A Case Report on Single Vessel Disease

Introduction: Coronary artery disease (CAD) involves the decrease flow of blood to muscle of the heart because of the to build-up of plaque (atherosclerosis) in arteries of the heart. It is one of the most common cardiovascular disease. Tiny branches off larger coronary arteries are get damaged and not able to dilate proper. Small vessels need to expand and also providing oxygen-rich blood


INTRODUCTION
Coronary artery disease affected 110 million population and 8.9 million deaths. It makes up 15.6% of all deaths, Its become common cause of death globally. In the developed country risk of death from CAD decreased between 1980 and 2010. As of 2010, CAD was leading cause of death globally resulting in over 7 million deaths. It affect individuals at any age but it more among older ages. Mostly Males affecting than females [1].
Risk factors are like hypertension, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, depression, and consumption of more amount alcohol. Investigation will help for making diagnosis like electrocardiogram, cardiac stress testing, coronary computed tomographic angiography [2].
For reducing the risk of CAD includes of taking a healthy diet, doing exercise regular, and avoid doing smoking. Medications such as antiplatelets (including aspirin), beta blockers, or nitroglycerin recommend. In severe cases, percutaneous coronary intervention or coronary artery bypass surgery can benefit [3].

Patient Information
A case of 60 year old men admitted in the cardiac unit with chief complaints about the pain in abdomen, nausea and vomiting 2 days, blood pressure is 110/80mmof Hg. He had these complaints since 2 days.

Medical / Surgical History
The patient has developed the problem of hypertension before 6 year ago. After some investigation done the Abdominal angiography, inferior mesenteric artery occlusion with coronary artery disease -single vessel disease diagnosed. Patients IMA (Ischemic mesenteric artery) stenting was done in 2016 has a history of hypertension. No past and present surgical history of the patient.

Pulmonary/cardiovascular
Inspection -Symmetrical of chest movement, Palpation -No tenderness, no masses, symmetric chest expansion, Auscultation -Murmur sound is present, Percussion -Fluid accumulation present.

Integumentary
No any skin lesions.

Musculoskeletal system
He was normal and body mass index (BMI) of the 24.60. Slow range of motion (ROM). Muscle weakness was present and a reduction in muscle strength. No Periphery edema in lower extremities.
In Urine examination urine albumin is nil, urine sugar is nil, an epithelial cell is 1 cell /hpf.
In peripheral smear,red blood cell (RBC's)normocytic normochromic platelets are adequate on smear,seen in clumps no haemoparasite seen.

In electrocardiogram (ECG)
An ECG may reveal abnormalities in heart rhythm seen in the ECG.

Coronary angioplasty report
Anesthesia: Local, 2D echo: Left ventricular ejection fraction (LVEF) 45%, Approach: R trans Brachial, Contrast: Non ioninc Onipaque r 350 mg 1/100ml=80ml,catherer: 6F sheath FBU 3.5. Note: there is a define risk of stent thrombosis and even re stenosis after angioplasty and stent placement life style modification, regular check up and continuing Aspirin and ticagrelor are mandatory.

Antiplatelet
Tab.Ecosprin 150mg is an antiplatelet medicine containing acetylsalicyclic (also called Aspirin). It prevent blood clot formation within the body. It is used to prevent the risk of heart attacks, stroke and chest pain( heart related). It is also used to reduce the chances of formation of clot after surgery, in patients with risk of vascular thrombosis [4].

Tab. Ultracet
Tab.Ultracet is a pain relieving medicine. It is used in various condition such as muscle ache, back pain, joint pain [5].

Antibiotic
Tab. Augmentin 625 is a penicillin type of antibiotic it helps body fight with infections caused by bacteria. It is help for treating infection of the lungs.(e.g.Pneumonia ), Ear, Nasal sinus [6].

SURGICAL MANAGEMENT
The most common major cardiac surgery is CABG' surgery. Also Percutaneous coronary intervention to stretch narrowed arteries another surgical procedure for client of coronary artery disease.

NURSING MANAGEMENT
Prevention of infection it must be at the forefront of the techniques for nurses. Patients must need to know of their condition and make motivated to the required adjustments to their lifestyle, which will be important in avoiding recurrence. Nurses must calm and reassuring and can be able to handle patients pain and sign symptoms. Nurses must provide psychosocial support. Hemodynamic control also the close examination of vital signs are general objectives of patients and also recognition of cardiac changes on the ECGs is also important aspect of nursing care [9].

Acute Pain Related Coronary Artery Disease
Goal:-to relieve the pain of patient Intervention: -

Anxiety Related Diagnostic Procedure and Treatment Modality
Goal: To reduce anxiety of patients Intervention : 1.Assess the Anxiety of patients 2. Maintain proper communication with patient 3. Give respond to patients every question and provide psychological support to patient [10].

THRAPAEUTIC DIET PLAN
For coronary artery disease right diet can improve health of the artery. Oats have betaglucan, its fiber that blocks absorb cholesterol from digestive tract. Beans help arteries for decrease amount of cholesterol absorb from food. Olive & canola oils are naturally low in saturated and also having trans fats, also containing unsaturated fats. Almonds, pistachios, walnuts, nuts are best food for blood vessels. They contain arginine, Amino acid that making blood vessels relax, also making blood flow freely within body. Fish are good source of omega-3 fats, help for slow plaque growth [11].

REDUCE RISK FACTORS
Initial step for treatment of coronary artery disease is reducing risk factors. 3. Take heart healthy diet: Taking green leafy vegetables, fruits in diet for it help for reduce heart disease risk. 4. Avoid alcohol use: Alcohol consumption must be in limit by men and women 5. Increase activity: Exercise can help for lose weight, improving in physical condition and also for relieving of stress [12].

DISCUSSION
A 60 year old male complained of pain in the Coronary Intervention also performed on client. Early diagnosis and surgery are essential to protect heart and it help prevent severe morbidity.

CONCLUSION
While it is complex and difficult to diagnose single vessel disease, careful examination of symptom presentations such as sudden onset chest pain is important symptoms. The coronary angiography report help provide information regarding coronary artery -single vessel disease. When diagnosed with single vessel disease, surgery is not the primary basis of diagnosis and treatment.
Coronary bypass graft or Percutaneous Coronary Intervention, are also other choices. Following healthy life style like taking healthy diet, daily exercise, avoiding smoking, tobacco chewing are more helpful for avoiding coronary artery disease.

While
preparing case report and for publication patient's informed consent has been taken.

ETHICAL APPROVAL
As per international standard or university standard written ethical approval has been collected and preserved by the author(s).