CORONARY

ARTERY DISEASE
Coronary Artery Disease
Is the narrowing or blockage of the coronary arteries, usually
caused by artherosclerosis.

Artherosclerosis(the hardening or clogging of the arteries) is

the build-up of cholesterol and fatty deposits(plaques) on the
inner walls of the arteries. These plaques can restrict the
blood flow to the heart muscle by physically clogging the
artery or by causing abnormal artery tone function. This can
also lead to chest pain or angina, or a heart attack.
Over time, CAD can also weaken the heart muscle
and contribute to heart failure and arrythmias.

Heart failure means the heart can’t pump blood well

to to the rest of the body. Arrythmias are changes in
the normal rhythm of the heart.
Percentage of CVDs
CVDs are the number 1 cause of death globally: more
people die anually from CVDs than from any other cause.
An estimated 17.9 million people died from CVDs in
2016, representing 31% of all global deaths. Of these
deaths 85% are due to heart attack and stroke.
Over three quarters of CVD deaths take place in low- and middle-
income countries.
Out of 17 million premature deaths (under 70 years old) due to
non-communicable diseases in 2015, 82% are in low- and middle-
income countries, and 37% are caused by CVDs.
In the Philippines

 In 2017, Coronary Heart Disease (CHD) deaths reached 122,950 or

19.86% of total deaths. The age adjusted rate is 11.82 per 100,000 of
popn ranks Philippines 116th in the world.
Risk Factors

Non-modifiable
 Gender
 Age
 Familiy History
 Race
Risk Factors
Modifiable
 Cigarette smoking
 High blood cholesterol, high triglycerides
 Hypertension
 Uncontrolled Diabetes
 Sedentary Lifestyle
 Obesity
 Uncontrolled Stress and anger
 Unhealthy Diet
Symptomatology
 Chest pain (Angina Pectoris) it may also be felt in the left
shoulder, arms, neck, back or jaw.
 Chest discomfort, heaviness, tightness, pressure, aching,
burning, numbness, fullness, or squeezing.
 Shortness of breath
 Irregular heart beats or rapid heart beats
 Dizziness
 Sweating
 Fatigue
 Nausea
 Palpitations
Diagnostic tests
Tests Functions
ECG or EKG Measures the electrical activity,
rate and regularity of your
heartbeat
Echocardiogram Uses ultrasound to assess cardiac
structure and mobilty.
Exercise stress test Measures heart rate while
walking on a treadmill. Helps to
determine how well the heart
functions while it has to pump
more blood.
 Tests Functions
Heart CT Scan To see calcium deposits in
arteries that can narrow arteries.

Cardiac Catheterization To assess O2 levels, blood flow,

CO, heart structures and
coronary artery visualization.

Angiogram Involves introduction of contrast

medium into the vascular system
to outline the heart and blood
vessels
ECG
Echocardiogram
Exercise
stress
test
Heart CT Scan
Cardiac Catheterization and Angiogram
Laboratory tests
 Hemoglobin- decreased hgb increases the risk of oxygen deficit in the tissues
when cardiovascular disease is present.
 Total cholesterol- high level can increased risk of heart disease.
 LDL- too much LDL in the blood causes accumulation of fatty deposits in
arteries, which reduces blood flow.
 HDL- the good cholesterol.
 Triglycerides- high levels of these can increase the risk of heart disease.
 Lipoprotein- is a LDL. High level of this increase the risk of heart attack,
stroke, blood clots, fatty build-up.
 Creatinine-Kinase CK-MB- is a cardiac muscle cells that therefore increase
when there is damage to these cells.
What are the different coronary arteries?

The 2 main coronary arteries are the left main and right coronary arteries.
 Left main coronary artery (LMCA). The left main coronary artery supplies blood to
the left side of the heart muscle (the left ventricle and left atrium). The left main
coronary divides into branches:
 The left anterior descending artery branches off the left coronary artery and
supplies blood to the front of the left side of the heart.
 The circumflex artery branches off the left coronary artery and encircles the
heart muscle. This artery supplies blood to the outer side and back of the heart.
 Right coronary artery (RCA). The right coronary artery
supplies blood to the right ventricle, the right atrium, and the
SA (sinoatrial) and AV (atrioventricular) nodes, which regulate
the heart rhythm. The right coronary artery divides into smaller
branches, including the right posterior descending artery and
the acute marginal artery. Together with the left anterior
descending artery, the right coronary artery helps supply blood
to the middle or septum of the heart.
Pathophysiology
Medical Management
Pharmacologic Therapy
 Cholesterol-modifying medications- by decreasing the amount of
cholesterol in the blood, espescially LDL, these drugs decrease
the primary material that deposits on the coronary arteries.

 Platelet Aggregation Inhibitors- class of drug that decreases

platelet aggregation and inhibit thrombus formation.
Pharmacologic Therapy
 Beta-adrenergic Blockers- it decreases blood pressure and
heart rate. It reduces the risk for future heart attacks.

