Coronary Artery Disease

Description of concept Definition Coronary Artery Disease - most common heart disease -also known as coronary heart disease(CHD), ischemic heart disease *Ischemia-is a temporary deficiency in oxygenated blood flow to tissues *Atherosclerosis-is a disease in which plaque builds up inside your arteries. Anatomy Coronary artery- either of two arteries that originate in the aorta and supply the heart muscle with blood.

Etiology/cause The primary impairment in CAD is an imbalance od myocardial oxygen supply to meet the MVO2. The decrease in supply is due to a narrowing to narrowing of the lumen of the coronary artery, usually due to fixed atherosclerotic lesions. The lesions are caused by an initial endothelial injury but the cause of the lesions are not well understood. the MVO2

Epidemiology As the leading cause of death in the United, coronary artery disease continues to overwhelm mortality and morbidity statistics. In the United States, 1 in 5 deaths are attributed to CAD, the leading cause of death of both males and females. CAD kills approximately five times more females than does breast cancer.

Pathophysiology Generally the pathophysiology of the heart can be viewed as a failure of any of the three interrelated factors that influence the pump functioning:

1.) Oxygen supply to the heart 2.) Contractility of the ventricles 3.) Conduction *Clinically, an imbalance of myocardial oxygen supply and demand is the Hallmark of CAD, inadequate myocardial oxygen supply to meet the metabolic oxygen demands of the myocardium.

Clinical Manifestation Patients may have occlusions within their coronary arteries and have symptoms of CAD are not experienced until the lumen is atleast 70 % occluded. The clinical conditions resulting from CAD are due to inadequate myocardial oxygen supply to meet the MVO2. The most common clinical presentations of CAD: ischemia, infarction or arrhythmias. Many patients are unaware of their subacute occlusions. An estimated, 50 % of patients with CAD present with sudden death (cardiac arrest) as their first symptom. Ventricular fibrilation- most commonly associated with sudden death.

Complications (common) Chest pain (angina). When your coronary arteries narrow, your heart may not receive enough blood when demand is greatest particularly during physical activity. This can cause chest pain (angina) or shortness of breath. Heart attack. If a cholesterol plaque ruptures and a blood clot forms, complete blockage of your heart artery may trigger a heart attack. The lack of blood flow to your heart may damage to your heart muscle. The amount of damage depends in part on how quickly you receive treatment. Heart failure. If some areas of your heart are chronically deprived of oxygen and nutrients because of reduced blood flow, or if your heart has been damaged by a heart attack, your heart may become too weak to pump enough blood to meet your body's needs. This condition is known as heart failure. Abnormal heart rhythm (arrhythmia). Inadequate blood supply to the heart or damage to heart tissue can interfere with your heart's electrical impulses, causing abnormal heart rhythms.

II. PT Management A. PT Evaluation procedures Risk Factor Modification and Interventions Electrocardiogram (ECG) Echocardiogram. Stress test. CT scan Magnetic resonance angiography (MRA

B. Appropriate Interventions and Rationale of treatment Drugs Cholesterol-modifying medications. By decreasing the amount of cholesterol in the blood, especially low-density lipoprotein (LDL, or the "bad") cholesterol, these drugs decrease the primary material that deposits on the coronary arteries. Boosting

your high-density lipoprotein (HDL, or the "good") cholesterol may help, too. Your doctor can choose from a range of medications, including statins, niacin, fibrates and bile acid sequestrants. Aspirin. Your doctor may recommend taking a daily aspirin or other blood thinner. This can reduce the tendency of your blood to clot, which may help prevent obstruction of your coronary arteries. If you've had a heart attack, aspirin can help prevent future attacks. There are some cases where aspirin isn't appropriate, such as if you have a bleeding disorder or you're already taking another blood thinner, so ask your doctor before starting to take aspirin. Beta blockers. These drugs slow your heart rate and decrease your blood pressure, which decreases your heart's demand for oxygen. If you've had a heart attack, beta blockers reduce the risk of future attacks. Nitroglycerin. Nitroglycerin tablets, sprays and patches can control chest pain by opening up your coronary arteries and reducing your heart's demand for blood. Afterload reducers. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). These similar drugs decrease blood pressure and may help prevent progression of coronary artery disease. If you've had a heart attack, ACE inhibitors reduce the risk of future attacks. Calcium channel blockers. These medications relax the muscles that surround your coronary arteries and cause the vessels to open, increasing blood flow to your heart. They also control high blood pressure. Procedures to restore and improve blood flow

