EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON

KNOWLEDGE AND PRACTICE REGARDING PREVENTION OF

CORONARY ARTERY DISEASE AMONG PATIENTS WITH
MODIFIABLE RISK FACTORS OF CAD

Dissertation Submitted To
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY
CHENNAI
IN PARTIAL FULFILMENT OF REQUIREMENT FOR
DEGREE OF
MASTER OF SCIENCE IN NURSING
APRIL 2016
 EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON
KNOWLEDGE AND PRACTICE REGARDING PREVENTION OF
CORONARY ARTERY DISEASE AMONG PATIENTS WITH
MODIFIABLE RISK FACTORS OF CAD

Dissertation Submitted To
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY
CHENNAI
IN PARTIAL FULFILMENT OF REQUIREMENT FOR
DEGREE OF
MASTER OF SCIENCE IN NURSING
APRIL 2016

INTERNAL EXAMINER EXTERNAL EXAMINER

Signature : Signature :

Date : Date :
 EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON
KNOWLEDGE AND PRACTICE REGARDING PREVENTION OF
CORONARY ARTERY DISEASE AMONG PATIENTS WITH
MODIFIABLE RISK FACTORS OF CAD
2015-2016

COLLEGE SEAL:

SIGNATURE: _________________

PROF. Mrs. V.KAVITHA

R.N., R.M., M.Sc. (N),
Principal,
Arvinth College of Nursing,
Namakkal, Tamil Nadu.

Dissertation Submitted To
THE TAMIL NADU DR.M.G.R.MEDICAL UNIVERSITY
CHENNAI
IN PARTIAL FULFILMENT OF REQUIREMENT FOR
DEGREE OF
MASTER OF SCIENCE IN NURSING
APRIL 2016
 EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON
KNOWLEDEGE AND PRACTICE REGARDING PREVENTION OF
CORONARY ARTERY DISEASE AMONG PATIENTS WITH
MODIFIABLE RISK FACTORS OF CAD
2015-2016

Approved by Dissertation Committee on: 23:12:2015

Research Guide : PROF. Mrs. V.KAVITHA M.Sc (N)

Principal & Research Guide,
Arvinth College of Nursing,
No 2/191, Ellaikkal Medu,
Mettupatti post,
Namakkal (DT)-637020

Nurse Guide : Mrs. R.RUCKMANI M.Sc (N),

Associate Professor,
H.O.D, Medical Surgical Nursing,
Arvinth College of Nursing,
No 2/191, Ellaikkal Medu,
Mettupatti post,
Namakkal (DT)-637020

Dissertation Submitted To
THE TAMIL NADU DR.M.G.R MEDICAL UNIVERSITY
CHENNAI
IN PARTIAL FULFILMENT OF REQUIREMENT FOR
DEGREE OF
MASTER OF SCIENCE IN NURSING
APRIL 2016
 CERTIFICATE

This is to certify that, this thesis, titled, “A STUDY TO ASSESS THE

EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE
AND PRACTICE REGARDING PREVENTION OF CORONARY ARTERY
DISEASE AMONG PATIENTS WITH MODIFIABLE RISK FACTORS OF CAD IN
A PRIVATE HOSPITAL, KERALA” submitted by Mr. Eby Korah, M.Sc (Nursing)
(2014-2015 Batch) Arvinth College of Nursing in partial fulfillment of the requirement of the
Degree of Master of Science in Nursing from The Tamil Nadu Dr. M.G.R Medical University
is his original work carried out under our guidance.

PROF. Mrs. V.KAVITHA M.Sc (N)

Principal & Research Guide,
Arvinth College of Nursing,
No 2/191, Ellaikkal Medu,
Mettupatti post,
Namakkal (DT)-637020
 ACKNOWLEDGEMENT

“The lord is my shepherd; I shall not want”

The journey from the basic search from dissertation up to this bound book is solitary.
In a project like this, the investigator requires assistance, encouragement and support from
many. I am fortune to have an abundance of all requisites at every step.
I wish to acknowledge first, The Lord Almighty for his abundance of blessing, will
power, strength and health throughout the dissertation.
At the outset I the researcher of this study, express my heartfelt gratitude to the
honorable Dr. K. Mani, MBBS, MS (ORTHO), D ORTHO Managing Trustee, Arvinth
College of Nursing for giving me an opportunity to undergo the post graduate programme in
this esteemed institution for the uplift of my professional career.
I express my sincere thanks to the Vice Chancellor and Research Department of
the Tamilnadu Dr. M.G.R Medical University, Guindy for giving me an opportunity to
undertake my post graduate degree in nursing at this esteemed university.
I express my immense thanks to Dr. M. DHANABAKIYAM, MBBS, DGO, Arvinth
Hospital for constant support and encouragement throughout the course of the study.
I express my gratefulness to Prof. Mrs. V. KAVITHA, M.Sc., (N) Principal, Arvinth
College of Nursing, honorary professor in Community Health Nursing for her valuable
guidance and motherly care and affection, thoughtful suggestions and constant
encouragement and tender rebuke throughout the study.
I owe my gratitude and heartfelt thanks to Mrs. R. RUCKMANI, M.Sc. (N),
Associate Professor, Head of the department, Medical Surgical Nursing without whose input,
guidance, motivation and untried efforts, I would not have accomplished this venture so I
very much grateful to her for molding and constructing me as a student. Without her help this
study would not have been possible.
My deepest gratitude and immense thanks to Mrs. V.THENDRAL, M. Sc. (N),
Associate Professor , Head of the Department, Maternal Nursing and coordinator of M.Sc (N)
Programme, for her constant guidance, patience, constructive effort, inspirational and
valuable suggestion , throughout the study.
I owe my gratitude and exclusive thanks to Mr. R. NAGARAJ, M.Sc., (N),
Assistant Professor, for his constant inspiration, timely help and patient endurance which
helped me in completion of the study.
 I also thank all the faculty members of Arvinth College of Nursing, Namakkal, who
helped me in conducting the study.
I thank our librarian, Mr. R. Raman Arvinth College of Nursing, Namakkal. I
express my sincere gratitude to Mrs. E. Suguna, Mr. Ramke office staffs for rendering
their help in all the way.
I express my sincere thanks to the administration and faculty members of
T.M.M HOSPITAL THIRUVALLA, to allow me to conduct my data collection in your
esteemed hospital.
I express my sincere thanks to Mr. G.K Venkataraman, statistician for his valuable
guidance and advice in statistical analysis and presentation of data.
We are what, we are with the blessing and love of our dear and near one. It would not
have been possible for me to complete this work, without the love and support of my parents
and my friends, who initiated me to take up this noble profession and also for their strong
support, prayers and encouragement throughout my carrier.
I extent my deep sense of gratitude to my lovable dad Mr. M. I Korah, my mom
Mrs. Kunjammakorah and my dear sister Mrs. Epsy .M. Korah for their invaluable
support, constant encouragement, timely help and inspiration throughout the course of this
study.
I render my deep sense of gratitude to all my classmates, seniors and friends for their
constant help throughout the study.
I thank all my well wishers who helped me directly and indirectly.
 LIST OF CONTENTS

CHAPTER CONTENTS PAGE NO.

I INTRODUCTION 1

Background of the study 1

Need for the study 2

Statement of the problem 6

Objectives of the study 6

Operational definitions 7

Assumptions 8

Research hypothesis 8

Delimitations 9

Outline of the report 9

II REVIEW OF LITERATURE 10

Review of literature 11

Conceptual framework 20

III RESEARCH METHODOLOGY 24

Research Approach 24

Research design 24

Variables 24

Setting of the study 25

Population 25

Sample 25

Sample size 25
CHAPTER CONTENTS PAGE NO

Criteria for the selection of samples 25

Sampling technique 25

Development and description of the tool 27

Content validity 28

Reliability 28

Pilot study 29

Procedure for data collection 29

Plan for data analysis 30

IV DATA ANALYSIS AND INTERPRETATION 32

V DISCUSSION 46
SUMMARY, CONCLUSION, NURSING
VI IMPLICATIONS, RECOMMENDATIONS AND 50
LIMITATIONS
REFERENCE 56

APPENDICES 62

ABSTRACT 163
 LIST OF TABLES

TABLE PAGE
TITLE
No. No.
Frequency and percentage distribution of demographic
1. 33
variables of patients with modifiable risk factors
Comparison of pretest and post test knowledge scores

2. regarding prevention of coronary artery disease among 38

patients with modifiable risk factors.
Comparison of pretest and post test practice scores

3 regarding prevention of coronary artery disease among 39

patients with modifiable risk factors.
Correlation between post test knowledge and practice scores
4 regarding prevention of coronary artery disease among 40
patients with modifiable risk factors.
Association of post test level of knowledge regarding

5 prevention of coronary artery disease among patients with 41

modifiable risk factors with selected demographic variables.
Association of post test level of practice regarding

6 prevention of coronary artery disease among patients with 44

modifiable risk factors with selected demographic variables.
 LIST OF FIGURES

FIGURE PAGE
TITLE
No. No.

