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B.

DIAGRAM OF PATHOPHYSIOLOGY

Non Modifiable Modifiable
Age (54 y/o) Smoking
Male Diet high in fat
Alcohol Consumption


Nonspecific injury to arterial wall (endothelial injury) decreased elasticity of blood vessels
Desquamation of endothelial lining and formation of plaques on blood vessels
Increased permeability or adhesion of molecules
Lipids (LDL, VLDL) and platelets assimilate in the area
Oxidized LDL attracts monocytes and macrophages to the site
Plaques begin to form from cells w/c imbibed into the endothelium narrowing of the Blood Vessels
Lipids are engulfed by the cells (foam cells) and smooth
Muscle cells develop.
Disruption of plaque continuous aggregation of platelets
Thrombus formation necrosis and scarring of the vascular endothelium
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Rapid increase in size of the thrombus in coronary artery wall
Coronary Artery Disease (CAD)
















Nursing Management
1. Monitor blood pressure, apical heart
rate, and respirations every 5
minutes during an anginal attack.
2. Maintain continuous ECG monitoring
or obtain a 12-lead ECG, as
directed, monitor for arrhythmias and
ST elevation.
3. Place patient in comfortable position
and administer oxygen, if prescribed,
to enhance myocardial oxygen
supply.
4. Identify specific activities patient
may engage in that are below the
level at which anginal pain occurs.
5. Reinforce the importance of notifying
nursing staff whenever angina pain
is experienced.
6. Encourage supine position for
dizziness caused by antianginals.
7. Be alert to adverse reaction related
to abrupt discontinuation of beta-
adrenergic blocker and calcium
channel blocker therapy. These drug
must be tapered to prevent a
rebound phenomenon; tachycardia,
increase in chest pain, and
hypertension.


Medical Management
1. Antianginal medications
(nitrates, beta-adrenergic
blockers, calcium channel
blockers, and angiotensin
converting enzyme inhibitors) to
promote a favorable balance of
oxygen supply and demand.
2. Antilipid medications to
decrease blood cholesterol and
tricglyceride levels in patients
with elevated levels.
3. Antiplatelet agents to inhibit
thrombus formation.
4. Folic acid and B complex
vitamins to reduce
homocysteine levels.

Surgical Management
1. Percutaneous
transluminal coronary
angioplasty or
intracoronary
atherectomy, or
placement of
intracoronarystent.
2. Coronary artery
bypass grafting.
3. Transmyocardial
revascularization.

Angina, Shortness of
breath, Dyspnea,
Heart Attack
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8. Explain to the patient the
importance of anxiety reduction to
assist to control angina.
9. Teach the patient relaxation
techniques.
10. Review specific factors that affect
CAD development and progression;
highlight those risk factors that can
be modified and controlled to
reduce the risk.

Prognosis
If not treated:
Chronic Obstructive Pulmonary Disease
(COPD)
Anterior wall MI (Myocardial Infarction)
Restoration of Health
Good Prognosis
Bad Prognosis
Death