Evan Joshua Matias

BSN-III

Is the most prevalent type of

cardiovascular disease in adults. For
this reason, nurse's must recognized
various manifestations of coronary
artery conditions and evidencebased methods for assessing,
preventing, and treating these
disorders.

An abnormal accumulation of lipid, or

fatty substances, and fibrous tissue in the
lining of arterial blood vessel walls. These
substances block and narrow the coronary
vessels in a way that reduces blood flow
to the myocardium.
It involves a repetitious inflammatory
response to injury of the artery wall and
subsequent alteration in the structural
and biochemical properties of the arterial
walls.

Smoking, Hypertension,
hyperlipidemia, and other factors.
Injury to the vascular endothelium and
progresses over many years.
Endothelium undergoes changes and stops
producing the normal antithrombic and
vasodilating agents.
The presence of inflammation attracts
inflammatory cells, such as monocytes
(macrophages)
Macrophage ingest lipids, becoming foam cells
that transport the lipids into the arterial wall.

Smooth muscle cells

proliferate and form
fibrous cap over a core
filled with lipid and
inflammatory infiltrate.

Release the biochemical

substances that can
further damage
endothelium.

Forming fatty streaks

Atheromas, or plaque,
protrude into the lumen
of vessels narrowing it
and obstruction blood
flow.

Contributing to the
oxidation of LDL.
Oxidized LDL is toxic to the
endothelial cells and fuels
progression of the
atherosclerotic process.

Plaque may be unstable or unstable, depending on the degree of

inflammation and thickness of the fibrous cap.

If the fibrous cap over the

plaque is thick and the lipid
pool remains relatively stable,
it can resist the stress of blood
flow and vessel movement.

If the cap is thin and

inflammation is ongoing, the
lesion becomes what is called
vulnerable plaque.

Ruptured plaque attracts platelets and

causes thrombus formation.
Thrombus may then obstruct blood flow.
Leading to acute coronary
syndrome (ACS)
Portion of heart muscle no longer
receives blood flow and becomes
necrotic.

Myocardial Infarction (MI)

Ischemia, an impediment to blood flow is usually

progressive, causing an inadequate blood supply
that deprives the cardiac muscle cells of oxygen
needed for their survival. Angina Pectoris, refers
to chest pain that is brought about by myocardial
ischemia.
Sudden Cardiac Death, decrease in blood supply
from CAD may even cause the heart to abruptly
stop beating.
Patient with Myocardial ischemia, some complain
of epigastric distress and pain that radiates to
the jaw or left arm.
Patients who are older/history of diabetes or
heart failure, may report shortness of breath.

Atypical symptoms
Indigestion
Nausea
Palpitations
Numbness
Prodromal symptoms
Angina a few hours to days before
the acute episode.
Major cardiac event.

Nonmodifiable Risk Factors: circumstance

over which a person has no control.
Family history of CAD (first-degree relative
with CVD at 55 years of age or younger for
men and at 65 years of age or younger for
women.
Increasing age (more than 45 years for men;
more than 55 years for women)
Gender (men develop CAD at an earlier age
than women)
Race (higher incidence of heart disease in
African Americans than in Caucasians)

Modifiable risk factors: one over which a

person may exercise control, such as by
changing a lifestyle or personal habit or
by using medication.
Hyperlipidemia
Cigarette smoking, tobacco use
Hypertension
Diabetes
Metabolic syndrome
Obesity
Physical inactivity

Central adiposity
Increased fasting blood glucose and production of
adipokines by adipose cells
Metabolic syndrome:
Insulin resistance
Increased fasting blood glucose
Dyslipidemia
Hypertension
Chronic inflammation
Direct atherogenic effects
ATHEROSCLEROSIS

Four modifiable risk factors----cholesterol

abnormalities, tobacco use, hypertension,
and diabetes----have been cited as major
risk factors for CAD and its complications.

All adults 20 years and older should have a

fasting lipid profile (total cholesterol, LDL,
HDL and triglycerides) performed at least
once every 5 years, and more often if the
profile is abnormal.
Patients who have had an acute event (e.g.,
MI), a percutaneous coronary intervention
(PCI), or a coronary artery bypass graft
(CABG) require assessment of their
procedure, because LDL levels may be low
immediately after the acute event or
procedure.

Subsequently, lipids should be monitored

every 6 weeks until the desired level is
achieved and then every 4 to 6 months.

