CORONARY ARTERY DISEASE

•An abnormal condition that may affect the heart’s arteries and produce
various pathologic
effects especially reduced flow of oxygen and nutrients to the myocardium.
•Angina Pectoris is the classic symptom of CAD and results from myocardial
ischemia.
•Coronary Atherosclesrosis an abnormal accumulation of lipid or fat
substances andfibrous tissue in the lining of arterial blood vessel wall that
blocks and narrows thecoronary vessels leading to a reduced blood flow in the
myocardium.

Risk Factors:
A. MODIFIABLE

Hyperlipidemia
Smoking
HPN, DM
Obesity
Physical Inactivity
Lack of estrogen in women

B. NON-MODIFIABLE
Family History
Increasing Age
Gender (men>women)
Race (African American)

Diagnostic Studies
• 12-lead ECG
• Holter monitor
• Exercise tolerance test (stress test)
– Exercise to increase demand on heart
– Stressed via drugs if patient cannot tolerate exercise, e.g., adenosine
– Monitoring vital signs, ECG
• Chest x-ray

Cardiac Catheterization and Arteriography

• Catheter (right or left)
– Heart pressures (similar to PA catheter)
– Cardiac output
• Arteriography
– Visualize blood vessels

Postcatheterization Care
• Bedrest; head of bed no higher than 30 degrees
• Monitor bleeding; newer collagen agents for hemostasis may be used
• Monitor pulses
• Antiplatelet drugs after the procedure (usually after interventions such
as PCI)
May be discharged in 6 to 8 hours; depends on diagnosis and procedures
done in catheterization laboratory
Cardiac Enzymes
Serum enzymes released with tissue death:
• CK-MB (cardiac specific)
– 4 to 8 hours; peak 18 to 24 hours
• Troponin I and T
– As early as 1 hour after injury
• Myoglobin
– 30 to 60 minutes after injury

Management:
Control cholesterol abnormalities
Diet: LSLF, high fiber
Smoking cessation
Managing HPN and DM
Physical Activity:
a.30 mins. regular moderate exercise (brisk walking)
b.5 mins. warm-up and cool down period
c.Instruct to wear loose fitting clothing
d.STOP if chest pain, unusual SOB, dizziness, lightheadedness or
nausea occurs

Medications:
a.Statins (Simvastatin, Provastatin)– blocks cholesterol synthesis, decreases
LDL & triglycerides, increases HDL levels.
Side Effects:Myopathy, Hepatotoxic

b.Nicotinic Acid (Niacin)– decreases lipoprotein synthesis, decreased LDL &

triglyceride, increased HDL levels.
Side Effects:GI upset, gout, flushing, & Hepatotoxic

c.Fibric Acid/Fibrates (Gemfibrozil) – decreased synthesis of cholesterol,

decreased triglycerides,
increased HDL levels.
Side Effects:Use cautiously with “statins” can cause Myopathy & ARF,
dyspepsia, &
gallstones.
d.Bile Acid Sequestrants/Resins (Cholestyramines)– bind cholesterol in the
intestines, increase its breakdown & decrease LDL levels with little effect on
HDL’s
and no effect on triglycerides.