1. Conceptual frame work 23

2. Schematic representation of research methodology 26

Percentage distribution of pretest and post test level of

3. knowledge regarding prevention of coronary artery disease 36

among patients with modifiable risk factors of CAD
Percentage distribution of pretest and post test level of

4. practice regarding prevention of coronary artery disease 37

among patients with modifiable risk factors of CAD
Association of family history of CAD with post test level of

5. knowledge regarding prevention of coronary artery disease 43

among patients with modifiable risk factors of CAD
 LIST OF APPENDICES

PAGE
APPENDIX TITLE
No.
I Letter seeking permission to conduct study 62

II Letter seeking experts opinion for content validity 63

III List of experts for content validity 64

IV Format for content validity 65

V Informed consent form 73

VI Certificate for content validity 74

VII Certificate for English editing 75

VIII Certificate for Malayalam editing 76

Teaching module
77
IX 1. English
109
X 2. Malayalam
Copy of the tool for data collection
138
XI 1. English
153
XII 2. Malayalam
 CHAPTER – I

INRODUCTION

BACKGROUND OF THE STUDY

Coronary artery disease should now be considered an important public health problem
due to epidemiological transition characterized by changing lifestyles and a problem related to
interplay of factors with regards to their existence, casualty and attributes. (Bedi HS, 2005;
Ahmad N, Bhopal R, 2005; Wannammethee GS, 2006) The epidemiological factors like
ageing and changing lifestyles, which culminate in an epidemic of non-communicable disease is
rapidly occurring in the developing countries. (Bedi HS, 2005; Gupta R, et al., 2003)

CAD, is also called Coronary arteriosclerosis, Coronary atherosclerosis. Coronary artery

disease (CAD) is the most common type of heart disease. It is the leading cause of death in the
United States in both men and women. CAD happens when the arteries that supply blood to heart
muscle become hardened and narrowed. This is due to the build-up of cholesterol and other
material, called plaque, on their inner walls. This build-up is called atherosclerosis. As it
grows, less blood can flow through the arteries. As a result, the heart muscle can't get the blood
or oxygen it needs. This can lead to chest pain (angina) or a heart attack. Most heart attacks
happen when a blood clot suddenly cuts off the hearts' blood supply, causing permanent heart
damage. Over time, CAD can also weaken the heart muscle and contribute to heart failure and
arrhythmias. Heart failure means the heart can't pump blood well to the rest of the body.
Arrhythmias are changes in the normal beating rhythm of the heart. (Medline, 2010)

An estimated 17 million people die of CVDs, particularly heart attacks and strokes, every
year. A substantial number of these deaths can be attributed to tobacco smoking, which increases
the risk of dying from coronary heart disease and cerebrovascular disease 2–3 fold. Physical
inactivity and unhealthy diet are other main risk factors which increase individual risks to
cardiovascular diseases. One of the strategies to respond to the challenges to population health
and well being due to development and implementation of appropriate policies. (WHO Report,
2010)

Indians have the highest rates of CAD all over the world. It is 2-4 times higher at all ages
and 5-10 times higher in those below 40 years of age. The excess burden of CAD in Indians is

1
due to combination of nature and nurture. Due to industrialization and changing feature of socio-
economic scenario, the incidences of CAD are rising in the developing countries as well
prevalence of CAD in India is 3 to 4 fold higher than in America and Europe. (Reddy SS,
Prabhu GR, 2005)

According to existing knowledge, CAD epidemics are essentially preventable. For

example, CAD mortality has fallen one-third to one-half in the last three decades in majority of
developed countries. The reasons for the accelerated decline in CAD mortality from 1980-1990
were analysed. They found that 25% of the decline was due to primary prevention, 29% due to
secondary prevention and 43% was due to improvements in treatments of patients. This
demonstrates that modification of risk factors related to lifestyle in the entire nation, rather than
advances in management of few with overt CAD is largely responsible for dramatic decline of
CAD mortality in the developed countries. This is clear proof that the average of CAD reduced
with appropriate measures. (Enas EA, Senthil Kumar A, 2001) An increasing number of
Indians, even among the younger age groups are prone to get heart diseases due to their health
damaging lifestyle. (Bedi HS, 2005)

NEED FOR STUDY

In today’s world, most deaths are attributable to non-communicable diseases, 32 million
and just over half of these, 16.7 million are as a result of CHD. More than one third of these
deaths occur in middle aged adults. In developed countries heart disease is the first cause of
death for adult men and women. (WHO Report, 2003)

Dr.V.K Bahl (AIIMS, Delhi) says, “It is estimated by the year 2020, India will have the
largest cardiovascular burden in the world” and among Indians coronary heart diseases tend to
occur earlier in life than in any other ethnic group.(Ghaffar A, Reddy KS, Singhi M, 2006).

In a study conducted on HDL- a molecule with a multi-faceted role in coronary artery

disease, High density lipoprotein cholesterol (HDL-C) is popularly known as "good cholesterol"
due to its ability to protect against atherosclerosis. High Density Lipoprotein (HDL) is best
known as a key player to promote efflux of cholesterol from cells and promote reverse
cholesterol transport (RCT) which decreases the accumulation of foam cells in arterial walls.
Several roles of HDL discovered recently include anti-oxidant effect, anti-inflammatory role,
anti-thrombotic role, all of which potentiate the athero-protective role of HDL. Besides reverse

2
cholesterol transport, the antioxidant and anti-inflammatory properties of HDL may also play a
major role in protection against development of atherosclerosis. Two different scales define the
athero-protective effects of HDL- quantity of HDL-C (measured in mg/deciliter or mmol/L) is
inversely correlated with cardiovascular risk, the other is the quality or 'functionality' of
HDL.(Arora S, Patra SK, Saini R, 2015)

A study conducted on Benefits of exercise training on coronary blood flow in coronary

artery disease patients in United States. Every 34 seconds an American experiences a myocardial
infarction or cardiac death. Approximately 80% of these coronary artery diseases (CAD)-related
deaths are attributable to modifiable behaviours, such as a lack of physical exercise training
(ET). Regular ET decreases CAD morbidity and mortality through systemic and cardiac-specific
adaptations. ET increases myocardial oxygen demand acting as a stimulus to increase coronary
blood flow and thus myocardial oxygen supply, which reduces myocardial infarction and angina.
ET augments coronary blood flow through direct actions on the vasculature that improve
endothelial and coronary smooth muscle function, enhancing coronary vasodilatation.
Additionally, ET promotes collateralization, thereby, increasing blood flow to ischemic
myocardium and also treats macro vascular CAD by attenuating the progression of
coronary atherosclerosis and restenosis, potentially through stabilization of atherosclerotic
lesions. In summary, ET can be used as a relatively safe and inexpensive way to prevent and
treat CAD. (Bruning RS, Sturek M ,2015)

Cross-sectional studies in India revealed that mortality attributed to cardiovascular

disease in expected to rise by 100% in men and 90% in women between 1985 and 2015. It would
not be wrong to say that coronary artery disease among Indians occurs earlier in life and that the
mortality rates are also high. Cardiologists around the world are supporting these facts.
(Banerjee K, 2006)

In view of the wide prevalence of CAD is necessary to focus our attention to preventive
aspect, rather than curative aspect alone. In countries like India, we cannot afford to provide
sophisticated health care facilities to all the people. Hence “prevention is better than cure”. The
process of disease prevention must be aimed at not only understanding the disease mechanism,
but also identifying the risk factors and establishing intervention strategies that definitively
reduces the risk. (Bedi HS, 2005; Kaur K, Bains K, 2006).

3
 Public awareness programme is the best instrument in the prevention of occurrence of
CAD by helping people to take care of their own health. Although community education is the
best instrument to impart knowledge providing information is not the only solution. The
education must include strategies for motivation also and necessary practice in their lifestyle.
(Bedi HS, 2005).

The incidence of CAD in young adults is increasing, mainly due to tobacco consumption,
lack of physical activity, sedentary lifestyle and obesity. The report includes history of one or
more risk factors mainly smoking (76.8%) obesity (20%) hypertension (19%)
hypercholesterolemia (18.5%) diabetes mellitus (17%) and family history of previous myocardial
infarction (Yavagal, 2001).

A consistent association between sedentary lifestyle and CAD has been demonstrated in
different epidemiological studies explaining the prevalence of CAD in sedentary workers. The
risk for CVD increases among bank employees with sedentary lifestyle. The nature of their jobs
was mainly writing, typing, ledger keeping, cash payment-receipt and mental activities which are
usually classified as sedentary activities (Bhattacharya P, 1999).

