MONICA JOY C.

CASTILLANO BSN IV- E

Coronary Artery Disease

✓ Is a narrowing or blockage of your coronary arteries, usually due to plaque buildup.
✓ Coronary arteries supply oxygen-rich blood to the heart – plaque buildup (cholesterol deposits) in these
arteries, it limits how much blood can reach your heart.
✓ With CAD, you might not notice anything is wrong until the plaque triggers a blood clot. The blood clot is like a
concrete barrier in the middle of the road.
✓ Patient might have CAD for many years and not have any symptoms until he/she experiences a heart attack.
That’s why it is called a “silent killer”.

Risk Factors:
• Overweight
• Physical Inactivity
• Unhealthy eating
• Smoking tobacco
• Family history of heart disease also increases the risk for CAD at an early age (50 or younger).
Signs and Symptoms:
• Chest pain or discomfort (angina) it may feel like heartburn
• Weakness
• Light-headedness
• Nausea (feeling sick to your stomach)
• Cold sweat
• Pain or discomfort in the arms or shoulder
• Shortness of breath
Diagnosis:
• ECG EKG – Measures the electrical inactivity, rate, and regularity of your heartbeat.
• Echocardiogram – Uses ultrasound (special sound wave) to create a picture of the heart.
• Exercise stress test – Measures your heart rate while you walk on a treadmill. This helps to determine how well
your heart is working when it has to pump more blood.
• Chest x ray – Uses x-rays to create a picture of the heart, lungs, and other organs in the chest.
• Cardiac catheterization – Checks the inside of arteries for blockage by inserting a thin, flexible tube through an
artery in groin, arm, or neck to reach the heart. Health care professionals can measure blood pressure within
the heart and the strength of blood flow through the heart’s chambers as well as collect blood samples from
the heart or inject dye into the arteries of the heart (coronary arteries).
• Coronary Angiogram – monitors blockage and flow of blood through the coronary arteries. Uses x-rays to
detect dye injected via cardiac catheterization.
Cardiac rehab is a supervised program that include:
Physical Activity
Education about healthy living, including healthy eating, taking medicine as prescribed, and ways to help you quit
smoking
Counseling to find ways to relieve stress and improve mental health
• Lifestyle changes, such as eating a healthier (lower sodium, lower fat) diet, increasing physical activity,
reaching a healthy weight, and quitting smoking
• Medicines to treat risk factors for CAD, such as high cholesterol, high blood pressure, or an irregular heartbeat
• Surgical procedures to help restore blood flow to the heart
Hypertensive Crisis
✓ Is a sudden, severe increase in blood pressure. The blood pressure reading is 180/120 (mm Hg) or greater. A
hypertensive crisis is a medical emergency.
✓ It can lead to a heart attack, stroke, or other life-threatening health problems.
✓ The majority of hypertensive emergencies occur in patients already diagnosed with chronic hypertension

Blood Pressure Crisis:

Hypertensive Urgency
✓ If the blood pressure of your patient is 180/120 or greater, wait about five minutes and try again to take a
reading.
✓ If the second reading is just as high and you are not experiencing any other associated symptoms of target
organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision or
difficulty speaking, this would be considered hypertensive urgency

Hypertensive Emergency
• If blood pressure reading is 180/120 or greater and patient are experiencing any other associated symptoms of
target organ damage such as chest pain, shortness of breath, back pain, numbness/weakness, change in vision
or difficulty speaking, this would be considered a hypertensive emergency

Organ damage Associated with:

• Changes in mental status, such as confusion
• Bleeding into the brain (stroke)
• Heart Failure
• Chest pain - unstable angina
• Pulmonary edema
• Heart Attack
• Aneurysm – aortic dissection
• Eclampsia (occurs during pregnancy)

Hypertensive Crisis
o Headache or blurred vision
o Increasing confusion
o Seizure
o Increasing chest pain
o Pain in the nape
o Increasing shortness of breath
o Swelling or edema (fluid buildup in the tissues)
Diagnosis:
o Blood pressure check
o Blood tests – complete blood cell count (to out-rule microangiopathic anemia)
✓ Cholesterol levels
✓ Cardiac markers (to rule-out damage in the heart)
✓ Blood urea nitrogen, creatinine (to assess renal function test)
o Chest X-ray may give hint pulmonary edema.
o Ct scan- abdomen (to rule out aortic dissection), head (to rule out hemorrhagic stroke)
o Urine tests and urine toxicology test – (only as indicated) to evaluate possible accidental or intentional
overdose or poisoning
✓ Alcoholism
✓ A dipstick urinalysis to see if there is hematuria or proteinuria and urine microscopy to detect red blood
cells/casts must also be performed
o Electrocardiogram (EKG)
o Computed tomography (CT) scan of your lung or head to rule out hemorrhagic stroke

Treatment:
o A first-line medical therapy in this situation is labetalol, an adrenergic receptor blocker with both selective
alpha 1-adrenergic and nonselective beta-adrenergic receptor blocking actions.
o This drug is available in intravenous (I.V) and oral forms. In a hypertensive emergency, use the I.V. route.

Cardiomyopathy
o Problems with your heart muscle that can make it harder for your heart to pump blood.
o Is a disease that affects your myocardium (heart muscle). Cardiomyopathy can make your heart stiffen, enlarge
or thicken and can cause scar tissue.
o As a result, your heart can’t pump blood effectively to the rest of your body.
o In time, your heart can weaken and cardiomyopathy can lead to heart failure.

Symptoms:
✓ Heart palpitations
✓ Chest pain
✓ Arrhythmia
✓ Shortness of breath (dyspnea)
✓ Fatigue
✓ Swelling (edema) in your legs or ankles
✓ Syncope (fainting)

Risk Factors:
✓ History of heart failure, cardiomyopathy or sudden cardiac arrest in your family.
✓ Personal history of heart attacks
✓ Long-term use of cocaine or alcohol
✓ Pregnancy
✓ A highly stressful experience such as the loss of love one.
✓ Radiation or chemotherapy to treat cancer
✓ A body mass index (BMI) higher than 30
18.5 to 24.9 – normal
o If your BMI is less than 18.5, it falls within the underweight range
o If your BMI is 18.5 to 24.9, it falls within the Healthy Weight range
o If your BMI is 25.0 to 29.9, it falls within the overweight range
Causes:
o Coronary artery disease
o Autoimmune diseases, such as connective tissue diseases
o Infections that affect your heart muscle
o Heart inflammation
o Diabetes
o Thyroid disease
o Muscular dystrophy
o High cholesterol diseases

Complications:
✓ Arrhythmias (irregular heartbeats)
✓ Heart failure
✓ Heart valve disease
✓ Stroke
✓ Cardiogenic Shock
✓ Cardiac arrest

Diagnosis:
✓ Physical exam
✓ Ambulatory monitoring
✓ Blood tests
✓ Chest X-ray
✓ Electrocardiogram EKG
✓ Cardiac CT
✓ Echocardiogram
✓ Exercise stress test
✓ Heart MRI
✓ Cardiac Catheterization
✓ Myocardial Biopsy

Treatment:
Lifestyle changes:
✓ Eating food with low fat and salt
✓ Staying at a weight that’s healthy
✓ Getting regular exercise
✓ Getting the amount of sleep each one of us needs
✓ Reducing stress level
✓ Avoiding the use of tobacco products
✓ Avoiding alcohol

Medications:
• Antihypertensives
• Blood thinners (anticoagulants)
• Antiarrhythmics
• Medications to lower cholesterol
• Aldosterone antagonists
• Corticosteroids