Cardiovascular disease are becoming a leading cause of morbidity and mortality in developed countries and they are also emerging as prominent national health problem in developing countries. Coronary artery disease has become the major cause of early death and disability in the population. Coronary artery disease (CAD) can also be used interchangeably with the terms atherosclerotic heart disease or ischemic heart disease. All of these terms imply insufficient perfusion of the coronary arteries from an abnormal narrowing of the vessels, leading to insufficient oxygen delivery to the myocardial tissue. 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. Non modifiable risk factors Modifiable risk factors Contributing risk factors

1. CORONARY ARTERY DISEASE
Mr. ANILKUMAR BR , M.SC Nursing
Assit Professor Medical – Surgical Nursing

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

3. OVERVEIW
Cardiovascular disease are becoming a leading cause
of morbidity and mortality in developed countries and
they are also emerging as prominent national health
problem in developing countries.
Coronary artery disease has become the major cause of
early death and disability in the population.

4. 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.

5. Coronary artery disease (CAD)
Coronary artery disease (CAD) can also be used
interchangeably with the terms atherosclerotic heart
disease or ischemic heart disease.
All of these terms imply insufficient perfusion of the
coronary arteries from an abnormal narrowing of the
vessels, leading to insufficient oxygen delivery to the
myocardial tissue.

6. CORONARY ATHEROSCLEROSIS: The most common
heart disease in the United States is atherosclerosis,
which is an abnormal accumulation of lipid, or fatty,
substances and fibrous tissue in the vessel wall.
These substances create blockages or narrow the vessel
in a way that reduces blood flow to the myocardium.

7. Coronary artery disease (CAD)
Coronary artery disease comprises a variety of clinical
problems resulting from an inadequate oxygenation of
myocardium.
For the heart function normally, it must have an
adequate blood supply.
Myocardium receives its blood supply from two
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.

14. Coronary artery disease

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

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

19. Modifiable risk factors
 Cigarette smoking, tobaccouse
Hypertension
 Diabetes mellitus
Obesity
 Sedentary lifestyle
 Physicalinactivity
 Hyperlipdemia or elevated
cholesterol

20. 1. Psychological tension (Stress, anxiety,
depression, etc. )
2. Menopause
3. Oral contraceptives
4. Type A personality ( Time urgency,
aggression behavior, impatience, and
frustrations.)
Contributing factors

22. Risk factors of coronary artery
disease

23. Risk factors of coronary artery
disease

24. 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.

25. 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.

26. Preventions
Four modifiable risk factors—cholesterol
abnormalities, cigarette smoking (tobacco use),
hypertension, and diabetes mellitus— have been
cited as major risk factors for CAD and its consequent
complications.

27. 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.

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

29. Improve physical activity
Physical Activity. Regular, moderate physical
activity increases HDL levels and reduces
triglyceride levels.
The goal for the average person is a total of 30
minutes of exercise, three to four times per week.

30. Medications
Medications are used in some instances to control
cholesterol levels.
If diet alone cannot normalize serum cholesterol levels,
several medications have a synergistic effect with the
prescribed diet.

31. 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 bloodflow to the myocardium.

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

33. Assessment and diagnostic
findings
History collection ( Family history
of CAD, any history of HTN , DM and
nutritional history.)
Complete physical examination
ECG
Ecocardiogram
Cardiac stress test
Cardiac catheterization

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

35. Reducing the risk factors
Primary prevention.
1. Healthy lifestyle.
2. Education.
3. Smoking cessation.
4. Dietary habits changes
5. Physical exercise.
6. Periodic health check up and Etc

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

37. PCI (Percutaneous coronary
interventions)
It is a Invasive intetventional procedure to
treat angina and CAD include:
1. PTCA ( Percutaneous translumenal
coronary angioplasty)
2. Intracoronary Stent implantation
3. Atherectomy and brachytherapy
4. CABG ( Coronary artery bypass graft)

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

39. 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.

40. PTCA

42. 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.

43. Atherectomy

44. Nursing management