Coronary Artery Disease

(Coronary Heart Disease)

Is a condition in which plaque builds up inside the coronary arteries (atherosclerosis). These arteries supply oxygen-rich blood to your heart muscle. It is the most prevalent type of cardiovascular disease in adults. Atherosclerosis, an abnormal accumulation of lipid, or fatty substances, and fibrous tissue in the lining of arterial blood vessel walls. Atherosclerosis involves a repetitious inflammatory response to injury of the artery wall and subsequent alteration in the structural and biochemical properties of the arterial wall.

SIGN & SYMPTOMS The most common symptoms of coronary artery disease are:

Chest pain or discomfort, also called angina. Shortness of breath when exercising or during another vigorous activity.

Other symptoms include:

A fast heartbeat. Weakness, dizziness, and feeling sick to your stomach (nausea). Increased sweating.

RISK FACTORS

Non-Modifiable Risk Factors

Modifiable Risk Factors

Family History Increasing Age Gender Race

Hyperlipidemia Tobacco Smoking Hypertension Diabetes Mellitus Metabolic Syndrome Obesity Physical Inactivity

DIAGNOSTIC TEST

Electrocardiogram (ECG) Echocardiogram. An echocardiogram uses sound waves to produce images of your heart. During an echocardiogram, your doctor can determine whether all parts of the heart wall are contributing normally to your heart's pumping activity. Parts that move weakly may have been damaged during a heart attack or be receiving too little oxygen. This may indicate coronary artery disease or various other conditions. Stress test. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG. This is known as an exercise stress test. In some cases, medication to stimulate your heart may be used instead of exercise. Some stress tests are done using an echocardiogram. For example, your doctor may do an ultrasound before and after you exercise on a treadmill or bike. Or your doctor may use medication to stimulate your heart during an echocardiogram.

Cardiac catheterization or angiogram. To view blood flow through your heart, your doctor may inject a special dye into your arteries (intravenously). This is known as an angiogram. The dye is injected into the arteries of the heart through a long, thin, flexible tube (catheter) that is threaded through an artery, usually in the leg, to the arteries in the heart. This procedure is called cardiac catheterization. The dye outlines narrow spots and blockages on the X-ray images. If you have a blockage that requires treatment, a balloon can be pushed through the catheter and inflated to improve the blood flow in your coronary arteries. A mesh tube (stent) may then be used to keep the dilated artery open. CT scan. Computerized tomography (CT) technologies, such as electron beam computerized tomography (EBCT) or a CT coronary angiogram, can help your doctor visualize your arteries. EBCT, also called an ultrafast CT scan, can detect calcium within fatty deposits that narrow coronary arteries. If a substantial amount of calcium is discovered, coronary artery disease may be likely. A CT coronary angiogram, in which you receive a contrast dye injected intravenously during a CT scan, also can generate images of your heart arteries. Magnetic resonance angiography (MRA). This procedure uses MRI technology, often combined with an injected contrast dye, to check for areas of narrowing or blockages.

MANAGEMENT Manage Heart Disease through: 1.) 2.) 3.) 4.) 5.) 6.) Lifestyle changes and understanding the symptoms of heart attack. Decrease risk factors by not smoking keeping cholesterol in check Exercise (if overweight, to lose weight but seek help from professionals) Managing Stress Eating healthfully (like eating foods rich in omega 3 like fish and fish oil. Because omega 3 is unsaturated fatty acid which is thought to reduce inflammation throughout the body) 7.) Take prescribed medications and see a cardiologist regularly.

NURSING INTERVENTION 1. Monitor blood pressure, apical heart rate, and respirations every 5 minutes during an anginal attack. 2. Maintain continuous ECG monitoring or obtain a 12-lead ECG, as directed, monitor for arrhythmias and ST elevation. 3. Place patient in comfortable position and administer oxygen, if prescribed, to enhance myocardial oxygen supply. 4. Identify specific activities patient may engage in that are below the level at which anginal pain occurs. 5. Reinforce the importance of notifying nursing staff whenever angina pain is experienced. 6. Encourage supine position for dizziness caused by antianginals. 7. Be alert to adverse reaction related to abrupt discontinuation of beta-adrenergic blocker and calcium channel blocker therapy. These drug must be tapered to prevent a rebound phenomenon; tachycardia, increase in chest pain, and hypertension. 8. Explain to the patient the importance of anxiety reduction to assist to control angina. 9. Teach the patient relaxation techniques. 10. Review specific factors that affect CAD development and progression; highlight those risk factors that can be modified and controlled to reduce the risk. MEDICAL MANAGEMENT 1.) 2.) 3.) 4.) 5.) 6.) Nitroglycerin widens arteries Aspirin can prevent clots Beta blockers improve blood flow Ranolazine helps chronic angina Ace inhibitors improve survival after heart attack Lipid management helps control cholesterol that can block arteries.

ALTERNATIVE MEDICINE - Supplements that will reduce your blood pressure and cholesterol level. This includes: 1.) Omega 3 fatty acids rich foods 2.) Barley 3.) Cocoa 4.) Garlic 5.) Oat bran found it oatmeal 6.) CoenzymeQ10

Prepared by: BEBITA, GILEA BERNICE V. PACIS, JEFFERSON S.

REFERENCES: Brunner & Suddarths Medical-Surgical Nursing Volume 1 Twelfth Edition (page 756-762) Medical-Surgical Nursing by Udan Concepts and Clinical Manifestation Secon Edition 2009 (page 159-170) http://www.webmd.com/heart-disease/tc/coronary-artery-diseasesymptoms
http://www.nhlbi.nih.gov/health/health-topics/topics/cad/ http://www.mayoclinic.com/health/coronary-arterydisease/DS00064/DSECTION=complications http://www.facebook.com/l.php?u=http%3A%2F%2Fnursingcrib.com%2Fnursingnotes-reviewer%2Fcoronary-artery-disease%2F&h=4AQGGVnC5