The constant interaction with the people and interchange of health related thoughts and
observation of modifiable risk factors like smoking, obesity, pan chewing etc and their sedentary
nature of work have highlight that there is inadequate knowledge on rising non-communicable
diseases like CAD, hypertension, diabetes mellitus and its prevention. Today, CAD is the most
prevalent non-communicable disease and the main risk factor identified among the people is
physical inactivity and sedentary lifestyle.

In 2005 overall death rate from cardiovascular disease (CVD) (International

Classification of Diseases 10, I00–I99) was 278.9 per 100 000. The rates were 324.7 per 100 000
for white males, 438.4 per 100 000 for black males, 230.4 per 100 000 for white females, and
319.7 per 100 000 for black females. From 1995 to 2005, death rates from CVD declined
26.4%.Preliminary mortality data for 2006 show that CVD accounted for 34.2% (829 072) of all
2 425 900 deaths in 2006 or 1of every 2.9 deaths I the United States.

On the basis of 2005 mortality rate data, nearly 2400 Americans die of CVD each day an
average of 1 death every 37 seconds. The 2006 overall preliminary death rate from CVD was
262.9. More than 150 000 Americans killed by CVD (I00–I99) in 2005 were <65 years of age. In
4
2005, 32% of deaths from CVD occurred before the age of 75 years, which is well before the
average life expectancy of 77.9 years.

Coronary heart disease (CHD) caused about 1 of every 5 deaths in the United States in
2005. CHD mortality in 2005 was 445 687. In 2009, an estimated 785 000 Americans will have
a new coronary attack, and about 470 000 will have a recurrent attack. It is estimated that an
additional 195 000 silent first myocardial infarctions occur each year. About every 25 seconds,
an American will have a coronary event, and about every minute someone will die from one. In
2005, 1 in 8 death certificates (292 214 deaths) in the United States mentioned heart failure.

Coronary heart disease (CHD) is a major cause of mortality and morbidity all over the
world. According to a report of World Health Organization (WHO) in 2005, cardiovascular
disease (CVD) caused 17.5 million (30%) of the 58 million deaths that occurred worldwide.
While the prevalence and mortality due to CHD is declining in the developed nations, the same
cannot be held true for developing countries. There has been an alarming increase over the past
two decades in the prevalence of CHD and cardiovascular mortality in India and other south
Asian countries. India is going through an epidemiologic transition whereby the burden of
communicable diseases have declined slowly, but that of non-communicable diseases (NCD) has
risen rapidly, thus leading to a dual burden. There has been a 4-fold rise of CHD prevalence in
India during the past 40 years. Current estimates from epidemiologic studies from various parts
of the country indicate a prevalence of CHD between 7% and 13% in urban, 2% and 7% in
rural populations. Epidemiologic studies have shown that there are at present over 30 million
cases of CAD in this country.

A study by Gajalakshmi et al during 1995–1997 showed that CVD deaths are the highest
(38.6%) in urban Chennai. Similar data are published by Joshi et al from Andhra Pradesh. The
Global Burden of Diseases Study reported that the disability-adjusted life years lost by CAD in
India during 1990 was 5.6 million in men and 4.5 million in women; the projected figures for
2020 were 14.4 million and 7.7 million in men and women respectively.

In Kerala, 20% of all deaths are caused by coronary heart disease (CHD/CAD).The age-
adjusted CAD (coronary artery disease) mortality rates per 100,000 are 382 for men and 128 for
women in Kerala. These CAD rates in Kerala are higher than those of industrialized countries
and 3 to 6 times higher than Japanese and rural Chinese.CAD in Kerala is premature and

5
malignant resulting in death at a very young age. Approximately 60% of CAD deaths in men and
40% of CAD deaths in women occur before the age of 65 years.

The average age of a first heart attack decreased by at least 10 years in Kerala, in sharp
contrast to a 20 year increase in many western countries. In the 1960s and 70s, heart attack in the
very young (before the age of 40) was very uncommon in Kerala. Heart attack rate among men
in this age group increased 40-fold by 1990 with at least 20% heart attacks occurring before age
40 and 50% before age 50.The high rates of premature heart disease in Kerala also results in a
high economic burden as high as 20% of its state domestic product.

The investigator experienced a range of questions by patients related to association of

risk factors and prevention of CAD. Here an attempt is made by the researcher to design a
planned teaching programme which will be useful and informative to the patients on CAD and
its prevention, which helps them to internalise their risk status and thereby motivated to bring
about the desired modification in their lifestyle.

STATEMENT OF THE PROBLEM

A study to assess the effectiveness of planned teaching programme on knowledge and
practice regarding prevention of coronary artery disease among patients with modifiable risk
factors of CAD in a private hospital, Kerala.

OBJECTIVES OF THE STUDY

1. To assess the pre test and post test level of knowledge regarding prevention of coronary
artery disease among patients with modifiable risk factors of CAD.
2. To assess the pre test and post test level of practice regarding prevention of coronary
artery disease among patients with modifiable risk factors of CAD.
3. To assess effectiveness of planned teaching programme regarding prevention of coronary
artery disease among patients with modifiable risk factors of CAD.
4. To correlate the post test knowledge and practice scores regarding prevention of coronary
artery disease among patients with modifiable risk factors of CAD
5. To associate the post test level of knowledge and practice regarding prevention of
coronary artery disease among patients with modifiable risk factors of CAD with their
selected demographic variables.

6
OPERATIONAL DEFINITIONS

Assess
It is an organised, systematic and continuous process of collecting data from patients
regarding CAD with regard to its risk factors and prevention.

Effectiveness
Effectiveness in this study refers to the extent to which the power point presentation has
achieved the desired effect as measured by subjects gain in knowledge and practice scores on
prevention of coronary artery disease.
Planned Teaching Programme (PTP)
In this study, planned teaching programme refers to systematically planned teaching
programme designed for patients to understand logically the related anatomy and physiology of
heart, meaning of coronary artery disease, risk factors, signs and symptoms, diagnosis, treatment,
management and steps for prevention of Coronary Artery Disease.

Knowledge
In this study knowledge refers to patient’s awareness regarding Coronary Artery Disease
and its prevention.

Range Interpretation
≤50% Inadequate knowledge
51 – 75% Moderately adequate knowledge
>75% Adequate knowledge

Practice
Refers to the regular activity and practice of patients regarding prevention of Coronary
Artery Disease assessed by a checklist

Range Interpretation
≤50% Inadequate practice
51 – 75% Moderately adequate practice
>75% Adequate practice

7
Prevention of Coronary Artery Disease
Coronary Artery Disease (CAD) defined as acute or chronic form of cardiac disability
arising from imbalance between myocardial supply and demand for oxygenated blood.
Prevention of CAD can be done by modification of risk factors in healthy way.

Modifiable Risk Factors of CAD

In this study modifiable risk factors which can be reduced and changed by healthy
lifestyle of CAD refers high blood pressure, high cholesterol, smoking, alcoholism, drug abuse,
diabetes, obesity, lack of physical activity, and unhealthy diet.

Patients
Patients admitted for any other conditions except CAD in a private hospital, Kerala, with
modifiable risk factors of CAD.

ASSUMPTIONS
1. Patients may have some knowledge and practice regarding coronary artery disease and its
prevention.
2. The planned teaching programme on coronary artery disease and its prevention can bring
about desired changes in the lifestyle of patients with modifiable risk factors of CAD.

HYPOTHESES
H1: There may be a significant improvement in the post test level of knowledge and practice
regarding prevention of coronary artery disease among patients with modifiable risk factors
of CAD.
H2: There will be a significant relationship between post test knowledge and practice score
regarding prevention of coronary artery disease among patients with modifiable risk factors
of CAD.
H3: There will be significant association of post test of knowledge and practice scores regarding
prevention of coronary artery disease among patients with modifiable risk factors of CAD
and their selected demographic variables.

8
VARIABLES

Dependent Variable

The dependent variables in this study are knowledge and practice.

Independent Variable
The independent variable in this study is planned teaching programme on prevention of
coronary artery disease.

Extraneous Variable
The extraneous variables are age, sex, educational status, occupation, known case of
hypertension, known case of diabetes and family history of heart disease.

DELIMITATIONS
1. Patients admitted with modifiable risk factors of CAD in a private hospital, Kerala
2. Patients who are available at the time of data collection.

PROJECTED OUTCOME
 The study findings will improve the knowledge and practice on prevention of coronary
artery disease among patients with modifiable risk factors of CAD.
 The study will help to treat and prevent the complications of Coronary Artery Disease
and its complications.
 The study will help to share the information on prevention of coronary artery disease with
colleagues, family members and surrounding people.

9
 CHAPTER – II

REVIEW OF LITERATURE

Review of literature is a systematic search of literature to gain information about a

research topic (Polit and Hungler). The literature review was based on an extensive survey of
journal, books, and articles.

