L3.3.2: Coronary Artery Disease

• ● Coronary Artery

  ○ Supplies blood to the heart

  ○ The largest artery in the body.
• ● Coronary Artery Disease

  ○ Heart disease caused by impaired coronary blood flow.

  ○ Coronary Arteries which supply oxygen-rich blood to the heart muscle are blocked (occlusion) or narrowed (stenosis).

  ○ Brought about by a part of the heart that does not receive enough supply of blood (oxygenation).

  ■ Unsupplied oxygen to a tissue will cause it to die.
• ● Coronary Artery Disease

  ○ Also known as Ischemic Heart Disease.

  ■ Ischemia - insufficient supply of the blood to some parts of the body; leads to

  ■ Infarction - injury and death of a tissue; leads to

  ■ Neurosis
• Coronary Artery Disease

  ● Occlusion vs. Stenosis

  ○ Occlusion: Blockage in the vessels that makes it difficult for the blood to pass through.

  ○ Stenosis: Narrowing of the diameter of the blood vessel, making it difficult for the blood to go through.

  ■ Different from vasoconstriction as vasoconstriction can still be able to its normal size.
• Coronary Artery Disease

  ETIOLOGY / CAUSE

  ● Atherosclerosis

  ○ Buildup of plaque or hardened fat.

  ○ Usually occurs when there’s high levels of cholesterol in the blood.

  ■ Bad Cholesterol: VLDL (Very Low Density Lipoprotein)
• ARTERIOSCLEROSIS

  ● A general term describing any narrowing (and loss of elasticity) of medium or large arteries.
• ATHEROSCLEROSIS

  ● A narrowing of blood vessels specifically due to plaque.

  ● Atherosclerosis is the common form of arteriosclerosis.

  ● Associated with age
• RISK FACTORS OF CARDIOVASCULAR DISEASES

  MODIFIABLE

  ● Elevated Blood Lipids / Cholesterol – Lipid Profile

  ● Hypertension (HPN)

  ● Smoking

  ○ Causes vasoconstriction

  ● Diabetes Mellitus (DM)

  ● Obesity

  ● Physical Inactivity – Sedentary Lifestyle

  ● Stress
• RISK FACTORS OF CARDIOVASCULAR DISEASES

  NON-MODIFIABLE

  ● Hereditary – Family History

  ● Gender (More prevalence in men)

  ● Increasing Age (Old Adults around 50)
• CAD (CORONARY ARTERY DISEASE) WARNING SYMPTOMS

  ● Chest pain (Angina)

  ● Shortness of breath

  ● Arrhythmia

  ● Nausea and dizziness

  ● Palpitations

  ● Fatigue and weakness
• CAD (CORONARY ARTERY DISEASE) WARNING SYMPTOMS ● Chest pain (Angina)

  ○ Feels like there is a heavy object on top of your chest.

  ○ Constricting and sudden pain

  ○ Not yet a myocardial infarction

  ○ Feeling of impending doom

  ○ Can be triggered by emotions, temperature (cold constriction)

  ○ Extremity of pain

  ○ Common dialogue: “parang may elepanteng nakadagan sa dibdib” (Perona, 2024)
• CAD (CORONARY ARTERY DISEASE) WARNING SYMPTOMS

  ● Shortness of breath

  ○ A compensatory mechanism due to low amount of oxygen circulating around the body
• CAD (CORONARY ARTERY DISEASE) WARNING SYMPTOMS

  ● Arrhythmia

  ○ Abnormal heart rhythm (skipping beats)
• CAD (CORONARY ARTERY DISEASE) WARNING SYMPTOMS

  ● Nausea and dizziness

  ○ Change in the sensorium brought by the decrease of oxygen, nutrients, etc.
• CAD (CORONARY ARTERY DISEASE) WARNING SYMPTOMS

  ● Palpitations

  ○ Strength of the contractions are felt
• CAD (CORONARY ARTERY DISEASE) WARNING SYMPTOMS

  ● Fatigue and weakness

  ○ Brough by the decreased oxygen production
• Note: Myocardial Infarction is the end result of CAD = Myocardium no longer contracts.
• PREVENTION OF CAD

  1. Promote regular physical activity and exercise (in moderation; not strenuous)

  2. Encourage proper nutrition

  3. Maintain body weight and prevent obesity

  4. Smoking cessation: active & passive smoking

  5. Early diagnosis, prompt treatment, and control of DM & HPN
• TREATMENT/PROCEDURES

  ● Atherectomy

  ● Stenting + Angiography

  ● Coronary Artery Bypass Surgery

  ● Vasodilator Medications
• TREATMENT/PROCEDURES ● Atherectomy

  ○ procedure to remove plaque from artery
• TREATMENT/PROCEDURES

  ● Stenting + Angiography

  ○ a stent is used to widen the artery/blood vessel
• TREATMENT/PROCEDURES

  ● Coronary Artery Bypass Surgery

  ○ An open heart surgery

  ○ Creates a new path for blood to flow around a blocked or partially blocked artery in the heart.
• TREATMENT/PROCEDURES

  ● Vasodilator Medications

  ○ To dilate blood vessels

  ○ There are no medications to remove cholesterol in the blood vessels.
• Note: There is no procedure to scrape cholesterol
• Screening of Coronary Artery Disease

  ● For HYPERTENSION — BLOOD PRESSURE

  ○ Blood pressure must be checked.

  ○ 120/80 used to be the normal BP but due to the increase in the incidence of diseases, the standard decreased to 110/70 mmHg.
• Systolic and Diastolic Blood Pressure and its Categories

  Category | SBP mmHg | DBP mmHg

  Normal | < 120 | < 80

  Prehypertension | 120 - 139 | 80 - 89

  HPN, Stage 1 | 140 - 159 | 90 - 99

  HPN, Stage 2 | ≥ 160 | ≥ 100
• Screening of Coronary Artery Disease

  ● For CHOLESTEROL in the Blood — LIPID PROFILE TEST

  ○ Hypercholesterolemia (Elevated Cholesterol in the Blood)

  ■ Prior to testing, the client must have fasted for at least 8 hours.

  ■ Drinking water is allowed