Coronary Artery Disease

Coronary Artery Disease

1. Diagnosis

   • due to less blood supply heart can't get the Oxygen or blood it requires
     • Due to build up of cholestrol and fatty deposits called plaque
       • Arteries that supply blood to heart muscle become weakened and narrowed
       • build up is called Atherosclerosis
     • Leads to Angina and Heart failure
   • Electrocardiogram
     • Detects Heart rate/rythm/strengh
   • Stress Test
     • Exercise makes your
   • Echocardiography
     • uses sound waves to make a moving picture of heart
   • MRI
     • Detailed picture of heart
   • Blood Test
     • Checks levels of fat, cholestrol, sugar and protein
   • Diagnostic studies
     • Non-modifiable Risk factors
   • Angoigram
     • a cathetar is passed into an artery in groin & guided into the cornoary artereis using X-rays. A dye is injected into the catheter

2. Complication

   • Psychological complications
     • Depression
     • Anxiety
   • Inability to tolerate stress
   • chest pain
   • Arrhythmia
   • Ruptured plaque formation leading to blood clots
   • fatigue
   • Heart Failure
   • Myocardial Infarction
   • Stenonsis
   • Total occulusion
   • Cerebral Vascular accident
     • Refractory Angina ( unaffected by medications, angioplasty,or CABG)

3. Assessment

   • Symptoms
     • Angina
     • Heart Attack
     • Heart failure
     • Arrhythmia
     • Fatigue
     • Shortness of breath
     • Sweating & dizziness
     • Some people have no signs called silent CAD
   • Risk factors
     • High cholestrol
     • Obesity
     • Smoking
     • Diabetes
     • Lack of physical activity
     • High LDL and low HDL
     • family history

4. Treatment

   • Exercise
     • Regular physical activity + diet can prevent quarter of CAD
     • Maintain a healthy weight
       • BMI < 25
     • Moderate intensity aerobic excercise for 2 hours and 30 minutes per week
       • Weight loss lowers BP, decreases LDL and increases HDL
   • Drug Therapy
     • Anticoguants
       • Aspirin
       • Warfarin
     • Beta-blockers
       • Metaprolol
         • Lowers BP
     • Ca channel blocker
       • Amlodipine
         • Dilates Coronary artries
   • Nutritional therapy
     • Heart healthy eating
       • Avoid trans and saturated fat
       • Limit Alcohol intake
         • Raises BP & tryglycerides levels which leads to weight gain
         • Women < 1 drink
         • Men < 2 drinks
   • Quit smoking
     • Harms blood cells
     • Damages structure of heart and blood vessels
   • Managing stress
   • Surgical treatment
     • PCI (Angioplasty)
       • Non-surgical procedure
         • opens blocked Coronary artries
           • A tube with a ballon on the end is threaded through a blood vessel to the blocked artery
             • ballon compresses the plaque against wall of the artery
     • Coronary artery bypass grafting
       • A healthy vein or artery from the body is connected to the blocked artery
         • grafted artery bypasses the blocked artery
           • creates new path for oxygen rich blood to enter the heart
     • Cardiac Rehab
       • Medically supervised program that helps improve the well-being of heart patients
         • Doctors
         • Nurses
         • Exercise specialist
         • PT and OT
         • Dietician
         • Nutritionist
       • Doctors prescribe rehab after Angioplasty or heart attack
       • there is two types of Rehab
         • Education & counciling
           • Help client understand heart condition
             • how to adjust to new life style
         • Exercise training
           • Helps clients to exercise safely
             • Improves stamina
               • Care plan

5. Development of CAD

   • Injury to epithelium
     • Local Inflammatory response
       • C-reactive protein level rise
         • Unstable plaque formation
         • LDL oxidation
       • LDL enters through endothelium lesion
         • Phagocytosis of LDLs via macrophages
           • Foam cell formation
             • Fatty streak
               • Thickening of arterial wall
                 • platelet formation and LDL
               • smooth muscle proliferation
                 • Collagen covers the fatty streaks
                   • Fibrous cap (plaque)
                     • Inflammation
                       • Plaque rupture
                         • Thrombus formation
                           • Further narrowing artery
                           • Total occulasion
                             • Complicated lesion

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