MANAGEMENT OF

PATIENTS WITH
CORONARY
VASCULAR
DISORDERS
Coronary Artery Disease

- Refers to a variety of pathologic conditions that

obstruct oxygenated blood flow
through the arteries that supply the heart - Most
prevalent type of cardiovascular disease
- One of the leading causes of morbidity and
mortality in the Philippines

Layers
of the
Artery
Arteriosclerosis
- A diffuse process whereby the muscle fibers and
the endothelial lining of the walls of
arteries/arterioles become thickened
- “Hardening of the arteries”
- Due to chronic smoking

Atherosclerosis
- A progressive and reversible atherosclerosis
affecting the intimal

layers of the coronary arteries

RISK FACTORS
• Increasing age
• Gender (Men develop
CAD at an earlier stage
Non-modifiable than women)
• Family history of CAD • Race (Higher incidence
in African Americans)
 Modifiable • Diabetes
• Hyperlipidemia • Metabolic syndrome
• Cigarette smoking • Obesity
(tobacco use) • Physical inactivity
• Hypertension

PATHOPHYSIOLOGY

Accumulation of lipids/fatty
streaks in the intima of
coronary artery
↓
Macrophages ingest the
lipids and die
 ↓
Proliferation of smooth
muscle cells forming a

fibrous cap
↓
Development of
atheroma or fibrous
plaque
↓
Degenerative
changes in the
 arterial wall
• Narrowing of the lumen
• Increased resistance to blood
flow
• Thrombus formation
↓
Decreased blood flow to the
myocardium
↓
Myocardial
ischemia
↓
Angina Pectoris
↓
MYOCARDIAL INFARCTION
Clinical Manifestations: • Angina –
classic sign of CAD

• Nausea and vomiting • Fainting

• Diaphoresis, cool
extremities

• Sudden cardiac death

LABORATORY/DIAGNOSTICS:
ECG – arrhythmias
• T wave depression
• ST segment depression

Coronary Angiography – location and

extent of narrowing

Stress Test – treadmill/bicycle

- May provoke chest pain

Medical Management:

Goals:
• Decrease myocardial oxygen
demand/cardiac workload
• Increase oxygen supply to the
myocardium
 • Alleviate chest pain

Control of Risk Factors (Modifiable) Drug therapy

• Vasodilators

• Anticoagulant
• Antilipemics

• Antihypertensives (Beta-blockers, Calcium

channel blockers)

• Thrombolytics

NUTRIENT CONTENT OF
 THE THERAPEUTIC
LIFESTYLE
CHANGES (TLC) DIET
Nutrient Recommended Intake
Total Calories Balance intake and
expenditure to maintain
desirable weight
Total fat 25-35% of calories
Saturated fat <7% of calories
Polyunsaturated fat Up to 10% of total calories
Monounsaturated fat Up to 20% of total calories
Carbohydrates 50-60% of total calories
Dietary fiber 20-30 g/day
Protein Approximately 15% of
total calories
Cholesterol <200 mg/day
 ANTILIPIDEMIC AGENTS

HMG-COA
REDUCTASE
INHIBITORS (STATINS)
(HMG-CoA – 3 hydroxy-3
• Atorvastatin (Lipitor) • methylglutaryl coenzyme A)
Simvastatin (Zocor) involved in the lipid
synthesis.
• They inhibit the enzyme
• Myalgia and arthralgia are • Monitor liver function tests
common adverse effects

FIBRIC ACIDS (FIBRATES)

• Fenofibrate (TriCor) •
Gemfibrozil (Lopid)
• They increase HDLs and
decrease triglycerides.
• Contraindicated to
patients with severe renal
and liver disease.

BILE ACID SEQUESTRANTS


• Cholestyramine
(Questran)
• Colestipol (Colestid)
• They decrease LDLs and
slightly increase HDLs.
• They oxidize cholesterol
into bile acids, which
lower fat absorption.
• Taken before meals

CHOLESTEROL
ABSORPTION INHIBITOR
• Ezetimibe (Zetia) • Decrease LDLs
• Inhibits absorption of
cholesterol in the small
intestine.
• Used in combination with
 statins.
• Contraindicated in liver
disease

OMEGA-3 ETHYL ESTERS

• Fish oil capsules • Lower triglycerides by inhibiting TG
production
in the liver.
• May be used with statins.

Surgeries
• Coronary Artery Bypass Graft (CABG)
• Percutaneous Transluminal Coronary
Angioplasty (PTCA)

• Coronary Artery Stenting

• Laser Angioplasty
Nursing Management:
• Initiating primary and secondary
prevention

• Prevention/control of risk factors

Cholesterol levels
❖ Low Density Lipoproteins (LDL)
❖ High Density Lipoproteins (HDL)
❖ Total Cholesterol

•
Tobacco Use

• Hypertension

• DM

• Weight Reduction

• Diet Modification

• Exercise Programs

• Stress Reduction Techniques

end