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Coronary Artery Disease Nursing Guide

The content was created by Bobbi Whittington, RN, BSN

Coronary Artery Disease Overview

This course is intended as a Quick Reference for coronary artery disease and will cover an overview as well as nursing considerations utilizing the nursing process.

Etiology and Epidemiology 

Coronary Artery Disease Definition

Coronary arteries supply oxygen-rich blood to the heart to keep it pumping. The four main arteries are (Cleveland Clinic, 2021): 

  • Right coronary artery 
  • Left main coronary artery 
  • Left anterior descending artery 
  • Left circumflex artery 

Coronary artery disease or coronary heart disease is the most common type of heart disease in the U.S., and it is caused by plaque buildup in the walls of the arteries. Plaque is made up of deposits of cholesterol and other substances that build up inside of the arteries. This process is called atherosclerosis and it causes the arteries to narrow over time which can partially or totally block the flow of blood to the heart (Centers for Disease Control and Prevention [CDC], 2021a). 

There are three main types of coronary heart disease (CAD), which include (National Heart, Lung and Blood Institute [NIH], n.d.): 

  • Obstructive coronary artery disease: Arteries are greater than 50% blocked 
  • Nonobstructive coronary artery disease: Large arteries are narrowed but less than the obstructive arteries 
  • Coronary microvascular disease: There is plaque buildup in the small vessels of the heart 

According to the CDC (2021b), the following statistics were found in men with heart disease: 

  • Heart disease is the leading cause of death in men in the U.S., killing 357,761 in 2019 
  • Approximately 1 in 13 White men, 1 in 14 Black men, and 1 in 17 Hispanic men have CAD 
  • Half the men who die abruptly of CAD had no previous symptoms 

In the past, it was believed that heart disease was only prevalent in men, but women are at risk for developing heart disease, including CAD. According to the CDC (2020), the following statistics were found in women: 

  • Heart disease is the leading cause of death for women in the U.S., killing 299,578 women in 2017 
  • Heart disease is the leading cause of death for Black and White women in the U.S. 
  • One in 16 women over the age of 20 have CAD 

There are several risk factors for CAD and the more that factors the individual has, the more likelihood they will develop CAD. The risk factors include: 

  • Hypertension 
  • Hypercholesterolemia 
  • Family history of heart disease 
  • Diabetes 
  • Smoker 
  • Overweight 
  • Sedentary lifestyle 
  • Men over the age of 45 
  • Post-menopausal women 
  • Ethnicity 
  • Stress 

Coronary Artery Disease ICD-10 Code: I25.10

  • Atherosclerotic heart disease of native coronary artery without angina pectoris

Coronary Artery Disease Diagnosis 

Diagnosis of CAD is made through a thorough history and physical examination by the healthcare provider. Atherosclerosis occurs over a period of time, so the individual may not know they have CAD until they experience a heart attack. Signs and symptoms of CAD may include: 

  • Chest pain 
  • Shortness of breath 
  • Dizziness 
  • Fatigue 
  • Nausea 
  • Heart palpitations 
  • Angina 
  • Elevated blood pressure 
  • Tachycardia 
  • Sweating 

The healthcare provider may order the following diagnostic tests to diagnose CAD: 

  • Cholesterol screening 
  • Cardiac enzymes 
  • C-reactive protein 
  • Troponin level 
  • CMP 
  • CBC 
  • Chest x-ray 
  • EKG 
  • Echocardiogram 
  • Stress test (physical or chemical) 
  • Cardiac catherization 
  • Hemoglobin A1C 

Management & Treatment of Coronary Artery Disease

The management and treatment of CAD will depend on the physical presentation of the individual, their medical history, and the healthcare provider’s preferences on treatment. Here are some ways that CAD can be treated: 

  • Heart-healthy lifestyle changes, including diet and exercise 
  • Smoking cessation 
  • Antihypertensive medications 
  • Cholesterol lowering medications 
  • Diabetes medications to lower blood sugars 
  • Nitrates to control chest pain 
  • Surgical management, such as stent placement or coronary artery bypass grafting (CABG) 
  • Stress management 

Coronary Artery Disease Nursing Care Plan

Nursing Considerations 

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for coronary artery disease are listed below. 

Assessment 

Assess for signs and symptoms, such as: 

  • Chest pain 
  • Tachycardia 
  • Sweating 
  • Fatigue 
  • Elevated blood pressure 
  • Nausea 
  • Anxiety 
  • Restlessness 
  • Shortness of breath 

Nursing Diagnosis/Risk For 

  • Acute pain related to decreased myocardial blood flow, evidenced by: 
    • Verbalization of pain 
    • Restlessness 
    • Elevated blood pressure 
  • Decreased cardiac output related to alteration in heart rate and rhythm, evidenced by: 
    • Fatigue 
    • Angina 
    • Shortness of breath 
  • Anxiety related to situational crisis, evidenced by: 
    • Verbalization of anxiety 
    • Restlessness 
    • Fear 

Coronary Artery Disease Interventions 

  • Maintain ABCs: Airway, breathing, and circulation 
  • Pain medications, as ordered 
  • Non-pharmacological interventions for pain control 
  • Provide comfortable stress-free environment 
  • Oxygen, as ordered 
  • Monitor ventilation and oxygenation 
  • Monitor vital signs 
  • Monitor neurological status 
  • Anti-anxiety medications, as ordered 
  • Administer cardiac medications, as ordered 
  • Provide supportive environment for individual and family 
  • Provide wound care post-surgery, as ordered 
  • Monitor response to medications administered 

Expected Outcomes 

  • Achieves and maintains adequate pain control 
  • Achieves and maintains increased cardiac output 
  • Demonstrates decreased episodes of anxiety 
  • Verbalizes understanding of coping strategies 

Individual/Caregiver Education 

  • Condition, treatment, and outcomes 
  • Risk factors of CAD 
  • Signs and symptoms of CAD 
  • Importance of compliance with healthy lifestyle changes 
  • Medication regimen and side effects 
  • Smoking cessation 
  • Stress reduction 
  • Follow-up with cardiologist as needed 
  • Notify healthcare provider or seek immediate medical attention for the following: 
    • Chest pain 
    • Profuse sweating 
    • Pain to back, shoulder, and jaw 
    • Weakness 

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Additional Information

Content Release Date 

4/1/2022

Content Expiration

12/31/2025

Course Contributor 

The content for this course was created by Bobbi Whittington, RN, BSN 

Bobbi started her nursing career as a CNA in long term care and developed a passion for working with older adults in the post-acute setting. She obtained her LPN certificate in 1997 from South Central Area Vocational Technical School in Missouri. Continuing her education, she earned her Associate degree in nursing in 2007 from Texas County Technical Institute in Missouri then obtained her Bachelor of Science degree in nursing from Chamberlain College of Nursing in 2013. Bobbi has over 24 years clinical and managerial experience in the skilled nursing industry. 

References 

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