CORONARY ARTERY DISEASE
CAD:
• A type of blood vessel disorder that is included in the general category of atherosclerosis
o Beings as soft tissue deposits of fat that harden with age
o Referred to as "hardening arteries"
Risk Factors:
• Age
o Higher in middle aged men & women after 55 à decreased hormones
• Gender
o Women are more likely to die after first MI
o Women have other comorbidities such as…
§ Palpitations
§ Upper back pain
§ Indigestion
§ Anxiety
§ Fatigue
§ SOB
§ Memory issues
• Ethnicity
o White males have highest incidence and highest mortality
o Black males have a higher incidence compared to hispanics and Asians
o Hispanics have lower rates and death rates
o Native americans die earlier than expected and mortality rate under 65 are twice as high
• Genetics
o Having a family hx makes a person more at risk
• High serum lipids
• Hypertension
• Tobacco use Znarrow blood vessels PLDL's OHDL's
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• Physical inactivity
• Obesity à increased LDL & triglyceride levels
• Diabetes mellitus à 2x more incidence
• Metabolic syndrome
• Psychologic states
• Homocysteine levels
• Substance use
, Case Study
You are working at a cardiac prevention and rehab center. Your new patient is Fred. He is 41 years old and a salesman. He
is married and has 3 children. He tells you his work does not let him slow down. During a recent evaluation for his chest p!,
he underwent a cardiac cath procedure that showed moderate single-vessel disease with a 65% stenosis in the mid R CA.
He was given a prescription for SL nitroglycerin and told how to use it. He is referred to your cardiac rehab program for
sessions 3 days a week. Fred's wife comes along to help him with healthy lifestyle changes. The following is the nursing hx.
• Family history
o Father died suddenly at age 42 of a myocardial infarction
o Mother (still living) had a quadruple CABG at age 52
• Past history & current meds:
o Diagnosed with prediabetes 5 years
o Metoprolol 25 mg po Q12 H
o Aspirin 325 mg per po QAM
o Simvastatin 20 mg po QPM
• Lifestyle habits:
o Smokes an average of 1 ½ packs of cigarees per day for the past 20 years
o Drinks an "occasional" beer and "a 6-pack every weekend when watching football"
o Dietary history à high fried and fast food because of his traveling
o Exercise à "I don't have time to take walks"
• General assessment
o Weight à 235 lb
o Height: 5 ft. 8 in.
o B/P à 148/88 mmHg
o Pulse à 82 bpm
o Resp à 18 breaths/min
o Temp à 98.4 F
Fred has several risk factors for CAD
• Genetic
• Prediabetes
• Smokes
• Drinks
• Diet
• Exercise
Recent Labs for Fred
• Total cholesterol à 240 mg/dL
• Triglycerides à 178 mg/dL
• LDL à 112 mg/dL
• HDL à 35 mg/dL
CAD:
• A type of blood vessel disorder that is included in the general category of atherosclerosis
o Beings as soft tissue deposits of fat that harden with age
o Referred to as "hardening arteries"
Risk Factors:
• Age
o Higher in middle aged men & women after 55 à decreased hormones
• Gender
o Women are more likely to die after first MI
o Women have other comorbidities such as…
§ Palpitations
§ Upper back pain
§ Indigestion
§ Anxiety
§ Fatigue
§ SOB
§ Memory issues
• Ethnicity
o White males have highest incidence and highest mortality
o Black males have a higher incidence compared to hispanics and Asians
o Hispanics have lower rates and death rates
o Native americans die earlier than expected and mortality rate under 65 are twice as high
• Genetics
o Having a family hx makes a person more at risk
• High serum lipids
• Hypertension
• Tobacco use Znarrow blood vessels PLDL's OHDL's
a
• Physical inactivity
• Obesity à increased LDL & triglyceride levels
• Diabetes mellitus à 2x more incidence
• Metabolic syndrome
• Psychologic states
• Homocysteine levels
• Substance use
, Case Study
You are working at a cardiac prevention and rehab center. Your new patient is Fred. He is 41 years old and a salesman. He
is married and has 3 children. He tells you his work does not let him slow down. During a recent evaluation for his chest p!,
he underwent a cardiac cath procedure that showed moderate single-vessel disease with a 65% stenosis in the mid R CA.
He was given a prescription for SL nitroglycerin and told how to use it. He is referred to your cardiac rehab program for
sessions 3 days a week. Fred's wife comes along to help him with healthy lifestyle changes. The following is the nursing hx.
• Family history
o Father died suddenly at age 42 of a myocardial infarction
o Mother (still living) had a quadruple CABG at age 52
• Past history & current meds:
o Diagnosed with prediabetes 5 years
o Metoprolol 25 mg po Q12 H
o Aspirin 325 mg per po QAM
o Simvastatin 20 mg po QPM
• Lifestyle habits:
o Smokes an average of 1 ½ packs of cigarees per day for the past 20 years
o Drinks an "occasional" beer and "a 6-pack every weekend when watching football"
o Dietary history à high fried and fast food because of his traveling
o Exercise à "I don't have time to take walks"
• General assessment
o Weight à 235 lb
o Height: 5 ft. 8 in.
o B/P à 148/88 mmHg
o Pulse à 82 bpm
o Resp à 18 breaths/min
o Temp à 98.4 F
Fred has several risk factors for CAD
• Genetic
• Prediabetes
• Smokes
• Drinks
• Diet
• Exercise
Recent Labs for Fred
• Total cholesterol à 240 mg/dL
• Triglycerides à 178 mg/dL
• LDL à 112 mg/dL
• HDL à 35 mg/dL
