CORONARY ARTERY DISEASE Dr. Jamal Dabbas

Objectives Coronary Artery Diseases Angina Types Mechanism Causes Clinical manifestation Complication Nursing care 2/17/2019 www.health-nurses-doctors.blogspot.com

Coronary Artery Disease Definition: CAD is a term that refers to the effect of the accumulation of atherosclerosis plaque in the coronary arteries that obstructs blood flow to the myocardium 2/17/2019 www.health-nurses-doctors.blogspot.com

conditions result from CAD 1. Angina Pectoris Cont. conditions result from CAD 1. Angina Pectoris 2. Myocardial Infarction 2/17/2019 www.health-nurses-doctors.blogspot.com

Angina Pectoris Definition: Angina: Choking or suffocation. Pectoris: Chest. Angina pectoris, is the medical term used to describe acute chest pain or discomfort. Angina occurs when the heart’s need for oxygen increases beyond the level of oxygen available from the blood nourishing the heart. It has 3 types Stable Angina Un stable angina & Variant Angina (Prinzmetal’s or resting angina) : 2/17/2019 www.health-nurses-doctors.blogspot.com

Normally the chest discomfort is relieved with rest, Cont. Types of Angina Stable angina: People with stable angina have episodes of chest discomfort that are usually predictable. That occur on exertion or under mental or emotional stress. Normally the chest discomfort is relieved with rest,  nitroglycerin (GTN) or both. It has a stable pattern of onset, duration and intensity of symptoms. 2/17/2019 www.health-nurses-doctors.blogspot.com

Cont. Unstable angina: It is triggered by an un predictable degree of exertion or emotion. (progressive), more severe than stable. Characterized by increasing frequency & severity. Provoked by less than usual effort, occurring at rest & interferes with pt lifestyle. 2/17/2019 www.health-nurses-doctors.blogspot.com

Cont. Variant Angina (Prinzmetal’s or resting angina) : occur spontaneously with no relationship to activity. Occurs at rest due to spasm. Pt discomfort that occurs rest usually of longer duration. Appears to by cyclic & often occurs at about the same time each day (usually at night). Thought to be caused by coronary artery spasm 2/17/2019 www.health-nurses-doctors.blogspot.com

Mechanism Of Angina 2/17/2019 www.health-nurses-doctors.blogspot.com

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Causes Coronary atherosclerosis (atheroma ) Factors increasing preload : Hyperthyroidism Exercise Anemia Factors increasing after load: Hypertension Aortic stenosis Obstructive cardio myopathy Coronary artery spasm Pre load Right Aterialpresure After load After contraction left over lood 2/17/2019 www.health-nurses-doctors.blogspot.com

Clinical Manifestations Characteristics: Squeezing, burning, pressing, choking, or bursting pressure. Onset: Quickly or slowly Location: Chest, right or left arms, shoulder, or neck, jaw. Duration: Less then 5 minutes. Associated: Dyspnea, Sweating, faintness, palpitation, dizziness ect. Relieving: GTN and rest. Aggravating: exertion, exercise, heavy meal, emotional upset, and anger. 2/17/2019 www.health-nurses-doctors.blogspot.com

Investigations Complications: Electrocardiogram ( ECG) Coronary angiography Exercise Electrocardiogram (Stress test). Complications: Myocardial infarction Cardiac Arrhythmias 2/17/2019 www.health-nurses-doctors.blogspot.com

Myocardium Infarction Myo means muscle, “Cardiac” heart, infarction means “death of tissues due to lack of blood supply”. It is also called heart attack. It occurs when coronary arteries become blocked and the part of myocardial muscles become dead due to prolonged lack of oxygen supply to the muscle cells. 2/17/2019 www.health-nurses-doctors.blogspot.com

PATHOPHYSIOLOGY Coronary artery cannot supply enough blood to the heart in response to the demand due to CAD Within 10 seconds myocardial cells experience ischemia Ischemic cells cannot get enough oxygen or glucose Ischemic myocardial cells may have decreased electrical & muscular function Cells convert to anaerobic metabolism. Cells produce lactic acid as waste Pain develops from lactic acid accumulation Pt feels anginal symptoms until receiving demand increase 02 requirements of myocardial cells 2/17/2019 www.health-nurses-doctors.blogspot.com

