Coronary Artery Disease - Fast Facts
Clinical Quick Reference Guides/ Concept Overview-CAD/ Topic Overview and Questions
Coronary artery disease (abbreviated: “CAD”) is the most common type of heart disease in the US, according to the CDC.
It is also referred to as coronary heart disease or ischemic heart disease.
Causes of coronary artery disease
CAD is caused by plaque buildup in artery walls. These are the arteries that supply blood to the heart and other body areas.
Plaque is a substance made up of deposits of cholesterol and other substances. This buildup causes the inside of the arteries to narrow. As the arteries narrow, blood flow may be partially or totally occluded. This process is known as atherosclerosis.
CAD Symptoms
The most common symptom is angina (“chest pain”).
Angina begins when the plaque builds up inside arteries, causing narrowing.
Narrowed arteries can cause angina as the blood flow is occluded to the patient’s heart muscle and the rest of their body. However for some patients, the first indication they have CAD is a MI.
Unfortunately, as time passes, CAD will weaken the heart muscle and that may lead to heart failure.
Risk Factors
Risk factors for CAD include:
being overweight,
decreased physical activity,
unhealthy eating, and smoking.
Additionally, a family history of heart disease increases the risk for CAD.
That risk is further increased in those individuals who have a family history of heart disease occurring at an early age (50 or younger).
There are many risk factors, and they are typically divided into two categories. Those that can be controlled (modifiable) and those factors that are outside of the patient's control (unmodifiable). Examples of modifiable risk factors are: hypertension; high blood cholesterol levels; smoking; diabetes; overweight or obesity; lack of physical activity; unhealthy diet and stress. Those risk factors that cannot be controlled are: age; sex; family history; and race.
Treatment
Includes education on lifestyle changes, smoking cessation, healthy eating habits and exercising more. Sometimes, medications and procedures are necessary.
Medications
There are many drugs available to treat coronary artery disease. The healthcare provider will determine which ones are the right choice for a particular patient, dependent on their individual needs:
Cholesterol drugs: Including statins, niacin, fibrates and bile acid sequestrants.
Aspirin: helps thin the blood and prevent blood clots.
Caution: Daily use of aspirin can have serious side effects, including bleeding in the stomach and intestines. Do not start taking a daily aspirin without talking to your health care provider.
Beta blockers: Slow the heart rate and they also lower blood pressure.
Calcium channel blockers: Can help improve symptoms of chest pain.
Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs): These medicines lower blood pressure and they may help slow, or keep coronary artery disease from getting worse.
Nitroglycerin: Widens the heart arteries. Can control or relieve chest pain. Available as a pill, spray or patch. This medication can cause severe headaches that should become less severe as the patient continues to use it. Common side effects may include: flushing (sudden warmth, redness, or tingly feeling); feeling light-headed, fainting. Patients should not chew, crush, or swallow nitroglycerin sublingual tablets
Ranolazine: May help people with angina. Might be prescribed with or in place of a beta blocker.
Some patients may also need surgeries or other procedures.
Topic Review Questions
A 64 year-old male client is admitted to the telemetry unit from the emergency department. He was evaluated for complaints of increasing chest pain after shoveling his driveway. The pain radiated to his left shoulder and arm, and was not relieved by rest. Myocardial infarction was ruled out and the client was diagnosed with coronary artery disease and angina. In addition to a statin medication and aspirin, the client has an as needed order for buccal nitroglycerin. After ambulating back to bed from the bathroom, the client begins to complain of chest pain.
Which of the following does the nurse take into consideration when providing nitroglycerin to the client? (Select all)
Exhibits:
Vital Signs on Admission:
Temperature
97.8 F
Pulse
102
Respiratory Rate
20
Blood Pressure
106/94
Pulse Oximetry
98% on room air
Body System Assessment Findings on Admission:
Neurologic
Oriented x 3
Respiratory
All Lung Fields Clear
Cardiovascular
S1, S2
Gastrointestinal
Bowel Sounds normoactive x 4
Extremities
Slightly cool to the touch, capillary refill brisk, pedal pulses 2+; no edema
Choices:
1. Understand it is generally not necessary to recheck pulse and blood pressure prior to administering nitroglycerin
2. Use only nitroglycerin that has been properly stored in light resistant container
3. Administer dose with 240cc of PO fluids
4. Be sure medication is placed between the patient’s gum and teeth
5. Store the nitroglycerin bottle away from heat and moisture
Correct choices:
2) Nitroglycerin should be stored in a light resistant container, in a cool environment. Nitroglycerin is a volatile substance that evaporates from tablets if strict precautions are not taken. The tablets are usually kept in small, amber, tightly capped glass bottles.
