Coronary Artery Disease and Hypertension

Coronary Artery Disease

• Atherosclerosis, a leading cause of death worldwide, affects the heart's blood vessels.
• Symptoms often don't appear until angina (chest pain).
• Plaque rupture can cause a heart attack (MI).
• Collateral circulation (new blood vessels) develops to bypass blockages.
• Factors contributing include genetics, chronic ischemia, and reduced perfusion. Lifestyle changes can impact collateral development.
• Risk factors include:
  • Age (women more at risk)
  • Genetics
  • Native American population
  • Dyslipidemia
  • High total cholesterol
  • High triglycerides
  • Low HDL
  • High blood pressure (HTN)
  • Smoking
  • Sedentary lifestyle
  • Obesity (apple-shaped worse)
  • Diabetes
  • Metabolic syndrome

Hypertension

• Elevated blood pressure (BP) can lead to multiple health issues.
• A chronic condition requiring ongoing monitoring and often both pharmacological and non-pharmacological interventions.
• Risk factors include:
  • Gender (women, especially after menopause, and those on birth control, men before middle age)
  • Age (over 50)
  • Lifestyle (sedentary, excess alcohol, smoking, stress)
  • Ethnicity (Black population at higher risk)
  • Other abnormalities (sodium-water retention issues, insulin resistance, diabetes, elevated lipids, family history, obesity)

Hypertension Complications

• Hypertensive Heart Disease (HHD)
  • Sustained high blood pressure leads to left ventricle thickening (hypertrophy) and potentially heart failure.
  • Initially a compensatory adaptation but leads to significant health problems.
• Cerebrovascular Disease (TIA + CVA)
  • High blood pressure is a significant stroke risk factor due to atherosclerosis.
• Nephrosclerosis: High blood pressure is a leading cause of chronic kidney disease (CKD).
• Retinal Damage: High blood pressure can damage the eyes over time.

Hypertension Assessment

• Patient positioning (legs and arms uncrossed, arm at heart level).
• Repeat BP readings on both arms.
• Monitor to detect Orthostatic Hypotension (BP drop after changing position).

Chronic Stable Angina

• A condition characterized by chest pain due to reduced blood flow to the heart muscle.
• Etiology: Most often coronary artery narrowing due to atherosclerosis.
• Other causes include heavy exertion and stress.
• Symptoms: Pain, usually intermittent and occurring with increased activity. It typically dissipates when activity stops; location and type of pain can vary.
• Assessment (PQRST): Precipitating event, quality, region, severity, and time.
• Procedures include Cardiac Catheterization and Coronary Artery Bypass Graft (CABG).

Lifestyle Modifications (for both conditions)

• Healthy Eating habits (Mediterranean Diet, DASH = Dietary Approaches to Stop Hypertension.)
• Exercise
• Weight loss
• Smoking cessation
• Blood pressure control
• Blood sugar control
• Stress management

Drug Therapy (for both conditions)

• Medication for both conditions is generally very common and often required
• Side effects are common.
• Education about medications and their importance is critical to patient understanding and compliance.