coronary artery disease

1. Nursing management patients with
cardiovascular disease or problems.

2. Ischemic heart disease
Cardiac arrhythmias
Congestive heart failure
Rheumatic and other Valvular heart
disease
Endocarditis, cardiomyopathies

3. Congenital heart disease
Hypertension
Heart block

4. Cardiac emergencies : Cardiac arrest,
acute pulmonary oedema, cardiac
temponode, cardiogenic shock,
aneurysms and peripheral vascular
disease (PVD), recent advancement in
cardiology.

6. Coronary artery disease (CAD) or
Ischemic heart diseas…
Definition
Risk factors
Pathophysiology
Preventions
Clinical manifestations
Medical and nursing management
Surgical management……. ..

7. Introduction
Normal functioning of heart is based on
a balance between adequate oxygen
supply and oxygen demand.
The function as an effective pump, the
heart muscle must be adequately
supplied with blood from the coronary
arteries.

8. In Coronary heart disease atherosclerosis
develops in the coronary arteries, causing
them to be become narrowed or blocked.
When a coronary artery is narrowed or
blocked partially or completely, the blood
flow to the area of the heart supplied by
that artery is reduced

9. If the remaining blood flow is
inadequate to meet the oxygen
demand of the heart the area may
become ischemic and injured and
further complications will be occur.

10. Definition… ….
The term coronary heart disease, also
known as coronary artery disease or
Ischemic heart disease, is a condition
refers to diseases of the heart that
result from a decrease in blood
supply to the heart muscle.

13. RISK FACTORS FOR CHD
Non modifiable risk factors
Modifiable risk factors
Contributing risk factors

14. Non modifiable risk factors
Family history of CAD
Increasing age
Gender (men develop CAD at an
earlier age than women.)

15. Modifiable risk factors
Cigarette smoking, tobacco use
Hypertension
Diabetes mellitus
Obesity
Sedentary life style
Physical inactivity
Hyperlipdemia or elevated cholesterol

16. Contributing factors
Stress
Menopause… … .

18. PATHOPHYSILOGY
Due to risk factors
Atherosclerosis primarily affects the intima
of the arterial wall and normally takes years
to develop and is a gradual process.
The continued development of
atherosclerosis involves an inflammatory
response, which begins with injury to the
vascular endothelium.

19. Continue… ..
 The injury may be initiated by smoking, HTN
and other factors.
 The blockage of CA when partially or completely
it will cause inadequate blood and oxygen
supply to the heart muscle. It causing the
ruptured plaque,is contributing for thrombus
formation.
 The thrombus may then obstruct blood flow,
leading to sudden Cardiac death and AMI.

20. Preventions… … …
Modified or control the major modifiable
risk factors is a major aspects.
Normalize blood cholesterol levels
Cessation of smoking
Managing Hypertension
Maintain near normal blood glucose levels.

21. Continue…
Dietary measures (TLC) Therapeutic
lifestyle changes.
This includes weight loss, cessation
of tobacco use and increased
physical activity

22. Clinical manifestations… … .
CAD or atherosclerosis produces
symptoms and complications according
to the location and degree of narrowing
of the coronary arteries, level of
thrombus formation and obstruction of
the blood flow to the myocardium.

23. Chest pain (ANGINA PECTORIS)
Shortness of breath (SOB)

24. Assessment and diagnostic findings
History collection
Complete physical examination
ECG
Ecocardiogram
Cardiac stress test
Cardiac catheterization

25. Medical management… … .
The primary goals of management
patients with CAD are reducing and
controlling risk factors and restoring
blood supply to the myocardium.

26. Reducing the risk factors… …
Primary prevention. (healthy lifestyle.
Education. Smoking cessation.,diatery
habits changes, physical exercise.
Periodic health check up… .. Etc

27. Restore blood supply… ..
Various techniques have been developed
to open the vessels and restore blood
flow through the coronary arteries.
PCI (Percutaneous coronary interventions

28. PCI
It is a Invasive intetventional procedure
to treat angina and CAD include PTCA,
Intracoronary Stent implantation
Atherectomy and brachytherapy…
CABG

29. Pharmacologic therapy… ..
 Organic nitrates (isosorbide,
Mononitriate and denigrate.)
Beta blockers (reducing Cardiac work
load and oxygen demand.
( e.g propranolol,
Amano lol and timolol)

30. Pharmacologic therapy continue… ..
Calcium channel blockers (reduce the
total coronary flow by blocking beta2
receptors. (nifedipine, amlodipine)
Aspirin or antiplatelet (improve the rate
of survival in patients with AMI and
reduce risk of MI in patients with AP
and after recovery from MI.

31. PTCA

33. Atherectomy
Atherectomy is an Invasive
intetventional procedure that
involves the removal of the atheroma
or plaque, from a coronary artery by
cutting, shaving, or grinding.

35. Nursing management