CAD.pdf

Coronary Artery Disease Accumulation of fatty deposits or plaques (ATHEROSCLEROSIS) along the innermost layer of the coronary arteries leading to restriction of blood flow to the heart and inadequate oxygen supply to the heart muscle. Coronary Artery Disease LDL known as “bad cholesterol” that...

Coronary Artery Disease Accumulation of fatty deposits or plaques (ATHEROSCLEROSIS) along the innermost layer of the coronary arteries leading to restriction of blood flow to the heart and inadequate oxygen supply to the heart muscle. Coronary Artery Disease LDL known as “bad cholesterol” that irritate and damage the inner layer of the coronary vessel  RISK FACTORS Age Diet Gender Sedentary lifestyle Race. Smoking Heredity or family history Alcohol Stress Hypertension Obesity DM R I S K F A C T O R S P Etiology/ Risk Factors A T H LDL adhere to the artery wall O P H Y Plaque formation/ Athersclerosis S I O Blood restriction into the heart L O G Signs and symptoms of Ischemia, MI y  Signs and Symptoms of CAD Chest pain- STABLE and Unstable Angina Shortness of breath Very tired, feeling run down especially with activity Diaphoresis Nausea Tachycardia  STABLE ANGINA (UNSTABLE ANGINA) Precipitated by physical Occurring at rest exertion and emotional stress Pain is less than 15 minutes Last longer than 15 minutes Relieves by rest and Unrelieved by rest/ SL nitroglycerine nitroglycerine Good prognosis Can cause sudden death Poor prognosis  DIAGNOSTIC TESTS Blood tests: Lipid profile: total cholesterol, LDL, HDL, triglycerides ECG: ST segment depression, ST segment elevation Stress testing Cardiac catheterization/coronary angiography- presence, location and extent of coronary lesion  Goal/Planning to maintain normal blood and oxygen supply to the heart to eliminate the signs and ss patient can resume his/her ADL prevent further progression of CAD Nursing Interventions Assess signs and symptoms and when to seek help Monitoring heart rate and blood pressure and oxygen saturation Modifying lifestyle: Diet (low fat, low calorie), Exercise , Smoking cessation, weight loss Educating patient about treatment, preventive measure, medications, and management Education about procedures: EKG, stress test, heart cath, lipid profile blood test Educate the patient about the significance and complications of CAD  Medical Management Antiplatelet prevent clots from forming or growing which decrease the chances of ischemia Aspirin and Plavix Nursing Considerations: watching for GI bleeding and monitor Thrombotic Thrombocytopenic Purpura (TTP) Nitrates causes vasodilation Sublingual, transdermal Place one tab or one spray under the tongue for maximum of 3 doses Monitor their blood pressure SE: dizzy or hot flushing after taken. BETA BLOCKERS Decrease myocardial oxygen demand by decreasing the heart rate, BP, myocardial contractility and calcium output Propranolol, metropolol, atenolol, pindolol, esmolol Monitor the HR, and BP Calcium Channel Blockers Inhibit the calcium ions transportation into myocardial cells to depressed inotropic and chronotropic activity decreasing cardiac work load Promote vasodilation and reduces coronary vasospasm. Verapamil, Nifedipine, Diltiazem, Amlodipine, Nicardipine Monitor HR and BP ACE Inhibitors ends in “pril” Lisinopril, ramipril blocks the conversion of angiotensin I to angiotensin II which caused vasodilation, lowers blood pressure, decreases the workload on the heart. Side effect: nagging dry cough Statins (“tins) Simvastatin, Atorvastatin, helps lower LDL, total cholesterol, triglycerides, and increase HDL. Educate not to replace diet and exercise Notify doctor if they develop muscle pain or tenderness Monitor CPK (creatine kinase) levels if elevated Monitor liver function  Surgical Management Percutaneous Transluminal Coronary Angioplasty A balloon tip catheter is placed in a coronary vessel narrowed by plaque The balloon is inflated and deflated to stretch the vessel and flatten the lesion Blood flows freely through the unclogged vessel to the heart.  Surgical Management Intra Coronary Stent A diamond mesh tubular device is placed in the coronary artery Prevents re-stenosis (after PTCA) by providing skeletal support  Surgical Management Intra Coronary Atherectomy A blade tip catheter is guided in a coronary vessel to the site of the plaque The plaque is cut, shave, or pulverized then removed  Surgical Management Coronary Artery Bypass Graft A graft is surgically attached to the aorta and the other end of the graft is attached to a distal portion of a coronary vessel. By passes obstructive lesion in the vessel and returns to adequate blood flow to the heart muscle supplied by the artery.