NCM 106 [CORONARY ARTERY DISEASE]

CORONARY ARTERY DISEASE

 Most prevalent type of cardiovascular disease
 Leading cause of death Response to injury:
Monocyte immigration
1. Atherosclerosis – accumulation of fats in the vessel wall Smooth muscle proliferation
2. Arteriosclerosis – loss of elasticity of vessel or simply hardening Fatty streak, lymphocytes
of the vessel Fibrofatty atheroma, collagen,
Risk factors lipid debris
Races (caucasian)
Increased BP
Stress
Known Lifestyle 2 yr old – vessels are clean
Factors ( Hereditary, Hormone homocystiene which is constantly high in chronic disease) and free from fats and etc.
Alcohol Use
Cigarette smoking
Type A personality
Obesity
Result of DM
Sex

Angina and Myocardial Infarction

Clinical Manifestations
Chest pain that is poorly localized
Chest heaviness
SOB
Feeling of impending doom/death
Cool and clammy skin
Diaphoresis
Increased heart rate
Dizziness, nausea, and vomiting
Causes
Thrombus formation
Emboli results to Atrial Fibrillation
*Atheroma- the degeneration of the vessel walls due to formation of plaque and scar tissue

Angina Pectoris
 Temporary reduction of blood flow ( emotion provoking, exertion, excessive eating, extreme cold temperature)
 Pain is relieved by rest ( 3-20/ 5-15 mins)
 Medication ( NTG) – Expansion of vessels
Variant Decription

Stable Angina Predictable pattern, On exertion, Transient ST segment depression

Relieved by rest

Nocturnal Angina At night

Decubitus Angina Lying flat, Relieved by sitting up

Spasm (Prinzmetal) At rest , Transient ST segment elevation, May cause arrhythmias lead to infarction
Angina

Unstable Angina Accelerate ( Crescendo), Precipitated by arrhythmia

 NCM 106 [CORONARY ARTERY DISEASE]

Myocardial Infarction
 Heart Attack
 Acute coronary Syndrome
 Critical Reduction of blood flow to heart muscles
 Unrelieved by rest and NTG
 Relieved with morphine sulphate
 Lasts for more than 20 min.
Dx tests
ECG- Gold standard test for ACS in the first 24 hours
P waves – Atrial Depolarization “ LUB”
QRS complex – Ventricular depolarization “DUB”
T wave – ventricular repolarization
ST elevation – Seen with MI
Angiography
Contrast Dye, X-ray
WOF allergies in Iodine, Seafoods
Lipid Profile
Serum Cholesterol: 120-250 mg/dL
Triglycerides: 140- 200 mg/dL
Isoenzymes (cardiac Specific)
CK-MB increases first 24 hrs
Myoglobin increases 1-3 and peaks at 12 hrs
Troponin I – elevated until 3 weeks
Troponin T-Gold standard test for MI and angina
Cardiac Catheterization
Gold standard test for all cardiac disorders
Identifies patency of coronary vessel
Assess blood volume
Prevention
 Primary Prevention – prevent
occurrence  Therapeutic Lifestyle changes
 Secondary Prevention – Prevent  No Smoking
Progression  Relaxation techniques
 Regular lipid profile at age 20 (ideally q  Stress management
5 yrs)  Maintain healthy weight
 Increase physical Activity  Control DM
Nursing Interventions
o Providing Comfort measures o Monitor BP for cardiogenic shock
o Drugs – (NTG, Morphine)  -Narrowing pulse pressure (D-S)
o O2 inhalation N=30-40mmhg
o Positioning (upright) o Oliguria
o Work quietly and systematically o Decreased LOC
o Maintain a hemodynamic stability o Assist intra aortic balloon pump
o Monitor skip beats/Arrhythmias o Maintain patent IV line
 -Lidocaine but updated to
Amiodarone (DOC)
Drug therapy, administer proper meds
Thrombolytic Therapy
Indicated for :
a. Chest pain >20 mins or unrelieved with NTG c. Less than 24 hrs onset
b. ST elevation
Contraindicated in:
a. Active bleeding, recent surgery, Hemorrhagic stroke, uncontrolled HPN
 NCM 106 [CORONARY ARTERY DISEASE]

Types of Thrombolytics
Fibrinolytics ( dissolve Blood clots, Streptokinase)
Anticoagulants ( Prevent Blood Clot, Heparin and Coumadin)
Platelet inhibiting (Aspirin)
Anti-lipidemics (simvastatin)

Maintain Adequate Nutrition, Elimination and exercise

 NPO for 24 hrs  Maintain a quiet environment
 Liquid Diet  Facilitate Adequate Bowel Movement
 After 48 hrs provide small frequent feeding  Avoid Constipation
 Provide Physical and Psychological Rest  Passive ROM and Active when possible
 Sedation  Adequate fluid intake and fiber foods
 Limit visitors  Laxative

Adequate Understanding of Sex

 Resume 4- 6 wks after attack  Do in a familiar place with a familiar partner
 Monitor BP  Prolonged foreplay
 Take medications prior to sex (NTG)  Side lying position
 Instruct best time to have sex ( Early morning)

Cardiac rehabilitation
Phase I – Begins in the diagnosis of atherosclerosis, low level activities, prioritize on self-care, indication of calling 911,
Medications, rest activity balance, follow-up appointments.
Phase II
Occurs after patients discharge, may last 4-6 wks up to 6 months, ECG Monitoring, support and guidance, counseling in
lifestyle changes, prevent complications and hospitalization, heart healthy diet
Phase III
Maintain cardiovascular stability, patient is self-directed and does not require supervision, long term conditioning

Surgery
 Percutaneous Transluminal Coronary angioplasty
 Balloon angioplasty
 Stent
 Coronary Bypass graft
Monitor complications
Cardiac tamponade (fluid or blood in pericordial sac)
 Reduces CO
 hallmark sign = Pulsus Paradoxus ( sudden decrease in BP
during Inhalation)
 treatment - Pericardiocentesis