Coronary Artery Disease (CAD)

WHAT WENT WRONG?

Cholesterol, calcium and other elements carried by the blood are deposited on the

wall of the coronary artery resulting in the narrowing of the artery and the reduction

of blood flow through the vessel. This impedes blood supply to the heart muscle.

These deposits start out as fatty streaks and eventually develop into plaque that

inhibits blood flow through the artery. Elevated cholesterol levels and fat intake

can contribute to this plaque build-up, as can hypertension, diabetes, and smoking.

When the plaque builds up within the artery, the heart muscle is deprived of oxygen

and nutrients ultimately damaging the heart muscle.

PROGNOSIS

Lifestyle changes and medications can significantly impact the risks of the individual.

Dietary modification, activity, and medications can help to alter the disease

process. Patients who continue with prior bad habits will continue with disease progression.

Risk factors include age, male gender, and family history.

HALLMARK SIGNS AND SYMPTOMS

• Asymptomatic.

• Chest pain (angina) because of decreased blood flow to heart muscle and/or

increase in myocardial oxygen demand resulting from stress.

• Pain may radiate to the arms, back, and jaw.

• Chest pain occurs after exertion, excitement, or when the patient is exposed

to cold temperatures because there is an increase in blood flow throughout

the body, raising the rate. • Chest pain lasts between 3 to 5 minutes.

• Chest pain can occur when the patient is resting.

INTERPRETING TEST RESULTS

• Blood chemistry:

• Increased total cholesterol.

• Decreased high-density lipoproteins (HDL)—helps with reverse transport

of cholesterol.

• Increased low-density lipoproteins (LDL).

• Electrocardiogram during chest pain:

• T-wave inversion—sign of ischemia.

• ST-segment depressed—sign of injury to muscle.

• The waves are depressed because of tissue injury.

TREATMENT

Treatment consists of risk factor modification, life style changes, medications, and

revascularization.

• Weight loss.

• Diet change: lower sodium, lower cholesterol and fat, decreased calorie

intake, increased dietary fiber.

• Administer low doses of aspirin.

• Administer beta-adrenergic blockers to reduce workload of heart:

• metroprolol, propranolol, nadolol.

• Administer calcium channel blockers to reduce heart rate, blood pressure,

and muscle contractility; helps with coronary vasodilation; slows AV node

conduction.

• Administer nitrate if patient has symptomatic chest pains to reduce discomfort

and enhance blood flow to myocardium.

• Platelet inhibitors:

• dipyridamole

• clopidogrel

• ticlopidine• Administer HMG CoA reductase inhibitors (statins)—lowers cholesterol:

• lovastatin

• simvastatin

• atorvastatin

• fluvastatin

• pravastatin

• rosuvastatin

• Fibric acid derivatives reduce synthesis and increase breakdown of VLDL

particles:

• gemfibrozil

• Bile acid binding resins binds bile acid in the intestine:

• colestipol

• Nicotinic acid reduces production of VLDL:

• niacin

DIAGNOSES

• Acute pain

• Activity intolerance

• Impaired gas exchange

INTERVENTION

• Monitor vital signs—signs of hypertension, irregular heart rate

• Monitor electrocardiogram—look for end organ damage, signs of heart disease

• Monitor labs—periodic lipid panel, liver function for patients on statins

• Monitor for myalgias (muscle aches)

• Explain to the patient:

• Stop smoking

• Reduce alcohol consumption

• Change to a lower-fat, lower-cholesterol diet, as well as increased dietary

fiber intake

• Increase daily activity

• Weight reduction

• Stress management

• Hospital-based cardiac rehabilitation programs

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