CORONARY ARTERY DISEASE

The disorder of the coronary arteries that

disrupts bld supply to the myocardium.
Permanent disruption of bld flow causes
myocardial dysfxn, including sudden death.

CARDIOVASCULAR RISK FACTOR PROFILE
family hx of heart dse
sex Males: 35-55yrs
- Females: > 50 yrs or p menopause
hpn
smoking
overwt or obesity
elevated serum level of lipids & fats
DM
physical inactivity; sedentary lifestyle
stress
for women < 50 yrs: use of estrogen & smoking
ATHEROSCLEROSIS the basic underlying dse
affecting coronary lumen size, is marked by
changes in the intimal lining of the arteries.
- obstructions of more than 75% of the
lumen of one or more of the three coronary
arteries inc. the risk of death.

ANGINA PECTORIS chest pain
- used to describe pain as a symptom of
myocardial ischemia w/c is the result of an
imbalance bet myocardial O2 supply & demand.

MYOCARDIAL INFARCTION development of
ischemia & necrosis of myocardial tissue. It results
from the sudden decrease in coronary perfusion
or an increase in myocardial O2 demand w/o
adequate coronary perfusion

PATHOPHYSIOLOGY
Waxy cholesterol plaque
- Pearly grey mounds of tissue
Deposit in the inner lining of the arteries
Rough surface
Attract platelet & fibrin
Narrowing & less vessel wall surface
Prevent absorption of
nutrients by vessel wall
Vessel wall weakens
Distension of the vessel
wall
aneurysm
Depress
adjacent
tissues
rupture
hemorrhage
Blocking of vessel
amt of bld the different
parts of the heart
Myocardial ischemia
Angina
pectoris
Sudden
cardiac death
Myocardial
infarction
Area of
concern
Stable angina
pectoris
Variant
(Prinzmetals)
angina
Unstable angina
pectoris
Myocardial
infarction
Chest
Pain
quality
Aching, sharp,
tingling or
burning
Similar to
stable angina
Similar to
stable angina
Crushing,
squeezing,sta
bbing,
oppressive or
as if a heavy
obj sitting on
the chest
location
&
radiation
Substernal w/
radiation to L
shoulder, down
the inner
aspect of L or
both arms;
neck, jaw, &
scapula
Similar to
stable angina
Similar to
stable angina
Retrosternal
& L precordial
radiating
down L arm &
to the neck,
jaws, teeth,
epigastric
area, & back
Area of
concern
Stable angina
pectoris
Variant
(Prinzmetals)
angina
Unstable
angina
pectoris
Myocardial
infarction
Precipitating
factors
Exercise or
activity that
myocardial
O2 demand
Onset at rest;
pain is cyclic,
often occuring
during sleep
Pain may be
brought on w/
less than
usual
exertion; may
occur at rest
May occur at
reat or during
exercise
Duration &
alleviating
factors
3-15 mins;
relieved by
rest, stopping
pain-inducing
activies,
nitroglycerine
SL
Pain
intensifies
quickly, tends
to last longer
than angina &
subsides w/
exercise
Prolonged &
not ususally
as quickly
relieved by
rest or taking
nitroglycerine
Continuous,
lasting more
than 30 mins,
unrelieved by
rest, position
change or
taking
nitroglycerine
Diagnosis
ECG
Cardiac enzymes
CBC, ESR
lipid levels
Exercise Stress Test
Cardiac catherterization & angiography
Cardiac profile
Cardiac
enzyme
Normal value with Acute Myocardial Infarction
onset peak Duration
Troponin I 0 ng/ml
(> 1.5 ng/ml is dx
for MI)
3.5 7 hrs 4 6 days
CPK 96 140 IU/L (F)
38 174 IU/L (M)
4 6 hrs 12 - 24 hrs 3 -4 days
CPK MB 0 24 48 hrs 12 24 hrs 2 3 days
SGOT 6 18 IU/L (F)
7 21 IU/L (M)
12 18 hrs 24 48 hrs 3 -4 days
LDH 70 180 mg/dl 24 48 hrs 3 6 days 7 10
days
Other associated manifestations
anxiety
dyspnea
nausea & vomiting
cold clammy skin
epifastric pain
low grade fever
leucocytosis
ECG changes
- injury: elevated ST
- ischemia: inverted T wave
- infarction: significant or
deep Q wave
Management
medications
- vasodilators
- antihyperlipidemic agents
- streptokinase
- antiplatelet agent (aspirin)
- diperidamole
surgery
- CABG (Coronary Artery Bypass Grafting)

- PTCA (Percutaneous Transluminal
Coronary Angioplasty)
general mgt
- CV monitoring: arrhythmias, heart failure, extension of
MI, cardiogenic shock, ventricular muscle rupture
- ECG
- IABP (Intra-Aortic Balloon Pump)
- admission to CCU
- Diet: Acute phase NPO or clear liquids progressing
to 1500 cal, soft, low salt; no caffeine; small
frequent feedings
Discharge diet reduced saturated fats, cholesterol,
Na restriction, limit total caloric consumption to
maintain IBW
- oxygenation
Angina Pectoris
1. Stop activity. Rest
2. Nitroglycerine SL
3. Pearls of Amyl nitrate
4. Whiskey or brandy
5. Beta-blockers
6. Ca channel blockers
Myocardial infarction
1. Reduce pain & promote
comfort Morphine SO4; O2;
semifowlers
2. Maintain adequate bld
circulation
3. CBR
4. Diet
5. Facilitate fecal elimination
6. Promote adequate sexual
expression
7. Encourage gradual return to
usual activities
NSG MGT