1. Coronary
Artery
Disease

2. What is
coronary artery
disease?
A narrowing of the coronary arteries that prevents adequate
blood supply to the heart muscle. Usually caused by
atherosclerosis, it may progress to the point where the heart
muscle is damaged due to lack of blood supply. Such
damage may result in infarction, arrhythmias, and heart
failure.

3. •Is a muscle about the size of your fist
•Weighs approximately one pound
•Is located behind and slightly to the left of the breastbone
•Pumps about 5 quarts (4.7 liters) of blood every minute

4. The function of the heart is to circulate blood throughout the
body by:
•Pumping blood through the lungs removes carbon dioxide
and refreshes the blood with oxygen
•The oxygenated blood is pumped to the body to provide
oxygen and nutrients and to remove waste products.
•The coronary arteries are the blood vessels that supply blood
and oxygen to the heart muscle.

6. 2 coronary arteries branch from
the main aorta just above the
aortic valve. “No larger than
drinking straws, they divide and
encircle the heart to cover its
surface with a lacy network .
They carry out about 130 gallons
of blood through the heart
muscle daily.” (Clark, 119)
Blood Supply To The Heart

7. Coronary Artery Disease
• Coronary artery disease is one of the most common
and serious effects of aging. Fatty deposits build up
in blood vessel walls and narrow the passageway for
the movement of blood. The resulting condition,
called atherosclerosis often leads to eventual
blockage of the coronary arteries and a “heart
attack”.

9. Deposition of fatty substances in the
inner layer of an artery forming a plaque

10. The Plaque– How is it formed ?
• Damage to the endothelial cells
• Fats,cholesterol,monocytes,platelets…..
Deposited in arterial walls

12. Complications of Atherosclerosis
• Narrowing of arterial lumen
• Plaque fissure
• Thrombus formation

13. Coronary artery disease
• When atherosclerosis affects the coronary
arteries it results in Coronary artery
disease

14. Pathophysiology
• coronary artery disease occurs when part of the smooth,
elastic lining inside a coronary artery (the arteries that supply
blood to the heart muscle) develops atherosclerosis.
• With atherosclerosis, the artery's lining becomes hardened,
stiffened, and swollen with all sorts of "grunge" - including
calcium deposits, fatty deposits, and abnormal inflammatory
cells - to form a plaque. Deposits of calcium phosphates
(hydroxyapatites) in the muscular layer of the blood vessels
appear to play not only a significant role in stiffening arteries
but also for the induction of an early phase of coronary
arteriosclerosis.

16. • High blood cholesterol
• High blood pressure
• Smoking
• Obesity
• Lack of physical activity

17. Risk Factors
Uncontrollable
•Sex
•Hereditary
•Race
•Age
Controllable
•High blood pressure
•High blood cholesterol
•Smoking
•Physical activity
•Obesity
•Diabetes
•Stress and anger

18. Signs and Symptoms
• None: This is referred to as silent
ischemia. Blood to your heart may be
restricted due to CAD, but you don’t
feel any effects.
• Chest pain: If your coronary arteries
can’t supply enough blood to meet the
oxygen demands of your heart, the
result may be chest pain called angina.
• Shortness of breath: Some people may
not be aware they have CAD until they
develop symptoms of congestive heart
failure- extreme fatigue with exertion,
shortness of breath and swelling in
their feet and ankles.
• Heart attack: Results when an artery to
your heart muscle becomes completely
blocked and the party of your heart
muscles fed by that artery dies.
Signs &
Symptoms
None
Chest
Pain
Shortness
Of Breath
Heart
Attack

19. • Many people are able to manage
coronary artery disease with lifestyle
changes and medications.
• Other people with severe coronary
artery disease may need angioplasty or
surgery.

20. Nitroglycerine SL
– Carry NTG on person at all time
– Sit or lie down when taking
– Take one tablet under tongue every 5 min
until angina relieved. If no relief after 3 tabs,
call emergency
– May take immediately before activity causing
angina

21. Beta blockers
– Reduce myocardial oxygen consumption by
decreasing heart rate, contractility and blood
pressure
– Caution client not to stop med abruptly; may
cause rebound angina
– Monitor heart failure clients for worsening
failure
– Side effects – hypotension, bradycardia,
bronchial spasm, masks hypoglycemia
– Ex: Lopressor or Toprol (metoprolol),
Inderal (propranolol), Tenormin (Atenolol)

22. Calcium channel blockers
– Dilate arteries – decreases SVR which decreases
workload and O2 consumption
– Decrease heart rate and myocardial contractility –
decreases O2 consumption
– Avoid in clients with severe heart failure
– Side effects - hypotension, bradycardia, constipation,
edema, AV blocks
– Ex: Adalat or Procardia (nifedipine), Cardene
(nicardipine), Cardizem (diltiazem)

23. Antiplatelet medications
– Prevent platelet aggregation on atheroma or
thrombus
• ASA – side effects: GI irritation, bleeding,
increased bruising
• Ticlid (ticlopidine) – side effects: neutropenia,
GI upset, N/V/D, rash. Must monitor CBC
• Plavix (clopidogrel) – side effects: increased
bleeding tendencies, N/V/D, rash

24. Antcoagulants
Heparin
• Given IV in acute situations or subcutaneous in
non-acute situations
• Monitor partial thromboplastin time (PTT)
• Antidote – Protamine Sulfate
• Observe bleeding precautions
• Monitor for signs and symptoms of bleeding
• Half-life of 1-2 hrs
• Monitor for Heparin induced thrombocytopenia
(HIT)

25. Other Drugs
– Cholesterol lowering medications, such as statins,
are useful to decrease the amount of "bad" (LDL)
cholesterol.
– ACE inhibitors, which treat hypertension and
may lower the risk of recurrent myocardial
infarction
– Aspirin

26. Oxygen therapy
– Administered usually at 2 L/min per nasal
cannula
– Increases amount of O2 delivered to
myocardium

28. Treatment (continued)
1) Stenting
• a stent is introduced into a blood vessel on a balloon
catheter and advanced into the blocked area of the artery
• the balloon is then inflated and causes the stent to expand
until it fits the inner wall of the vessel, conforming to
contours as needed
• the balloon is then deflated and drawn back
•The stent stays in place permanently, holding the vessel
open and improving the flow of blood.

29. Treatment (continued)
2) Angioplasty
• a balloon catheter is passed through the guiding catheter to the
area near the narrowing. A guide wire inside the balloon catheter is
then advanced through the artery until the tip is beyond the
narrowing.
• the angioplasty catheter is moved over the guide wire until the
balloon is within the narrowed segment.
• balloon is inflated, compressing the plaque against the artery wall
• once plaque has been compressed and the artery has been
sufficiently opened, the balloon catheter will be deflated and
removed.

30. Treatment (continued)
3) Bypass surgery
• healthy blood vessel is removed from leg, arm or chest
• blood vessel is used to create new blood flow path in your heart
• the “bypass graft” enables blood to reach your heart by flowing
around (bypassing)
the blocked portion
of the diseased
artery. The
increased blood
flow reduces angina
and the risk of heart
attack.

31. •Get regular medical checkups.
•Control your blood pressure.
•Check your cholesterol.
•Don’t smoke.
•Exercise regularly.
•Maintain a healthy weight.
•Eat a heart-healthy diet.
•Manage stress.