Coronary Artery Disease (CAD)

Adult Health Nursing – Cardiovascular System

Complete Notes | Clinical Cases | NORCET & Nursing Officer Revision

High-Yield Topic 25 MCQs 30-Minute Test

1. Definition

Coronary Artery Disease (CAD) is a condition in which the coronary arteries become narrowed or obstructed, most commonly due to atherosclerotic plaque formation, reducing blood supply to the myocardium.

Important terminology

CAD: Disease of the coronary arteries, usually due to atherosclerosis.
Myocardial ischemia: Inadequate oxygen supply to heart muscle.
Angina pectoris: Chest discomfort due to myocardial ischemia without acute myocardial necrosis.
Myocardial infarction (MI): Death of myocardial cells due to prolonged ischemia.
Acute coronary syndrome (ACS): Unstable angina, NSTEMI, and STEMI.

2. Coronary Arteries

The right and left coronary arteries arise from the aortic root and supply oxygenated blood to the myocardium.

Left anterior descending (LAD): Supplies much of the anterior wall and interventricular septum.
Left circumflex (LCx): Supplies parts of the lateral wall; distribution varies.
Right coronary artery (RCA): Commonly supplies the right ventricle and, in many people, the SA/AV nodes and inferior myocardium.

3. Etiology and Pathophysiology

Atherosclerosis

Atherosclerosis is the major cause of chronic CAD. Lipid accumulation, inflammation, and fibrous tissue form plaques in the arterial wall. Plaque narrowing restricts blood flow; plaque rupture can trigger platelet aggregation and thrombosis, causing ACS.

Endothelial injury / dysfunction

↓

LDL accumulation and inflammation

↓

Atherosclerotic plaque

↓

Coronary narrowing

↓

Reduced oxygen supply to myocardium

↓

Ischemia → angina / ACS / MI

Supply–demand imbalance: Myocardial ischemia occurs when oxygen demand exceeds oxygen supply. Increased heart rate, blood pressure, or contractility can increase demand; coronary obstruction, anemia, or hypoxemia can reduce supply.

4. Risk Factors

Non-modifiable	Modifiable
Increasing age	Smoking and tobacco use
Family history of premature CAD	Hypertension
Inherited predisposition	High LDL cholesterol / dyslipidemia
Biological sex influences risk patterns	Diabetes mellitus
	Obesity, physical inactivity, unhealthy diet
	Excessive alcohol use and chronic stress may contribute

NORCET point: Diabetes can be associated with atypical or silent myocardial ischemia. Absence of severe chest pain does not exclude ACS.

5. Clinical Manifestations

Chest pressure, heaviness, squeezing, tightness, or discomfort.
Pain may radiate to the arm(s), shoulder, neck, jaw, back, or epigastrium.
Shortness of breath, sweating, nausea, vomiting, fatigue, or dizziness.
Symptoms may occur with exertion, emotional stress, or at rest depending on the condition.
Older adults, women, and people with diabetes may have less typical symptoms.

Types of Angina

Type	Typical pattern	Key feature
Stable angina	Predictable with exertion or stress	Usually improves with rest or prescribed nitroglycerin
Unstable angina	New, worsening, or at rest	Acute emergency; no biomarker evidence of myocardial necrosis
Vasospastic (Prinzmetal) angina	Often at rest, sometimes in cycles	Coronary artery spasm
Microvascular angina	Variable symptoms	Dysfunction of small coronary vessels

Emergency warning: New, severe, persistent, or recurrent chest discomfort, especially with breathlessness, sweating, collapse, or nausea, requires emergency assessment. Do not delay care while trying to identify the type of angina.

6. Diagnostic Investigations

Investigation	Purpose / important point
12-lead ECG	Assess ischemic changes, ST elevation/depression, T-wave changes, and arrhythmias. A normal ECG does not rule out ACS.
High-sensitivity cardiac troponin	Preferred biomarker for myocardial injury; interpret serial values and clinical context.
Exercise or pharmacological stress testing	Assesses inducible ischemia in appropriately selected, stable patients.
Echocardiography	Assesses ventricular function, wall-motion abnormalities, and complications.
Coronary CT angiography	Non-invasive assessment of coronary anatomy in selected patients.
Invasive coronary angiography	Defines coronary anatomy and can guide PCI when indicated.
Lipid profile and glucose / HbA1c	Evaluate cardiovascular risk factors.

ECG and troponin:

STEMI: Compatible symptoms with diagnostic ST elevation or an equivalent pattern requires urgent reperfusion evaluation.
NSTEMI: Acute myocardial injury with a rise/fall in troponin plus evidence of ischemia, without diagnostic persistent ST elevation.
Unstable angina: Ischemic symptoms without acute troponin-defined myocardial injury; diagnosis requires clinical evaluation.

