1. Life University
Assignment
Subject: Adult Nursing II
Professor: Sek Sophon

2. Coronary Artery Disease
and Acute Coronary Syndrome
Professor: Sek Sophon
Presented by:
1. Cheng Chanmara
2. Chea Linna
3. Mek Sophy
4. Sopha Sokny
5. Say Chantha
6. Sorm Chanthy
7. Tang Sareth
8. Chou Nimol
9. Sy Sreythin

3. Learning Objectives:
 Describe the etiology and pathophysiology of
coronary artery disease, angina, and acute
coronary syndrome.
 Identify risk factors for coronary artery
disease and the nursing role in the promotion
of therapeutic lifestyle change in patients at
risk.
 Describe clinical manifestations, and
collaborative care and nursing management
of the patients with coronary artery disease
and chronic stable angina.
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4. Learning Objectives: (cont.)
Describe the clinical manifestations,
complications, diagnosis, and
collaborative care of the patient with
acute coronary syndrome.
Describe the pathophysiology of
myocardial infarction.
Identify commonly used drug therapy in
treating patients with coronary artery
disease and acute coronary syndrome.
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5. Learning Objectives: (cont.)
Identify key issues to include in the
rehabilitation of patients recovering
from acute coronary syndrome and
coronary revascularization procedures.
Describe the collaborative care of
patients who are at risk for or have
experienced sudden cardiac death.
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6. Coronary Artery Disease
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7. Description
Coronary artery disease (CAD; also called
atherosclerotic heart disease) is a type of blood
vessel disorder that is included in the general
category of atherosclerosis (hardening of the
arteries).
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8. Description (cont.)
It occurs when fatty deposits
called plaque build up inside the
coronary arteries. The coronary
arteries wrap around the heart
and supply it with blood and
oxygen. When plaque builds up,
it narrows the arteries and
reduces the amount of blood that
gets to your heart.
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9. Etiology
Cause of coronary artery narrowing are:
Atherosclerosis
Thrombosis
Spasm
Coronary dissection
Aneurysm formation
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10. Pathophysiology
Progression of Atherosclerosis:
1. Fatty streak:
 Injury to intimal
endothelium
 Lipid deposits
 No obstruction
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11. 1. Fibrous plaque:
*Plaque and thrombus formation
 Protrusion into arterial lumen
 Proliferation of smooth muscle cells
 Irreversible progression
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12. 1. Complicate lesion:
*Total occlusion
 Plaque calcification
 Plaque rupture
 Thrombus formation
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13. By total occlusion it can lead to:
Ischemia
Myocardial infarction
Sudden death
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14. Collateral circulation
An area of tissue or an organ has
different pathways for blood to reach it.
This is often as a result of
anastamoses.
Branches formed between adjacent
blood vessels.
Collaterals increase in the presence of
chronic ischemia.
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15. When occlusion occurs slowly over a
long period, there is a greater chance of
adequate collateral circulation
developing.
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16. Risk Factors for Coronary Artery
Disease
 Risk factors can be divided:
Non- modifiable
Age
Sex
Family Hx
Ethnic background
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17. Risk Factors for Coronary Artery
Disease
Modifiable risk factors:
Elevated serum lipids
Hypertension
Smoking
Obesity
Physical inactivity
Diabetes mellitus
Stressful lifestyle
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18. Clinical expression of coronary disease
Unstable MI
angina
Stable Coronary Heart
Angina failure
Disease
Prinzmetal’s Sudden
Angina death
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19. Angina
Results when the lack of oxygen supply is
temporary and reversible
Types of Angina
Chronic Stable Angina
Unstable Angina
Prinzmetal’s Angina
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20. Chronic Stable Angina
Is the most common angina type.
It can also be referred to as exertional
angina, emotional stress, cold weather,
and large meal.
With rest, the angina attack symptoms
generally improve.
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21. Unstable Angina
Is the second most common angina
type.
This is a dangerous condition that
requires emergency treatment.
Can occur without physical exertion and
is not relieved by rest or medicine.
The condition is caused by blood clots
that partially or totally block a coronary
artery.
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22. Prinzmetal’s Angina
Also called Variant angina.
Is a rare angina type.
Caused by a spasm in a coronary
artery.
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23. Clinical Manifestations
Angina
Chest pain or discomfort (due to
ischemia)
A strange feeling, pressure, or ache in the
chest
Constrictive, squeezing, heaving, choking,
or suffocating sensation
Indigestion, burning
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24. Location of Chest Pain
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25. Treatment for stable angina
The two general approaches to treat
are:
Invasive therapy
Bypass surgery
Coronary angioplasty
Stents
Non-invasive therapy (medical therapies)
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26. Bypass Surgery
 Bypass surgery is a
surgical procedure
performed to relieve angina
and reduce the risk of death
from coronary artery
disease.
 It improve the blood supply
to the coronary circulation
supplying the myocardium.
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27. Coronary Angioplasty
Coronary angioplasty is a procedure
used to open blocked or narrowed
coronary arteries.
The procedure improves blood flow to
the heart muscle.
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28. Stent
Vascular stent to prevent the artery from
closing and prevent restenosis
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29. Watch a video
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30. 30

