Cardiovascular Monitoring

Coronary Artery Disease

• BY DR NOHA ELSAYED

Outline

• What is Coronary Heart Disease?• Who is at Risk for Coronary Heart Disease?• Signs and Symptoms of Coronary Heart Disease.• How Is Coronary Heart Disease Diagnosed/

treated ?• Nuclear Medicine Part !!!

What Is Coronary Artery Disease?

• (CAD) is one type of heart disease that occurs when the blood vessels that supply blood to the heart muscle (coronary arteries) are narrowed or blocked. This narrowing or blockage is most often caused by the buildup of fat (cholesterol) and calcium inside the walls of the arteries leading to the heart. This process is called atherosclerosis, or hardening of the arteries. The buildup of fat and calcium inside the arteries is called a plaque.

• Coronary artery disease leads to Myocardial ischemia (angina)and myocardial infarction.

AAH

• 10 Factors That Increase the Risk of Heart Disease and Heart Attack:

• 1) Tobacco Smoke• 2) High Blood Cholesterol • 3) High Blood Pressure • 4) Physical Inactivity • 5) Obesity and Overweight • 6) Diabetes Mellitus • 7) Stress• 8) Alcohol• 9) Diet and Nutrition • 10) Age

What Are the Symptoms of Coronary Artery Disease?

• Angina, can be described as a heaviness, pressure, aching, burning, numbness, fullness, squeezing or painful feeling. usually felt in the chest, but may also be felt in the left shoulder, arms, neck, back, or jaw.

• Chest pain (character ,site , increase by, decrease by, association).

• Shortness of breath• Palpitations (irregular heart beats)or a faster heartbeat.• Weakness or dizziness• Nausea• Sweating

What Is Ischemia?

• 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 your heart's needs.

• Reversible condition

Ischemia is most commonly experienced during increase by:-

• Exercise• Eating• Excitement or stress• Exposure to cold

Myocardial Infarction

• Irreversible damage to the myocardium caused by lack of blood supply as a result of occluded arteries.

• Can occur with no signs or symptoms(silent).

• Can cause sudden death.

Myocardial Infarction

How Is Coronary Artery Disease Diagnosed?

Your doctor can tell if you have coronary artery disease by:

Talking to you about your symptoms, medical history, and risk factors.

Performing a physical exam. Performing diagnostic tests, including an

electrocardiogram (ECG or EKG), exercise stress tests, electron beam (ultrafast) CT scans, cardiac catheterization.

Radionuclide imaging .

Other Diagnostic Tests

• LDH• CK-MB• Tropp- I • Radionuclide studies• Myocardial perfusion scintigraphy• Exercise radionuclide ventriculography• Echocardiography• Ambulatory ECG monitoring• Coronary arteriography

Complications following acute MI

Congestive heart failure Myocardial rupture Arrhythmia Pericarditis Cardiogenic shock

How Is Coronary Artery Disease Treated?

Treatment for coronary artery disease involves making lifestyle changes, taking medications, possibly undergoing invasive and/or surgical procedures, and seeing your cardiologist for regular checkups.

• Reduce risk factors. Quit smoking. Avoid high-cholesterol foods and adopt a low-fat, low-salt diet. Keep blood sugar in control if you have diabetes. Exercise more to maintain a healthy weight.

• Medications. If making lifestyle changes isn't enough to control heart disease, medications may be needed to help heart work more efficiently and receive more oxygen-rich blood. The drugs you are on depend on you and your specific heart problem.

How Is Coronary Artery Disease Treated?

• Surgery and other procedures. Common procedures to treat coronary artery disease include balloon angioplasty (PTCA), stent placement, and coronary artery bypass surgery.

• All of these procedures increase blood supply to the heart, but they do not cure coronary heart disease. You will still need to decrease your risk factors to prevent future disease.

Percutaneous Transluminal Coronary Angioplasty

, Cardiovascular System 15

stent placement

Coronary artery By-pass Graft (CABG)

Chapter 18, Cardiovascular System 17

• Angioplasty is a procedure to open narrowed or blocked blood vessels that supply blood to your legs.

• A stent is a small, metal mesh tube that keeps the artery open.

• CABG a harvested great saphenous vein of the leg, attaching the proximal end to the aorta or one of its major branches, and the distal end to immediately beyond a partially obstructed coronary artery.

Assignment

Group 1 :How patient history and physical exam.

Group 2 :Signs and symptoms of angina & myocardial infraction

Group 3: Lab test for angina & myocardial infraction

Reference

• http://www.nursingceu.com/courses/398/index_nceu.html

• https://www.nlm.nih.gov/medlineplus/ency/article/007393.htm