Prepared By: Eunice

Coronary heart disease (CHD), also called

coronary artery disease (CAD) and atherosclerotic heart disease is the end result of the accumulation of atheromatous plaques within the walls of the arteries that supply the myocardium (the muscle of the heart). Coronary artery disease results from focal narrowing of large and medium-sized coronary arteries due to intimal plaque formation.

 Angina

Nausea and vomiting

Dizziness and syncope

Diaphoresis and cool, clammy skin

Apprehension or a sense of impending doom

 Modifiable

Cigarette smoking Elevated blood pressure High blood cholesterol (hyperlipidemia) Hyperglycemia (diabetes mellitus) Obesity Physical inactivity Use of oral contraceptives Infection Behavior patterns (stress, aggressiveness, hostility) Geography: higher incidence in industrialized regions

 Non-modifiable

Positive family history (a first-degree relative with cardiovascular disease at age 55 or less for males and at age 65 or less for females) Age (more than 45 years for men, more than 55 years for women) and increasing age Gender: occurs three times more often in men than in women Race: higher incidence in African American than in Caucasians

Modifiable and non-modifiable risk factors Injury to the vascular endothilium Lesions Activation of inflammatory response Attraction of monocytes in the lesions Macrophages ingest lipids Attracts platelet Initiates clotting in the lesions Attached macrophage continues to attract lipids

Smooth muscle cells proliferate

Atherogenesis Atheroma continues to grow Narrows blood vessels Increase pressure of blood in the area Rupture of plaque Thrombus formation

Thrombus formation
Brain Decrease blood supply Decrease oxygen in brain Heart beats faster Increase pressure to area that is blocked Rupture of blood vessels

Cerebral hemorrhage

Thrombus formation
Heart

Decrease blood supply to the heart muscles

Decrease oxygen supply to heart Chest pain Myocardial ischemia Premature ventricular contractions

Thrombus formation Kidney Decrease blood flow to kidneys Decrease urine output Kidneys activate renin- angiotensin aldosterone system Increase blood pressure to increase blood supply Decrease blood supply and oxygen supply Kidney necrosis Death of organ

 Provide care during an acute angina attack

Promote pain relief

Prepare the client for possible treatment

Provide client and family teaching to promote

optimal management of the disease and to minimize anxiety. Provide referrals.

Your testing may include: Electrocardiogram (ECG or EKG) Blood tests Chest X-ray Stress test Echocardiogram (Doppler echocardiogram) Nuclear scan Single-photon emission computerized tomography (SPECT) Positron emission tomographic scan (PET) Angiogram (coronary catheterization) Magnetic resonance imaging (MRI) CT scan.

1. Achieves desired activity level; meets self-care needs with minimal or no pain. 2. Free of complications.

3. Disease process/prognosis and therapeutic regimen understood.

4. Participating in treatment program, behavioral changes. 5. Plan in place to meet needs after discharge.

 Medications can help prevent progression of CAD and improved blood flow to

your heart. Your doctor may prescribe these medications: Aspirin. Aspirin thins your blood and reduces the tendency for blood to clot within a narrowed coronary artery. Nitroglycerin. Nitroglycerin relieves chest pain (angina) by slightly relaxing or dilating narrowed blood vessels, which improves blood flow to your heart. Beta-blockers. Beta-blockers slow your heart rate and reduce your blood pressure. Cholesterol-lowering medications. Cholesterol-lowering medications can reduce the formation of blockages in your heart arteries. ACE inhibitors (angiotensin-converting enzyme inhibitors). ACE inhibitors lower your blood pressure and may improve heart function after heart attacks. Calcium channel blockers. These medications dilate your coronary arteries and reduce high blood pressure. They also may relieve angina. Omega-3 fatty acids and vitamins. These supplements may reduce heart disease risk factors such as high cholesterol.

 Doctors tailor treatment for coronary artery disease

depending on the cause and severity of your CAD.

Catheter-assisted and surgical procedures:
Coronary angioplasty and stents Magnetic-assisted intervention Coronary artery bypass surgery

1.

Minimally invasive heart surgery

2. Healthy lifestyle programs. Adopting a healthy lifestyle can prevent or slow development of coronary artery disease.
Heart disease risk management

Heart-healthy diet and nutrition

Smoking cessation assistances

Regular exercise and physical activity

3. Cardiac rehabilitation programs