Angioplasty and stent placement (percutaneous coronary revascularization). In this procedure, your doctor inserts a long, thin tube (catheter) into the narrowed part of your artery. A wire with a deflated balloon is passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A stent is often left in the artery to help keep the artery open. Some stents slowly release medication to help keep the artery open. Coronary artery bypass surgery. A surgeon creates a graft to bypass blocked coronary arteries using a vessel from another part of your body. This allows blood to flow around the blocked or narrowed coronary artery. Because this requires openheart surgery, it's most often reserved for cases of multiple narrowed coronary arteries.

Goals of intervention 1. Aerobic capacity increased 2. Ability to perform physical tasks related to self-care, home management, community and work intergration or reintegration, and leisure activities is increased. 3. Physiological response to increased oxygen demand is improved. 4. Strength, power, and endurance are increased. 5. Symptoms associated with increased oxygen demand are decreased. 6. Ability to recognize a recurrence is increased, and intervention is sought in a timely manner. 7. Risk of recurrence is reduced. 8. Behaviors that foster healthy habits, wellness, and prevention acquired. 9. Decision making is enhanced regarding health of patient and use of health care resources by patient/client, family, significant others, and caregivers.

Prevention of Complications PRIMARY PREVENTION FOR CORONARY ARTERY DISEASE GENERAL COUNSELLING PROGNOSIS DEITARY MODIFICATION: low salt, low fat, high fiber MEDICATION LIFESTYLE/ACTIVITY RECOMMENDATION: exercise COMPLIANCE OF TREATMENT PLAN Lifestyle changes -Quit smoking. -Eat healthy foods. -Exercise regularly. -Lose excess weight. -Reduce stress PT journal report

Heart Disease Published on Tuesday, 12 February 2013 14:35 Written by EDUARDO GONZALES, MD It was pretty much talking about what CAD is and what typical questions and theories that come out of curiosity towards CAD and the author had simply answered them. The author provided ways as well on how to decrease the risk of CAD. Coronary artery disease happens when the blood vessels that supply the heart with blood, called coronary arteries, get partially or completely clogged because of the buildup of cholesterol and other fatty substances (a process called atherosclerosis) in their walls. Aside from hypertension, there are several other factors that contribute to atherosclerosis and CAD. They include: advanced age, family history of heart disease, smoking, persistent high blood levels of cholesterol (hyperlipidemia), obesity, diabetes mellitus, a sedentary lifestyle and chronic psychological stress. These risk factors often build on each other and act synergistically in promoting atherosclerosis. CAD is not really more common in men than in women, but the disease develops about 10 years earlier in men because before menopause, women are protected from the disease by estrogen, the female hormone. If you go over the list of risk factors for atherosclerosis, you will note that the only ones that you cannot modify are advancing age and family history. Hence, by observing certain dietary and lifestyle practices, you can prevent CAD. To prevent coronary artery disease, your dietary and lifestyle goals, according to the American Heart Association (AHA), should be to: establish an overall healthy eating pattern, maintain an appropriate body weight, maintain a desirable blood cholesterol profile, and maintain normal blood pressure. Additional ways to decrease the risk was to quit smoking, lose weight (if overweight), eat a variety of foods specially on fruit and veggies, limit alcohol intake, and decrease stressful situations.