 Calcium-channel Blockers- it inhibits the transport of

calcium into myocardial and vascular smooth muscle
cells,resulting in inhibition of exacitation-contraction
coupling and subsequent contraction. It has systemic
vasodialation effect resulting in decreased BP. Coronary
vasodilation resulting in decreased frequency and severity of
attacks of angina.
 Nitroglycerin- increases blood flow by dilating
coronary arteries and improving collateral flow to
ischemic regions. Decreases blood pressure.

 ACE inhibitors and ARBs- these similar drugs

decrease blood pressure and help in preventing the
progression of coronary artery disease.
 Analgesic-Morphine sulphate, may be used in acute
onset because of its several beneficial effects, e.gg.,
causes peripheral vasodilation and reduces myocardial
workload, has sedative effect to produce relaxation.
Medical Procedures
 Angioplasty and stent replacement (Percutaneous coronary
revascularization)- mechanical dilation of the coronary vesell
wall by compressing the atheromatous plaque. A specially
designed balloon-tipped catheter is inserted under flouroscopic
guidance and advanced to the site of the coronary obstruction.
Stent hepls prevent the artery from closing up again, A drug-
eluting stent has a medicine embedded in it that helps prevent the
artery from closing in the long term.
Coronary bypass surgery- redirects blood
around a section of a blocked or partially blocked
artery in the heart to improve blood flow to the heart
muscle. This procedure involves taking a health
blood vessel from leg, arm orchest and connect it
beyond the blocked arteries in the heart.
Nursing Interventions in Drug Therapy
Nitroglycerin therapy
 Assume sitting or reclining position when taking the drug.
 Caution patient to change position slowly.
 If to be taken sublingually, offer sips of water before administration
because dryness of mouth may inhibit drug absorption.
 Instruct client to avoid drinking alcohol, to avoid hypotension, weakness
and faintness.
 Inform patient that headache, flushed face, dizziness, faintness, tachycardia
are common side effects during first few doses.
 Transderm- nitropatch applied OD in the morning.
 Evaluate effectiveness: relief of chest pain
Beta-adrenergic Blockers
 Assess pulse rate before adminitsration of the drug, withhold if
bardycardia is present
 Administer after meals to prevent GI upset.
 Do not admisiter propanolol to asthma patients because it causes
bronchoconstriction.
 Do not give propanolol to patients with DM because it causes
hypoglycemia.
 Give with extreme caution to patients with heart failure.
 Observe for side effects: nausea, vomiting, mental depression, mild
diarrhea, fatigue and impotence.
 Antidote for beta blocker poisoning is Glucagon
Calcium- channel Blockers
 Assess HR and BP
 Monitor hepatic and renal function
 Administer1 hour before or 2 hours after meals. Food
delays absorption and decreases plasma levels of the drug.
 Theantidote for calcium-channel blocker poisoning is
Glucagon.
Platelet Aggregation Inhibitors

 Assess for signs and symptoms of bleeding.

 Avoid straining at stool. To prevent at rectal bleeding.
 Should be given after meals to prevent GI upset.
 Observe for Aspirin Toxicity- tinnitus(ringing in the ears.)
 Aspirin may cause bronchostriction. Observe for wheezing.
Nursing Interventions
 Instruct patient and watchers to notify nurse immediately when chest
pain occurs.
 Identify precipitating event , if any: frequency, duration, intensity, and
location of pain
 Assess and document patient’s response to medication.
 Observe for associated symptoms: dyspnea, nausea and vomiting,
dizziness, palpitations, desire to urinate.
 Evaluate reports of pain in jaw, neck, shoulder, arm or hand usually in
left side.
 Obtain results of cardiac markers- creatinine, CK-MB, total
Cholesterol, LDL, HDL, Lipoprotein, hemoglobin and triglycerides as
ordered.
 Place patient at complete rest during anginal episodes.
 Position patient to modertate high back rest to improve
chest expansion and oxygenation
 Monitor patient’s vital signs with pain and O2 saturation.
Note the heart’s rhythm.
 Monitor and obatain ECG results to note abnormal
tracings.
 Provide oxygen as needed or as ordered.
 Administer vasodilators, beta-blockers, calcium-channel
blockers and platelet aggregation inhibitors as ordered.
 Monitor patient’s vital signs every 15 minutes during initial
anginal attack.
 Maintain quiet, comfortable environment. Restrict visitors as
necessary.
 Advisepatient to minimize emotional outbursts, worry and tension
because anginal pain is often precipitated by emotional stress.
 Provide assistance with the activities of patient to avoid over
exertion.
 Stay with patient who is experiencing pain or appears anxious.
 Provide light meals or small frequent feedings. Have patient rest
for 1hr after meals.
Home teachings
 Daily management of hypertension. Take medicines at regular
basis.
 Stop smoking. Smoking reduces available oxygen to the heart and
can precipitate angina. It also increases heart rate and blood
pressure.
 Follow a heart healthy diet- Low sodium, low fat, low cholesterol
and high fiber diet. Avoid saturated fats.
 If obese or overweight, lose weight.
 Reduce stress because stress stimulates increase of norepinohrine
that causes vasoconstriction and tachycardia. Stress also causes
anginal pain.
THANK YOU!