A literature review is body of text that aims to review the critical points of knowledge on
a research and evaluate report of information found in the literature to evaluate and clarifies. The
main purpose of the literature review is to convey the readers about the work already done and
knowledge and ideas that have been already established on a particular topic of the research.

This chapter deals with the related literature review which aids to generate a picture of
what is known and not known about a particular situation.

An extensive review of literature was done by the investigator to gain an insight into the
problem, collect maximum information from systematic and critical review of scholarly
publications, unpublished scholarly print materials. The logical sequence of the chapter is
organized on the following sections:

PART-I: REVIEW OF RELATED LITERATURE

The reviews related to the study are carried out on the following headings,

 Studies related to risk factors and prevention of CAD

 Studies related to knowledge on CAD
 Studies related to practice on CAD
 Studies related to structural teaching programme on prevention of CAD

PART-II CONCEPTUAL FRAME WORK

10
 PART –I

REVIEW OF LITERATURE

Studies related to risk factors and prevention of CAD

Yang X et al.., (2015) conducted a study on Association of Sleep Duration with the
Morbidity and Mortality of Coronary Artery Disease: Meta-analysis was applied to calculate the
combined relative risks (RRs) with 95% confidence intervals (CI) for sleep with morbidity and
mortality of CAD. Compared with normal sleep duration, the pooled RRs (95%CI) of short sleep
duration were 1.10(1.04-1.17) and 1.25(1.06-1.47) for the morbidity and mortality of CAD, and
the pooled RRs (95%CI) of long sleep duration were 1.03(0.92-1.16) and 1.26(1.11-1.42) for the
morbidity and mortality of CAD, respectively. The effect of short and long sleep duration on
mortality of CAD were always significantly greater than the morbidity of CAD.

Rao M et al.., (2015) conducted a systematic review on the prevalence, risk factors,
treatments and outcomes of Coronary Artery Disease (CAD) in Indians. They conducted a
systematic review of studies in Indians with CAD from Jan 1969 to Oct 2012. Initial search
yielded 3885 studies and after review 288 observational studies were included. The prevalence of
CAD in urban areas was 2.5%-12.6% and in rural areas, 1.4%-4.6%. The prevalence of risk
factors was: smoking (8.9-40.5%), hypertension (13.1-36.9%) and diabetes mellitus (0.2-24.0%).
The median time to reach hospital after an MI was 360 min. In hospital rates of drug use were:
antiplatelets 68%-97.9%, beta blockers 47.3%-65.8% and ACEIs 27.8-56.8%.

Goldfarb M Slobod D et al.., (2015) conducted a study on Relatives of people

with coronary artery disease are at high risk of cardiovascular (CV) disease. Researchers
identified 18 studies that reported screening strategies and 15 reporting interventions to reduce
CV risk. Proband willingness to refer relatives for screening was high (n = 6 studies, pooled
rate = 87%; 95% confidence interval [CI], 80%-95%). Studies using a screening strategy in
which the relative was contacted by health care professionals reported a pooled participation rate
of 88%. The quality of interventional studies was highly variable. Random-effects meta-analysis
of the highest quality randomized studies (n = 6) consisting of a specialized risk factor
intervention compared with usual care was consistent with modest improvements in low-density
lipoprotein cholesterol control. Improvements in diet, smoking

11
rates, exercise, and blood pressure were also observed with active intervention; however,
reported outcomes were heterogeneous precluding a formal meta-analysis.

Srinivasan MP et al.., (2015) conducted a case control study to identify the factors that
are associated with a favorable CAD profile among the patients with Type 2 diabetes mellitus.
Study samples were 76 patients with type 2 diabetes mellitus who were on treatment for more
than 10 years duration and undergoing a coronary angiogram. The presence and absence of
significant CAD was determined after a coronary angiogram. Clinical history, and
anthropometric and biochemical parameters were analyzed. The differences in HOMA-IR and
urine micro albumin were found to be statistically significant among those who did not have
CAD when compared to those who had CAD. The difference in lipid profile, HbA1C, fasting
blood sugar, BMI, waist hip ratio, waist and hip circumference was not significant.

Gyung-Min Park, MD et al.., (2013) done risk score model for the assessment of
coronary artery disease in asymptomatic patients with type 2 diabetes. They analyzed 607
asymptomatic patients with type 2 diabetes who underwent CCTA. Patients were categorized
into low (≤3), intermediate (4–6), or high (≥7) risk group. There were significant differences
between the risk groups in the probability of significant CAD and 5-year cardiac event-free
survival rate. This model predicts significant CAD on CCTA and has the potential to identify
asymptomatic type 2 diabetes with high risk.

William A LaFramboise et al.., (2012) conducted a study on Serum protein profiles

predict coronary artery disease in symptomatic patients referred for coronary angiography. A
total of 14 overlapping signatures classified patients without significant coronary disease (38% to
59% specificity) while maintaining 95% sensitivity for patients requiring revascularization.
Proteins in the serum of CAD patients predominantly reflected (1) a positive acute phase,
inflammatory response and (2) alterations in lipid metabolism, transport, per oxidation and
accumulation. There were surprisingly few indicators of growth factor activation or extracellular
matrix remodeling in the serum of CAD patients except for elevated OPN.

Mattila, K.J., M.S. Valle, et al.., (2011) conducted a case-control study on dental
infections and coronary atherosclerosis. Sixty one patients that CAD was confirm in them by
coronary angiography compared with sixty one patients with normal angiography. PDD was
evaluated by two indices, gingival index and periodontal disease index. Odds ratio was

12
calculated for the risk of PDD for CAD. The results were shown no differences between groups
about sex, age, educational level and occupation. The odds ratio of periodontal disease for CAD
was 58 with CI95% (51-65). Finding of the current study suggested that periodontal disease is
the risk factor for CAD.

Friedrich, N., et al., (2010) conducted a cohort study on nonfatal and fatal coronary
heart disease in relation to obesity in a prospective of 115,886 U.S. women who were 30 to 55
years of age and free of diagnosed coronary disease, stroke, and cancer. During eight years of
follow-up (775,430 person-years), we identified 605 first coronary events, including 306 nonfatal
myocardial infarctions, 83 deaths due to coronary heart disease, and 216 cases of confirmed
angina pectoris. These prospective data emphasize the importance of obesity as a determinant of
coronary heart disease in women. After control for cigarette smoking, which is essential to assess
the true effects of obesity, even mild-to-moderate overweight increased the risk of coronary
disease in middle-aged women.

Nazeer M et al.., (2010) conducted a control study of risk factors for coronary artery
disease in Pakistani females. In 198 patients 147 were post menopausal and 51 were pre
menopausal women. Diabetes mellitus was the only risk factor in pre menopausal females
associated with coronary artery disease while diabetes, hyperlipidemia and increased waist
circumference were significantly associated with coronary artery disease in post menopausal
females.

Studies related to knowledge on CAD

Faraz Kureshi et al., (2014) conducted a study to assess the perceptions of patients with
stable coronary artery disease of the urgency and benefits of elective percutaneous coronary
intervention. The samples were 991 patients with stable coronary artery disease undergoing
elective percutaneous coronary intervention. Although nearly two thirds of patients (n=661)
reported improvement of symptoms as a benefit of Percutaneous coronary intervention (site
range 52-87%), only 1% (n=9) identified this as the only benefit. The study concluded that
patients have a poor understanding of the benefits of elective percutaneous coronary
intervention, with significant variation across sites.. These findings suggest that hospital level
interventions into the structure and processes of obtaining informed consent for percutaneous
coronary intervention might improve patient comprehension and understanding.

13
 Mamta Choudhary et al.., (2014) conducted a study which attempted to quantify
knowledge regarding preventive measures of Coronary Artery disease among patients attending
OPD of selected hospital of Ludhiana city. Information was collected from 150 patients
attending medical and surgical OPD’s who were not diagnosed with any of heart disease. The
result revealed that only 15.33% of subjects had good level of knowledge, and 84.67% subject
had poor level of knowledge regarding prevention of CAD. The highest mean knowledge score
of 14.55 + 0.65 was in the age group of 41-50 years. The study recommends the need of
awareness raising program regarding preventive measures of CAD to decrease the burden of
such devastating disease.

Grzegorz Gajos et al.., (2013) conducted a prospective, double-blind, placebo-

controlled, randomized study, in which adiponectin, leptin and resistin were determined at
baseline, 3–5 days and 30 days during administration of omega-3 PUFA 1 g/day (n  =  20) or
placebo (n  =  28). The multivariate model showed that the independent predictors of changes
in adiponectin at 1 month (P  <  0.001) were: omega-3 PUFA treatment, baseline platelet count,
total cholesterol and those in leptin (P  <  0.0001) were: omega-3 PUFA treatment and waist
circumference. Independent predictors of A/L ratio changes (P  <  0.0001) were: assigned
treatment, current smoking and hyperlipidemia. In high risk stable coronary patients after PCI
omega-3 PUFA supplementation improves adipokine profile in circulating blood. This might be
a novel, favorable mechanism of omega-3 PUFA action.