31. Medical therapies
Three categories of drugs are
commonly used:
Nitrates
Beta blockers
Calcium channel blockers
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32. Nursing and Collaborative Management
Coronary artery disease
Health Promotion
Identification of high-risk persons
Management of high-risk persons
Risk factor modification
Physical fitness
Health education in schools
Nutrition (weight control, ↓ fat, ↓ cholesterol
intake)
Cholesterol-lowering medications
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33. Acute Coronary Syndrome
Acute coronary syndromes result from acute
obstruction of a coronary artery.
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34. Etiology and Pathophysiology
It occurs when an atherosclerotic
plaque ruptures, fissures or ulcerates
and precipitates thrombus formation.
Alternatively thrombus may break off
from a ruptured plaque and occlude
smaller vessels like coronary arteries.
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35. Manifestation of Acute coronary
syndrome
 Acute coronary syndrome (ACS) is usually
involving with one between:
 Myocardial infarction
 Unstable angina
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36. Myocardial Infarction
Myocardial infarction occurs as a result
of sustained ischemia, causing
irreversible cells death (necrosis).
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37. Clinical manifestation of MI
Tachycardia or bradycardia
Normotension or hypotension
Tachypnea
Pulmonary edema, crackles
Air hunger, orthopnea
Frothy sputum
Restlessness, confusion, anxiety.
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38. Complication of MI
Dysrhythmias
Heart failure
Cardiogenic shock
Papillary muscle dysfunction
Ventricular aneurysm
Pericarditis
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39. DIAGNOSIS
Electrocardiogram
Serum Cardiac Marker
Coronary Angiography
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40. Collaborative Care
Medical Management
Percutaneous transluminal coronary
angioplasty (PTCA)
Pain control: (MONA)
Morphine
Oxygen
Nitroglycerin
Aspirin
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41. Medical management (cont.)
Nutritional therapy:
Initially patient may be NPO except for sip
of water until stable.
Low salt
Low saturated fat
Low cholesterol diet
Coronary surgical revascularization
Bypass surgery
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42. Nursing management
Chronic stable angina and Acute coronary
syndrome
Nursing Assessment
Subjective data:
Past health history of CAD, angina, MI, CHF,
hypertension, diabetes, anemia,
hyperlipidemia, lung disease, aortic stenosis
Medications: use of aspirin, nitrate, cholesterol
lowering drug, antihypertension, and vitamin
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43. Objective data:
General: anxiety, fear, restlessness.
Integumentary: cool, clammy, pale skin
Cardiovascular: tachycardia or bradycardia, BP
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44. Nursing Diagnosis:
Acute pain related to myocardial ischemia,
radiation of pain to the neck and arms.
Ineffective tissue perfusion (cardiac)
related to myocardial injury.
Anxiety related to perceived threat of
death, pain, possible lifestyle changes as
evidenced by restlessness.
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45. Planning:
Relief of pain
Preservation of myocardium
Immediate and appropriate treatment
Effective coping with illness associated
anxiety
Participation in a rehabilitation plan
Reduction of risk factors
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46.  Nursing Implementation: Chronic stable angina
 Health Promotion: we have to control and change some
behavior such as
Hypertension
Elevated serum lipids
Tobacco use
Physical inactivity
Stressful lifestyle
Obesity
Diabetes
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47. Acute Intervention: If angina attack occurs
nurse should
Administration of supplemental oxygen
Determination of vital signs
12-leads ECG
Pain relief first with Nitrate
Auscultation of heart sounds
Comfortable positioning of the patient.
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48. Ambulatory and Home Care:
The patient should be provided information
regarding CAD, angina, precipitation factors for
angina, risk factor reduction, and medications.
Patient teaching can be handle in a variety of
ways.
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49.  Nursing Implementation: Acute coronary syndrome
 Acute Intervention include:
Pain assessment and relief
Physiologic monitoring
Promotion of rest and comfort
Alleviation of stress and anxiety
Understanding patient’s emotional and behavioral reaction
 Ambulatory and Home Care:
Cardiac Rehabilitation
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50. Evaluation
The expected outcomes that the patient will
Relief of pain
Preservation of myocardium
Immediate and appropriate treatment
Effective coping with illness associated
anxiety
Participation in a rehabilitation plan
Reduction of risk factors
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51. Sudden cardiac death
Also called sudden cardiac arrest.
Is an unexpected death due to cardiac
condition
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52. Etiology and Pathophysiology
In SCD there is an abrupt disruption in
cardiac function, producing an abrupt
loss of cardiac output and cerebral
blood flow.
Occurring in a short time period
(generally within 1 h of symptom onset)
CAD is most common cause of SCD.
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53. Nursing and Collaborative
Management
 Serial analysis of cardiac markers and ECGs
must be obtain and the patient must be
treated
 The most common approach to preventing a
recurrent is the use of implantable
cardioverter-difibrillator.
 The nurse should attuned to the specific
needs of the patient and the family and teach
them accordingly while providing emotional
support.
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54. References
 Medical Surgical Nursing Volume 1 (Seventh Edition)
 http://en.wikipedia.org/wiki/Circulatory_anastomosis
 http://www.mayoclinic.com/health/acute-coronary-
syndrome/DS01061/DSECTION=causes
 http://emedicine.medscape.com/article/151907-
overview
 http://www.cardiosmart.org/HeartDisease/CTT.aspx?
id=724
 http://en.wikipedia.org/wiki/Coronary_artery_bypass_
surgery
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55.  http://www.healthscout.com/animation/1/38/main.html
 http://heartdisease.about.com/od/coronaryarterydisea
se/a/medrx_angina.htm
 http://heart-disease.emedtv.com/angina/angina-
types.html
 http://www.nlm.nih.gov/medlineplus/angina.html
 http://www.patient.co.uk/health/Coronary-
Angiography.htm
 http://www.webmd.com/heart-disease/guide/heart-
disease-coronary-artery-disease
 http://en.wikipedia.org/wiki/Coronary_artery_disease
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56. Thanks You!
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