CORONARY ARTERY DISEASE

 ARTERIOSCLEROSIS: loss of elasticity of the

arteries intimal layer * sometimes called hardening of the
arteries *
 ATHEROSCLEROSIS: accumulation in the arteries of
fatty plaque made of lipids

CAUSES:
 Aging
 Stress
 Genetics
 Depletion of estrogen after menopause
 High-fat, high-cholesterol diet
 Use of tobacco and alcohol
 Hypertension
 Diabetes mellitus
 Overweight or obesity
 Inactivity

PATHOPHYSIOLOGY
 Narrowing or obstruction of the coronary arteries by an
embolus, vasospasm, or accumulated plaque
 Decreased perfusion and inadequate myocardial oxygen
supply

ASSESSMENT FINDINGS
 Elevated BP
 Hx of Angina
 Dyspnea
 Peripheral edema
 Fatigue

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Diagnosing CAD
 Coronary arteriography: plaque formation
 ECG or Holter monitoring: ST depression, T-wave inversion

Complications
 Angina
 MI
 Heart failure
 Arrhythmias
 Stroke

⇒NURSING INTERVENTIONS
 Assess cardiovascular status
 Administer oxygen and medications, as prescribed
 Monitor and record VS, hemodynamic variables, I/O, ECG,
and lab
 Obtain ECG during anginal episodes
 Maintain the pt’s Rx diet
 Encourage the pt to express anxiety, fears, or concerns
 Provide info about American Heart Association

Possible surgical interventions

 CABG
 PTCA

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MEDICAL MANAGEMENT
DIET:
 low-cal
 low-sodium,
 low-cholesterol
 low- fat
 WT reduction
 O2 therapy
 SMOKING CESSATION
 Monitoring blood glucose levels
 Medication
- Antiplatelet agents:
- Aspirin
- Clopidogrel (Plavix)
- Nitrates:
- Nitroglycerin (Nitro-Bid)
- Isosobide dinitrate (Isordil)
- Antilipemic agents:
- Cholestyramine (Questran)
- Atorvastatin (Lipitor)
- Simvastatin (Zocor)
- Ezetimibe (Zetia)
- Nicotinic acid (Niacin)
- Gemfibrozil (Lopid)
- Colestipol (Colestid)
- Analgesic:
- Morphine (I.V.)
- Beta-adrenergic blockers:
- Propranolol (Inderal)
- Nadolol (corgard)
- Calcium channel blockers:
- Nifedipine (Procardia)

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- Verapamil (Calan)
- Diltiazem (Cardizem)
- Antianxity agents:
- Diazepam (Valium)
- Laser angioplasty
- Atherectomy

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ANGINA
 Chest pain caused by inadequate myocardial
oxygen supply – FOUR TYPES
o CLASSICAL EFFORT: consistent
symptoms with pain relieved by rest
o UNSTABLE/ACUTE ANGINA:
Increase in severity; duration; and
frequetcy of pain which is relieved by
Nitroglcerin
o PRINAZMETAL/VARIANT ANGINA:
Pain that occurs at rest
o MICROVASACULAR ANGINA:
Impairment of vasodilator reserve causes
angina-like in a pt with normal coronary
arteries

CAUSES:
 Atherosclerosis
 CAD
 Vasospasm
 Aortic stenosis
 Activity or disease that increases metabolic
demands

PATHOPHYSIOLOGY
⇒ plaque accumulation causes narrowing of the coronary arteries
⇒ obstruction of blood flow diminishes myocardial oxygen supply

ASSESSMENT FINDINGS
 Substernal, crushing, compressing pain
o may radiate to the arms
o usually lasts 3-5 min.

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 o usually occurs after exzertion, emotional excitement,
or exposure to cold but also can develop when the pt is
@ rest
 Dyspnea
 Palpitations
 Tachycardia
 Diaphoresis
 Anxiety

DIAGNOSTIC TEST FINDINGS

 ECG: ST depression, T-wave inversion during acute pain
 Stress test: abnormal ECG, chest pain
 Coronary arteriography: plaque accumulation
 Bld chemistry: serum lipids
 Cardiac enzymes within normal limits depending on severity
and type of angina
 Holter monitoring: ST depression, T-wave inversion

⇒ NURSING INTERVENTIONS ⇒
 Assess pain level
 Assess cardiovascular status
 Monitor VS, lab studies
 Administer O2 and Meds
 Obtain ECG during anginal episodes

COMPLICATIONS
 Arrhythmias
 Heart failure
 MI

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MYOCARDIAL INFARCTION: death of a portion of
the myocardial muscle cells caused by a lack of oxygen
from inadequate perfusion.
An occlusion of a coronary artery
MI leads to oxygen deprivation
Myocardial ischemia
Eventual necrosis
It’s one component of acute coronary syndrome

PATHOPHYSIOLOGY
 Narrowing and eventual obstruction of the coronary
arteries from plaque accumulation
 Death of the myocardial cells from inadequate perfusion and
oxygenation

CAUSES
 Atherosclerosis
 Inadequate perfusion to meet metabolic needs/demands
 Embolism or thrombus
 Coronary artery spasm