7. Medical Management

Treatment depends on whether the patient has stable chronic CAD or an acute coronary syndrome. Prescriptions must be individualized according to vital signs, ECG, renal function, bleeding risk, contraindications, and clinician orders.

Antianginal and preventive medicines

Antiplatelets: Aspirin and/or a P2Y12 inhibitor when indicated to reduce thrombotic events.
Statins: High-intensity statin therapy is commonly recommended for established atherosclerotic cardiovascular disease, unless contraindicated.
Nitrates: Nitroglycerin may relieve angina by reducing cardiac workload and improving coronary blood flow.
Beta-blockers: Reduce heart rate and myocardial oxygen demand; appropriate use depends on the clinical situation.
Calcium-channel blockers: Useful for selected patients, including vasospastic angina.
ACE inhibitors / ARBs: Used in appropriate patients, especially with selected comorbidities or ventricular dysfunction.
Anticoagulants: Used in selected acute coronary syndrome settings according to protocol.

Nitroglycerin safety: Check blood pressure and contraindications. Nitrates can cause hypotension and must not be combined with PDE-5 inhibitors such as sildenafil or tadalafil within the clinically specified avoidance interval. Follow local emergency protocols and prescribed instructions.

Revascularization

Percutaneous coronary intervention (PCI): Balloon angioplasty with stent placement when indicated.
Coronary artery bypass grafting (CABG): Surgical grafting to bypass obstructed coronary segments.
Reperfusion in STEMI: Primary PCI is preferred when it can be delivered promptly; fibrinolysis may be considered for eligible patients when timely PCI is unavailable, following a specialist-led protocol.

8. Nursing Management

Immediate nursing priorities for suspected ACS

Recognize symptoms promptly and activate the emergency / ACS pathway.
Assess airway, breathing, circulation, vital signs, pain, consciousness, and oxygen saturation.
Obtain a 12-lead ECG promptly, ideally within 10 minutes of first medical contact in suspected ACS, according to local protocol.
Establish IV access and collect blood samples, including serial troponin, as ordered.
Initiate continuous cardiac monitoring when indicated; keep defibrillation capability available in high-risk settings.
Administer prescribed antiplatelet, antianginal, anticoagulant, and other treatments after checking contraindications and monitoring response.
Provide oxygen for hypoxemia or respiratory distress as indicated. Routine oxygen is not recommended for patients who are not hypoxemic.
Reassess pain, ECG, vital signs, rhythm, and response to treatment; document and escalate deterioration.

Ongoing nursing care

Monitor for dysrhythmias, hypotension, heart failure, recurrent ischemia, and bleeding.
Balance rest and gradual activity according to clinical stability and prescribed rehabilitation.
Provide medication education and reinforce adherence.
Encourage tobacco cessation, heart-healthy diet, suitable physical activity, and risk-factor control.
Support cardiac rehabilitation and follow-up.
Teach patients to seek emergency help for new or persistent chest symptoms.

9. Possible Complications

Acute myocardial infarction
Ventricular tachycardia or ventricular fibrillation
Heart failure and pulmonary edema
Cardiogenic shock
Mechanical complications after MI, including papillary muscle dysfunction or rupture and ventricular septal rupture
Sudden cardiac death

10. Patient Education and Prevention

Stop smoking and avoid second-hand smoke.
Control blood pressure, diabetes, and cholesterol.
Follow a heart-healthy eating pattern rich in vegetables, fruit, whole grains, legumes, and suitable lean protein.
Maintain a healthy weight and undertake regular physical activity after clinical assessment and advice.
Take medicines exactly as prescribed; do not discontinue antiplatelets or other cardiac medicines without medical advice.
Attend follow-up visits and cardiac rehabilitation when recommended.
Understand the action plan for angina and when to call emergency services.

11. High-Yield NORCET Revision

Question clue	Answer / concept
Most common underlying cause of CAD	Atherosclerosis
Preferred biomarker for myocardial injury	High-sensitivity cardiac troponin
Stable angina pattern	Predictable with exertion; usually relieved by rest or prescribed nitroglycerin
New chest pain at rest	Suspect ACS; urgent assessment
Major immediate test in suspected ACS	12-lead ECG, promptly
Routine oxygen for normoxemic ACS	Not recommended
Potential nitrate adverse effect	Hypotension and headache
Major fatal early complication of MI	Ventricular arrhythmia, including VF
STEMI treatment priority	Urgent reperfusion assessment
Important secondary prevention	Antiplatelet/statin therapy when indicated plus risk-factor control

12. Practice Test: 25 MCQs

Attempt all questions. Select one best answer for each question. The test has a 30-minute timer, navigation controls, automatic submission on expiry, and explanations after submission.

CAD Nursing Test
Question 1 of 25

Time Left: 30:00
Answered: 0/25

Educational practice material for nursing students. It is not a substitute for local ACS protocols, clinician assessment, or individualized medical advice.

Coronary Artery Disease Notes With MCQs Practice