CAD, atherosclerotic heart disease: Damage or disease in the heart's major blood vessels. More than 10 million cases per year (India)

1. CORNARY ARTERY DISEASE
PRESENTED BY: Dr. PALLAVI PATHANIA

2. www.drsarma.in 2

7. INTRODUCTION
• Coronary artery disease (CAD),
also known as ischemic heart
disease (IHD), is a group of
diseases that includes:
stable angina, unstable angina,
myocardial infarction, and
sudden coronary death

8. – The arteries, which is
smooth and elastic, become
narrow and rigid, restricting
blood flow to the heart. The
heart becomes starved of
oxygen and the vital
nutrients ,which needs to
pump properly.

10. ATHEROSCLEROSIS
• A disease of the arteries characterized by the
deposition of fatty material on their inner walls.

11. ARTERIOSCLEROSIS
The thickening and hardening of the walls of the
arteries.

12. DEFINITION :DEFINITION :
It is an abnormal
accumulation of the lipids or
fatty substances and fibrous
tissue in the vessel wall.
which blocks and narrow the
blood vessel, reducing the
blood flow to myocardium.

13. • CAD is characterized by
accumulation of plaque with in layer
of coronary artery. The plaque
progressively enlarge, thickens and
calcify causing a critical narrowing
of the coronary artery lumen,
resulting decrease in blood flow.

14. • What Is Ischemia?
– Ischemia is a condition in which the blood
flow (and thus oxygen) is restricted or
reduced in a part of the body. Cardiac
ischemia is the name for decreased blood
flow and oxygen to the heart muscle.
– Cardiac ischemia occurs when plaque and
fatty matter narrow the inside of an artery
to a point where it cannot supply enough
oxygen-rich blood to meet heart's needs.

16. RISK FACTORS :RISK FACTORS :
MODIFIABLE :
• HIGH BLOOD CHOLESTROL LEVEL.
• CIGARETTE SMOKING AND TOBACCO CHEWING.
• HYPERTENSION
• DM.
• PHYSICAL INACTIVITY.
• OBESITY
NON MODIFIABLE:
• FAMILY HISTORY
• INCREASING AGE
• GENDER
• RACE

17. PATHOPHYSIOLOGY:PATHOPHYSIOLOGY:
ETIOLOGICAL FACTORSETIOLOGICAL FACTORS
ACCUMULATION OF LIPIDSACCUMULATION OF LIPIDS
NARROWING OF LUMEN AND DECREASED IN BLOODNARROWING OF LUMEN AND DECREASED IN BLOOD
FLOW.FLOW.
FORMATION OF THROMBUS.FORMATION OF THROMBUS.
OBSTRUCTION IN BLOOD FLOW.OBSTRUCTION IN BLOOD FLOW.
CADCAD

18. CLINICAL MANIFESTATION:
• ACUTE ONSET OF CHEST PAIN.
•NAUSEA AND VOMITING.
•INDIGESTION
•FAINTING
•CHANGES IN ECG.
•HIGHER LEVEL OF CARDIAC ENZYME.

19. • A common symptom is chest pain
or discomfort which may travel
into the shoulder, arm, back, neck,
or jaw.
• Occasionally it may feel like
heartburn. Usually symptoms
occur with exercise or emotional
stress, last less than a few minutes,
and get better with rest.
• Shortness of breath may also occur
and sometimes no symptoms are
present
• irregular heartbeat

20. DIAGNOSTIC EVALUATION:
• ECG
• STRESS TESTING
• BLOOD TEST
• ANGIOGRAPHY
• CARDIAC
CATHETERIZATION
• PET (POSITRON EMISION TOMOGRAPHY)

21. ECG
•P = contractions of the atria
•QRS= ventricular contractions..
•T and U = follow the ventricular
contractions.

22. ECG FINDINGS

23. TREADMILL STRESS TEST
• This is the commonest test done to screen for heart
problem.
• It involves placing electrodes on body and a blood
pressure cuff on arm, then have to walk on a
treadmill.
• This is to make heart work hard so that any blockage
in artery will show up as an abnormality in ECG.

