Chapter 37: Coronary Artery Disease & ACS

Coronary artery disease develops through atherosclerotic processes involving endothelial injury, lipid accumulation, and inflammatory responses that progressively narrow coronary vessels, ultimately compromising myocardial perfusion. Multiple risk factors contribute to disease development, including hypertension, dyslipidemia, tobacco use, diabetes mellitus, obesity, and genetic predisposition. Chronic stable angina manifests as reversible myocardial ischemia triggered by physical exertion or emotional stress, typically presenting as chest discomfort that responds to rest or sublingual nitroglycerin administration. Acute coronary syndrome encompasses a spectrum of conditions resulting from atherosclerotic plaque rupture and subsequent thrombus formation, including unstable angina, non-ST-elevation myocardial infarction, and ST-elevation myocardial infarction. Each condition reflects varying degrees of coronary occlusion and myocardial tissue damage. Diagnostic evaluation relies on electrocardiographic changes, cardiac biomarker elevation including troponin and creatine kinase-MB, and advanced imaging techniques. Interprofessional management emphasizes rapid reperfusion strategies, with percutaneous coronary intervention serving as the preferred treatment for ST-elevation myocardial infarction, while non-ST-elevation conditions require antiplatelet therapy, anticoagulation, and risk stratification. Surgical interventions include balloon angioplasty with stent placement and coronary artery bypass grafting for complex disease presentations. Comprehensive nursing care focuses on prompt symptom recognition, hemodynamic monitoring, medication administration, patient education regarding lifestyle modifications, and coordination of cardiac rehabilitation programs to optimize long-term cardiovascular outcomes and prevent future cardiac events.