coronary artery disease (CAD), an abnormal condition that may affect the heart’s arteries and produce various pathological effects, especially the reduced flow of oxygen and nutrients to the myocardium. The most common kind of coronary artery disease is coronary atherosclerosis, now the leading cause of death in the Western world. Other coronary artery diseases include coronary arteritis and fibromuscular hyperplasia of the coronary arteries. Also called coronary heart disease. ▪ OBSERVATIONS: Angina pectoris, the classic symptom of coronary artery disease, results from myocardial ischemia. Diagnosis of coronary artery disease is usually based on patient history and tests such as exercise stress tests, electrocardiography, coronary angiography, and myocardial perfusion imaging. ▪ INTERVENTIONS: Treatment concentrates on reducing myocardial oxygen demand or on increasing oxygen supply. Therapy commonly includes the administration of nitrates, such as nitroglycerin or isosorbide dinitrate; a beta-adrenergic blocker; or calcium channel blockers. Surgical interventions include coronary artery bypass surgery, angioplasty, insertion of cardiac stents, and atherectomy. The prevalence of coronary artery disease highlights the importance of preventive measures, such as reduced caloric intake by the obese patient; lowered salt, fats, and cholesterol consumption; regular exercise; abstention from the use of tobacco products; and reduction of stress. ▪ PATIENT CARE CONSIDERATIONS: Many of the risk factors for heart disease can be modified to reduce mortality and health care costs. Improved models of care using a team-based approach provide the opportunity to cost effectively prevent complications related to chronic cardiovascular problems subsequent to coronary artery disease. Rehabilitation of the patients following acute exacerbation should stress the importance of following the prescribed regimens of diet, medication, exercise, and cessation of tobacco use.
