CARE OF CLIENTS WITH Objectives

CORONARY ARTERY  define the coronary artery disease

DISEASE  list the etiology and clinical manifestations of coronary

artery disease

 explain the pathophysiology of coronary artery disease

 explain the collaborative management of coronary artery

disease

 determine the nursing care of coronary artery disease

Norfidah Binti Mohamad

Definition Risk Factors

 Heart disease caused by impaired blood flow to  Non-modifiable
myocardium
a. Age: > 50% are 65 or older; 80% of deaths
b. Gender: male
 Cause is accumulation of atherosclerotic plaque
in coronary arteries (blood supply of heart) c. Genetic factors: occurs in families

 May be asymptomatic or cause angina pectoris,  Modifiable: Life-style factors and

myocardial infarction (heart attack),
dysrhythmias, heart failure, sudden death pathologic conditions predispose client to
development of CHD
 Leading cause of death
a. Highest incidence in white males > 45
b. Post menopause women’s risk equal to risk of men

Can Be Modified Pathophysiology

 High blood cholesterol  Coronary artery disease (CAD) is caused by
atherosclerosis (the thickening and hardening of
 High blood pressure the inside walls of arteries).

 Cigarette smoking  Some hardening of the arteries occurs normally

as a person grows older.
 Diabetes
 Overweight or obesity  In atherosclerosis, plaque deposits build up in the
arteries.
 Lack of physical activity
 Plaque is made up of fat, cholesterol, calcium,
and other substances from the blood.

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  Plaque buildup in the arteries often
begins in childhood. Over time, plaque
buildup in the coronary arteries can:

1. Narrow the arteries. This reduces the amount

of blood and oxygen that reaches the heart
muscle.

2. Completely block the arteries. This stops the

flow of blood to the heart muscle.

1. Cause blood clots to form. This can block the

arteries that supply blood to the heart
muscle.

 Plaque in the arteries can be: Coronary heart disease has 2 categories
1.Chronic ischemic heart disease:
 Hard and stable. Hard plaque causes the artery  stable and vasospastic angina, silent
walls to thicken and harden. This condition is myocardial ischemia
associated more with angina than with a heart
attack, but heart attacks frequently occur with
hard plaque. 2.Acute coronary syndromes:
 range from unstable angina to myocardial
 Soft and unstable. Soft plaque is more likely to infarction
break open or to break off from the artery
walls and cause blood clots. This can lead to a
heart attack.

Collaborative Care
Care focused on aggressive risk factor
management to:

1.Slow down atherosclerotic process

2.Maintain myocardial perfusion

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Diagnostic Tests
Assessment of risk factors
a.Total serum cholesterol: elevated in
hyperlipidemia
b.Lipid profile: includes triglyceride, HDL,
LDL level and ratio of HDL to total
cholesterol
Risk Factor Management
Conservative management of CHD
1. Smoking
 Quitting reduces risk by 50% regardless
of time spent smoking
 Improvement of HDL levels
 Lower LDL levels
 Reduces blood viscosity
3. Exercise
 Done regularly lowers VLDL, LDL,
triglycerides; raises HDL
 Reduces blood pressure and insulin
resistance
 30 minutes 5 – 6 times/week
 Tests to identify subclinical
(asymptomatic) CHD when multiple risk
factors are present:
a. Exercise ECG, ECG assesses the
response to increased cardiac
workload induced by exercise,
positive for CHD if
 ST depression on ECG > 3 mm
 Client develops chest pain
 Test stopped due to excessive
fatigue, dysrhythmias or symptoms
before maximal heart rate attained
2. Diet
 Reduce saturated fat and cholesterol
intake
 Strategies to lower LDL
 Avoid saturated fats (whole-milk
products, red meats, coconut oil);
 Include nonfat dairy products, fish, as
protein sources;
 Increase intake of fiber
Medications
 Cholesterol-lowering drugs: goal to lower
LDL > 130mg/dL
1.Statins
a. First line drugs
b. Can cause myopathy or increase liver
enzymes
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Medications
 Anticoagulants help to prevent clots from forming
in arteries and blocking blood flow.
 Aspirin, and other antiplatelet medicines, help to
prevent clots from forming in arteries and
blocking blood flow. Aspirin may not be
appropriate for some people because it increases
the risk of bleeding.
 Discuss before starting aspirin therapy.
 Calcium channel blockers (verapamil, diltiazem)
relax blood vessels (arteries and veins) and lower
blood pressure. These medicines can reduce
heart's workload, help widen coronary arteries,
and relieve and control angina.
Nursing management
 Cardiac rehabilitation program
 Exercise; < BP, < weight (“exercise
buddy”)
 Stop smoking
 Dietary recommendation (avoid drastic
changes), BMI, obesity
 ACE (angiotensin-converting enzyme) inhibitors
help to lower blood pressure and reduce strain on
heart, reduce the risk of a future heart attack and
heart failure.
 Beta blockers slow heart rate and lower blood
pressure to decrease the workload on heart, to
relieve angina and may also reduce the risk of a
future heart attack.
 Nitroglycerin widens the coronary arteries,
increasing blood flow to the heart muscle and
relieving chest pain.
 Long-acting nitrates are similar to nitroglycerin
but are longer acting and can limit the occurrence
of chest pain when used regularly over a long
period.
 Cholesterol-synthesis inhibitors (lovastatin)-
lovering LDL, increase HDL levels
 Assess intake and eating patterns Vs
physical activity
 Stress; relaxation, meditation
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Nursing diagnoses
 Altered nutrition: more than body
requirements r/t excess kcal and fat
intake
 Altered tissue perfussion; cardiac r/t
atheroslerotic process
 Health seeking behaviors; risk factor
management
 Decisional conflict regarding integration of
risk factor management strategies into life
style r/t perceived need for changes in
current life style