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INTRODUCTION
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The heart muscle needs a constant supply of oxygen-rich blood. The coronary arteries, which
branch off the aorta just after it leaves the heart, deliver this blood. Coronary artery disease can
block blood flow, causing chest pain (angina) or a heart attack (also called myocardial infarction,
or MI).
Coronary artery disease was once widely thought to be a man's disease. On average, men
develop it about 10 years earlier than women because, until menopause, women are protected
by high levels of estrogen. However, after menopause, coronary artery disease becomes more
common among women. Among people aged 75 and older, a higher proportion of women have
In developed countries, coronary artery disease is the leading cause of death in both men and
the arteries,” which involves fatty deposits in the artery walls and may progress to narrowing
and even blockage of blood flow in the artery), occurs in about 5 to 9% (depending on sex and
race) of people aged 20 and older. The death rate increases with age and overall is higher for
men than for women, particularly between the ages of 35 and 55. After age 55, the death rate
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for men declines, and the rate for women continues to climb. After age 70 to 75, the death rate
for women exceeds that for men who are the same age.
Coronary artery disease affects people of all races, but the incidence is extremely high among
blacks and Southeast Asians. The death rate is higher for black men than for white men until
age 60 and is higher for black women than for white women until age 75.
II. OBJECTIVES
A. GENERAL OBJECTIVES
At the end of the presentation, students are expected to gain the necessary information
regarding Coronary Artery Disease for them to determine the appropriate nursing care
management they should provide to those patients having this kind of illness
B. SPECIFIC OBJECTIVES
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1. To improve students ability in handling patients with coronary artery disease.
3. To be able to identify the major risk factors for development of coronary artery disease.
Client’s Centered
1. To educate the client about the possible development of the disease complication.
3. To encourage the client to seek medical assistance regarding their health status
Name: JGM
Age: 50
Sex: Female
Nationality: Filipino
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Occupation: Baranggay Councilor
FAMILY HISTORY
The client stated that they don’t have any history of the disease.
HEALTH HISTORY
In her younger years she was very workaholic and has no time for relaxation.
Mrs. JC had great fun of eating fatty and salty foods, and also smoking since 30 years old. These
unhealthy lifestyles contribute a lot for her to develop high blood pressure.
The client stated that when she was 40 years old she was check up at Bongabon District
Hospital and diagnose having hypertension. She was given medication and despite of her
Mrs. JC and other Brgy. Officials had attended a seminar in Baguio last March 2008, and
after three days of staying she felt a severe chest pain, shortness of breath, headache and
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blurry vision. When she was on her way to the terminal riding on a taxi and suddenly taxi driver
noticed her face and neck was red in appearance. And the taxi driver decided to bring her in
Baguio General Hospital. At the emergency room she was given oxygen inhalation and
medication. After a few hours when she was already on good condition she went home.
Mrs. JC experienced again the same manifestations last August 2008 and was brought to
The patient is presently taking medications such as Avastat 20mg., Anoion 200mg.,
mmHg
Temperature 36.6 °C 36.8 °C 36.6 °C 36.7 °C
Pulse Rate 62 bpm 70 bpm 68 bpm 66 bpm
Respiratory Rate 24 cpm 26 cpm 25 cpm 22 cpm
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2. Thin hair
5. Dry lips
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NUTRITION AND METABOLIC PATTERN
3-5 glasses/day
None
Any Supplements:
None
Bladder
Usual frequency: 5-6 times/ day
Bowel
Time: No specific
Color: Brownish
Consistency: Semi-form
None
Sleep Pattern:
A. DEFINITION OF DISEASE
Coronary artery disease (CAD), also called coronary heart disease, is a condition in which
plaque builds up inside the coronary arteries. These arteries supply your heart muscle
Plaque is made up of fat, cholesterol calcium, and other substances found in the blood.
Atherosclerosis
Figure A shows a normal artery with normal blood flow. Figure B shows an artery with
plaque buildup.
Plaque narrows the arteries and reduces blood flow to your heart muscle. It also makes
it more likely that blood clots will form in your arteries. Blood clots can partially or
Overview
When your coronary arteries are narrowed or blocked, oxygen-rich blood can't reach
Angina is chest pain or discomfort that occurs when not enough oxygen-rich blood is
flowing to an area of your heart muscle. Angina may feel like pressure or squeezing in
your chest. The pain also may occur in your shoulders, arms, neck, jaw, or back.
A heart attack occurs when blood flow to an area of your heart muscle is completely
blocked. This prevents oxygen-rich blood from reaching that area of heart muscle and
causes it to die. Without quick treatment, a heart attack can lead to serious problems
Over time, CAD can weaken the heart muscle and lead to heart failure and arrhythmias.
