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An overview of coronary artery disease (CAD) and acute coronary syndromes, including chronic stable angina, non-ST-segment elevation MI (NSTEMI), and ST elevation MI (STEMI). It discusses the causes, symptoms, and treatment options for each condition, as well as risk factors for metabolic syndrome and genetic risk. The document also highlights the importance of patient-centered care and the unique challenges faced by women with ischemic heart disease.
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Coronary artery disease (CAD) // Coronary Heart Disease o Coronary artery disease (CAD), AKA Coronary heart disease (CHD) or simply heart disease, is the single largest killer of American men and women in all ethnic groups. o A broad term that includes Chronic stable angina & Acute coronary syndromes. o It affects the arteries that provide blood, oxygen, & nutrients to the myocardium. When blood flow through the coronary arteries is partially or completely blocked, ischemia & infarction of the myocardium may result. o When the arteries that supply the myocardium (heart muscle) are diseased, the heart cannot pump blood effectively to adequately perfuse vital organs and peripheral tissues. o When perfusion is impaired, the patient can have life-threatening signs & symptoms and possibly death. o Over the past decade there has been a decrease in the death rate from CAD due to: Increasingly effective treatment. Increased awareness/emphasis on reducing major cardiovascular risk factors Major Cardiovascular Risk Factors: Hypertension, Smoking, High Cholesterol. o However, some coronary events occur without common risk factors.
Chronic Stable Angina Pectoris
o It is important to obtain a “right-sided” ECG to assess for right ventricular involvement. Patient-Centered Care
- Many women with symptomatic ischemic heart disease or abnormal stress testing DO NOT have abnormal coronary angiography.
Etiology and Genetic Risk Atherosclerosis is the Primary Factor in the Development of CAD. Metabolic syndrome, also called syndrome X, has been recognized as a risk factor for cardiovascular (CV) disease. o This health problem increases the risk for developing Diabetes & CAD. o Prevalence is higher in Mexican Americans, American Indians, & Alaska Native people living in the southwestern United States. o Management is aimed at reducing risks, managing hypertension, and preventing complications. Patients who have THREE of the following factors are diagnosed with metabolic syndrome. o Hypertension o Decreased HDL-C (usually with high LDL-C) o Increased Level of Triglycerides o Increased Fasting Blood glucose (caused by diabetes, glucose intolerance, or insulin resistance). o Large waist size (excessive abdominal fat causing central obesity). Indicators of Risk Factors for Metabolic Syndrome
Prevention of Coronary Artery Disease
Patient and Family Education: Preparing for Self-Management (Text of Chart 38-1) Prevention of Coronary Artery Disease Smoking/Tobacco Use
Patient-Centered Care
o Some patients with diagnosed CAD have AEDs in their homes or at work.
Physical Assessment/Signs and Symptoms
- Many women of any age experience Atypical angina. - Atypical angina: Manifests as Indigestion, Pain between the shoulders, an Aching jaw, or a Choking sensation that occurs with exertion. o These symptoms typically manifest during stressful circumstances or ADLs. o Women may curtail activity as a result of angina, and HCPs need to ask about changes in routine. - Symptoms in women typically include Chest discomfort, Unusual fatigue, and Dyspnea.