Guoxin Tong et al.., (2013) conducted study on Common variants in adiponectin gene
are associated with coronary artery disease and angiographic severity of coronary atherosclerosis
in type 2 diabetes. This study investigated whether common single nucleotide polymorphisms
(SNPs) in the adiponectin gene influenced plasma adiponectin level and whether they were
associated with the risk of coronary artery disease (CAD) and its angiographic severity in type 2
diabetes in Chinese population. The severity and extent of coronary atherosclerosis were
assessed using the angiographic Gensini score and Sullivan Extent score. Haplotypes analysis
revealed different haplotype distributions in case and control subjects (P = 0.0003), with two
common haplotypes GGG and GAG of the rs266729, rs182052, and rs1501299 being associated
in heterozygotes with a greater than threefold increase in cardiovascular risk.

Charles T. Upchurch, Eugene J. Barrett (2012), conducted a study on review of

bibliographies of professional CAD screening guidelines, review articles, and clinical trials
14
published within the last 10 yr, although they have included relevant older studies. Screening for
coronary ischemia or atherosclerosis does provide incremental prognostic information in patients
with T2DM and previously undiagnosed CAD; this has not been found to significantly impact
outcomes. This appears to result from comparable efficacy of revascularization and optimal
medical therapy in stable CAD. Limited evidence supports the hypothesis that those with more
severe CAD (three-vessel, left main, proximal left anterior descending) amenable to bypass
surgery may be potential beneficiaries of screening. The low prevalence of such candidates in the
asymptomatic population, continuing advances with percutaneous intervention, and the lack of
prospective trials makes such a recommendation currently unsupportable.

Smith MM et al.., (2011) conducted a study on Coronary Artery disease knowledge test
which tested the validity and reliability of a written test designed to assess knowledge of
coronary artery disease (CAD) and its risk factors. The subjects were 93 males diagnosed with
CAD. Validation of this test yielded difficulty ratings (DRs) between 0 percent and 98 percent,
with an average DR of 63 percent. Construct validation indicated that the average test score of
subjects participating in a CRP was significantly higher than that of non-participants. The
internal-consistency reliability of the test was 0.84. The results indicate that this test is a valid
and reliable tool for assessing patients' knowledge of CAD and its risk factors.

Studies related to practice on CAD

Khandker MD, Nurus Sabah et al.., (2014) conducted a cross sectional study on
patients in Department of Cardiology in DMCH and those referred in the cath-lab of the
Department of Cardiology for CAG during November 2009 to October 2010 involving 120
patients. They were divided into group-A (with coronary score ≥7) and group-B (coronary score
<7) depending on Gensisni score. To determine whether waist-to-height ratio correlates with
coronary artery disease (CAD) severity better, than the body mass index (BMI) as assessed by
coronary angiography in Bangladeshi population. There were no statistically significant
difference regarding the distribution of age, sex and clinical diagnosis and parameters between
the two groups. Multivariate analysis also yielded that a patient with BMI ≥25 kg/m2 and waist-
to height ratio of ≥0.55 are 3.06 times and 6.77 times, more likely to develop significant
coronary artery disease respectively. The waist-to-height ratio showed better correlation with the
severity of coronary artery disease than the BMI.

15
 Xiao-Zhi Zheng, Bin Yang et al.., (2013) conducted a study on Sex-specific assessment
of reduced coronary sinus flow in non-hypertensive patients with coronary artery disease at rest
access to data on the coronary flow in the coronary sinus (CS) can aid in the diagnosis of
coronary artery disease (CAD).The ante grade phase of coronary flow in the CS was analyzed
and compared in 140 male and 135 female non-hypertensive subjects who had all undergone
coronary angiography. There were statistically significant differences noted between males and
females for the CS flow both in normal subjects and patients with CAD. Compared with normal
subjects, patients with CAD had significantly lower blood flow in the CS both in males and
females.

Abhinav Vaidya et al.., (2013) conducted a study determined the knowledge, attitude
and practice/behavior of cardiovascular health in residents of a semi urban community of Nepal.
The study population included 777 respondents from six randomly selected clusters in both
villages. Result shows that 70% of all participants were women and 26.9% lacked formal
education. The burden of cardiovascular risk factors was high; 20.1% were current smokers,
43.3% exhibited low physical activity and 21.6% were hypertensive. Participants showed only
poor knowledge of heart disease causes; 29.7% identified hypertension and 11% identified
overweight and physical activity as causes, whereas only 2.2% identified high blood sugar as
causative. The study concluded that a gap was found between cardiovascular health knowledge,
attitude and practice/ behavior in a semi urban community in a low-income nation, even among
those already affected by cardiovascular disease.

Mika Kivimaki et al., (2013) conducted a study on associations of job strain and
lifestyle risk factors with risk of coronary artery disease. Individual-level data from 7 cohort
studies comprising 102 men and 128 women who were free of existing coronary artery disease.
Questionnaires were used to measure job strain (yes v. no) and 4 lifestyle risk factors: current
smoking, physical inactivity, heavy drinking and obesity The risk of coronary artery disease
among people who had an unhealthy lifestyle practices compared with those who had a healthy
lifestyle practices was higher than the risk among participants who had job strain compared with
those who had no job strain. The findings revealed that the 10-year incidence of coronary artery
disease among participants with job strain and a healthy lifestyle practices was 53% lower than
the incidence among those with job strain and an unhealthy lifestyle practices.

16
 Po-Chao Hsu, Ho-Ming Su (2013) conducted a study to evaluate 970 consecutive
patients undergoing coronary angiography, and 501 patients with significant coronary artery
disease (SCAD) were finally analyzed. The collateral scoring system developed by Rentrop was
used to classify patient groups as those with poor or good collaterals. Coronary collateral
circulation plays an important role in protecting myocardium from ischemia and reducing
cardiovascular events. Low High-density lipoprotein cholesterol (HDL-C) level is a strong risk
factor for coronary artery disease (CAD) and is associated with poor cardiovascular outcome.
Hence, we investigated the influence of HDL-C on coronary collateral formation in Chinese
population. The patients with poor collaterals had fewer diseased vessels and lower diffuse score.
There was no significant difference in HDL-C and other variables between good and poor
collaterals. Multivariate analysis showed only number of diseased vessels was a significant
predictor of poor collateral development.

Mirsaeed Attarchi, Saber Mohammadi et al.., (2012) conducted a study to assess the
Knowledge and Practice on Assessment of Workers in a Pharmaceutical Company about
Prevention of Coronary Artery Disease. In this cross sectional study that was conducted in
Tehran, 1223 workers of a pharmaceutical company were enrolled. Data was collected using a
questionnaire that assessed the level of knowledge and practice of the participants towards
coronary artery disease. Regression analysis was used to evaluate the relationship between study
variables and the workers knowledge level. The findings of this study showed that increasing
level of knowledge of labors in order to prevent missing specialized work force, leads to
imposition of health costs to the industry and the labour society.

Brian G. Kral, Lewis C. Becker et al.., (2011) conducted a study on Family history of
premature coronary artery disease (CAD), in an apparently healthy individual conveys an
increased risk of future CAD. Asymptomatic siblings (n = 1287, aged 30–59 years) of patients
with onset of CAD <60 years of age underwent risk factor screening and maximal graded
treadmill testing with nuclear perfusion imaging, and were followed for incident CAD events for
up to 25 years. Incident CAD occurred in 15.2% of siblings (68% acute coronary syndromes);
mean time to first CAD event was 8.2 ± 5.2 years. Inducible ischemia was highly prevalent in
male siblings (26.9%), and was independently associated with incident CAD. Male siblings ≥40
years of age who were low or intermediate risk by traditional risk assessment, had a prevalence
of inducible ischemia and a 10-year risk of incident CAD that were near or ≥20%. In female

17
sibling’s ≥40 years of age, the presence of inducible ischemia was also independently associated
with incident CAD, but the prevalence of inducible ischemia was markedly lower, as was the
risk of incident CAD. For women, the prevalence of ischemia was so low as to not warrant
screening, but the incidence of CAD was high enough to at least warrant lifestyle interventions.

Studies related to structured teaching programme on prevention of CAD

Hislop TG, Shigeru S, Sadanobu K. (2008) conducted a field experiment community

study in three northern California towns to determine whether community health education can
reduce the risk of CAD and the subjects varied between 12,000 and 15,000 and in two of these
towns, intensive mass education campaigns were conducted against CAD risk factors over a
period of 2years and the third community served as control. The people from each community
were interviewed and examined before the campaign began, and one and two years afterwards to
assess the knowledge of behaviour related to CAD and to measure the physiological indicators of
risk of CAD increased over two years, but in the intervention were found after teaching. The
group demonstrated increase in knowledge and improvement in practice with the implementation
of teaching programme.

