The focus of our topic is occlusive coronary artery disease. If someone has arterial occlusive disease, obstuction or constriction of aorta lumen and its mayor brances will interup blood flow. Generally, acute or chronic occlusion causes ischemia, chest pain, and other heart disease sign symptoms.
Occlusive Coronary Artery Disease Overview
If we are talking about coronary, it means that the affected organ is heart. Coronary artery is artery that supplies blood into heart muscle. The coronary arteries carry blood containing rich oxygen and other nutrient essential to the normal functioning of the heart muscle. The occlusion or blockage may be partial or complete blockage.
According to the NetDoctor Medical Team, the most threaten life is a complete block of the coronary artery. This circumstance lead to death of the area of muscle served by that artery (myocardial infarction).
Partial occlusion or blockage of the coronary artery often occurs because of the gradual build-up of plaques rich in cholesterol. This may be further aggravated by the formation of a blood clot on these plaques. This is called coronary thrombosis.
Occlusive coronary artery disease may also be caused by temporary spasm of the muscles in the artery wall or as the result of inflammation in the coronary artery wall (rare case).
The partial blocage of the coronary artery may mean that when the heart tries to work harder, and to speed up the supply of oxygen carried in the blood is insufficient and the patient experiences pain. The chest pain usually called as angina pectoris diagnosis, sometimes called ‘angina of effort’.
What do cause Occlusive Coronary Artery Disease?
- Atherosclerosis. The formation of the cholesterol rich plaques causes atherosclerosis. As people grow older they are more likely to develop this plaque. In certain families, there is an inherited increased risk of developing the condition at an early age. Cholesterol may be the substance that causes plaque in artery wall, especially low density lipoprotein (HDL)
- Endogenous, it is because embolus or thrombosis formation. The effect of dietary animal fat and dietary cholesterol is less certain, but a reduced consumption is generally recommended. Certainly avoiding becoming overweight is important, as is taking regular exercise.
- Exogenous, it is because trauma or fracture.
- Aging process
- Certain Condition like hypertension, hyperlipidemia, and diabetes
- Vascular disturbance history like myocardium infarction or stroke
- Smoking. Smoking directly increases the risk of developing coronary occlusion. High blood pressure also increases the risk of developing the disease. Certain chronic diseases will increase the likelihood of the development of coronary artery disease.
Sign and symptoms for Occlusive Coronary Artery Disease
According to WebMd, the most common clinical sign and symptoms of occlusive coronary artery disease are like mild pain, tightness, or chest discomfort which may be ignored. However, the heart muscle tissue may be damaged. The symptoms of occlusive coronary artery disease is known as angina. Angina can be described as a:
- Painful feeling
Occlusive coronary artery disease can be mistaken for indigestion or heartburn. Angina is specific and is usually felt in the chest, but may also spread to:
- Left shoulder
Other symptoms are also reported:
- Nausea, sweating, fatigue, or shortness of breath can join the typical pressure-like chest pain.
- Shortness of breath
- Palpitations (irregular heartbeats, skipped beats, or a “flip-flop” feeling in your chest)
- A faster heartbeat
- Weakness or dizziness
- Arteriography shows types (thrombus or emboli), location, and obstruction degree and collateral circulation. Arteriography is useful for chronic disease or evaluating patient’s readiness toward reconstructive surgery
- Doppler ultrasonography and pletismography are non-invasive diagnosis examination that show blood flow disease toward occlusion
- Oftalmodinamometry helps determain obstruction degree in carotid artery by distinguishing ofalmic artery pressure with brachial artery pressure . more than 20 % ratio shows insufficiency
- EEG and computed tomography scan can be needed to eliminate brain lesion.
Treatment for Occlusive Coronary Artery Disease
- These include the nitrate group of drugs, such as glyceryl trinitrate or the slower acting isosorbide mononitrate that increase the diameter of the artery and increase the flow of oxygen containing blood.
- For chronic disease, supportive treatment are like limiting smoking activity, controlling hypertension, and walking program
- For intermittent claudication in chronic occlusion disease, pentoxifylline can increase blood supply in the capillary, especially for patient with improper to do surgery
- Acute arterial occlusive disease needs surgery to restore blood supply to occlusion artery area. The procedures that can be done are embolectomy, thromboendarterectomy, graft, artrectomy graft bypass
- Thrombolytic therapy with urokinase, streptokinase, or alteplase can be prescribed
- Angioplasties balloon will suppress the obstruction. Well-defined areas of occlusion can sometimes be stretched open with a balloon introduced into the coronary artery under X-ray control. This is called angioplasty.
- Laser angioplasty can be done (it will evaporate the obstruction)
- Stent to prevent recurrence of artery obstruction
- Alternatively surgery can be used either to bypass the obstruction using vein grafts usually taken from the leg or to provide an alternative blood supply from another nearby artery.
- All of therapy above can be combined
- Sympatectomy can be considered as adjuvant operation depend on simpatetic nervous system condition
- Heparin can be prescribed to prevent embolus
- Calcium antagonists such as nifedipine could and relax artery wall, increasing the bore and the blood flow in the artery.
Occlusive Coronary Artery Disease Nursing Care
- Give patient comprehensive teaching about how to take coronary artery care. Explain about diagnosis examination procedure. Suggest patient to stop smoking and avoid all of contra medication activity
- Pre-operative care (acute period)
- Assess patient’s circulation by assessing distal pulse and assessing skin color and temperature
- Give patient an analgesic
- Give heparin as needed in infusion drops. Use a tool that can determine and maintain drops in infusion
- Change patient’s leg to prevent decubitus or pressure ulcer; do not lift up the leg or compress with warm compress
- Look and pay attention toward fluid and electrolyte balance, monitor intake and output of patient to know patient’s kidney condition (probably urine can decrease about 30 ml/hour)
- Post-operative nursing care
- Monitor patient’s vital signs. Assess the circulation status continuously by checking skin color and temperature, and assessing the distal pulse. Compare the result before and after surgery. Check the hemorrhage signs like tachycardia and hypotension, and check the bandage to know the patient’s excessive bleeding
- If patient is ready to go home, ask patient to know the sign and symptoms of recurrence occlusion. Its sign and symptoms are like pain, pale, paralysis, no pulse that is caused by graft occlusion or other occlusion in certain places. Remind the patient no to use tight clothes.