Coronary Artery Disease

Presented by: Dave Jay S. Manriquez RN.

 Overview
 Coronary artery disease (also called CAD) is
the most common type of heart disease. It
is also the leading cause of death for both
men and women in the United States.
 It occurs when fatty deposits called plaque
build up inside the coronary arteries. The
coronary arteries wrap around the heart and
supply it with blood and oxygen. When
plaque builds up, it narrows the arteries and
reduces the amount of blood that gets to your
heart.
 What causes CAD?
 Research shows that the exact etiology of CAD is unknown.
However, numerous contributing risk factors have been
identified. It starts when certain factors damage the inner layers
of the coronary arteries. It is classified as modifiable & non-
modifiable.
 Non- modifiable
 Age

 Sex

 Family Hx

 Ethnic background
  Modifiable
 Smoking
High amounts of certain fats and
cholesterol in the blood
 Physical inactivity
 Stress (release of Catecholamine)
High amounts of sugar in the blood due to
insulin resistance or diabetes
 When damage occurs, your body starts a healing
process. Excess fatty tissues release compounds
that promote this process. This healing causes
plaque to build up where the arteries are damaged.
 The buildup of plaque in the coronary arteries
may start in childhood. Over time, plaque
can narrow or completely block some of your
coronary arteries. This reduces the flow of
oxygen-rich blood to your heart muscle.
 Plaque also can crack, which causes blood
cells called platelets (PLATE-lets) to clump
together and form blood clots at the site of
the cracks. This narrows the arteries more
and worsens angina or causes a heart attack
Plaque
 A Narrowing or obstruction of the coronary arteries
resulting from atherosclerosis. An accumulation of
fatty plaques made of lipids in the arteries
 Causes a decrease perfusion of myocardial tissue
and inadequate myocardial oxygen supply
Atherosclerosis
 Angina
I have chest pain!
Angina is chest pain or discomfort caused
when your heart muscle doesn't get enough
oxygen-rich blood.
 CHF :- Congestive Heart Failure
 Inability of the heart to do its job
 It is the the condition in which heart’s
function as a pump is inadiquate to
meet body’s needs
 Myocardial Infarction
 It occurs when blood decreases or
stop to part of heartmuscle .
 The most common symptoms is
chest pain & discomfort
 Signs & Symptoms
 Findings may be normal during asymptomatic
periods
 Chest pain - due to lack of oxygen
 Palpitations
 Dyspnea
 Syncope
 Cough of hemoptysis
 Excessive fatigue
Symptoms occurs when the coronary
artery is occluded to the point that
inadequate blood supply to the muscle
occurs causing ischemia.
Coronary artery narrowing is significant
if the lumen diameter of the left main
artery is reduced at least 50% or if any
major branch is reduced at least 75%
 Lab test / Dx
ECG
a. When blood flow is reduced and
ischemia occurs, ST segment depression
or T-wave inversion is noted; the ST
segment returns to normal when the blood
flow returns.
 Cardiac Catheterization
a. Provide the most definitive source for
diagnosis
b. Would show the presence of atherosclerotic
lesions
 Blood lipid levels
c. Blood lipid levels may be elevated
d. Cholesterol-lowering medications may be
prescribed to reduce the development of
atherosclerotic plaques
 Treatment

The goal of treatment is to alter the

atherosclerotic progression
 Diet Therapy
The aim is to decrease the serum
cholesterol and triglyceride
levels.
Low-fat, low-cholesterol
 Drug Therapy
Antilipemics - cholestyramine,
clofibrate, gemfibrizil, lovastatin
 Nitrates
 Calcium Channel Blocker
 Beta-blockers
 Surgical Procedures
 Percutaneous Transluminal Coronary Angioplasty
 PTCA:- Percutaneous transluminal
coronary angioplasty

Compress the plaque against the walls

of the artery and dilate the vessel.
It is a procedure that is commonly
performed on people with heart disease.
It is a procedure that is commonly
performed on people with heart disease.  
 Percutaneous Coronary Intervention

 Thrombus material (in a cup, upper left corner) removed from a

coronary artery during a percutaneous coronary intervention
to abort a myocardial infarction. Five pieces of thrombus are
shown (arrow heads).
 Stent
Vascular stent to prevent the artery
from closing and prevent restenosis
 Coronary Artery Bypass Graft
 To improve blood flow to the myocardial tissue that are at risk
for ischemia or infarction as a result of the occluded artery.
 Nursing Considerations
 Instruct the client regarding the purpose of
diagnostic medical & surgical procedures and the
pre- & post procedure expectations.
 Assist the client to identify risk factors that can be
modified, and set goals that will promote change in
lifestyle to reduce the impact of risk factors.
 Instruct client regarding a low-calorie, low-sodium,
low-cholesterol, low-fat diet with a increase in
dietary fiber. Stress that dietary changes are not
temporary and must be maintained for life.
 Provide community resources to client regarding
exercise, smoking cessation and stress reduction.
 Nursing Diagnosis

Altered (cardiopulmonary) tissue

perfusion related to imbalance
myocardial oxygen supply as evidence
by chest pain & shortness of breath.
THANK YOU