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Coronary artery disease slide

  3. CORONARY ARTERY DISEASE IS ALSO KNOWN AS • Ischemic heart disease • Atherosclerotic heart disease • Coronary heart disease • Simple heart disease
  4. • Coronary artery disease (CAD) is the most prevalent type of cardiovascular disease in adults. For this reason, it is important for nurses to become familiar with various manifestations of coronary artery conditions and methods for assessing, preventing, and treating these disorders. • Coronary artery disease is the leading cause of death in the united state . CAD is characterized by the accumulation of plague within the layers of the coronary arteries .
  5. The plague progressively enlarge , thicken and calcify , causing a critical narrowing (70%) of the coronary artery lumen , resulting in a decrease in coronary blood flow and an inadequate supply of oxygen to the heart muscles.
  8. Incidence • The 2016 heart disease and stroke statistic update of the American heart association has recently reported that 15.5 million person >20 years of age in the USA have coronary heart disease , whilst the reported prevalence increased with age for both women and men and it has been estimated that approximately every 42 seconds.
  9. TYPES OF CORONARY ARTERY DISEASE – • Obstructive coronary artery disease • Nonobstructive coronary artery disease • Coronary microvascular disease.
  10. • Obstructive CAD was defined as any stenosis 50% or greater in the left main coronary artery, 70% or greater in any other coronary artery, or both. Obstructive CAD was defined as any stenosis 50% or greater in the left main coronary artery, 70% or greater in any other coronary artery, or both.
  11. • Nonobstructive coronary artery disease (CAD) is atherosclerotic plaque that would not be expected to obstruct blood flow or result in anginal symptoms (such as chest pain). • Coronary microvascular disease (sometimes called small artery disease or small vessel disease) is heart disease that affects the walls and inner lining of tiny coronary artery blood vessels that branch off from the larger coronary arteries.
  12. CORONARYARTERY DISEASE CAUSES • Modifiable risk factor • Non modifiable risk factor • Contributing risk factor
  13. PATHOPHYSIOLOGY Coronary artery cannot supply enough blood to the heart in response to the demand due to CAD Within 10 second myocardial cells experience ischemia Ischemia cells cannot get enough oxygen or glucose Ischemic myocardial cells may have decrease electrical and muscular function
  14. Cells convert to anaerobic metabolism Cells produce lactic acid as waste Pain develops from lactic acid accumulation Angina symptoms increase oxygen requirements of myocardial cells v
  15. CLINICAL MANIFESTATION • Angina, which can feel like pressure, squeezing, burning, or tightness during physical activity. The pain or discomfort usually starts behind the breastbone, but it can also occur in the arms, shoulders, jaw, throat, or back. The pain may feel like indigestion. • Cold sweats
  16. • Dizziness • Light-headedness or dizziness • Nausea or a feeling of indigestion • Neck pain • Shortness of breath, especially with activity • Sleep disturbances • Weakness • Extreme fatigue. • Heart palpitations.
  17. • Swelling in your legs and feet, known as edema. • Swelling in your abdomen. • Cough or congestion, caused by fluid in your lungs. • Chronic ischemic heart disease can cause signs and symptoms such as the following: • Angina • Anxiety or nervousness • Fatigue • Neck pain 5
  18. DIAGNOSTIC EVALUATION • History collection • Physical examination • Electrocardiography • Exercise – Stress test • Echocardiography (including stress echocardiography) • Coronary angiography • Intravascular ultrasound • Magnetic resonance imaging (MRI)
  21. Echocardiography
  24. Magnetic resonance imaging
  25. COMPLICATION • Heart failure • CAD can lead to heart failure. Heart failure means that the heart isn’t able to pump enough blood to the rest of body. This can cause fluid buildup in the lungs, difficulty breathing, and swelling of the legs, liver, or abdomen.
  26. Abnormal heartbeat(arrhythmia ) Atrial fibrillation causes heart to be ineffective at pumping blood out of the atria to the lower chambers of the heart (ventricles) and into other parts of body for circulation. Over time, atrial fibrillation can lead to an ischemic stroke or heart failure.
  27. • Chest pain • Reduced blood flow in coronary arteries , heart doesn’t receive enough blood . This can cause a type of pain called angina. Angina may cause chest numbness sensations in chest with tightness heaviness pressure aching burning squeezing fullness.
  28. • Heart attack • If the fatty plaque in coronaries arteries ruptures, a blood clot can form. This can greatly block and decrease needed blood flow of heart, causing a heart attack. The severe lack of oxygenated blood flow can damage heart. Part of heart tissue may die. • Sudden death • If coronary artery blood flow to the heart is severely blocked and not restored, it can cause sudden death.
  29. MEDICAL MANAGEMENT • Beta blockers • Calcium channel blockers • Ranolazine • Nitroglycerin • Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). • Cholesterol-modifying medications. • Aspirin.
  30. SURGICAL MANAGEMENT • Percutaneous transluminal coronary angioplasty (PTCA ) -, A balloon tipped catheter is used to open blocked coronary vessels and resolve ischemia . it is used in patient with angina and as an intervention for ACS . the purpose of PTCA is to improve blood flow with in a coronary artery by compressing and cracking the atheroma .
  31. Coronary artery stent
  32. PREVENTION • Controlling cholesterol level • Dietary measure • Physical activity • Medication • Promoting cessation of tobacco use • Managing hypertension • Controlling diabetic mellitus • Stressful lifestyle
  33. HEALTH EDUCATION • Diet • Habits • Exercise • Medication • Bowels • Sexual advice
  34. RESEARCH ARTICLE • Personal Observation of Thiamine Therapy of Coronary Heart Diseases-A Preliminary Approach of Physiologic Therapy with Case Reports • Benjamin Yuehtung Lee1,3*, Julia H Bai2, Li Zhengya3 and Wang Yanrong3 • Abstract • This report was based on clinical findings from a population with terrible hard labor and inadequate food 6 decades ago. Thiamin was found essential in body energy regeneration, curable for many heart disorders including hypertension, and dramatically eliminating lipoma. Only thiamin 300 mg plus 1 ampule of VB Co. were injected twice daily in a case of severe coronary heart disease and cured. Another 32 patients were then followed. As the result of continuous 180-300 injections within 3-5 months, there was an initial non-responding stage about 3-8 weeks without improvement of cardiac signs possibly due to reducing the lipid/cholesterol blockers or blood cell debris.
  35. • Once an interval was found, lipid/cholesterol removal by thiamin would be progressed gradually or dramatically for totally 3-5 months until cardiac signs completely free for 2-4 years. No other routine medicine was required. The associated abnormalities were eradicated including kidney cyst, panic state, Parkinson syndrome, nail-layering, peripheral neuritis. It could be “refueled” with only vitamin B1 after a certain period if restenosis returned. Although all regular medicine was canceled, associate hypertension, hyperlipidemia, and diabetes were normalized or obviously reduced and diabetes greatly improved in measured cases. Thus, update by multiple institutes is required
  36. • Conclusion High dose of parenteral thiamin was curable for CHD. It should be also an essential and prompt rescue procedure in myocardial infarction, cerebral apoplexy and electric shock of the heart. Thiamin was highly effective in reducing body fat and eliminating lipoma and should be an essential agent in preventing and eliminating obesity.
  37. • CONCLUSION- • Coronary artery disease is highest among Indians . it is highly preventable and controllable with diet and exercise with present treatment of angioplasty and coronary bypass surgery person can live long and fruitful life. • The discomfort associated with angina pectoris abates when supply become adequate for demand , typically angina last for second to minutes up to 15 mint . it is cured with the help of proper early management .