1. Coronary Artery Disease
By: Amanda Robinson

2. Facts
Blood flows into the heart muscle by way of two small vessels: the right and left coronary arteries.
They arise from the base of the aorta, just below the semilunar valves, and curve around the heart to supply the myocardium with nutrients and oxygen.

4. Statistics CAD is the most common type of heart disease.
It is also the leading cause of death in the United States in both men and women.
Men are generally at greater risk of CAD than are women.
However, the risk for women increases after menopause.

5. Risk Factors Modifiable Smoking Obesity Exercise and inactivity
Stress and anger
High blood pressure
High cholesterol
Diabetes
Nonmodifiable
Age
Sex
Family history

6. Prevention Stop smoking Have regular medical checkups
Control your blood pressure
Check your cholesterol
Keep diabetes under control
Get moving
Eat healthy foods
Maintain a healthy weight
Manage stress

7. Etiology
Occurs when the coronary arteries become hardened, narrowed, or occluded by:
Plaque build up
Blood clots
Damage or injury
This buildup of plaque (cholesterol, lipids, & cellular debris) is known as atherosclerosis.
Obstructions of 75% or higher results in ischemia & increases the risk of death.

10. Pathophysiology
As the plaque increases in size, the insides of the coronary arteries get narrower and less blood can flow through them.
Eventually, oxygen and blood flow to the heart muscle is reduced or cutoff which can result in:
Angina
Arrhythmias
Heart attack
Heart failure
Shortness of breath

12. Signs & Symptoms Subjective Data Objective Data Chest pain (Angina)
Shortness of breath (SOB)
Fatigue
Palpitations (hard/rapid beating pf the heart)
Weakness
Dizziness
Light-headedness
Objective Data
Diaphoresis (sweating)
Syncope (fainting episode)
Dysrhythmias (irregularity in normal heart rhythm)
Blood pressure changes

13. Labs & Diagnostics An Electrocardiogram (ECG )
Takes a record of the heart’s activity
Echocardiogram (a visual record of the heart’s activity)
Stress Test
A treadmill exercise or drug induced heart exercise activity with Persantine or Adenosine
Cardiac Catheterization
Measures the pressure and blood volume relationship within a heart to measure cardiac competence by injecting a radio plaque dye into the arteries and taking x-rays)
Computerized Tomography
Magnetic Resonance Imaging (MRI)
CBC (identify levels of all blood-cell types in a sample)
Serum Lipids (↑ HDL is desired, but LDL’s ↑ the risk of cardiovascular diseases)
Serum Cardiac Markers
- To test blood for Troponin I and Myoglobin which are proteins released in reaction to myocardial injury

14. Cardiac Catheterization

16. Treatment Life style changes Smoking cessation Healthy diet
Regular exercise
Medication Therapy
Surgical Interventions

17. Medications Angiotensin-converting enzyme (ACE) inhibitors
Captopril (Capoten)
Beta blockers
Lopressor (Metoprolol)
Calcium channel blockers
Cardizem (Diltiazem HCL)
Cholesterol medications (Statins)
Atorvastatin (Lipitor)
Angiotensin II Receptor Blockers
Diovan (Valsartan)
Vasodilators
Nitroglycerin or Isosorbide

18. Surgical Interventions
Angioplasty (PTCC- Percutaneous transluminal coronary angioplasty)
The insertion of a balloon into the clogged artery to break up plaque and open the artery.
Stent placement
- The placement of an expandable, mesh like structure designed to open the artery and maintain vessel patency by compressing arterial walls resulting in vasodilation.
Coronary artery bypass surgery (CABG)
A graft done to bypass the occluded area of the arteries using the saphenous vein in the leg or a mammary artery).
Coronary brachytherapy
Radiation used to reopen an artery.
Laser revascularization
A beam used to create tiny channels in heart walls so new vessels can grow.

21. Nursing Interventions/Rationales
Monitor the patient’s vitals frequently
Auscultate the patient’s heart sounds
Assess patency of patient’s airways
Provide a low stimulus and stress free environment and/or maintain bed rest
Administer medications on time/regularly
Educate patient and family
Provide the patient with emotional support/physical comfort
To watch for condition changes in the patient
Assess heart dysrhythmias
Check oxygenation status of the patient
To decrease cardiac excitement and workload of the heart
To relieve patient of any pain he/she may have
To prevent/manage the patients condition
To decrease the patients fear/anxiety and pain

22. Patient Teaching About the disease Purpose of therapies
Proper procedures of therapies and use of medications
Importance of stress management

23. Possible NANDA’s Activity intolerance r/t ischemia pain or immobility
Fatigue r/t decreased cardiac output and/or lack of oxygenation
Decrease cardiac output r/t cardiac insufficiency
Ineffective coping r/t fear of/uncertainty about the disease process
Anxiety r/t change in health status or fear of death
Pain r/t ischemia of the myocardial heart muscle
Knowledge deficit r/t the disease process, risk factors, and therapeutic management

24. Prognosis Outcome is variable.
Some people can maintain a healthy life by changing diet, stopping smoking, and taking medications as long as they are closely monitored.
Others may require more drastic measures, such as surgery.
Everyone is different, but one important factor is detecting CHD early and treating it appropriately.