Coronary Artery Disease (CAD)

Prepared by:

Balingcasag, Lynie G.
Definition
● Coronary artery disease is a common heart condition that involves atherosclerotic
plaque formation in the vessel lumen.
● This leads to impairment in blood flow and thus oxygen delivery to the
myocardium.
● also called coronary heart disease (CHD), refers to the pathological process of
atherosclerosis, specifically affecting the coronary arteries
Etiology
● Coronary artery disease is a multifactorial phenomenon. Etiologic factors can be
broadly categorized into non-modifiable and modifiable factors.

● Non-Modifiable factors include:

○ Gender
○ Age
○ Family History
○ Genetics
● Modifiable factors include:
○ Smoking
○ Obesity
○ Lipid Levels
○ Psychosocial Variables
Epidemiology
● In one study, it was estimated that CAD represented 2.2% of the overall global
burden of disease and 32.7% of cardiovascular diseases.
● It is estimated that 7.6% of men and 5.0% of women in the US lived with coronary
artery disease from 2009 to 2012 based on the national health survey done by the
American Heart Association (AHA). This amounts to 15.5 million Americans afflicted
with the disease during this time.
● 51% of men and 48% of women between ages 55 and 64
● 71% of men and 79% of women older than 75 years
● In the US, there is 1 coronary event every 26 seconds, and 1 death every minute.

Coronary artery disease is the leading cause of death for Filipinos, accounting for
about 32% of all Filipino deaths.
Blood Flow through the Heat
○ The right atrium receives deoxygenated blood from the superior and inferior venae cavae and
coronary sinus
○ The right atrium contracts pushing blood through the right atrioventricular valve into the right
ventricle. The right ventricle then contracts to pass the blood into the pulmonary trunk via the
pulmonary valve to reach the lungs
○ In the lungs, the blood gets oxygenated then moves back into the heart entering the left
atrium through the pulmonary veins.
○ The left atrium contracts and pushes the blood into the left ventricle through the left
atrioventricular valve.
○ The left ventricle pushes oxygenated blood through the aortic semilunar valve into the aorta,
from which blood is distributed throughout the body.
CORONARY CIRCULATION
Pathophysiology
Signs and Symptoms
● Angina, or chest pain and discomfort, is the most common symptom of CAD.
Angina can happen when too much plaque builds up inside arteries, causing them
to narrow. Narrowed arteries can cause chest pain because they can block blood
flow to your heart muscle and the rest of your body.

a. Stable Angina - is the term used when angina occurs during exercise/activity;
response to rest & nitrates
b. Unstable Angina - sometimes referred to as preinfarction angina or crescendo
angina, typically occurs at rest without any obvious precipitating factors or with
minimal exertion. It is chest pain that increases in severity, frequency, and duration
and is refractory to treatment. Contraindicated to exercise
c. Prinzmetal Angina or Variant Angina caused by vasospasm of coronary arteries in
the absence of occlusive disease; responds to NTG for short-term management of
chest pain and calcium channel blocker for longterm mx
d. Nocturnal Angina is associated with dreams

For many people, the first clue that they have CAD is a heart attack. Symptoms of a
heart attack include
● Chest pain or discomfort (angina)
● Weakness, light-headedness, nausea (feeling sick to your stomach), or a cold
sweat
● Pain or discomfort in the arms or shoulder
Diagnostic Tools/Imaging Studies
● Electrocardiogram (EKG)
○ EKG is a very basic yet enormously helpful test in the evaluation of
coronary artery disease. It measures electrical activity in the cardiac
conduction system and is measured by 10 leads attached to the skin at
standardized locations. It provides information about both the
physiology and anatomy of the heart.

● Echocardiography
○ Echocardiography is an ultrasound of the heart. It is a useful and
non-invasive mode of testing that is performed in both acute and
chronic and inpatient and outpatient settings.

● Stress Test
○ The stress test is a relatively non-invasive test to evaluate for coronary
artery disease. It is used in the setting of suspected angina or angina
equivalent and is helpful in ruling in or out coronary pathology when
interpreted in an appropriate setting.

● Chest X-ray
○ Chest X-ray is an important component of the initial evaluation of
cardiac disease.
 D/DX DEFINITION R/I R/O

Narrowing of the
Coronary arteries that supply Chest pain, SOB,
Artery the hard d/t plaque cold sweats,Nausea
or a feeling of
Disease buildup along the indigestion.
(CAD) arterial walls
(atherosclerosis)

the death of some Chest pain

portion of the cardiac occasionally
Myocardial Pallor, heat or flushing
muscle d/t sustained radiating to arms,
Infarction
throat, neck, and
sensation, racing heart
(MI) myocardial ischemia
back, fatigue
aka “Heart Attack”

A condition that
Gastroesop
develops when there Heartburn, regurgitation of food or
hageal
is a retrograde flow of sour liquid, coughing, sore throat &
Reflux Chest pain,
stomach contents hoarseness, lump sensation in
Disease
back into the throat, diff swallowing
(GERD)
esophagus
Course/Prognosis

The prognosis of the disease depends on multiple factors, some of which could be
modified while others are non-modifiable. Patient's age, gender, family history and
genetics, ethnicity, dietary and smoking habits, medication compliance, availability of
healthcare and financial status, and the number of arteries involved are some of the
factors. Comorbid conditions including diabetes mellitus, hypertension, dyslipidemia,
and chronic kidney disease also have a role in the overall outcome.
Surgical Management

Percutaneous Transluminal Coronary Angioplasty (PTCA)

● Uses a balloon and collapsed stents (stainless steel “cage-like” tube with multiple
slots) on the tip of the catheter inserted into the radial or femoral artery and
advanced retrograde along the aorta to the openings of the coronary arteries
● The catheter is inserted into the coronary artery until the site of the lesion is
reached
● The balloon is then inflated and the stent expands, compressing the plaque
against the interior artery walls, thereby increasing the luminal area
● The balloon is deflated and removed and the stent holds the lumen open
● The stent is commonly coated with a drug (e.g., paclitaxel [Abraxanel])

Angioplasty – a procedure to open blocked or narrowed coronary (heart) arteries

and can improve the blood flow to the heart, relieve chest pain, and possibly prevent
a heart attack. Sometimes a small mesh tube called a stent is placed in the artery to
keep it open after the procedure.
Pharmacological Intervention

● Nitrates
○ Most people are given nitroglycerin, which relieves pain by lowering blood
pressure, which reduces the workload of the heart, and possibly by dilating
arteries. Usually, it is first given under the tongue, then intravenously.

● Beta-blockers
○ Because decreasing the heart’s workload also helps limit tissue damage, a
beta-blocker is usually given to slow the heart rate. Slowing the rate
enables the heart to work less hard and reduces the area of damaged
tissue.

● Calcium channel blockers

○ Calcium channel blockers prevent blood vessels from narrowing
(constricting) and can counter coronary artery spasms. All calcium channel
blockers reduce blood pressure.
○ This effect can be useful to many people, especially those who cannot take
beta-blockers or who do not get enough relief from nitrates.
OT theoretical foundations (MODELs/FRAMES OF
REFERENCES)

• Model of Human Occupations

MOHO emphasizes that to understand human occupation and problems of occupation,
we must also understand physical and social environments.

• EHP
The main focus is on the interdependent nature of the relationship between the person
and the environment; and how this relationship impacts on human performance.

• Rehabilitative Frame of reference

This FOR will be used to be able to use alternative interventions, task modification
techniques, work simplification techniques for the patient to still be able to perform IADL
independently and prevent him from exerting too much energy despite his condition.
THANK YOU!