Goyal A, Yusuf S (2006) conducted a study on burden of cardiovascular disease in the

Indian subcontinent. A hospital-based, cross sectional study was conducted at All India
Institutes of Medical Sciences (AIIMS), a major tertiary care hospital in New Delhi, India.
Participants (n = 217) recruited from patient waiting areas in the emergency room were provided
with standardized questionnaires to assess their knowledge of modifiable risk factors of CAD.
The risk factors specifically included smoking, hypertension, elevated cholesterol levels,
diabetes mellitus and obesity. Identifying 3 or less risk factors was regarded as a poor knowledge
level, whereas identifying 4 or more risk factors was regarded as a good knowledge level. A
multiple logistic regression model was used to isolate independent demographic markers
predictive of a participant's level of knowledge. In multiple logistic regression analysis
independent demographic predictors of a good knowledge level with a statistically significant (p
< 0.05) adjusted odds ratio (OR) were: routine exercise of moderate intensity, OR 8.41
(compared to infrequent or no exercise), no history of smoking, OR 8.25, and former smokers,
OR 48.28 (compared to current smokers). Although statistically insignificant, a trend towards a
good knowledge level was associated with higher levels of education.

18
 Tmmins. F. Kaliser M (2004) conducted a study to assess the perception of patients
immediately after their coronary disease of their needs in a cardiac education programme and to
compare these with their perception , 6 weeks after the event and also with their nurse education
, questionnaires comprises of 37 learning needs of the cardiac patients under several categories
each item given to 45 patients and 68 nurses (cardiac ward nurses , cardiac modification nurse,
all nurses employed in one coronary artery disease care unit).responded. The overall response
score distribution of the patients differed from that of the nurses , but this difference was
accounted by mainly three items , all in the “ physical activity” category , namely when to
resume driving ,when to resume sexual activity and when to resume work, which the nurse
scored high and patients low. Both patients and nurses gave the highest mean scores to four
items, namely what to do when in chest pain, what are the signs and symptoms of a heart attack.
When to call a doctor and what to do to reduce the chance of other heart attack. The findings
support the need for individual nurse /patient negotiated cardiac teaching programme that can be
tailored to suit the needs of the patient.

19
 PART – II
CONCEPTUAL FRAMEWORK

A conceptual framework or a model is made up of concepts, which are the mental images of
the phenomenon. This section deals with conceptual framework adopted for the study. A
conceptual framework of model provides the guidelines to proceed to attain the objectives of the
study based on a theory. It is a schematic representation of the steps, activities and outcomes of
the study.

Imogene King’s goal attainment theories is based on the personal and inter personal systems
including interaction, perception, communication, transaction, stress, growth and development,
time and action.

Nursing as defined by Imogene King is “A process of human interactions between the nurse
and the client where by each perceives the other and the situation, and through communications.
They set goals, explore means, and degree on means to achieve goals”.

According to this theory, the people meet in same situation, perceive each other, make
judgment about the other, take some mutual action and react to each one of the other. The next
step in the process is interaction, and then transaction, which is dependent upon the achievement
of a goal.

The study is based on Imogene King’s Goal attainment theory (1997) which would be
relevant to providing adequate knowledge and practice on prevention of coronary artery disease
among patients with modifiable risk factors.

Imogene King’s system is an open system. In this system humans are in constant interaction
with their environment. According to Imogene King each individual on the system has a goal
directed choice of perceived alternatives in made and acted upon by individuals or groups to
attain a goal. It is a process of human interaction in which two people who are usually strangers
come together in a health care organization to help and be helped to maintain a state of health
that permits functioning in roles

20
 The main concept in Imogene King’s open system is perception- a process of organizing,
interpreting and transforming information form sense data and memory that gives meaning to
one’s experience represents one’s image of reality and influences one’s behavior.

Judgment:
Each member of the dyad perceives the other and makes judgment for goal attainment.

Action:
Each member of the dyad makes judgment and there by action follows to attain goal.

Mutual goal setting:

Is an activity that includes the client and family when appropriate in prioritizing the goals of
care and in developing a plan of action to achieve those goals.

Interaction:
The acts of two or more persons in mutual presence a sequence of verbal and nonverbal
behaviours that are goal directed.

Transaction:
A process of interaction in which human beings communicate with the environment to
achieve goals that are valued, goal directed human behaviours.

In this model humans are in constant interaction with their environment. Adjustments to life
and healthcare influenced by individual’s interaction with environment. Each human being
perceives the world as a total person in making transaction with individual things in the world.

Inadequate knowledge and practice related to prevention of coronary artery disease can
affects the basic structure of the system and results in disturbance. If patients with modifiable
risk factors have adequate knowledge and practice on prevention of coronary artery disease
through this model, the patients with modifiable risk factors can attain their goal and maintain
maximum level of well being.

In this study the researcher and the subject come together for an interaction, a different set
of perceptions to exchange. The researcher perceives the subject’s need for teaching the benefits
of knowledge and practice on prevention of coronary artery disease. The researcher mobilizes the
resources and prepares the planned teaching programme on knowledge and practice on
21
prevention of coronary artery disease. The patients with modifiable risk factors of coronary
artery disease need to learn the benefits of prevention of coronary artery disease. It includes
anatomy and physiology of heart, meaning of coronary artery disease, risk factors, clinical
manifestations, diagnostic evaluations, prevention, management and complication of coronary
artery disease. The subjects verbalize the need for learning and accept for learning through
Planned Teaching Programme and give consent.

Both mutually set of goals to improve the knowledge and practice regarding prevention of
coronary artery disease. Pretest conducted to assess the knowledge and practice regarding
prevention of coronary artery disease among patients admitted with modifiable risk factors. The
researcher communicates with the patients by implementing the Planned Teaching Programme
on knowledge and practice regarding prevention of coronary artery disease. Transaction between
the subject and AV aids takes place. On 8th day the subject’s knowledge will be reassessed by a
post test in order to find out the effectiveness of Planned Teaching Programme. The goal is said
to be achieved when there is an improvement in the knowledge and practice.

22
 Goal Not
Perception: Need to teach the patients Attained:
with modifiable risk factors of CAD There is no
about knowledge and practice on improvement
prevention of coronary artery Disease in knowledge
and
Mutual
Practice on
Goal
Judgment: Mobilize the resources for prevention
Setting
teaching about prevention of Coronary Reaction Interaction Coronary
Nurse as a Artery Disease among patients with Artery Disease.
Educator modifiable risk factors of CAD To attend  Pre test
the PTP on To assess
 PTP on
knowledge level of
knowledge
Action: Planned to conduct PTP on and practice knowledge Transaction
and practice
knowledge and practice on prevention on and practice Difference in
on
of Coronary Artery Disease. prevention and develop level of
prevention of
of Coronary a tool, PTP knowledge and
coronary
Artery on practice on
artery
Action: Motivated to attend the PTP Disease knowledge prevention of
disease
on knowledge and practice on among and practice Coronary Artery
Patients with among
prevention of Coronary Artery patients on Disease.
modifiable risk patients with
Disease. with prevention
factors of CAD modifiable
modifiable of Coronary
risk factors Goal Attained:
risk factors Artery
Judgment: Seeking for information of CAD There is
of CAD Disease.
sources of learning will improve the  Post Test. improvement in
knowledge and practice. knowledge and
Practice on
prevention
Perception: Need to gain knowledge Coronary
and good practice on prevention of Artery Disease.
Coronary Artery Disease.
FIG.1: MODIFIED IMOGENE KING’S GOAL ATTAINMENT MODEL
 CHAPTER – III

RESEARCH METHODOLOGY

Methodology of research organizes all the components of study in a way that most likely
will lead to valid answers for the problems that have been posted. (Burns and Groove, 2008).

This chapter deals with the methodology adopted for the study. It includes the research
approach, research design, variables, setting, population, sample, and criteria for selection of the
sample, sample size, sampling technique, development and description of the tool, content
validity, pilot study, and reliability of the tool, data collection procedure and plan for data
analysis.

RESEARCH APPROACH
A quantitative research approach has been used for this study.

RESEARCH DESIGN
The research design used in this study was pre experimental one group pretest post test
research design.

The schematic representation follows

Pre test Intervention Post test

(O1) () (O2)
Assessment of
Planned teaching programme Assessment of post-test level
pre-test level of knowledge
on knowledge and practice of knowledge and practice
and practice regarding
regarding prevention of regarding prevention of
prevention of coronary artery
coronary artery disease coronary artery disease
disease

VARIABLES
Dependent Variable
The dependent variables in this study are knowledge and practice.

24
Independent Variable
The independent variable in this study is planned teaching programme on prevention of
coronary artery disease.
Extraneous Variable
The extraneous variables are age, sex, educational status, occupation, known case of
hypertension, known case of diabetes and family history of heart disease.

