Coronary+Artery+Disease

Kerri Roop - Facilitator Maggie Thompson - Editor Chris Strickland - Critical Friend Ashlie Hibshman - Editor Shayne Crosetto - Facilitator


 * Definition - MT
 * Signs and symptoms - KR
 * Diagnostic tools - CS
 * Treatment - AH
 * Prognosis/complications - SC

=Coronary Artery Disease =

**Definition and Causes :**

 * Coronary artery disease (CAD), also called coronary heart disease or atherosclerosis, is a condition where plaque builds up inside the coronary arteries, which blocks blood flow of oxygenated blood to the heart muscle (2009).
 * The plaque is made up of fat, cholesterol, calcium, and other substances. When this plaque builds up in the arteries the condition is called atherosclerosis (2009).
 * This makes blood clots more likely to form
 * Causes that can tend to damage the inner layers of the coronary arties and lead to the disease are:
 * Smoking
 * High blood pressure
 * High amounts of fats and cholesterol in blood
 * Diabetes, or high amounts of sugar in blood
 * When damage occurs the body starts healing, excess fatty tissues release compounds that promote this process. So this healing process causes plaques to build up where the arteries are damaged (2009).

**Reference:** (2009). Coronary artery disease. //National Heart Lung and Blood Institute: diseases and condtions index.// Retrieved from //[]//

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﻿ //Click here for a video explaining CAD (2010)!// =====

Pictures from (Trelogan, 2000)

**Signs and Symptoms:**
Symptoms of CAD vary from person to person: from no symptoms at all, to mild intermittent chest pain, to steady pain. In some cases, symptoms can be severe enough to hinder their normal daily activities <span style="color: black; font-family: 'Calibri','sans-serif'; font-size: 11pt; line-height: 115%;">(Trelogan, 2000). 1. Chest <span style="font-family: 'Calibri','sans-serif'; font-size: 11pt; line-height: 115%;">(Angina- heaviness, tightness, pain, burning, pressure, or squeezing, usually behind the breastbone) 2. Jaw 3. Epigastric 4. Back 5. Arm <span style="font-family: Calibri,sans-serif; font-size: 11pt; line-height: 115%;">(Ignatavicious, &Linda, 2006)
 * Pain
 * Nausea/Vomiting
 * Diaphoresis
 * Dizziness
 * Weakness
 * Palpitations
 * Shortness of Breath

**References**: Ignatavicious, D. & Workman, L.. (2006). Medical-surgical nursing: critical thinking for collaborative care. St. Louis, Missouri: Elsevier Sanders. Trelogan, S. (2000). Heart disease-what is coronary artery disease?. Retrieved from []

**Treatments:**

 * Treatments for CAD include medications, stents, and procedures or surgery.
 * There are several types of medications, here are four of the most common:
 * Angiotensin converting enzyme (ACE) inhibitors dilate the blood vessels
 * Angiotensin II Receptor Blockers (ARBs) block the chemicals that cause the vessels to constrict
 * Antiplatelet drugs help prohibit blood clots from foming
 * Aspirin helps prevent blood clots as well, and reduces pain and swelling related to heart disease
 * Stents are small tubes usually made of a metal mesh that is inserted to a narrow part of the vessel to open it up and allow blood to flow more easily
 * There are many types of procedures and surgeries, here are a few:
 * Angioplasty
 * Bypass surgery
 * Heart valve surgery
 * Reference:** (2011). WebMD Heart Disease Guide, Treatment and Care. Retrieved from []



**Diagnostic tools**:
There are many tools that are used to run diagnostic tests on people with Cardiovascular disease. Some of the non-invasive tools used are the following:


 * Electrocardiography, also known as ECG, uses computers to measure the various intervals and rates which can show irregularities of the heart. ECG is probably the most inexpensive and most widely used application.
 * Echocardiography uses ultrasound to create images of the heart and display them in real time on a television. An echocardiography doppler is most often used and sometimes in conjunction with other tools such as cardiac catheterization (see below).
 * Nuclear cardiac imaging involves the injection of radioactive isotopes into the patients’ blood. A camera machine that uses gamma rays to detect the radioactive emissions of these isotopes forms an image in the area of particular interest.

Two common invasive tools used in diagnostics are:

(Crawford) Note: when clicking link for reference below. You must input your username and password to access Lancaster General VPN and library. After putting these in, the link will go directly to referenced web page. Thank you! **Reference:** <span style="font-family: Verdana,Arial,Helvetica,sans-serif; font-size: 12px; line-height: 17px;">Crawford Michael H, "Chapter 1. Approach to Cardiac Disease Diagnosis" (Chapter). Crawford MH: CURRENT Diagnosis & Treatment: Cardiology, 3e: http://www.accessmedicine.com/content.aspx?aID=3646001. //Retrieved from []//
 * Cardiac Catheterization is the placement of a catheter into the veins of patient which leads to the heart. The most common use of catheters is to help alleviate the obstruction of blood flow to the coronary arteries by use of a stent or balloon expansion. An echocardiography Doppler is often used in this procedure.
 * Electrophysiology testing uses catheter-delivered electrodes in the heart to induce shocks to the heart to see if there are any rhythm disorders.

Below is a video showing the catherization lab at Lancaster General Hospital.

media type="youtube" key="rVYRpnQ2WZU" height="390" width="480" align="center"

**Prognosis and complications:**
The outlook on CAD is different for everybody. Some people can easily correct their health by quitting smoking, eating healthier, and taking certain medications. Other people are not so lucky and their outcome is usually surgery (2010).

The complications that can result from untreated coronary artery disease are :
 * Heart failure
 * Heart attack
 * Unstable angina - severe pain in chest, shoulders, arms, and neck
 * Sometimes even a sudden death


 * Reference**: (2010). Medline Plus. //Coronary Artery Disease.// Retrieved from: http://www.nlm.nih.gov/medlineplus/ency/article/007115.htm