pathophys of CAD
- Endothelial cells are injured
- --Become permeable to circulating lipoproteins
- --Fatty streak formsRepeated injury causes streak to grow to a plaque
- --Complicated lesion compromises vessel wall
- Atherosclerotic plaque may obstruct a coronary vessel
- Plaque may rupture, forming a thrombus
- Vessel may become partially or totally occluded
- --May occur anywhere in the vessel
Risk factors for CAD
- --age, family history, sex, and race
- --hypertension, tobacco, high LDL, diabetes, obesity, sedentary life, stress
- --Metabolic Syndrome (DM is a subset of of metabolic syndrome)
- --Hcy (homocystien, enflammatory marker).
SnSs of CAD
- The classic symptom of CAD is angina, the direct result of inadequate flow of oxygen to the myocardium (ischemic).
- P = Provocative
- Q = Quality
- R = Region/Radiation/Relief
- S = Severity/Other Symptoms
- T = Timing
Types of Angina
- Stable Angina: is predictable in frequency and durationhas not changed over a period of months
- Unstable Angina: increases in frequency and duration. Is more easily induced. Does not necessarily subsite with rest. Progressively gets worse, does not respond to nitrates.
- Prinzmetal’s Angina: results from unpredictable coronary artery spasmmay occur at rest or sleep. Not technically considered CAD.Look over this one for the test.
What does an ECG look like for angina?
- Often read while stressing heart via pt on treadmill.
- This is a normal one. With aschemic heart, ST segment will be below baseline, like this:
Treatment for Angina
- Beta-adrenergic blockers
- Calcium channel blockers
- ACE inhibitors
What are some invasive treatments for CAD?
- Cardiac Catheterization
- --Angiogram: photos taken via floroscapy (information gathering)
- --Angioplasty: the actual surgical procedure to correct blockage.
- --PCI: percutaneous cardiac intervension
Coronary Artery Bypass Graft (CABG)
- Coronary Artery Bypass Graft (CABG)
- --Graft circumvents the occluded artery entirely. Occluded artery stays in place and is simply not used due to blood flow originating above the site of original artery insertion.
- --For obstructive lesions
- --Uses vein and/or artery grafts
Nursing intervensions for angina/any cath-lab patient.
- Explain all procedures (education)
- Pain control. Sometimes nitro can help with this.
- Hemodynamic Monitoring
- Rest and comfort to keep cardiac demand down.
- Monitor insertion site for bleeding; check distal pulses and movement
- Instruct about fluids and bed rest
- Instruct about treatment
Increase 02 supply, decrease 02 demand.
Prevension of CAD/Angina
- Diet and Exercise
- Tobacco Cessation
- Stress Reduction
- Control of Hypertension, Serum Cholesterol, and Triglycerides
- Minimization of Platelet Aggregation (antithrombolytic)