Coronary Artery Disease

Presented by: Group 1 Buenafe, Ma.Cresencia S., Gepte, Princess Hannah Kelly V. Gketis Alexandros Herrera, Joash S. Ligon, Rowena P. Mercado, Colleen P. Perry, Mary Lez D. Pedrosa, Heidi

 Is a muscle about the size of your fist Weighs approximately one pound Is located behind and slightly to the left of the breastbone Pumps about 5 quarts (4.7 liters) of blood every minute

The function of the heart is to circulate blood throughout the body by: Pumping blood through the lungs removes carbon dioxide and refreshes the blood with oxygen The oxygenated blood is pumped to the body to provide oxygen and nutrients and to remove waste products. The coronary arteries are the blood vessels that supply blood and oxygen to the heart muscle.

Overview

Coronary artery disease (also called CAD) is the most common type of heart disease. It is also the leading cause of death for both men and women in the United States.
It occurs when fatty deposits called plaque build up inside the coronary arteries. The coronary arteries wrap around the heart and supply it with blood and oxygen. When plaque builds up, it narrows the arteries and reduces the amount of blood that gets to your heart.

What causes CAD?

Research shows that the exact etiology of CAD is unknown. However, numerous contributing risk factors have been identified. It starts when certain factors damage the inner layers of the coronary arteries. It is classified as modifiable & non-modifiable.  Non- modifiable Age Sex Family Hx Ethnic background

Modifiable Smoking High amounts of certain fats and cholesterol in the blood Physical inactivity Stress (release of Catecholamine) High amounts of sugar in the blood due to insulin resistance or diabetes
When damage occurs, your body starts a healing process. Excess fatty tissues release compounds that promote this process. This healing causes plaque to build up where the arteries are damaged.


The buildup of plaque in the coronary arteries may start in childhood. Over time, plaque can narrow or completely block some of your coronary arteries. This reduces the flow of oxygen-rich blood to your heart muscle.
Plaque also can crack, which causes blood cells called platelets (PLATE-lets) to clump together and form blood clots at the site of the cracks. This narrows the arteries more and worsens angina or causes a heart attack

Plaque is a sticky substance made up of fat, cholesterol, calcium,

and other substances found in the blood. Over time, plaque hardens and narrows your arteries.


A Narrowing or obstruction of the coronary arteries resulting from atherosclerosis. An accumulation of fatty plaques made of lipids in the arteries
Causes a decrease perfusion of myocardial tissue and inadequate myocardial oxygen supply

Atherosclerosis is a disease in which plaque builds up inside your arteries

It Leads to

Hypertension

Angina

Chest pain: If your coronary arteries cant supply enough blood to meet the oxygen demands of your heart, the result may be chest pain called angina.

CHF

Shortness of breath: Some people may not be aware they have CAD until they develop symptoms of congestive heart failure- extreme fatigue with exertion, shortness of breath and swelling in their feet and ankles.

Myocardial Infarction

Heart attack: Results when an artery to your heart muscle becomes completely blocked and the party of your heart muscles fed by that artery dies.

Death

Its my time!

Signs & Symptoms

Findings may be normal during asymptomatic periods

None: This is referred to as silent ischemia. Blood to your heart may be restricted due to CAD, but you dont feel any effects.
Chest pain - due to lack of oxygen
Palpitations
Dyspnea
Syncope
Cough of hemoptysis
Excessive fatigue


Symptoms occurs when the coronary artery is occluded to the point that inadequate blood supply to the muscle occurs causing ischemia.
Coronary artery narrowing is significant if the lumen diameter of the left main artery is reduced at least 50% or if any major branch is reduced at least 75%

Screening and Lab Test

Electrocardiogram
a. When blood flow is reduced and ischemia occurs, ST segment depression or T-wave inversion is noted; the ST segment returns to normal when the blood flow returns

ElectroElectrocardiogram

Stress Test An exercise stress test is a common test that doctors use to diagnose coronary artery disease. The test helps doctors see how the heart performs during exercise. You may also hear exercise stress tests called exercise tolerance tests, stress tests, exercise EKGs, or treadmill tests.

Stress Test

Cardiac Catheterization a. Provide the most definitive source for diagnosis b. Would show the presence of atherosclerotic lesions

Coronary Angiography

Other tests:
Blood tests: used to evaluate kidney and thyroid . function as well as to check cholesterol levels and the presence of anemia. Chest X-ray: shows the size of your heart and whether there is fluid build up around the heart and lungs. Echocardiogram: shows a graphic outline of the heart s movement Ejection fraction (EF): determines how well your heart pumps with each beat.