SETTING
The research setting was T.M.M Hospital, Thiruvalla, Kerala which is a 400 bedded
multispecialty hospital.

POPULATION
Target Population
Patients with modifiable risk factors of coronary artery disease
Accessible Population
All the patients with modifiable risk factors of coronary artery disease in T.M.M
Hospital, Thiruvalla

SAMPLE
The patients who satisfied the inclusion criteria were the samples of the study.

SAMPLE SIZE
It consisted of 30 patients. Samples were selected from T.M.M Hospital, Thiruvalla,
Kerala.

CRITERIA FOR SAMPLE SELECTION

Inclusion Criteria
1. Patients admitted with modifiable risk factors of CAD in a private hospital Kerala.
2. Patients who were willing to participate.
3. Patient who were willing to comeback on post test day in case of discharge.
Exclusion Criteria
1. Patients who do not know to read and write in Malayalam.

SAMPLING TECHNIQUE

30 patients were selected by non-probability purposive sampling technique from T. M.M

Hospital, Thiruvalla, Kerala.

25
26
DEVELOPMENT AND DESCRIPTION OF THE TOOL
After an extensive review of literature, discussion with the experts and with the
investigator’s professional experience, structured knowledge questionnaire and practice checklist
were developed.

The tool constructed for the study has three parts:

DATA COLLECTION TOOL

This consists of 3 parts

Part I: Assessment of demographic variables

Demographic variables include age, gender, educational status, occupational status,
religion, marital status, dietary habits, bad habits, known case of hypertension, known case of
diabetes, family history of heart disease, diagnosed with high cholesterol, BMI and waist
circumference.

Part II: Assessment of level of knowledge on prevention of Coronary Artery Disease.

Knowledge – 50 questions

It consists of 7 divisions.

a) Anatomy & Physiology – 5 items.

b) Definition – 2 items
c) Risk factors – 15 items
d) Clinical manifestations – 4 items
e) Diagnostic evaluations – 2 items
f) Prevention – 19 items
g) Management – 3 items

Each item has 1 correct response and each correct response carries ‘1’ mark and each
wrong answer carries ‘0’ mark.

Part III: Assessment of level of practice on prevention of Coronary Artery Disease

It consists of 20 ‘Yes’ or ‘No’ questions to assess the practice on prevention of CAD.
Correct answer carries 1 mark and wrong answer carries 0 marks.

27
SCORING AND INTERPRETATION

Scoring for knowledge

Range Interpretation
≤50% Inadequate knowledge
51 – 75% Moderately adequate knowledge
>75% Adequate knowledge

Scoring for practice

Range Interpretation
≤50% Inadequate practice
51 – 75% Moderately adequate practice
>75% Adequate practice

INTERVENTION
Planned teaching programme on prevention of Coronary Artery Disease

CONTENT VALIDITY
The content validity of the data collection tool and planned teaching was ascertained
from the expert’s opinion in the field of expertise.

Modifications suggested by the experts in the tool were related to the demographic
variables were incorporated in the tool. All the experts had their consensus and then the tool was
finalized.

RELIABILITY
The reliability of the tool was established by test retest method for knowledge
questionnaire and inter-rater method to assess the practice. The reliability score was r==
0.83 for knowledge r = 0.87 for practice. The ‘r’ value indicated the highly positive correlation,
which showed that the tool is reliable, feasible and practicable to conduct the main study.

28
PILOT STUDY PROCEDURE

Pilot study was conducted at Arvinth hospital, Namakkal, after getting ethical clearance.
A formal and written permission was sought from the Principal of Arvinth College of nursing,
Namakkal.

A total of 3 patients who fulfilled the inclusive criteria for sample selection were selected
using non-probability purposive sampling technique. After obtaining written consent from
patients, data collection was commenced.

The investigator administered structured knowledge questionnaire and practice check list
and planned teaching programme given for patients with modifiable risk factors which took
approximately 1 hour 30 minutes to complete the process. Post test level of knowledge and
practice was assessed on 8th day using the same knowledge and practice questionnaire.

The analysis of the pilot study revealed that the‘t’ value to determine the effectiveness of
planned teaching programme was 5.95, which showed high statistical significance at p<0.001.
The findings of the pilot study gave the evidence that the tool was reliable, feasible and
practicable to conduct the main study.

PROCEDURE FOR DATA COLLECTION

The main study was conducted after obtaining formal permission from the Principal,
Arvinth College of Nursing, Ethical Committee clearance and written permission was obtained
from the Medical Director and Nursing Superintendent of T.M.M Hospital, Thiruvalla, Kerala

A total of 30 patients with modifiable risk factors of CAD who fulfilled the inclusive
criteria were selected using non-probability purposive sampling technique. The data was
collected during the month of august 2015.

29
 No. of samples Date of pre test Date of post test

4 3/8/2015 11/8/2015

7 4/8/2015 13/8/2015

3 5/8/2015 13/8/2015

6 6/8/2015 14/8/2015

5 8/8/2015 16/8/2015

5 10/8/2015 18/8/2015

A brief introduction of self and explanation on the purpose of the study was given. The
written consent was obtained from the patients.

At first demographic details were obtained through structured profile from the patients
with modifiable risk factors. The investigator gave thorough description about the tool and data
collection procedure and intervention.

The investigator administered structured knowledge and practice questionnaire and

planned teaching given with Power Point presentation for patients which took approximately 1
hour 30 minutes to complete the process. On 8th day, Post test level of knowledge and practice
was assessed using the same knowledge and practice questionnaire.

Researcher insisted and referred to cardiologist for those who had bad personal habits
(smoking, drinking, drug abuse) with physical measurements issues (increased BMI & waist
circumference) and physiological issues (diabetic, high cholesterol, hypertension) immediately to
rule out cardiac problems.

PLAN FOR DATA ANALYSIS

The data obtained were analyzed by using both descriptive and inferential statistics.

30
Descriptive Statistics:
1. Frequency and percentage distribution to analyze demographic variables of patients with
modifiable risk factors of CAD.
2. Mean and standard deviation to analyze pre and post test knowledge and practice on
prevention of Coronary Artery Disease.

Inferential Statistics
1. Paired t’ test to compare the pre-test and post test level of knowledge and practice on
prevention of Coronary Artery Disease.
2. Chi-square test was used to associate selected demographic variables of patients with
modifiable risk factors of CAD with post test level of knowledge and practice.

31
 CHAPTER – IV
DATA ANALYSIS AND INTERPRETATION

This chapter deals with the analysis and interpretation of data collected from 30
patients admitted with modifiable risk factors in a private hospital, to assess the effectiveness
of planned teaching programme on knowledge and practice regarding prevention of coronary
artery disease. The data collected for the study was grouped and analyzed as per the
objectives set for the study. The findings based on the descriptive and inferential statistical
analysis are presented under the following sections.

ORGANIZATION OF DATA

The findings of the study were grouped and analyzed under the following sessions.

Section A : Description of the demographic variables.

Section B : Assessment of pretest and post test level of knowledge and practice regarding
prevention of coronary artery disease among patients with modifiable risk
factors of CAD.

Section C : Effectiveness of planned teaching programme on knowledge and practice

regarding prevention of coronary artery disease among patients with
modifiable risk factors of CAD.

Section D : Relationship between post test knowledge and practice scores regarding
prevention of coronary artery disease among patients with modifiable risk
factors of CAD.

Section E : Association of post test level of knowledge and practice regarding prevention
of coronary artery disease among patients with modifiable risk factors of CAD
with selected demographic variables.

32
SECTION A: DESCRIPTION OF THE DEMOGRAPHIC VARIABLES.
Table 1: Frequency and percentage distribution of demographic variables of patients
with modifiable risk factors of CAD n = 30

Demographic variables No %

Age in years
21 -30 years 4 13.33
31 - 40 years 5 16.67
41 - 50 years 6 20.00
Above 50 years 15 50.00
Gender
Male 15 50.00
Female 15 50.00
Educational status
High school 6 20.00
HSE 2 6.67
Graduate 18 60.00
Post graduate 4 13.33
Occupational status
Sedentary worker 8 26.67
Moderate worker 18 60.00
Heavy worker 4 13.33
Religion
Hindu 1 3.33
Muslim 1 3.33
Christian 28 93.33
Others 0 0.00
Marital status
Single 1 3.33
Married 29 96.67
Widower 0 0.00

33
 Demographical variables No %

Dietary habits
Vegetarian 5 16.67
Non Vegetarian 25 83.33
Bad habits
Alcoholic 3 10.00
Smoker/tobacco 5 16.67
Alcoholic/Smoker/tobacco 3 10.00
Drug abuse 0 0.00
Alcoholic /Smoker/Tobacco/Drug Abuse 1 3.33
None 18 60.00
Known case of hypertension
Yes 16 53.33
No 14 46.67
Known case of diabetic
Yes 8 26.67
No 22 73.33
Do you have family history of heart disease
Yes 16 53.33
No 14 46.67
Do you diagnosed with high cholesterol
Yes 11 36.67
No 19 63.33
BMI measures
Under weight<18.5 0 0.00
Normal weight 18.5 - 24.9 4 13.33
Overweight 25.0 - 29.99 17 56.67
Obese 30.0 - 39.9 9 30.00
Over 40 0 0.00

34
 Demographic variables No %

Waist circumference
More than 100cm in males 14 46.67
More than 88cm in females 12 40.00
Less than 100cm in males 1 3.33
Less than 88cm in females 3 10.00

The table 1 shows that majority 15(50%) were aged above 50 years, 15(50%) were
male and female respectively. Regarding the educational status, majority 18(60%) were
graduates, 18(60%) were moderate worker, 28(93.33%) were Christians, 29(96.67%) were
married, 25(83.33%) were non-vegetarian, 18( 60%) had no bad habits, 16(53.33%) had no
known case of hypertension, 22(73.33%) had no known case of diabetic, 16(53.33%) had
family history of heart disease, 19(63.33%) had not diagnosed with high cholesterol,
17(56.67%) were overweight 25.0 – 29.99 and 14(46.67%) had waist circumference of more
than 100 cm in males.

