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accumulation of plaque
within coronary arteries,
which progressively
enlarge, thicken and
calcify. This causes critical
narrowing of the coronary
artery lumen (75%
occlusion), resulting in a
decrease in coronary blood
flow and an inadequate
supply of oxygen to the
heart muscle.
• Ischemia may be silent
(asymptomatic but
evidenced by ST
depression of 1 mm or more on electrocardiogram (ECG) or may be manifested by
angina pectoris (chest pain).
• Risk factor for Coronary Artery Disease include dyslipidemia, smoking, hypertension,
male gender (women are protected until menopause), aging, non-white race, family
history, obesity, sedimentary lifestyle, diabetes mellitus, metabolic syndrome, elevated
homocysteine, and stress.
• Acute coronary syndrome is a complication of CAD due to lack of oxygen to the
myocardium. Mnaifestations include unstable angina, non ST-segment elevation
infarction, and ST-segment elevation infarction.
• Other causes of angina include coronary artery spasm, aortic stenosis, cardiomyopathy,
severe anemia, and thyrotoxicosis.
Assessment:
Diagnostic Evaluation:
1. Resting ECG may show left ventricular hypertrophy, ST-T changes, arrhythmias, and
possible Q waves.
2. Exercise stress testing with or without perfusion studies shows ischemia.
3. Cardiac catheterization shows blocked vessels.
4. Position emission tomography may show small perfusion defects.
5. Radionuclide ventriculography shows wall motion abnormalities and ejection fraction.
6. Fasting blood levels of cholesterol, low density lipoprotein, high density lipoprotein,
lipoprotein A, homocysteine, and triglycerides may be abnormal.
7. Coagulation studies, hemoglobin level, fasting blood sugar as baseline studies.
Pharmacologic Interventions:
Surgical Interventions:
Nursing Interventions:
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.