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Coronary artery disease : CAD, atherosclerotic heart disease

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Coronary artery disease : CAD, atherosclerotic heart disease

  1. 1. CORNARY ARTERY DISEASE PRESENTED BY: Dr. PALLAVI PATHANIA
  2. 2. www.drsarma.in 2
  3. 3. 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
  4. 4. – 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.
  5. 5. ATHEROSCLEROSIS • A disease of the arteries characterized by the deposition of fatty material on their inner walls.
  6. 6. ARTERIOSCLEROSIS The thickening and hardening of the walls of the arteries.
  7. 7. 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.
  8. 8. • 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.
  9. 9. • 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.
  10. 10. 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
  11. 11. 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
  12. 12. CLINICAL MANIFESTATION: • ACUTE ONSET OF CHEST PAIN. •NAUSEA AND VOMITING. •INDIGESTION •FAINTING •CHANGES IN ECG. •HIGHER LEVEL OF CARDIAC ENZYME.
  13. 13. • 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
  14. 14. DIAGNOSTIC EVALUATION: • ECG • STRESS TESTING • BLOOD TEST • ANGIOGRAPHY • CARDIAC CATHETERIZATION • PET (POSITRON EMISION TOMOGRAPHY)
  15. 15. ECG •P = contractions of the atria  •QRS= ventricular contractions.. •T and U = follow the ventricular contractions.
  16. 16. ECG FINDINGS
  17. 17. 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.
  18. 18. TREADMILL STRESS TEST
  19. 19. 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.
  20. 20. 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.
  21. 21. RADIONUCLIDE IMAGING
  22. 22. 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.
  23. 23. Magnetic Resonance Angiography • MRA is a newer non invasive imaging technique that can provide three-dimensional images of the major arteries to the heart.
  24. 24. COMPUTED TOMOGRAPHY • Computed tomography (CT) scans may be used to evaluate coronary artery disease.
  25. 25. BLOOD TEST INVESTIGATIONS
  26. 26. • 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.
  27. 27. • 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.
  28. 28. 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)
  29. 29. 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.
  30. 30. TREATMENT
  31. 31. 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.
  32. 32. SURGICAL TREATMENT • PTCA • STENT PROCEDURE • ANGIOPLASTY • ATHERECTOMY • BYPASS SURGERY {CABG} • MIDCAB
  33. 33. 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.
  34. 34. PCTA
  35. 35. STENT
  36. 36. 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.
  37. 37. • A DIRECTIONAL ATHERECTOMY device cuts away plaque, which is then collected in the tip of the device.
  38. 38. • A ROTATIONAL CUTTING DEVICE spins at a high speed and pulverizes plaque, which is then safely washed away in your bloodstream.
  39. 39. • A TRANSLUMINAL EXTRACTION device cuts away plaque using tiny rotating blades. The loose plaque is sucked into a tube through a vacuum.
  40. 40. 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
  41. 41. 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.
  42. 42. Provide healthy diet { fat free} Low sodium diet
  43. 43. 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
  44. 44. COMPLICATION • MI • CARDIAC DEATH • CARDIAC FAILURE
  45. 45. RESEARCH FINDINGS
  46. 46. • 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.
  47. 47. SUMMARIZATION
  48. 48. THANK YOU Eat good, Workout for a Strong Heart

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