ECG changes in Angina & MI Zone of Ischemia: T wave inversion Zone of Injury: ST elevation Zone of Necrosis: Abnormal Q wave 2/17/2019 www.health-nurses-doctors.blogspot.com

Sign and Symptom Classic symptom of heart attack are chest pain radiating to neck, jaws, back of shoulder, or left arm The pain can be felt like: Squeezing or heavy pressure A tight band on the chest An elephant sitting on the chest 2/17/2019 www.health-nurses-doctors.blogspot.com

Other symptoms include: Shortness of breath (SOB) Cont Other symptoms include: Shortness of breath (SOB) Weakness and tiredness Anxiety Lightheadedness Dizziness Nausea vomiting Sweating, which may be profuse 2/17/2019 www.health-nurses-doctors.blogspot.com

Collaborative Management Assessment: History Clinical manifestation Cardiovascular assessment Laboratory assessment Troponin T & I CK-MB 2/17/2019 www.health-nurses-doctors.blogspot.com

Radiographic Assessment ECG Stress Test Myocardial perfusion imaging MRI Cardiac Catheterization 2/17/2019 www.health-nurses-doctors.blogspot.com

IMPORTANT INFORMATION TO REMEMBER Increase supply of Oxygen Decreasing the demand of Oxygen: Stop activity and lie down (CBR) Take Tab. Angisid sublingually and wait till it dissolves. If pain continues take up to 03 Tab. Angisid one every five minutes. If pain is not relieved yet take another tab. and rush to EMERGENCY services. 2/17/2019 www.health-nurses-doctors.blogspot.com

IMMEDIATE MANAGEMENT OF MI: GOALS: To prolong life. Minimize infarct size. Reverse ischemia. Reduce cardiac work. Prevent and treat complications. A) INITIAL TREATMENT: Rapid triage. OMI (oxygen, monitor and I/V line). Check vital signs and O2 saturation. ECG within 10 minutes and repeat ECG. Blood samples for enymes, CBC, lytes, and lipid profile. 2/17/2019 www.health-nurses-doctors.blogspot.com

Intervention Medication: Morphine Sulphate Nitrates (GTN) Beta blockers Calcium Channel Blocker Anti platelets / Anti coagulant Thrombolytic therapy 2/17/2019 www.health-nurses-doctors.blogspot.com

Surgical management PTCA (Percutaneous Transluminal Coronary Angioplasty 2/17/2019 www.health-nurses-doctors.blogspot.com

Coronary Artery Bypass Graft surgery (CABG) 2/17/2019 www.health-nurses-doctors.blogspot.com

Nursing Diagnosis Acute pain R/T imbalance between myocardial oxygen supply and demand Ineffective tissue perfusion R/T interruption of arterial blood flow Ineffective coping R/T effects of acute illness and major changes in life style Impaired gas exchange related to ineffective breathing pattern and decreased systemic tissue perfusion. Anxiety related to present status and unknown future, possible lifestyle changes, pain, and perceived threat of death. Activity intolerance related to fatigue 2/17/2019 www.health-nurses-doctors.blogspot.com

Prevention Recognize the symptoms Reduce your risk factors: Lose weight Quit Smoking Keep your cholesterol at a normal level. Keep your blood pressure under control. Use techniques to ease stress. Control blood sugar level. Eat Right REGULER EXERCISE 2/17/2019 www.health-nurses-doctors.blogspot.com

COMPLICATIONS OF MI: Arrhythmias Hypertension. LV failure. Atrial arrhythmias. Ventricular arrhythmias. Bradycardia and heart block. Asystol. Hypertension. LV failure. Cardiogenic shock. 2/17/2019 www.health-nurses-doctors.blogspot.com

CARDIAC REHABILITATION: Cardiac rehabilitation provides a venue for continued education, re-enforcement of lifestyle modification, and adherence to a comprehensive prescription of therapies for recovery from MI, which includes exercise training Goals of Rehabilitation program: Develop a program for progressive physical activity Lives as full, vital and productive life Remain within the limits of the heart’s ability to respond to increases in activity and stress. 2/17/2019 www.health-nurses-doctors.blogspot.com

FOLLOW UP 2/17/2019 www.health-nurses-doctors.blogspot.com