Coronary Artery Disease:

Pathology & Treatment

Coronary Artery Disease (CAD)
• Narrowing of coronary arteries from atherosclerosis
• Forms of CAD:
1. AMI
2. Angina
3. Stroke
Coronary Pathology

Atherosclerosis causes:
• Acute intraluminal thrombus
• Progresses for decades before symptoms (affecting tunica
intima)
• Risk factors: HTN, high cholesterol, smoking, DM, genetics
• Elevated total cholesterol, elevated LDL
PROGRESSION OF ATHEROSCLEROSIS
Plaque Disruption
• Atherosclerotic plaque composed of
cholesterol
• Plaque tears, leads to form thrombus
• Thrombus absorbs into arterial wall,
narrowing the lumen
• Progresses until fully occluded
Atherosclerosis effects the _____.
A. tunica adventitia
B. tunica intima
C. tunica media
D. tunica externa
Angina (stable)

• Increased myocardial 02 demand

• Increased 02 demand occurs with
exertion
• Ischemic chest pain ensues
• Classified as stable or unstable
Angina (unstable)
• Symptoms occur at rest
• Methods to relieve pain don’t work
• Requires prompt management
• Impending MI
Acute Myocardial Infarction (AMI)

• Muscle necrosis caused by reduced

blood supply to myocardium
• Results from acute thrombus
• Note symptoms and observe EKG
findings
Clinical Presentations of Acute MI (AMI)
• Chest “pressure” rather than “tightness” or “heaviness”
• Most often mid-retrosternal, may radiate
• Diaphoresis, SOB, N/V also common
• ST segment elevations, T wave inversions
IDENTIFY. And don’t say anything about “bundle branches” or “peaked T waves”
Treatment of Ischemic CAD
Aspirin (ASA)
• 324 mg PO (chewed)
• Reduces chances of clot formation which reduces chance of
AMI
Beta-blockers
• Metoprolol (Lopressor) 5 mg slow IVP
• Reduces heart rate and contractility to decrease 02 demand
Nitrates
• Nitroglycerine tablet (or spray), 0.4 mg SL, q 3-5 mins
• Nitroglycerine paste, 1 inch, transdermal
• Tridal (nitro) drip
• Vasodilates coronary arteries, increasing coronary perfusion
Calcium Channel Blockers
• Debatable – discuss with contact medical control
• Not to be given if left ventricular dysfunction suspected/involved
• 12 leads (serial)
• Analgesia
• Most important:
• Thrombolytic therapy
• Cardiac catherization
47 y/o female c/o progressive weakness and bilateral elbow pain.
Denies SOB, denies N/V. She does not smoke or drink. Hx of DM II
which is somewhat managed.

B/P: 150/70
RR: 22
P: 52 regular
SPO2: 99%
BGL: 315
12 Lead: (next slide)
Which set is in the correct order to trear unstable angina?
A. 15 lpm 02, ASA 324 mg, 0.4 mg SL NTG, morphine 2 mg
B. ASA 320 mg, NTG 0.4 mcg,12 lead, fentanyl 1 mcg/kg
C. NTG 0.4 mg, ASA 324 mg, 12 lead, morphine 2-5 mg
D. 02 4 lpm, NTG 0.4 mg, ASA 324 mg, morphine 2 mg, 12 lead