24. TREADMILL STRESS TEST

25. ECHOCARDIOGRAMS
• An echocardiogram is a non invasive test that uses ultrasound images
of the heart. This test is more expensive than an ECG, but it can be
very valuable, particularly in identifying damage of the heart muscle.

26. RADIONUCLIDE IMAGING
• Radionuclide procedures use imaging techniques and computer
analyses to plot and detect the passage of radioactive tracers
through the region of the heart & given intravenously.
Radionuclide imaging is useful for diagnosing and determining:
• Severity of chronic coronary artery disease
• Severity of unstable angina when less expensive diagnostic
approaches are unavailable or unreliable
• Success of surgeries for coronary artery disease.

27. RADIONUCLIDE IMAGING

28. ANGIOGRAPHY
• Angiography is an invasive test.
• In an angiography procedure: A narrow tube is
inserted into an artery, usually in the leg or arm,
and then threaded up through the body to the
coronary arteries.
• A dye is injected into the tube, and an x-ray
records the flow of dye through the arteries.
This process provides a map of the coronary
circulation, revealing any blocked areas.

32. Magnetic Resonance Angiography
• MRA is a newer non invasive imaging technique that can
provide three-dimensional images of the major arteries to the
heart.

34. COMPUTED TOMOGRAPHY
• Computed tomography (CT) scans may be used to evaluate coronary artery
disease.

35. BLOOD TEST INVESTIGATIONS

36. • Complete Blood Count : The CBC can help detect blood diseases and
disorders, such as anaemia, infections, clotting problems, blood cancers, and
immune system disorders.
– Red Blood Cells : (4.4-5.8 million/ml)
– White Blood Cells: (3800-10.800/ml)
– Platelets : are blood cell fragments that help to blood clot. (130.000-400.000/ml)
– Blood Glucose : Abnormal glucose levels in your blood may be a sign of diabetes.

37. • Blood Enzyme Tests : Enzymes are chemicals that help control chemical
reactions in body. There are many blood enzyme tests. This section focuses on
blood enzyme tests used to check for heart attack.
– Troponin: (25.92ng/ml) Troponin is a muscle protein that helps your muscles
contract. When muscle or heart cells are injured, troponin leaks out, and its levels in
your blood rise.
– Creatine Kinase: (141.8ng/ml ) A blood product called CK is released when the
heart muscle is damaged. High levels of CK in the blood can mean that a heart
attack.

38. Cholesterol test
• A cholesterol test, also called a lipid panel or lipid profile, measures the fats
(lipids) in blood.
– Total cholesterol : less than 200 (mg/dL)
– Low-density lipoprotein cholesterol ( less than 130, mg/dL & under 100 mg/dL)
– High-density lipoprotein cholesterol (35-45 mg/dL}
– Triglycerides ( 30-150 mg/Dl)

39. POSITRON EMISSION TOMOGRAPHY
• Positron emission tomography (PET) is a
test that uses a special type of camera and
a tracer (radioactive chemical) to look at
organs in the body.
• During the test, the tracer liquid is put into
a vein in arm. The tracer moves through
body, where much of it collects in the
specific organ or tissues.
• The tracer gives off tiny positively charged
particles (positrons). The camera records
the positrons and turns the recording into
pictures on a computer.
• A PET scan may be used to look for
cancer, check blood flow, or find out how
well organs are working.

41. TREATMENT

42. MANAGEMENT:
MEDICAL MANAGEMENT:-
PREVENTION OF RISK FACTORS
NTG. (NITROGLYCERIN)
BETA ADRENERGIC BLOCKING AGENT (PROPANALOL)
CALCIUM CHANNEL BLOCKERS. (AMLODEPINE)
ANTI PLATELETS AND ANTI COAGLULANTS. (ASPIRIN AND HEPARIN)
THROMBOLYTIC AGENT.(STREPTOKAINASE)
ANALGESICS.(MORPHIN SULPHATE)
Aspirin or other antiplatelets to help prevent blood clots.
An ACE inhibitor or a beta-blocker to help lower blood pressure
A statin to help lower cholesterol.

