Coronary Artery Disease
Coronary artery disease, or CAD, is a vascular disorder that narrows or occludes the arteries of the heart. Atherosclerosis, which is plaque accumulation within the arterial wall, is the most common cause of Coronary artery disease. Narrowing or occlusion of the coronary arteries leads to an imbalance in coronary blood supply and demand of oxygen and nutrients which can lead to myocardial ischemia or infarction.
Patients experiencing myocardial ischemia or infarction may present with pain or tightness in their chest, jaw, abdomen, or left arm. These patients may also be clammy, diaphoretic, nauseous and vomiting, may also complain of palpitations, shortness of breath, anxiety, fatigue and more. It is important to keep in mind that women often present with atypical heart attack symptoms and may not complain of chest pain.
Myocardial ischemia and infarction can lead to heart failure. As the muscle is deprived of oxygen and nutrients, due to narrowed or occluded arteries, the muscle becomes less compliant and loses the ability to supply adequate blood flow to the rest of the body. Patients with heart failure often present with fatigue, hypertension or hypotension, dyspnea, edema, and pulmonary congestion.
Patients diagnosed with coronary artery disease are typically prescribed multiple medications to prevent worsening blockage and heart damage. Medications for Coronary artery disease include:
- Statins, which end in “-statin”, like atorvastatin
- Antiplatelet medication or blood thinners like aspirin or plavix
- beta blockers, which end in “-lol”, like metoprolol
- calcium channel blockers, which often (but not always) end with “-dipine”, like amlodipine
- nitrates, like nitroglycerin or isosorbide mononitrate
- angiotensin -converting enzyme inhibitors, also called ACE inhibitors. ACE inhibitors typically end with “-pril”, like enalapril
- Angiotensin II receptor blockers, also called ARBs. ARBs typically end with “-sartan”, like losartan
Let’s consider some modifiable and nonmodifiable risk factors for Coronary artery disease. Nonmodifiable risk factors for Coronary artery disease include advanced age, family history, male gender, or female gender after menopause. Modifiable risk factors for Coronary artery disease include cigarette smoking, hypertension, dyslipidemia, diabetes mellitus, obesity, sedentary lifestyle, and a diet high in fat, sodium, and sugar. These modifiable risk factor should be discussed with patients and as a nurse, you should always be on the lookout for these risk factors in your patients. These modifiable risk factors present a great opportunity to educate your patient on their risk and how they can make lifestyle changes to decrease Coronary artery risk.
Now let’s try a couple practice questions.
Which patient would you be most concerned about having coronary artery disease?
- A 40 year old premenopausal female with no family history of heart disease
- A 55 year old male with obesity, hypertension, and who currently smokes 1 pack per day
- A 70 year old male with a history of GERD who maintains a healthy diet
If you selected B, that is correct! A 55 year old male with obesity, hypertension and current tobacco use is at an increased risk for Coronary artery disease. This patient needs education on his modifiable risk factors for Coronary artery disease.
Let’s try another question.
You see a patient with a history of coronary artery disease, you would expect to see all of the following medications on the patient’s profile except…
- Isosorbide mononitrate
If you answered C, Citalopram, that is correct! Patients diagnosed with Coronary artery disease may be prescribed isosorbide mononitrate, aspirin, and labetalol. Treatment for Coronary artery disease does not typically include Citalopram.
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