Coronary Artery Disease ( Cad )

Coronary artery disease (CAD) develops when plaque builds up in the narrow arteries of the heart. The arteries that are affected supply blood to your heart, oxygen, and numerous amounts of nutrients to the heart. The plaque that builds in the arteries is from the amount of cholesterol that is accumulated in the arteries. The plaque that builds within the arteries of the heart decrease the blood flow to the heart often resulting in chest pain (angina), shortness of breath, or other symptoms. This disease is often not diagnosed until the patient has a heart attack. The reason that coronary artery disease goes unnoticed is because this disease develops over decades. “Heart disease is the leading cause of

The following summary is an updated case study of a 47 year old male patient, Jim who was diagnosed with Coronary Artery Disease. The patient did receive information on what CAD is and was informed that test were needed to fully diagnose and be evaluated for underlying conditions (high blood pressure, high blood cholesterol levels, diabetes and blockage. I will discuss the type of test needed for this condition and tests for any underlying conditions that are related to this disease. The type of treatment needed to control and lower his risk factor. I will also give the patient information about complementary and alternative medicine so the patient will be well informed about different types of treatment. The patient will be informed about the prognosis of the disease, and the options that the patient has to succeed in the changes in his lifestyle that are needed.

12 Lead Electrocardiogram (ECG) - There are typical changes to the normal pattern of the ECG in a heart attack. Patterns that occur include pathological Q waves and ST elevation (Koutoukidis, Stainton & Hughson 2013, p. 505). However, it is possible to have a normal ECG even if a patient has had a heart attack. The indicators for this test include: suspected myocardial infarction, suspected pulmonary embolism, perceived cardiac dysrhythmias, fainting or collapse, a third heart sound, fourth heart sound, a cardiac murmur or other findings to indicate structural heart disease. The

Coronary Artery Disease, also known as CAD, is the most common form of heart disease. (Heart and Stroke Foundation, 2009) Coronary Artery Disease obstructs the blood flow in vessels that provides blood to the heart which is caused by the buildup of plaque on the artery walls. (Rogers, 2011, p.87) (Heart and Stroke Foundation, 2009) Plaque is a yellow substance that consists of fat substances, like cholesterol, and narrows or clogs the arteries which prevents blood flow. (Heart and Stroke Foundation, 2009) Plaque can build up in any artery but usually favors large and medium sized arteries. (Heart and Stroke Foundation, 2009)

12 lead EKG: It is one of the tools for initial evaluation of patients suspected of coronary syndromes such as MI. It as a sensitivity of 80% (Kreatsoulas et al., 2016). ST segment changes of elevation or depression, left bundle branch block, presence of Q waves, new onset of T wave inversion are suggestive of ischemic changes of heart. In this case, then Intervention for cardiac catheterization with stent placement may be required (McConaghy & Oza, 2013).

In the following rhythm strip, there are four and then three normal beats when the P wave is followed by a pause rather than by a QRS; then the cycle repeats itself indicating 2nd degree heart block.

The labels of the waves indicate a particular action on the heart. P waves represent atrial depolarization or atrial contraction. The QRS complex indicates ventricular depolarization. While QRS is normally seen not ever complex has Q (negative deflection), R (positive

Bundle branch block is usually present when there is prolongation of the QRS complex. The conduction system starting from the AV node is then divided in the left or right bundle branches, which a block can cause delayed activation of the corresponding ventricles. Bifascicular block refers to an impaired conduction in two of the three fascicles; for example, right bundle branch block and a block in the left anterior-superior division of the left bundle

A sufficient coronary artery blood flow is essential to supply oxygen for normal cardiac activities (Craft, 2014, p. 599). Atherosclerosis is a common form of CHD. It is an inflammation disease when plasma cholesterol is high. Risk factors such as hypertension, high cholesterol, smoking and diabetes increase the risk of endothelium injuries, contributing to the increase in oxidated lipid-lipoprotein (LDL). Foam cell is produced by the increase in the number of macrophages signalled by oxidated LDL. Next, the accumulation of foam cells will cause the formation of fatty streak lesions on arteries walls. Over time, fatty streak lesions migrate to the site and form fibrous plaque due to the increase in smooth muscles and collagen. The thickening and hardening initiated by an accumulation in calcified fibrous plaque caused the blood vessels to narrow. As a result, a decrease in tissue perfusion contributing to the development of myocardial ischemia (Craft, 2014, p. 599; McCance & Huether, 2014, pp. 1145-1147).

Cardiac: rRegular rate and rhythm, no murmurs, rubs, or gallops; no JVD, thrills, or heaves; PMI non-displaced at 5th intercostal space

Long QT syndrome (LQTS) is a heart rhythm condition that can potentially cause fast, chaotic heartbeats. These rapid heartbeats might trigger a sudden fainting spell or seizure. In some cases, the heart can beat erratically for so long that it causes sudden death. The condition is treatable however the patient may need to take precautions in order to avoid an irregular heart beat the form of medication. Sometimes surgery or implantable devices have to be involved as part of a treatment plan. The patient will have to avoid medications known to cause the condition or provoke symptoms and some physical activities will have to be neglected.

Due to great progress in genetic testing during the last decade, there is an increasing awareness of congenital heart diseases that give a higher risk of sudden cardiac death (SCD). A good example of such heart disease is the congenital Long QT Syndrome (LQTS). This disorder is a leading cause of SCD in the non-adult population.1 Ion channels responsible for the ventricular repolarization are mutated, causing a prolongation of the QT-interval on ECG.2 This aberrant repolarization of the heart gives a risk of the occurrence of ventricular arrhythmias, called torsades de pointes. These arrhythmias are mainly precipitated by emotional or physical stress2 and cause symptoms such as syncope or cardiac arrest.

There are two common types of ectopic heartbeats, PVC -Premature ventricular contractions and PAC -Premature atrial contractions. First one, PVC can be found in both healthy and diseased hearts. “PVC is a premature beat (in the ventricle) that occurs earlier than the next expected beat. The normal (sometimes the P wave is not the same shape as other P waves) and these can be hard to pick out of a normal ECG. The identifying feature: The R-R interval between the PAC and the preceding beat is shorter than any of the other R-R intervals”

This ECG will be systematically interpreted using the mnemonic A RARE PQRST. By utilising this mnemonic, it is easy to determine that the patient is experiencing an anterior STEMI, which results from an occlusion of the left anterior descending artery.

Early repolarization pattern (ERP) is an enigmatic common electrocardiographic (ECG) finding,occurring in 1% to 2% of the general population (1). ERP prevalence is decreasing with advancing age (2) This ECG pattern is frequently observed in healthy persons,particularly young,male (3,4,5), athletic (6,7), and of African-American origin (4,5,6,7,8).On the 12-lead ECG the ERP is characterized as “notching” or “slurring” of the terminal portion of the R wave and beginning of the ST-segment that produces a positive hump known as J wave. The J wave is a deflection with a dome that appears immediately after the end of QRS complex followed by ST-segment elevation ≥ 0.1 mV (or 1 mm, varying from 1 to 4 mm) above isoelectric line