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NSG 326 Adult Health ISlide 2Slide 3Coronary Artery Disease (CAD)Coronary Artery Disease [CAD]Risk Factors CADCADSlide 8Slide 9Chronic Stable AnginaSlide 11Treatment Chronic Stable AnginaAcute Coronary SyndromeSlide 14Myocardial Infarction (MI)Slide 16Slide 17Slide 18HyperlipidemiaSlide 20Slide 21Diet ManagementSlide 23Weight ManagementSlide 25Exercise ManagementSlide 27Smoking ManagementNSG 326 Adult Health ICOROANRY ARTERY DISEASE4Coronary Artery Disease (CAD)Coronary artery disease (CAD) is a type of blood vessel disorder included in the general category of atherosclerosis. Atherosclerosis is characterized by a focal deposit of cholesterol and lipids within the intimal wall of the artery – called “atheroma.” Inflammation and endothelial injury play a central role in the development of atherosclerosis.Fatty deposits infiltrate the lining of the artery at sites of microscopic damage.5Coronary Artery Disease [CAD]CAD is a progressive disease that develops in stages and when it becomes symptomatic, the disease process is usually well advanced. Normally some arterial anastomoses or connections, termed collateral circulation, exist within the coronary circulation. The growth and extent of collateral circulation are attributed to two factors: (1) the inherited predisposition to develop new blood vessels (angiogenesis), and (2) the presence of chronic ischemia.6Risk Factors CADMany risk factors have been associated with CAD. Nonmodifiable risk factors are age, gender, ethnicity, family history, and genetic inheritance. Modifiable risk factors include elevated serum lipids, hypertension, tobacco use, physical inactivity, obesity, diabetes, metabolic syndrome, psychologic states, and homocysteine (an amino acid) level.7CADPrevention and early treatment of CAD must involve a multifactorial approach and needs to be ongoing throughout the lifespanA complete lipid profile is recommended every 5 years beginning at age 20. Persons with a serum cholesterol level greater than 200 mg/dl are at high risk for CAD.9CADManagement of high-risk persons starts with controlling or changing the additive effects of modifiable risk factors.A regular physical activity program should be implemented.Therapeutic lifestyle changes to reduce the risk of CAD include lowering LDL cholesterol by adopting a diet that limits saturated fats and cholesterol and emphasizes complex carbohydrates (e.g., whole grains, fruit, vegetables). Low-dose aspirin is recommended for people at risk for CAD. Aspirin therapy is not recommended for women with low risk for CAD before age 65. Common side effects of aspirin therapy include GI upset and bleeding. For people who are aspirin intolerant, clopidogrel (Plavix) can be considered.10Chronic Stable AnginaChronic stable angina refers to chest pain that occurs intermittently over a long period with the same pattern of onset, duration, and intensity of symptoms. Angina is rarely sharp or stabbing, and it usually does not change with position or breathing. Many people with angina complain of indigestion or a burning sensation in the epigastric region. Anginal pain usually lasts for only a few minutes (3 to 5 minutes) and commonly subsides when the precipitating factor is relieved. Pain at rest is unusual.12Treatment Chronic Stable AnginaThe treatment of chronic stable angina is aimed at decreasing oxygen demand and/or increasing oxygen supply and reducing CAD risk factors. In addition to antiplatelet and cholesterol-lowering drug therapy, the most common drugs used to manage chronic stable angina are nitrates.Common diagnostic tests for a patient with a history of CAD include a chest x-ray; a 12-lead ECG; laboratory tests (e.g., lipid profile); nuclear imaging; exercise stress testing; and coronary angiography.13Acute Coronary SyndromeAcute coronary syndrome (ACS) develops when ischemia is prolonged and not immediately reversible. ACS is associated with deterioration of a once stable atherosclerotic plaque. Unstable angina (UA) is chest pain that is new in onset, occurs at rest, or has a worsening pattern. UA is unpredictable and represents an emergency.15Myocardial Infarction (MI)Myocardial infarction (MI) occurs as a result of sustained ischemia, causing irreversible myocardial cell death. 80% to 90% of all MIs are due to the development of a thrombus that halts perfusion to the myocardium distal to the occlusion. Contractile function of the heart stops in the infracted area(s). Cardiac cells can withstand ischemic conditions for approximately 20 minutes. It takes approximately 4 to 6 hours for the entire thickness of the heart muscle to infarct.Infarctions are described based on the location of damage (e.g., anterior, inferior, lateral, or posterior wall infarction). Severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration is the hallmark of an MI. The pain is usually described as a heaviness, pressure, tightness, burning, constriction, or crushing.19HyperlipidemiaThe term hyperlipidemia means high lipid levels. Hyperlipidemia includes several conditions, but it usually means that you have high cholesterol and high triglyceride levels.20HyperlipidemiaMost hyperlipidemia is caused by lifestyle habits or treatable medical conditions. Lifestyle contributors include obesity, not exercising, and smoking. You can also inherit hyperlipidemia. The cause may be genetic if you have a normal body weight and other members of your family have hyperlipidemia.You have a greater chance of developing hyperlipidemia if you are a man older than age 45 or a woman older than age 55. If a close relative had early heart disease (father or brother affected before age 55, mother or sister affected before age 65), you also have an increased risk.21HyperlipidemiaMost blood tests measure levels of LDL (sometimes called "bad") cholesterol, HDL (sometimes called "good") cholesterol, total cholesterol (LDL plus HDL), and triglycerides. To have a low risk of heart disease, your desirable lipid levels are:•LDL less than 130 mg/dL•HDL greater than 40 mg/dL (men) or 50 mg/dL (women)•Total cholesterol less than 200 mg/dL•Triglycerides less than 200 mg/dL22Diet ManagementPhysicians usually recommend making changes in your diet and exercise habits called therapeutic lifestyle changes (TLC). TLC can lower total cholesterol by 10 to 20 percent in some


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UNCW NSG 326 - NSG 326 AH I WK #9 CAD

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