Coronary Artery Disease (CAD) Anatomy, Nursing, Heart Disease, Pathophysiology, Treatment Part 1

hey everyone it's sarah with registerednessrn.com and in this video i'm going to be going over coronary artery disease this will be part one of this video now this video is part of an nclex review series over the cardiovascular system so if you're studying this be sure to check out my other videos that are part of this series and a playlist should be popping up so you can access all those videos so what i'm going to do in this video like i said it's part one i'm going to be covering the definition of cad i'm going to be covering the patho the signs and symptoms the risk factors and how it is diagnosed and then in part two i'm going to cover the nursing interventions and the medications used to treat this disease so be sure you check out part two after you watch this video now after this lecture be sure to go to my website registernursern.com and take the free nclex review quiz that will test you on coronary artery disease and a card should be popping up so you can access that quiz so let's get started first let's start out talking about what is coronary artery disease well in a nutshell this is what it is um it's where your coronary arteries that deliver a constant blood supply to your heart muscle these arteries that set on top of the heart because your heart in order for those that muscle to work properly it has to have a constant fresh nice oxygenated blood going to it it starts to develop these fatty plaques which will cause blockages or restrict blood flow to the heart and these fatty plaques are caused by a condition called atherosclerosis and this occurs in the artery wall and it happens over time and like i said it limits the blood supply to the heart muscle and it can if it gets so bad it can eventually stop blood from flowing to certain parts of your heart and cause your heart tissue muscle to die as these plaques what is dangerous about these plaques can not only grow mess up blood flow but it can also they can also rupture there's certain blacks more vulnerable than others and they can rupture their contents form a thrombus and we go into myocardial infarction also atherosclerosis can lead to um hypertension because again atherosclerosis really means a lot of people determine hardening of the arteries so people can have high blood pressure get chest pain myocardial infarction and heart failure now let's look at the anatomy of the heart i want to cover the main arteries that feed your heart muscle there's a lot of different arteries that these branch off into but i want to go over the main ones and then i want to go over the pathophysiology with you of how this actually happens in the artery okay here we have an anterior view of the heart and you have the aorta which branches off into your left coronary artery and your right coronary artery now remember from our heart blood flow videos and everything we learned that the aorta has been supplied with rich oxygenated blood from the lungs it just went got pumped through the heart got oxygenated now it's going to go through the body and replenish the body so let's talk about the left coronary arteries first okay your left coronary artery comes out of your aorta out of your aorta goes to the left side because remember this is the left side of the heart this is the right side of the heart and it branches off into some other arteries now you can't we can't see the left coronary artery here because it's going to be on the other side of the heart the posterior view so that's why it's outlined a little bit differently but then it branches off into the left circumflex artery remember circum means around so this artery actually comes around the heart and it provides blood to the left atrium and to the side and the back of the left ventricle so knowing where your ventricles and atrium set in the heart really help you to know what these arteries are feeding so again it feeds the left atrium because remember your left atrium is up here and the side and the back of your left ventricle and then go down through here we branch off into the led which is the left anterior descending artery and this provides blood to the front and the bottom of the left ventricle and the front of the septum then we come over here to our right coronary artery and comes from the aorta and it branches off into the right marginal artery and this supplies blood to the branches of the right ventricle and then you have the posterior descending artery and all these arteries the main job of the right coronary artery is to provide blood to your right atrium your right ventricle and to the bottom of the left ventricle in the back of the septum now let me cover what's called collateral circulation because this is really neat what happens okay a lot of times whenever a person has chronic ischemia chronic blockage the body the heart will actually try to reroute circulation around that blockage so it can get blood to that heart muscle so let me demonstrate this okay say that we have a blockage right here okay what's happening we're not getting any blood flow at all here and the body's like oh no we've got to fix this so what happens is it starts to develop these little tiny blood vessels that will just like branch off and we'll go around that blockage over to the other side so it can somehow get blood flow there so that is what is called collateral circulation so if you ever hear that that's what it is it's just the rerouting with tiny blood vessels to go around that blockage so they can get some blood supply to that heart tissue now let's look at the pathophysiology of how this actually develops now there are certain risk factors that will increase a patient's chance of developing coronary artery disease like smoking a family history of it diabetes things like that high cholesterol so um more other patients are more susceptible to this so this is how it starts out first you have a nice healthy artery and normally going through your artery is blood and in that blood you have red blood cells and you have what's called ldl which is low density lipoprotein which is your bad cholesterol and you also have hdl which is your high density lipoprotein but what happens is that over time say patient has one of those risk factors there's damage to that artery the ldl starts to stick to that artery wall and it starts