Heart failure is a condition in which your heart can't pump enough blood throughout
your body. Arrhythmias are problems with the speed or rhythm of your heartbeat.
Outlook
CAD is the most common type of heart disease. Lifestyle changes, medicines, and/or
Atherosclerosis
Heart disease
THE HEART
Your heart is located under the ribcage in the center of your chest between your
right and left lung. It’s shaped like an upside-down pear. Its muscular walls beat, or
The size of your heart can vary depending on your age, size, or the condition of
your heart. A normal, healthy, adult heart most often is the size of an average
clenched adult fist. Some diseases of the heart can cause it to become larger.
The heart is the muscle in the lower half of the picture. The heart has four
chambers. The right and left atria are shown in purple. The right and left
Connected to the heart are some of the main blood vessels—arteries and veins
The ventricle on the right side of your heart pumps blood from the heart to your
lungs. When you breathe air in, oxygen passes from your lungs through blood
vessels where it’s added to your blood. Carbon dioxide, a waste product, is
passed from your blood through blood vessels to your lungs and is removed from
lungs. The pumping action of your left ventricle sends this oxygen-rich blood
The superior and inferior vena cavae are in blue to the left of the muscle as you
look at the picture. These veins are the largest veins in your body. They carry
used (oxygen-poor) blood to the right atrium of your heart. “Used” blood has
had its oxygen removed and used by your body’s organs and tissues. The
superior vena cava carries used blood from the upper parts of your body,
including your head, chest, arms, and neck. The inferior vena cava carries used
The used blood from the vena cavae flows into your heart’s right atrium and
then on to the right ventricle. From the right ventricle, the used blood is pumped
through the pulmonary arteries (in blue in the center of picture) to your lungs.
Here, through many small, thin blood vessels called capillaries, your blood picks
The oxygen-rich blood passes from your lungs back to your heart through the
pulmonary veins (in red to the left of the right atrium in the picture).
The Left Side of the Heart
Oxygen-rich blood from your lungs passes through the pulmonary veins (in red to
the right of the left atrium in the picture). It enters the left atrium and is pumped
into the left ventricle. From the left ventricle, your blood is pumped to the rest of
Like all of your organs, your heart needs blood rich with oxygen. This oxygen is
supplied through the coronary arteries as it’s pumped out of your heart’s left
ventricle. Your coronary arteries are located on your heart’s surface at the
beginning of the aorta. Your coronary arteries (shown in red in the drawing)
HEART INTERIOR
The Septum
The right and left sides of your heart are divided by an internal wall of tissue
called the septum. The area of the septum that divides the two upper chambers
(atria) of your heart is called the atrial or interatrial septum. The area of the
septum that divides the two lower chambers (ventricles) of your heart is called
Heart Chamber
The picture shows the inside of your heart and how it’s divided into four
chambers. The two upper chambers of your heart are called atria. The atria
receive and collect blood. The two lower chambers of your heart are called
ventricles. The ventricles pump blood out of your heart into the circulatory
Heart Valves
The picture shows your heart’s four valves. Shown counterclockwise in the
picture, the valves include the aortic valve, the tricuspid valve, the pulmonary
The arrows in the drawing show the direction that blood flows through your
heart. The light blue arrows show that blood enters the right atrium of your
heart from the superior and inferior vena cavae. From the right atrium, blood is
pumped into the right ventricle. From the right ventricle, blood is pumped to
The light red arrows show the oxygen-rich blood coming in from your lungs
through the pulmonary veins into your heart’s left atrium. From the left atrium,
the blood is pumped into the left ventricle, where it’s pumped to the rest of your
For the heart to function properly, your blood flows in only one direction. Your
heart’s valves make this possible. Both of your heart’s ventricles has an “in”
(inlet) valve from the atria and an “out” (outlet) valve leading to your arteries.
Healthy valves open and close in very exact coordination with the pumping
action of your heart’s atria and ventricles. Each valve has a set of flaps called
leaflets or cusps, which seal or open the valves. This allows pumped blood to
pass through the chambers and into your arteries without backing up or flowing
backward.
Suferior Vena Cava
Right Atrium Tricuspid Valve Right Ventricle
Pulmonary Artery
Cholesterol
Foam Cells
Oxidized LDL
Plaque Formation
Reduces Oxygen And Nutrients In The Heart And Affects The Supply Of Oxygen To The Vital Organs
Research suggests that coronary artery disease (CAD) starts when certain factors
damage the inner layers of the coronary arteries. These factors include:
Smoking
When damage occurs, your body starts a healing process. Excess fatty tissues release
compounds that promote this process. This healing causes plaque to build up where the
The buildup of plaque in the coronary arteries may start in childhood. Over time, plaque
can narrow or completely block some of your coronary arteries. This reduces the flow of
Plaque also can crack, which causes blood cells called platelets to clump together and
form blood clots at the site of the cracks. This narrows the arteries more and worsens
thrombus formation.
atherosclerosis.