Fasting lipid profile should demonstrate the ff.

values:
LOW DENSITY LIPOPROTEIN
CHOLESTEROL

Less than 100 mg/dl (less than

70 mg/Dl for every high-risk
patients)

TOTAL CHOLESTEROL

Less than 200 mg/dl

HIGH DENSITY LIPOPROTEIN

Greater than 40 mg/Dl for

males and greater than 50
mg/dl for females.

TRIGLYCERIDES

Less than 150 mg/dl

Diet low in saturated fat and high in soluble from

fiber
General recommendations may need to be
adjusted for the individual patient who has other
nutritional needs, such as the patient who has
diabetes.
Mediterranean diet, promotes vegetables and
fish and restricts red meat. It is reported to
reduce mortality from cardiovascular disease.
Cookbooks and recipes that include the
nutritional contents of foods can be included as
resources for patients.
Label information such as serving size, amt. of
total fat per serving, amt. of saturated fat and
trans fat per serving, amt. of cholesterol per
serving, and amt. of fiber per serving.

Engage in moderate-intensity aerobic activity

of at least 75 minutes per weak or vigorousintensity aerobic activity of at least 75
minutes per week, or an equivalent
combination.
For sustained activity, patients should begin
with a 5-minute warm-up period before
stretching to prepare the body for exercise.
They should end the exercise with a 5minute cool-down period in which they
gradually reduce the intensity of the activity
to prevent a sudden decrease in cardiac
output.

When the weather is hot and humid, patients

should exercise during the early morning, or
indoors, and wear loose-fitting clothing.
When the weather is cold, they should layer
coating and wear hat.
Patients should stop any activity if chest
pain, unusual shortness of breath, dizziness,
lightheadedness, or nausea occurs.

HMG-CoA Reductase inhibitors (statins):

Atorvastatin (Lipitor)
Simvastatin (Zocor)
Nicotinic Acids:
Niacin extended release (Niaspan)
Niacin sustained release (Slo-Niaspan)
Fibric acids: (Fibrates)
Fenofibrate (TriCor)
Gemfibrozil (Lopid)
Bile acid sequestrants:
Cholystyramine (Questran)
Colestipol (Colestid)
Cholesterol Absorption Inhibitor:
Ezetimibe (Zetia)
Omega-3 Acid Ethyl Esters:
Fish oil capsules

Encouraged to stop tobacco use through any

means possible:
Educational programs, counseling, consistent
motivation and reinforcement messages,
support groups, and medications.
Use of medications such as the nicotine patch
(NicoDerm CQ, Habitrol), varenicline (Chantix),
or bupropion (Zyban) may asssist with stopping
the use of tobacco.
Products containing nicotine have some of the
same effects as smoking: cathecolamines release
(increase HR and BP) and increased platelet
adhesion.

Hypertension is defined as BP repeatedly

exceeds 140/90mm Hg. The risk of CVD
increases as BP increases, and people with a
BP greater than 120/80mm Hg are considered
prehypertensive and at risk.
Early detection of high BP and adherence to
a therapeutic regimen can prevent the
serious consequences associated with
untreated elevated BP, including CAD.

Diabetes is known to accelerate the

development of heart disease. Treatment
with insulin, metformin (Glucophage), and
other therapeutic interventions that lower
plasma glucose levels can lead to improves
endothelial function and patients outcomes.

Heart disease has long been recognized as a

cause of morbidity and mortality in men, but it
has not been as readily recognized and treated in
women until recently.
Women tend to not recognize the symptoms of
CAD as early as men, and they wait longer to
report their symptoms and seek medical
assistance.
CVD may be well developed by the time of
menopause despite the supposed protective
effects of estrogen. Although hormone therapy
(HT) (formerly referred to as hormone
replacement therapy) for menopausal women
was once promoted as preventive therapy for
CAD, research does not support HT as an
effective means of prevention.

In the past, women who possibly had

coronary vascular events were less likely
than men to be reffered for coronary artery
diagnostic procedures such as heart
catheterization or treatment with invasive
interventions (e.g., PCI). However, as a
result of better education of health care
professionals and general public, gender
differences now have less influence on
diagnosis and treatment.
Women also have poorer results related to
symptom relief. These differences may be
due to older age, more comorbid conditions,
smaller coronary arteries, and differences in
the distribution of plaque in the coronary
arteries.