to grow over time and as it grows notice that it is limiting the blood flow that would normally go to the heart this one's nice and open this one's narrowing so the patient a lot of times it's asymptomatic doesn't have symptoms but as they start doing activity they notice that they become really short of breath and they're starting to get some chest pain but when they rest then the chest pain goes away and what's happening is that whenever you're doing activity your heart rate's increasing you're increasing that workload on the heart that blood flow is really being limited that's going there but when you rest relax straightens it out and they get relieved of chest pain but what can happen and then that's stable angina so whenever they're having chest pain on activity but it goes away stable angina they really need to go to the physician let them look at that out look at that and run some tests which we'll go over those tests a little bit later but what can happen to these fatty plaques is that they can rupture some plaques are more more vulnerable than others and what happens right here as you can see this plaque has ruptured it's spilled its contents into the blood the artery wall is messed up and the body's like oh no the artery wall is messed up we've got to do something about this so he thinks it's going to help but in reality it's going to cause more problems so right now the patient um starts to form a thrombus your body sends all those nice clotting things to your artery wall to repair it and as that thrombus gets bigger and bigger and grows it's going to completely stop blood flow and your patient's going to enter into acute coronary syndrome and they're going to have some unstable angina where their chest is literally it's completely unrelieved by rest it's severe it's hurting nitroglycerin's not helping and and the blood flow is going to stop as that thrombus right here completely blocks it you're going to get a myocardial infarction where your heart muscle is going to die or become damaged and so that is how that develops over time with the pathophysiology and how it grows now let's look at the risk factors what increases a patient's chance of having atherosclerosis of the arteries one thing is smoking smoking causes a lot of vasoconstriction damages those arteries increases the chances of those plaques forming being obese or overweight having a high cholesterol level having a sedentary lifestyle diabetes or family history so if you're given a test question and it throws out all these patients with these certain histories pay attention and look for these certain signs and symptoms especially if you're doing a medical health history and they tell you all these things because that increases their chances of developing this okay how do these patients usually present what are their signs and symptoms like i said earlier typically in the early stages of coronary artery disease they're going to be asymptomatic until that plaque starts growing more and more and they may notice that they have some chest pain with activity it's like a heaviness on their chest and it may they may have some shortness of breath with this and have fatigue but it will go away whenever they rest this is considered stable angina and it is not a medical emergency but it needs to be evaluated so if a patient's having this they need to go to the doctor tell them so their doctor can order some tests to help diagnose this now it may progress to unstable angina this is where the chest pain is not relieved with rest it's more intense they may take some nitroglycerin doesn't work and this is a medical emergency needs to be treated immediately see what's going on also the patient may just feel tired feeling run down okay how is this diagnosed what do physicians normally order because as the nurse you need to know what's ordered how to educate your patients things like that so number one a lot of times this is usually routine for everyone getting a checkup is a blood test they will look at your lipoprotein file a protein profile and what this is going to look at is going to look at your ldl remember that's your bad fats your hdl that's your good fats your total cholesterol levels and your triglycerides and if these are high they will educate you about managing your diet cutting out some fatty foods and if that doesn't work putting you on some medications which we'll cover in the next video the statins help decrease that cholesterol level another thing is they'll probably order an ekg very simple to do hook them up to that and they will look um at your qrs pqrs rhythm and what they're looking for is problems with st segment or your t waves and this can tell them a lot it can show if a heart attack's in progress if you're having chest pain right now let's look let's see what's going on with your st segment and see if you've had a previous heart attack if there's been injury to that heart or if you're having some compromised blood flow going on another thing they may order along with this i put this under the ekg category is they may order a 24-hour or a 48-hour halter monitor and this is where the patient wears a heart monitor that will monitor their heart rhythm for that amount of time and the patient needs to usually keep a log whenever they're having chest pain so when the physician goes back to read the 24 hour or 48 hour holster monitor they can see if there was any changes in their ekg rhythm whenever they're having that maybe stable angina to see if there was some compromise blood flow so let's go over some normal little st segments and let me just give you an idea of what it looks like now whenever you are looking at a 12 lead ekg there's a lot of different areas you're going to look at to see if there's st depression or st elevation and here i just want to go over the basics i'll be making a video in the future that will go in depth in this but let's just look what a normal one looks like with and then what one looks like with depression and elevation okay a normal um pqrs complex you have the p wave your qrs complex nice st segment with your t wave normal looks great then you come over here and you notice your p wave your qrs complex and then you have this depression right here notice here straight no depression it's going underneath because whenever you're looking at your ekg you have an isoelectric line and what you're