Age – As you get older, your risk for CAD increases. Genetic or lifestyle
factors cause plaque to build in your arteries as you age. By the time
symptoms.
o In women, the risk for CAD risk increases after age 55.
Overweight or obesity – Overweight is having extra body weight from
muscle, bone, fat, and/or water. Obesity is having a high amount of extra
body fat.
Stress – Research shows that the most commonly reported "trigger" for a
anger.
Alcohol – Heavy drinking can damage the heart muscle and worsen other
risk factors for heart disease. Men should have no more than two drinks
containing alcohol a day. Women should have no more than one drink
Palpitations
Palpitations
Fatigue
Fatigue
Dizziness
Dizziness
Weakness
Blurring of vision
Peripheral Edema
G. DIAGNOSTIC TEST
Your doctor will diagnose coronary artery disease (CAD) based on:
No single test can diagnose CAD. If your doctor thinks you have CAD, he or she will
ECG (Electrocardiogram)
An ECG is a simple test that detects and records the electrical activity of your heart. An
EKG shows how fast your heart is beating and whether it has a regular rhythm. It also
shows the strength and timing of electrical signals as they pass through each part of
your heart.
Certain electrical patterns that the EKG detects can suggest whether CAD is likely. An
During stress testing, you exercise to make your heart work hard and beat fast while
heart tests are performed. If you can't exercise, you're given medicine to speed up your
heart rate.
When your heart is beating fast and working hard, it needs more blood and oxygen.
Arteries narrowed by plaque can't supply enough oxygen-rich blood to meet your
heart's needs. A stress test can show possible signs of CAD, such as:
During the stress test, if you can't exercise for as long as what's considered normal for
someone your age, it may be a sign that not enough blood is flowing to your heart. But
other factors besides CAD can prevent you from exercising long enough (for example,
Some stress tests use a radioactive dye, sound waves, positron emission tomography
(PET), or cardiac magnetic resonance imaging (MRI) to take pictures of your heart when
These imaging stress tests can show how well blood is flowing in the different parts of
your heart. They also can show how well your heart pumps blood when it beats
Echocardiography
This test uses sound waves to create a moving picture of your heart. Echocardiography
provides information about the size and shape of your heart and how well your heart
The test also can identify areas of poor blood flow to the heart, areas of heart muscle
that aren't contracting normally, and previous injury to the heart muscle caused by poor
blood flow.
Chest X-ray
A chest x ray takes a picture of the organs and structures inside the chest, including
A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes
Blood Tests
Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your
blood. Abnormal levels may show that you have risk factors for CAD.
Your doctor may recommend electron-beam computed tomography (EBCT). This test
finds and measures calcium deposits (called calcifications) in and around the coronary
arteries. The more calcium detected, the more likely you are to have CAD.
EBCT isn't used routinely to diagnose CAD, because its accuracy isn't yet known.
Coronary Angiography and Cardiac Catheterization
Your doctor may ask you to have coronary angiography (an-jee-OG-ra-fee) if other tests
or factors show that you're likely to have CAD. This test uses dye and special x rays to
To get the dye into your coronary arteries, your doctor will use a procedure called
cardiac catheterization . A long, thin, flexible tube called a catheter is put into a blood
vessel in your arm, groin (upper thigh), or neck. The tube is then threaded into your
coronary arteries, and the dye is released into your bloodstream. Special x rays are
Cardiac catheterization is usually done in a hospital. You're awake during the procedure.
It usually causes little to no pain, although you may feel some soreness in the blood
VI. TREATMENT
Treatment for coronary artery disease (CAD) may include lifestyle changes, medicines,
Relieve symptoms
Reduce risk factors in an effort to slow, stop, or reverse the buildup of plaque
Lower the risk of blood clots forming, which can cause a heart attack
Lifestyle Changes
Making lifestyle changes can often help prevent or treat CAD. For some people, these
Follow a heart healthy eating plan to prevent or reduce high blood pressure and
Increase your physical activity. Check with your doctor first to find out how much
Therapeutic Lifestyle Changes (TLC). Your doctor may recommend TLC if you have high
cholesterol. TLC is a three-part program that includes a healthy diet, physical activity,
With the TLC diet, less than 7 percent of your daily calories should come from saturated
fat. This kind of fat is mainly found in meat and poultry, including dairy products. No
more than 25 to 35 percent of your daily calories should come from all fats, including
and the different kinds of fat in prepared foods can be found on the Nutrition Facts
label.
