Summary
Highlights
Coronary Artery Disease involves the buildup of plaque in the main vessels leading to the heart. High blood pressure and high cholesterol are primary causes, and chest pain is a common sign. Damage to vessel walls from high blood pressure leads to inflammation, thickening, and scar tissue, narrowing the pathway for blood. Plaque, formed from fats and lipids, sticks to these walls. Eventually, a piece of plaque can break off, triggering a clotting process that leads to a complete blockage (occlusion), cutting off oxygen to the heart muscle.
Risk factors for CAD include smoking (which causes high blood pressure), obesity (due to higher fat levels and blood pressure), diabetes (leading to inflammation and slowed blood flow), hyperlipidemia (build-up of fat/plaque), and a family history of CAD.
If blood flow is cut off, the heart muscle starts to die, leading to a heart attack. Acute Coronary Syndrome includes STEMI (complete blockage, high mortality), NSTEMI (partial blockage), and unstable angina (chest pain, even at rest). All these can lead to cardiac arrest.
Patients may have no symptoms until a heart attack. If symptoms are present, they can include chest pain radiating to the left arm, arrhythmias, irregular heart rhythms, shortness of breath (at rest or during exertion), and elevated blood pressure.
Diagnostic tests include EKG (to visualize heart rate/rhythm and ST segment elevation), cholesterol levels (to assess risk), CT scan (to visualize occlusions and stenosis), angiogram (to view inside vessels), and a stress test (to assess the heart's response to physical activity).
Medications include statins (to decrease plaque), antiplatelets/anticoagulants (to prevent clotting), beta-blockers (to decrease heart workload), calcium channel blockers (to relax vessels), and nitroglycerin (to open arteries and relieve chest pain). Procedures include angioplasty (to open vessels), stent placement (to keep vessels open), and coronary artery bypass surgery (to create new pathways around blockages).
Nurses should educate patients on quitting smoking, staying active, eating healthy, managing stress, and controlling diabetes to prevent complications. Key nursing concepts for CAD include clotting, perfusion, and EKG rhythms.