Coronary Artery Disease & ACS | Chapter 37 – Lewis’s Medical-Surgical Nursing (12th)

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Chapter 37 of Lewis’s Medical-Surgical Nursing (12th Edition) covers coronary artery disease (CAD) and acute coronary syndrome (ACS), two leading causes of morbidity and mortality worldwide. CAD develops primarily from atherosclerosis, where endothelial injury, lipid deposits, and inflammatory responses narrow coronary arteries, reducing blood flow to the myocardium. Risk factors include hypertension, hyperlipidemia, smoking, diabetes, obesity, sedentary lifestyle, age, gender, and family history. Nurses play a critical role in prevention through education, health promotion, and early intervention.

✨ Chronic stable angina results from reversible myocardial ischemia, typically triggered by exertion, stress, or heavy meals. It presents as chest pressure or tightness, relieved by rest or nitroglycerin. Long-term management includes beta-blockers, calcium channel blockers, nitrates, antiplatelets, statins, ACE inhibitors/ARBs, lifestyle modification, and revascularization when needed.
✨ Acute coronary syndrome (ACS) occurs when an atherosclerotic plaque ruptures, causing thrombus formation and partial or total coronary occlusion. ACS includes unstable angina (UA), non–ST-elevation myocardial infarction (NSTEMI), and ST-elevation myocardial infarction (STEMI). UA and NSTEMI involve partial occlusion; STEMI involves total occlusion, leading to transmural infarction if untreated.
✨ Myocardial infarction (MI) presents with severe chest pain, diaphoresis, nausea, vomiting, dyspnea, anxiety, and abnormal heart sounds (S3, S4, new murmur). Complications include dysrhythmias, heart failure, cardiogenic shock, papillary muscle dysfunction, pericarditis, and sudden cardiac death. Diagnostic tools include ECG changes (ST elevation, T-wave inversion, Q waves), cardiac biomarkers (troponin, CK-MB), echocardiography, and coronary angiography.
✨ Interprofessional management of ACS/MI prioritizes rapid reperfusion. Initial care follows the MONA protocol (morphine, oxygen, nitroglycerin, aspirin). STEMI requires immediate PCI (preferred) or thrombolytic therapy if PCI unavailable. NSTEMI and UA are managed with antiplatelets, anticoagulants, and possible PCI. Long-term therapy includes dual antiplatelet therapy, beta-blockers, ACE inhibitors/ARBs, statins, and cardiac rehabilitation.
✨ Surgical options include percutaneous coronary intervention (PCI) with balloon angioplasty and stenting, as well as coronary artery bypass grafting (CABG) for severe disease or failed PCI. Post-CABG care includes hemodynamic monitoring, chest tubes, wound care, infection prevention, pain management, and teaching for long-term lifestyle changes.
✨ Nursing care emphasizes rapid recognition of chest pain, ECG monitoring, medication administration, oxygen therapy, teaching about nitroglycerin use, adherence to therapy, lifestyle changes (diet, exercise, smoking cessation, stress management), and psychosocial support. Nurses also coordinate cardiac rehabilitation, which promotes recovery, improves functional ability, and reduces future cardiovascular risk.

Gerontologic considerations highlight atypical MI symptoms in older adults (dyspnea, confusion, syncope, indigestion), polypharmacy concerns, and the importance of individualized teaching.



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