Nursing Care and Pathophysiology of Coronary Artery Disease (CAD)

If you are trying to decide what may cause coronary artery disease, just think about what affects the vessels. Smoking raises the blood pressure, damaging the artery walls. Obesity doesn’t cause coronary artery disease itself, but the higher levels of fat in the blood and higher blood pressure that typically occurs in obese patients causes damage the vessel walls and the buildup of plaque. Diabetes causes inflammation and the slowing of the blood vessels. Hyperlipidemia means there is a high amount of lipids in the blood that may stick to the walls when damaged. Those with a family history of coronary artery disease are more likely to have it as well.

The damage, buildup of plaque, and blockage in the coronary artery supplying the heart muscle causes serious complications in the patient. If the blood flow is cut off from the heart, the heart muscle will begin to die. This is what a heart attack, or myocardial infarction is. Acute coronary syndrome consists of three different complications that may occur with coronary artery disease. STEMI stands for ST segment elevation myocardial infarction. STEMI is the most dangerous, and is known as the widowmaker because the patient is very likely go into cardiac arrest. STEMI involves a near or complete blockage of blood flow to the heart. NSTEMI stands for non ST segment elevation myocardial infarction. NSTEMI involves the partial blockage of the blood flow to the heart. Unstable angina is similar to NSTEMI in that there is a partial blockage and chest pain even while resting.

Next we will look at how the patient presents. Something to understand is that the patient may not have any symptoms until they have an MI. If they do have symptoms, they may have chest pain that can radiate to the left arm. You may notice an irregular heart beat when you listen to their heart and feel their pulses. An EKG will show if the patient has an arrhythmia. They may say they are short of breath while they are resting or getting up to perform activities. The patient with an elevated blood pressure is more likely to have coronary artery disease because that high blood pressure causes damage to the vessel walls.

If the doctor is concerned that the patient has coronary artery disease, they may order different tests. The electrocardiogram, or EKG, will show us the rate and rhythm of the heart, and we will be able to look for an ST segment elevation. Cholesterol levels may be drawn from the patient. Remember, higher cholesterol means more fat in the blood, increasing the risk for coronary artery disease. CT scans help us to visualize vessel occlusion and stenosis. Angiograms show us inside the vessels. A stress test may be done to show the heart’s response to stress during physical activity.