Treatment

The goal of treatment is to alter the atherosclerotic progression

Diet Therapy

The aim is to decrease the serum cholesterol and triglyceride levels.

Low-fat, low-cholesterol

Drug Therapy

Antilipemics - Subtance to treat hyperlipidemia (cholestyramine, clofibrate, gemfibrizil, lovastatin)

Nitrates Nitrates are a vasodilator. Vasodilators widen (dilate) the blood vessels, improving blood flow and allowing more oxygen-rich blood to reach the heart muscle. Nitrates also relax the veins. If less blood is returning to the heart from the arms and legs, it eases the workload on the heart. (nitroglycerin, isosorbide mononitrate)


Calcium Channel Blocker - are used to control high blood pressure (hypertension),chest pain (angina), and irregular heartbeats (arrhythmia). They slow the rate at which calcium passes into the heart muscle and into the vessel walls. This relaxes the vessels. The relaxed vessels let blood flow more easily through them, thereby lowering blood pressure. (nifedipine, verapamil, nicardipine)
Beta-blockers are used to treat high blood pressure (hypertension), congestive heart failure (CHF), abnormal heart rhythms (arrhythmias), and chest pain (angina). Beta-blockers are sometimes used in heart attack patients to prevent future heart attacks.


Beta-blockers "block" the effects of adrenaline on your body's beta receptors. This slows the nerve impulses that travel through the heart. As a result, your heart does not have to work as hard because it needs less blood and oxygen. Beta-blockers also block the impulses that can cause an arrhythmia.
Your body has 2 main beta receptors: beta 1 and beta 2.
Some beta-blockers are selective, which means that they block beta 1 receptors more than they block beta 2 receptors. Beta 1 receptors are responsible for heart rate and the strength of your heartbeat.
Nonselective beta-blockers block both beta 1 and beta 2 receptors. Beta 2 receptors are responsible for the function of your smooth muscles (muscles that control body functions but that you do not have control over).

Surgical Procedures

Percutaneous Transluminal Coronary Angioplasty

PTCA

Compress the plaque against the walls of the artery and dilate the vessel

a balloon catheter is passed through the guiding catheter to the area near the narrowing. A guide wire inside the balloon catheter is then advanced through the artery until the tip is beyond the narrowing. the angioplasty catheter is moved over the guide wire until the balloon is within the narrowed segment. balloon is inflated, compressing the plaque against the artery wall once plaque has been compressed and the artery has been sufficiently opened, the balloon catheter will be deflated and removed.

Percutaneous Coronary Intervention

Thrombus material (in a cup, upper left corner) removed from a coronary artery during a percutaneous coronary intervention to abort a myocardial infarction. Five pieces of thrombus are shown (arrow heads).

Stent

Vascular stent to prevent the artery from closing and prevent restenosis

a stent is introduced into a blood vessel on a balloon catheter and advanced into the blocked area of the artery the balloon is then inflated and causes the stent to expand until it fits the inner wall of the vessel, conforming to contours as needed the balloon is then deflated and drawn back

The stent stays in place permanently, holding the vessel open and improving the flow of blood

Coronary Artery Bypass Graft

To improve blood flow to the myocardial tissue that are at risk for ischemia or infarction as a result of the occluded artery.

healthy blood vessel is removed from leg, arm or chest blood vessel is used to create new blood flow path in your heart the bypass graft enables blood to reach your heart by flowing around (bypassing) the blocked portion of the diseased artery. The increased blood flow reduces angina and the risk of heart attack.

Nursing Diagnosis

Altered (cardiopulmonary) tissue perfusion related to imbalance myocardial oxygen supply as evidence by chest pain & shortness of breath.

Nursing Considerations

Instruct the client regarding the purpose of diagnostic medical & surgical procedures and the pre- & post procedure expectations.
Assist the client to identify risk factors that can be modified, and set goals that will promote change in lifestyle to reduce the impact of risk factors.
Instruct client regarding a low-calorie, low-sodium, low-cholesterol, low-fat diet with a increase in dietary fiber. Stress that dietary changes are not temporary and must be maintained for life.
Provide community resources to client regarding exercise, smoking cessation and stress reduction.

Prevention
Get regular medical checkups. Control your blood pressure. Check your cholesterol. Dont smoke. Exercise regularly. Maintain a healthy weight. Eat a heart-healthy diet. Manage stress.

Thank You for Listening!