43. SURGICAL TREATMENT
• PTCA
• STENT PROCEDURE
• ANGIOPLASTY
• ATHERECTOMY
• BYPASS SURGERY
{CABG}
• MIDCAB

44. PERCUTANEOUS TRANSLUMINAL CORONARY
ANGIOPLASTY
• In this procedure injecting some local anaesthesia into the
groin area and putting a needle into the femoral artery, the
blood vessel that runs down the leg.
• A guide wire is placed through the needle and the needle is
removed.
• An introducer is then placed over the guide wire, after which
the wire is removed. A different sized guide wire is put in its
place.
• Next, a long narrow tube is introducer over the guide wire, into
the blood vessel and after that the guide wire is removed. Once
the catheter is placed in the coronary arteries, injects dye and
takes an x-ray.
• If a treatable blockage is noted, then a balloon catheter is
advanced to the blockage site. The balloon is inflated for a few
seconds to compress the blockage against the artery wall. Then
the balloon is deflated.

45. PCTA

46. STENT

48. ATHERECTOMY
• Atherectomy is a minimally invasive endovascular
surgery technique for removing atherosclerosis from blood
vessels within the body
• Atherectomy involves techniques similar to those used
for angioplasty.
• The difference is that atherectomy uses special tools to
remove the plaque buildup from the artery wall.

49. • A DIRECTIONAL ATHERECTOMY device
cuts away plaque, which is then collected in the tip
of the device.

50. • A ROTATIONAL CUTTING DEVICE spins at
a high speed and pulverizes plaque, which is then
safely washed away in your bloodstream.

51. • A TRANSLUMINAL EXTRACTION device
cuts away plaque using tiny rotating blades. The
loose plaque is sucked into a tube through a
vacuum.

52. CABG
Coronary artery bypass grafting (CABG) is a type of surgery that improves blood
flow to the heart. Surgeons use CABG to treat people who have severe coronary
heart disease (CHD).
There are a number of sites from which the conduit can be harvested, including
the following:
•Saphenous vein
•Radial artery
•Left internal thoracic (mammary) artery (LITA)
•Right internal thoracic (mammary) artery (RITA)
•Inferior epigastric artery
•Splenic artery

54. MINIMALLY INVASIVE HEART BYPASS SURGERY
• Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) is a minimally
invasive surgery. MIDCAB is beating heart surgery, which means that stopping the heart
(cardioplegia) is not necessary and a heart-lung machine is not required.
• MIDCAB surgery can be performed through a 3"-5" incision placed between the ribs, or
may be done with several small incisions.
• MIDCAB surgery results in a faster recovery, fewer complications, and less pain after
surgery.
• It is indicated for use when bypassing one or two coronary arteries. For bypassing three
or more arteries, a conventional CABG is indicated.

56. Provide healthy diet { fat free}
Low sodium diet

57. Nursing management
MONITRING:
 BP.
 PULSE.
 CARDIAC MONITRING.
 HOURLY INTAKE OUTPUT.
 NAIL BEDS, LIPS, OR FOR CYANOSIS
 GIVE SEMI FOWLER POSITION
 MAILTAIN FLUID ELECTROLYTE BALANCE
 BED REST
 CVP MONITORING

58. COMPLICATION
• MI
• CARDIAC DEATH
• CARDIAC FAILURE

59. RESEARCH FINDINGS

60. • Coronary heart disease in rural population of Himachal--a population based study.
BACKGROUND: Cardiovascular disease has emerged as a major health burden worldwide. There
is no study in Himachal about the prevalence of coronary heart disease (CHD), hence the purpose of
the study.
• MATERIAL AND METHODS: Population based study was done in 3 different villages of
different districts of Himachal Pradesh. The people were well notified about the survey in advance.
They cover all persons above the age of 30 years. Total 812 persons were examined. History &
Detailed physical examination regarding presence and nature of chest pain was taken.. ECG of all
patients was taken.
• RESULTS: 812 patients were examined. 399 were males and 413 were females. 33 patients were
found to have coronary heart disease, giving the prevalence of 4.06%. Twenty six of 399 males had
CHD and 19 of 413 females had CHD . 17 of these CHD patients were hypertensive, two were
diabetic and 10 patients had family history of CHD.
• CONCLUSION: The prevalence of CHD was low in rural population of Himachal Pradesh, being
around 4%, more in males than in females.

61. SUMMARIZATION

64. THANK YOU
Eat good, Workout for a Strong Heart