CORONARY ARTERY

DISEASE

Dr. Jamal Dabbas

 Objectives
¡ Coronary Artery Diseases
l Angina
¡ Types
¡ Mechanism

¡ Causes

¡ Clinical manifestation

¡ Complication

¡ Nursing care

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 Coronary Artery Disease
Definition:
CAD is a term that refers to the effect of the
accumulation of atherosclerosis plaque in the coronary
arteries that obstructs blood flow to the myocardium

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 Cont.

conditions result from CAD

1. Angina Pectoris
2. Myocardial Infarction

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 Angina Pectoris
Definition:
Angina: Choking or suffocation.
Pectoris: Chest.
Angina pectoris, is the medical term
used to describe acute chest pain or
discomfort.
Angina occurs when the heart’s need
for oxygen increases beyond the
level of oxygen available from the
blood nourishing the heart.
It has 3 types
¡ Stable Angina
¡ Un stable angina &
¡ Variant Angina (Prinzmetal’s
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 Cont.

Types of Angina
¡ Stable angina:
l People with stable angina have
episodes of chest discomfort
that are usually
predictable. That occur on
exertion or under mental or
emotional stress.
Normally the chest discomfort
is relieved with rest,
nitroglycerin (GTN) or both.
l It has a stable pattern of
onset, duration and intensity
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 Cont.
¡ Unstable angina:
l It is triggered by an un
predictable degree of
exertion or emotion.
l (progressive), more
severe than stable.
Characterized by
increasing frequency &
severity. Provoked by less
than usual effort,
occurring at rest &
l interferes with pt
lifestyle.
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 Cont.

¡ Variant Angina
(Prinzmetal’s or resting
angina) :
occur spontaneously with no
relationship to activity.
Occurs at rest due to spasm.
Pt discomfort that occurs
rest usually of longer
duration. Appears to by
cyclic & often occurs at
about the same time each
day (usually at night).
Thought to be caused by
coronary artery spasm

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 ¡ Mechanism Of Angina

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 Causes
¡ Coronary atherosclerosis (atheroma )
¡ Factors increasing preload :
l Hyperthyroidism
l Exercise
l Anemia
¡ Factors increasing after load:
¡ Hypertension
¡ Aortic stenosis
¡ Obstructive cardio myopathy
¡ Coronary artery spasm

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 Clinical Manifestations
¡ Characteristics: Squeezing, burning, pressing,
choking, or bursting pressure.
¡ Onset: Quickly or slowly
¡ Location: Chest, right or left arms,
shoulder, or neck, jaw.
¡ Duration: Less then 5 minutes.
¡ Associated: Dyspnea, Sweating, faintness,
palpitation, dizziness ect.
¡ Relieving: GTN and rest.
¡ Aggravating: exertion, exercise, heavy meal,
emotional upset, and anger.

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 Investigations
¡ Electrocardiogram ( ECG)
¡ Coronary angiography
¡ Exercise Electrocardiogram (Stress test).

Complications:
¡ Myocardial infarction
¡ Cardiac Arrhythmias

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 Myocardium Infarction
¡ Myo means muscle, “Cardiac”
heart, infarction means “death
of tissues due to lack of blood
supply”.

¡ It is also called heart attack.

It occurs when coronary
arteries become blocked and
the part of myocardial
muscles become dead due to
prolonged lack of oxygen
supply to the muscle cells.

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 PATHOPHYSIOLOGY
Coronary artery cannot supply enough blood to the
heart in response to the demand due to CAD

Within 10 seconds myocardial cells experience

ischemia

Ischemic cells cannot get enough oxygen or glucose

Ischemic myocardial cells may have decreased

electrical & muscular function

Cells convert to anaerobic metabolism.

Cells produce lactic acid as waste

Pain develops from lactic acid accumulation

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increase 02 requirements of myocardial cells
 ECG changes in Angina & MI

¡ Zone of Ischemia: T wave inversion

¡ Zone of Injury: ST elevation
¡ Zone of Necrosis: Abnormal Q wave

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 Sign and Symptom

¡ Classic symptom of heart attack

are chest pain radiating to neck,
jaws, back of shoulder, or left arm
v The pain can be felt like:
F Squeezing or heavy pressure
F A tight band on the chest
F An elephant sitting on the chest

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 Cont

Other symptoms
include:
¡ Shortness of breath
(SOB)
¡ Weakness and
tiredness
¡ Anxiety

¡ Lightheadedness

¡ Dizziness

¡ Nausea vomiting

¡ Sweating, which may

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 Collaborative Management
¡ Assessment:
¡ History
¡ Clinical manifestation
¡ Cardiovascular assessment
¡ Laboratory assessment
¡ Troponin T & I
¡ CK-MB

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 Radiographic Assessment

ECG
Stress Test
Myocardial perfusion imaging
MRI
Cardiac Catheterization

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 IMPORTANT INFORMATION TO
REMEMBER

Increase supply of Decreasing the demand of

Oxygen Oxygen:
• Stop activity and lie down
(CBR)
•Take Tab. Angisid sublingually
and wait till it dissolves.
If pain continues take up to 03
Tab. Angisid one every five
minutes. If pain is not relieved
yet take another tab. and rush to
EMERGENCY services.
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IMMEDIATE MANAGEMENT OF MI:

GOALS:
¡ To prolong life.
¡ Minimize infarct size.
¡ Reverse ischemia.
¡ Reduce cardiac work.
¡ Prevent and treat complications.
A) INITIAL TREATMENT:
¡ Rapid triage.
¡ OMI (oxygen, monitor and I/V line).
¡ Check vital signs and O2 saturation.
¡ ECG within 10 minutes and repeat ECG.
¡ Blood samples for enymes, CBC, lytes, and lipid
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 Intervention

¡ Medication:
Morphine Sulphate
Nitrates (GTN)
Beta blockers
Calcium Channel Blocker
Anti platelets / Anti coagulant
Thrombolytic therapy

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 Surgical management
¡ PTCA (Percutaneous
Transluminal Coronary
Angioplasty

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 Coronary Artery Bypass Graft surgery
(CABG)

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 Nursing Diagnosis
¡ Acute pain R/T imbalance between myocardial
oxygen supply and demand
¡ Ineffective tissue perfusion R/T interruption of
arterial blood flow
¡ Ineffective coping R/T effects of acute illness and
major changes in life style
¡ Impaired gas exchange related to ineffective
breathing pattern and decreased systemic tissue
perfusion.
¡ Anxiety related to present status and unknown
future, possible lifestyle changes, pain, and
perceived threat of death.
¡ Activity intolerance related to fatigue
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 Prevention

¡ Recognize the symptoms

¡ Reduce your risk factors:
¡ Lose weight
¡ Quit Smoking
¡ Keep your cholesterol at a normal level.
¡ Keep your blood pressure under control.
¡ Use techniques to ease stress.
¡ Control blood sugar level.
¡ Eat Right
¡ REGULER EXERCISE

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 COMPLICATIONS OF MI:

¡ Arrhythmias
l Atrial arrhythmias.
l Ventricular arrhythmias.
l Bradycardia and heart block.
l Asystol.
¡ Hypertension.
¡ LV failure.
¡ Cardiogenic shock.

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 CARDIAC REHABILITATION:

Cardiac rehabilitation provides a venue for

continued education, re-enforcement of lifestyle
modification, and adherence to a comprehensive
prescription of therapies for recovery from MI,
which includes exercise training
Goals of Rehabilitation program:
¡Develop a program for progressive physical
activity
¡Lives as full, vital and productive life

¡Remain within the limits of the heart’s ability to

respond to increases in activity and stress.

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 FOLLOW UP

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