4) Be sure medication is placed between the patient’s gum and teeth. This is the “buccal route.” Let it dissolve. Do not eat, drink, smoke, or use chewing tobacco while the tablet is dissolving. Nitroglycerin tablets usually give relief in 1 to 5 minutes.
5) Store the nitroglycerin bottle away from heat and moisture. Chemical and physical stability of nitroglycerin tablets can be affected by environmental and physical factors such as excessive heat and moisture.
Incorrect choices:
1) Understand it is generally not necessary to recheck pulse and blood pressure prior to administering nitroglycerin -
-Incorrect-Be sure to check blood pressure and pulse before each administration of NTG-this is because blood pressure can drop precipitously after a single dose
3) Administer with 240 cc of PO fluids -
-Incorrect-Let it dissolve- advise the client not to eat, drink, smoke, or use chewing tobacco while a tablet is dissolving. The onset of action of nitroglycerin tablets is rapid (1 to 3 minutes)
References
Harding, M, kwong, J.,Roberts, D.,Hagler, D., & Reinisch, C. (2020). Lewis’s Medical Surgical Nursing: Assessment and Management of Clinical Problems (11th ed.). Elsevier. (pp. 817-829)
Next Question:
The discharge planner is meeting with a client newly diagnosed with coronary artery disease and angina. The nurse understands that a client who reports experiencing chest pain and shortness of breath while performing activities, but that is relieved with rest is a characteristic of which of the following:
1. Variant angina
2. Unstable angina
3. Prinzmetal angina
4. Stable angina
Correct Answer:
4) Stable angina
The characteristics of stable angina are: pain usually lasting 3 to 5 minutes that subsides when precipitating factor is relieved; Pain at rest is unusual.
Incorrect Answers:
1) Variant angina refers to Prinzmetal angina; pain with this condition generally occurs at rest. It is usually due to spasm of a major coronary artery.
2) Unstable angina – pain will be described as new in onset, not relieved by rest and has a worsening pattern. The pattern of pain is often unpredictable. Condition is associated with deterioration of a once stable atherosclerotic plaque.
3) Prinzmetal angina, as noted above – is also called variant angina or vasospastic angina. Prinzmetal variant angina symptoms include chest pain episodes that occur during the night when the client is at rest. Testing may not show any CAD.
Key points:
Stable angina generally has a precipitating cause, while unstable angina may occur at rest.
References
Harding, M, kwong, J.,Roberts, D.,Hagler, D., & Reinisch, C. (2020). Lewis’s Medical Surgical Nursing: Assessment and Management of Clinical Problems (11th ed.). Elsevier. (pp. 815-826)
Next Question:
The nurse manager at the outpatient cardiology clinic is educating a community center group on risk factors for coronary artery disease. The nurse is confident that teaching has been effective when a community member identifies which of the following as modifiable risk factors for coronary artery disease:
Select all that apply:
1. Age
2. Gender
3. Ethnicity
4. Elevated serum lipids
5. Genetic predisposition
6. Smoking
Correct Answers:
4, 6 - Modifiable risk factors for coronary artery disease include: Elevated serum lipids, Hypertension, smoking, obesity, physical inactivity, diabetes mellitus, and stressful lifestyles.
Incorrect:
1, 2, 3, 5 - Unmodifiable risk factors are related to age, gender, ethnicity, and genetic predisposition.
Key points:
Coronary artery disease is the most common type of heart disease in the United States. Risk factors for coronary artery disease can be divided into unmodifiable risk factors and modifiable risk factors. Early, thorough education can provide the information needed to make informed lifestyle changes and acquire medical help that may aid in more timely, accurate diagnosis and treatment being initiated.
References
Harding, M, kwong, J.,Roberts, D.,Hagler, D., & Reinisch, C. (2020). Lewis’s Medical Surgical Nursing: Assessment and Management of Clinical Problems (11th ed.). Elsevier. (pp. 815-829)
This study guide and resource listing of medications is not intended to be used as medical advice. Note that products used tend to vary from institution to institution. Always pursue and follow the advise of your healthcare provider, facility protocols or supervising agency in matters of health issues or problems. Call 911 in case of emergency.