CORONARY ARTERY

DISEASE
 BROAD OBJECTIVES
• By the end of this presentation the
learners must be able to acquire
knowledge and skills on coronary
artery disease, causes and its
management.
 SPECIFIC OBJECTIVES
• Definition of coronary artery disease.
• Describe etiology.
• Describe the risk factors.
• explain the pathophysiology.
• Describe the clinical manifestation.
• Describe the diagnostic studies.
• .Describe the medical management.
• Describe the management.
• Describe the assessment.
• Discuss the diagnosis
• Explain patient education.
• Describe the complications
 DEFINITION
• It is the accumulation of
plaque in the coronary artery.
• This condition can occur in
any artery of the body but
has preference for the
coronary artery.
• CAD can also be described as a blood
vessel disorder that is included in
the general category of
atherosclerosis.
• CAD is also known as cardiovascular
heart disease
 ETIOLOGY
• Atherosclerosis is the main cause of
coronary artery disease.
• It is characterized by the deposition
of cholesterol and lipids primarily in
the intimal wall of the artery.
 RISK FACTORS.
• Factors that increase the risk of
atherosclerosis includes;
• Smoking, high blood pressure,
diabetes mellitus, obesity, age and
gender, family history and genetics
and stress.
 PATHOPHYSIOLOGY.
• Atherosclerosis is the major cause of CAD which
is characterized by focal deposits of cholesterol
and lipids in the intimal wall of the artery
• Coronary artery atherosclerosis is a progressive
disease that begins early in life.
• Although several risk factors are present ,
endothelial injury is caused by an inflammatory
response in the intimal layer of the artery and
the deposition of the lipids in the wall.
 PATHO CONT....
• The process has been shown to occur
in three developmental stages and
these are;
• Fatty streak
• Fibrous plaque
• Complicated lesion
 PATHO CONT
Fatty streak.
• Early lesion of atherosclerosis by
lipid filled smooth muscle cells.
Fatty streak can be observed in the
coronary arteries by the age of 15
and progresses as patient ages.
• It is thought to be reversible.
 PATHO CONT….
Fibrous plaque.
• This develops over time.
• The smooth muscle cells stimulated
by low density of lipo proteins and
platelets activated growth factors
proliferate, produce collagen and
migrate over the fatty streak.
• This forms a fibrous plaque. The
fibrous plaque is whitish or grayish in
color.
 PATHO CONT….
• It may develop in one portion of the
artery or circle the entire lumen.
• Fibrous plaque contributes to loss of
arterial elasticity and impairs vessel
ability to vasodilate to meet
increased oxygen need.
 PATHO CONT……
Complicated lesion.
• This involves the development of an
ulceration or rupture of plaque.
Platelets adhere to the lesion.
Platelets adherence trigger the
coagulation cascade with the
development of thrombus that
obstructs the artery.
 CLINICAL
MANIFESTATIONS
• These include;
• Angina pectoris
• Acute coronary syndrome
• Dizziness
• Dyspnea
• Anxiety
• Nausea
• Vomiting
 CONT….
• Tachycardia
• Dsyrhythmia.
DIAGNOSTIC STUDIES
• Chest x-ray for cardiac enragement
• Aortic calcifications and pulmonary
congestion.
• ECG
• Lab test for lipid profile.
 MEDICAL
MANAGEMENT
• Administer aspirin po 325 -650 mg
per day.
• Heparin
• vasodilators
 MANAGEMENT
HEALTH HISTORY
• Assess for chest pain : focus on the location,
severity, intensity, duration and onset.
• Precipitating factors ; exercises, stress and smoking.
• Measures attempted, to control pain for example,
lying down, eating or drinking.
• Assess for risk factors for CAD; positive family
history, lipid profile, tobacco use, stress level and
exercise pattern.
• Assess for other illnesses lines diabetes,
hypertension.
 PHYSICAL
EXAMINATION
Assessing for the following ;
• Posture indicating chest pain e.g. rubbing
chest, leaning forward.
• Changes in vital signs ; tachycardia,
bradycardia, hypertension or hypotension
• Dyspnea, crackles, dsyrhythmia.
• Levels of consciousness
 DIAGNOSIS
• Altered breathing pattern related to imbalance between
myocardial oxygen supply and demand as evidenced by an
increase in respiratory rate.
Goal
• The patient will have normal respirations
Intervention
• Position the patient in a high fowler’s position to allow
maximum lung expansion
• Administer oxygen therapy, 4-6litres/minute to supplement
oxygen supply. Discontinue oxygen therapy if oxygen
saturation is greater than 90%.
 CONT……
• Altered comfort (chest pain) related
to inflammatory response of the
arteries as evidenced by patient
rubbing the chest.
Goal
• Pain relief ; patient should be free
from chest pain
 CONT……
Intervention
• Get patient in a position which
he/she is feeling comfortable
• Administer prescribed analgesics e.g.
pcm 1 gram.
 CONT…..
• Activity intolerance related to dyspnea as
evidenced by inability to perform some of ADLs

Goal
• Patient will tolerate gradually with increasing
levels of activities.
Intervention
• Promote , encourage and provide activities of
daily living.
 CONT…
• Anxiety related to unknown outcome
of the disease as evidenced by
patient repetitive question.
Goal
• Patient will experience manageable
level of anxiety .
 CONT….
Interventions
• Provide calm environment.
• Explain every procedure to the
patient.
• Keep family members informed of
the disease process.
 PATIENT/ FAMILY
EDUCATION
• Provide specific verbal and written
instructions on smoking cessation,
stress management and diet
modification.
• Encourage adherence to a diet low in
saturated fats and cholesterol.
• Discuss benefits of stress
management techniques in decreasing
negative effort on oxygen demand.
 COMPLICATIONS 0F
CAD
• Heart failure : It occurs in response to decreased
contractility secondary to ischemic myocardium .
• Dsyrithmia : this the disturbance in heart rhythms.
• Pericarditis : the heart pericardial lining can
become inflamed and fluid may accumulate
between the pericardial and the visceral layers so,
the patient complaints of pericardial chest pain.
 SUMMARY
• Coronary artery disease is caused by
accumulation of cholesterol and lipids in the
artery of the heart.
• The development of the condition occurs in
three stages, namely fatty streak, fibrous
plaque and complicated lesion.
• The diet which is high in lipids and cholesterol
increases susceptibility of coronary artery
disease.
thankyou