Foods high in soluble fiber also are part of a healthy eating plan. They help block the
Legumes such as kidney beans, lentils, chick peas, black-eyed peas, and lima
beans
compounds in your diet. These compounds, called plant stanols or sterols, work like
soluble fiber.
Fish are an important part of a heart healthy diet. They're a good source of omega-3
fatty acids, which may help protect the heart from blood clots and inflammation and
reduce the risk for heart attack. Try to have about two fish meals every week. Fish high
You also should try to limit the amount of sodium (salt) that you eat. This means
choosing low-sodium and low-salt foods and "no added salt" foods and seasonings at
the table or when cooking. The Nutrition Facts label on food packaging shows the
triglyceride level. (Triglycerides are a type of fat found in the blood.) Alcohol also adds
extra calories, which will cause weight gain. Men should have no more than two
alcoholic drinks a day. Women should have no more than one alcoholic drink a day.
Dietary Approaches to Stop Hypertension (DASH) eating plan. Your doctor may
recommend the DASH eating plan if you have high blood pressure. The DASH eating plan
focuses on fruits, vegetables, whole grains, and other foods that are heart healthy and
lower in salt/sodium.
This eating plan is low in fat and cholesterol. It also focuses on fat-free or low-fat milk
and dairy products, fish, poultry, and nuts. The DASH eating plan is reduced in red meat
(including lean red meat), sweets, added sugars, and sugar-containing beverages. It's
Regular physical activity can lower many CAD risk factors, including LDL ("bad")
cholesterol, high blood pressure, and excess weight. Physical activity also can lower your
risk for diabetes and raise your levels of HDL cholesterol (the "good" cholesterol that
Check with your doctor about how much and what kinds of physical activity are safe for
you. Unless your doctor tells you otherwise, try to get at least 30 minutes of moderate-
intensity activity on most or all days of the week. You can do the activity all at once or
More intense activities, such as jogging, swimming, and various sports, also may be
Maintaining a healthy weight can decrease risk factors for CAD. If you're overweight,
aim to reduce your weight by 7 to 10 percent during your first year of treatment. This
amount of weight loss can lower your risk for CAD and other health problems.
After the first year, you may have to continue to lose weight so you can lower your body
BMI measures your weight in relation to your height and gives an estimate of your total
considered obese. A BMI of less than 25 is the goal for preventing and treating CAD.
Quit Smoking
If you smoke or use tobacco, quit. Smoking can damage and tighten blood vessels and
raise your risk for CAD. You also should avoid exposure to secondhand smoke.
Reduce Stress
Research shows that the most commonly reported "trigger" for a heart attack is an
emotionally upsetting event—particularly one involving anger. Also, some of the ways
people cope with stress, such as drinking, smoking, or overeating, aren't heart healthy.
Physical activity can help relieve stress and reduce other CAD risk factors. Many people
also find that meditation or relaxation therapy helps them reduce stress.
Medicines
You may need medicines to treat CAD if lifestyle changes aren't enough. Medicines can:
Prevent or delay the need for a special procedure (for example, angioplasty or
Medicines used to treat CAD include anticoagulants, aspirin and other antiplatelet
glycoprotein IIb-IIIa, statins, and fish oil and other supplements high in omega-3 fatty
acids.
Medical Procedures:
Angioplasty
with a balloon or other device on the end is threaded through a blood vessel to the
narrowed or blocked coronary artery. Once in place, the balloon is inflated to push the
plaque outward against the wall of the artery. This widens the artery and restores the
flow of blood.
Angioplasty can improve blood flow to your heart, relieve chest pain, and possibly
prevent a heart attack. Sometimes a small mesh tube called a stent is placed in the
Coronary artery bypass surgery, also coronary artery bypass graft surgery, and
angina and reduce the risk of death from coronary artery disease. Arteries or veins from
elsewhere in the patient's body are grafted to the coronary arteries to bypass
atherosclerotic narrowings and improve the blood supply to the coronary circulation
supplying the myocardium (heart muscle). This surgery is usually performed with the
Your doctor may prescribe cardiac rehabilitation (rehab) for angina or after
CABG, angioplasty, or a heart attack. Cardiac rehab, when combined with medicine and
surgical treatments, can help you recover faster, feel better, and develop a healthier
lifestyle. Almost everyone with CAD can benefit from cardiac rehab.
The cardiac rehab team may include doctors, nurses, exercise specialists,
therapists.