lead to heart muscle damage. It can also worsen other risk factors of coronary artery disease. Contraceptive uses

11. 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 Pathophysiology

12. Proliferation of smooth muscle cells with in the vessel Formation of fibrous cap over dead fatty core ( atheroma ) Protrusion of atheroma in to the lumen of vessel Narrowing and obstruction If cap is thin the lipid core may grow causing it to rupture

13. Hemorrhage into plaque allowing thrombus to develop Thrombus and obstruct the blood flow leading to sudden cardiac death of myocardial infarction Angina and other symptoms

14. Clinical features The most common symptom is  angina, or chest pain which is Aching , Burning , Fullness , Heaviness , Numbness , Pressure , Squeezing type. (People mistake with indigestion or heartburn.) The pain may radiated to Arms ,Back ,Jaw ,Neck .Shoulder Nausea / Vomiting.  Faster heartbeat

15. Palpitations Shortness of breath Sweating Weakness or dizziness Angina pain

16. Diagnostic studies History collection. Physical examination ECG Cardiac enzyme test. 2D-echocardiogram. Stress test/ tread meal test. Cardiac angiography. Coronary angiography .

17. ECG changes

18. Stress test CT Angiography 2D-echo

19. Treatment Treatment for coronary artery disease usually involves lifestyle changes and, if necessary, drugs and certain medical procedures. Lifestyle changes Quit smoking. Eat healthy foods. Exercise regularly. Lose excess weight. Reduce stress.

20. Management Anti anginal medications : Nitroglycerin tablets, sprays and patches can control chest pain. Beta adrenergic blockers :  Slow the heart rate and decrease blood pressure ex- Atenolol Calcium channel blockers :- Nefidipine

21. Ace inhibitors / Angiotensin -converting enzyme (ACE) inhibitors : D rugs decrease blood pressure and may help prevent progression of coronary artery disease ( captopril ) Statins / Cholesterol-lowering medications: Atorvastatin ,  Rosuvastatin ,  Fluvastatin Oxygen administartion . Nitroglycerin. Morphine :

22. Surgical management Surgical procedures to help restore blood flow to the heart Percutaneous transluminal coronary angioplasty ( PTCA ) Coronary artery bypass  grafting ( CABG ) 

23. Percutaneous transluminal coronary angioplasty (PTCA) PTCA is accomplished using a balloon-tipped catheter inserted through an artery in the groin or wrist to enlarge a narrowing in a coronary artery

24. Coronary artery bypass  grafting ( CABG )  CABG is the most common type of open-heart surgery ,  a healthy artery or vein from the body is connected, or grafted, to the blocked coronary artery.

25. Nursing diagnosis Acute Pain Deficient Knowledge Anxiety Risk for Decreased Cardiac Output

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