looking at is you're measuring how many millimeters this is actually dipping below that isoelectric line and usually two milliliter two millimeters is um something that's very suspicious as a nurse working in the stress lab i have seen this and it's very an interesting phenomenon we'll do a stress test a patient may be exercising on the treadmill and all of a sudden they get chest pain and we'll be watching that ekg and the st segment will start dipping and their chest pain will be getting more severe we'll get them off the treadmill medially give them some nitroglycerin and as that chest pain is being relieved that blood flow is going back because they're not getting blood flow it's causing ischemia so you're seeing that st depression but once we give them the nitroglycerin they rest this starts to return to baseline at the isoelectric line and that tells us hey we got a blockage going on we got some ischemia right now it's reversible we can fix it um but we've got to do something so they'll probably go for a heart cath or something like that to see what's going on but then on the other hand you can have st elevation have seen this as well and what happens as you can tell it completely looks very funny it can vary on how much elevation you have but here your st segment is completely elevated and what has happened is that there has been injury to the muscle of the heart and it's irreversible and we need to um right here with depression we can hopefully go in fix it find that blockage but here it's a little bit too late there's been some damage done so those are the differences between the depression and the elevation another thing that may be ordered is a stress test and this is where the patient will go to a stress lab they will either exercise on a treadmill or have it done chemically if they can't and what will happen is that their ekg will be monitored while that heart has stress on it because remember with stable angina it's aggravated with exercise or stress because you're increasing that workload on the heart so if there is a blockage that is significantly um compromising the blood flow to the heart you will see some ekg changes like s t segment depression now sometimes a nuclear stress test can be ordered with this this is where instead of just exercising on the treadmill looking for ekg changes the patient will do this as well or get the chemical but a tracer will be injected during that activity which will allow the patient to take pictures of the heart with a special machine to look to see how that blood flow is actually flowing to that heart muscle during activity is there some areas that isn't aren't getting good enough blood flow compared to other areas and a lot of times what happens in the hospital setting is that the patient will come in with stable angina they're not really sure what it is but some things look suspicious so they'll have this stress test and stress test does not show the imaging looks very suspicious there could possibly be a blockage then they will go for a heart cath which is another thing that is diagnosed so typically they want to do the most non-invasive route first and then progress but if they're having unstable angina that medical emergency they're going to go bypass the stress test and they're going to go straight for a heart cath a heart cath catheterization is where a catheter is inserted either into the femoral or radial artery they're starting to use the radial artery instead of femoral because complications are a little less risk return recovery times a little bit better or the patient whenever they go radial and a dye is injected into those coronary arteries and they inject the dye in there they take x-ray imaging and they're looking for those blockages to see where it where it's at and what they can do about it now whenever they have this procedure they're breathing on their own they're given moderate sedation now if the doctor finds anything cardiologists is who's doing this if they find anything they will do what's called pci percutaneous coronary intervention sometimes people call it angioplasty and they will do they can do a couple things one of the most popular things that they do is um a balloon angioplasty and this is where they inflate a balloon and that clogged artery they see the clogged from the imaging from the x-ray where they injected the dye and they take a balloon and they compress that plaque up against that artery wall and then they go in and place a stent to keep that artery open so now that artery that wasn't getting any blood flow all of a sudden is opened up and it's getting blood flow a lot of times after patients have this in order to keep that scent from getting clotted they will have to be on plavix and things like that and which i'll be going over in part two talking about the medication so be sure to check that out another thing they may do instead of that is a arthrectomy which is where they go in and they remove plaque from that artery now sometimes these arteries are blocked so bad that they can't put a stint in them and if that's so that a surgeon will have to be consulted and they will do a coronary artery bypass grafts sometimes i have seen where the patient went for a heart cath it was so bad whenever they got in there and looked at the heart cath that they immediately just took them to the or and the patient had open heart surgery and opened that up because it was worse than they thought so that is how coronary artery disease and how it works and what it is so be sure to go to my website registerednessaurian.com and take the free quiz and collect quiz that will test you on this material and be sure to check out part two which will include the nursing interventions and the medications for this disease management and thank you so much for watching and please consider subscribing to my youtube channel

Channel: RegisteredNurseRN

Views: 1,365,644

Keywords: coronary artery disease, coronary artery anatomy, coronary artery, coronary artery disease nursing, coronary artery disease animation, cad nursing, coronary arteries, coronary angiography, coronary heart disease, coronary artery disease pathophysiology, coronary artery disease treatment, coronary heart disease video, heart disease symptoms, nclex review, nclex exam, coronary artery disease NCLEX

Id: vHpRrsDSheE

Length: 19min 57sec (1197 seconds)

Published: Mon Sep 05 2016