35
SECTION B: ASSESSMENT OF PRETEST AND POST TEST LEVEL OF
KNOWLEDGE AND PRACTICE REGARDING PREVENTION OF CORONARY
ARTERY DISEASE AMONG PATIENTS WITH MODIFIABLE RISK FACTORS OF
CAD.
Figure 3: Percentage distribution of pretest and post test level of knowledge regarding
prevention of coronary artery disease among patients with modifiable risk factors of
CAD.

Pretest
100 Post test
83.33
90
80 70

70
60
Percentage

50
40 26.67
30 16.67
20
3.33 0
10
0
Inadequate Moderately Adequate
Adequate

Level of Knowledge

The Figure 3 shows that in the pretest, majority 21(70%) had moderately adequate
knowledge, 8(26.67%) had adequate knowledge and only one (3.33%) had inadequate
knowledge. Whereas in the post test after the planned teaching programme majority
25(83.33%) had adequate knowledge and only 5(16.67%) had moderately adequate
knowledge regarding prevention of coronary artery disease among patients with modifiable
risk factors of CAD.

36
Figure 4: Frequency and percentage distribution of pretest and post test level of
practice regarding prevention of coronary artery disease among patients with
modifiable risk factors of CAD.

Pretest
100 Post test

90
76.67
80

70 60

60
Percentage

50

40
26.67 23.33
30
13.33
20
0
10

0
Inadequate Moderately Adequate
Adequate
Level of Practice

The Figure 4 shows that in the pretest, majority 18(60%) had moderately adequate
practice, 8(26.67%) had inadequate practice and only 4(13.33%) had adequate practice.
Whereas in the post test after the planned teaching programme majority 23(76.67%) had
adequate practice and 7(23.33%) had moderately adequate practice.

37
SECTION C: EFFECTIVENESS OF PLANNED TEACHING PROGRAMME
ON KNOWLEDGE AND PRACTICE REGARDING PREVENTION OF
CORONARY ARTERY DISEASE AMONG PATIENTS WITH MODIFIABLE
RISK FACTORS OF CAD.
Table2: Comparison of pretest and post test knowledge scores regarding
prevention of coronary artery disease among patients with modifiable risk
factors of CAD.
n = 30
Knowledge Mean S.D Paired ‘t’ Value
Pre test 36.30 4.16 t = 9.775
Post Test 45.93 4.71 p = 0.000, S
***p<0.001, S – Significant

The table 2 shows that in the pretest, the mean score of knowledge was
36.304.16 whereas in the post test the mean score of knowledge was 45.93  4.71.
The calculated paired‘t’ value of t = 9.775 was found to statistically significant at
p<0.001 level. This clearly shows that the planned teaching programme imparted to
patients with modifiable risk factors of CAD had significant improvement in the post
test level of knowledge regarding prevention of coronary artery disease.

38
Table 3: Comparison of pretest and post test practice scores regarding
prevention of coronary artery disease among patients with modifiable risk
factors of CAD.
n = 30
Practice Mean S.D Paired ‘t’ Value
Pre test 11.86 3.30 t = 7.301
Post Test 17.56 2.50 p = 0.000, S
***p<0.001, S – Significant

The table 3 shows that in the pretest, the mean score of practice was
11.863.30 whereas in the post test the mean score of practice was 17.562.50. The
calculated paired‘t’ value of t = 7.301 was found to statistically significant at p<0.001
level. This clearly shows that the planned teaching programme imparted to patients
with modifiable risk factors of CAD had significant improvement in the post test level
of knowledge regarding prevention of coronary artery disease.

39
SECTION D: RELATIONSHIP BETWEEN POST TEST KNOWLEDGE AND
PRACTICE SCORES REGARDING PREVENTION OF CORONARY
ARTERY DISEASE AMONG PATIENTS WITH MODIFIABLE RISK
FACTORS OF CAD.
Table 4: Correlation between post test knowledge and practice scores regarding
prevention of coronary artery disease among patients with modifiable risk
factors of CAD.
n = 30
Variables Mean S.D ‘r’ Value
Knowledge 45.93 4.71 r = 0.570
Practice 17.56 2.50 p = 0.001, S**
**p<0.01, S – Significant

The table 4 shows that the post mean score of knowledge was 45.934.71 and
the posttest practice score was 17.562.50. The calculated Karl Pearson’s Correlation
value of r = 0.570 shows a positive correlation and it was found to be statistically
significant at p<0.01 level. This clearly indicates that when the knowledge regarding
prevention of coronary artery disease among patients with modifiable risk factors of
CAD increases their practice level also increases in the post test.

40
SECTION E: ASSOCIATION OF POST TEST LEVEL OF KNOWLEDGE
AND PRACTICE REGARDING PREVENTION OF CORONARY ARTERY
DISEASE AMONG PATIENTS WITH MODIFIABLE RISK FACTORS OF
CAD WITH SELECTED DEMOGRAPHIC VARIABLES.
Table 5: Association of post test level of knowledge regarding prevention of
coronary artery disease among patients with modifiable risk factors of CAD with
selected demographic variables. n = 30
Moderately
Adequate Chi-
adequate
Demographic Variables (>75%) square
(51-75%)
value
No. % No. %
Age in years
21 -30 years 0 0 0 13.3 2=6.000
31 - 40 years 0 0 5 16.7 d.f=3
p=0.112
41 - 50 years 0 0 6 20.0 N.S
Above 50 years 5 16.7 10 33.3
Gender 2=2.160
Male 4 13.3 11 36.7 d.f=1
p=0.142
Female 1 3.3 14 46.7 N.S
Educational status
High school 0 0 5 16.7 2=0.600
HSE 0 0 2 6.7 d.f=3
p=0.896
Graduate 3 10.0 15 50.0 N.S
Post graduate 1 3.3 3 10.0
Occupational status
2=0.600
Sedentary worker 3 10.0 6 20.0
d.f=3
Moderate worker 3 10.0 15 50.0 p=0.896
N.S
Heavy worker 0 0 4 13.3
Religion
Hindu 0 0 1 3.33 2=0.429
Muslim 0 0 1 3.33 d.f=2
p=0.807
Christian 5 16.7 23 76.7 N.S
Others - - - -

41
 Moderately
Adequate Chi
adequate
Demographic Variables (>75%) square
(51-75%)
value
No. % No. %

Do you have family history of heart disease 2=0.429

d.f=2
Yes 5 16.7 15 50.0.
p=0.014
No 0 0 10 33.3 S*
**p<0.05, S* – Significant, N.S – Not Significant

The table 5 shows that the demographic variable family history of heart
disease had shown statistically significant association with post test level of
knowledge regarding prevention of coronary artery disease at p<0.05 level and the
other demographic variables had not shown statistically significant association with
post test level of knowledge among patients with modifiable risk factors of CAD.

42
Figure 5: Association of family history of heart disease with post test level of
knowledge regarding prevention of coronary artery disease among patients with
modifiable risk factors of CAD

Yes
100 No

90

80

70
50
60
Percentage

50
33.3
40

30 16.7

20
0
10

0
Moderately Adequate Adequate

Level of Knowledge

Figure 5: Association of family history of heart disease with post test level of
knowledge regarding prevention of coronary artery disease among patients with
modifiable risk factors of CAD

43
Table 6: Association of post test level of practice regarding prevention of
coronary artery disease among patients with modifiable risk factors of CAD with
selected demographic variables. n = 30
Moderately
Adequate Chi-
Adequate
Demographic Variables (>75%) Square
(51 – 75%)
No. % No. % Value

Age in years
21 -30 years 1 3.3 3 10.0 2=2.516
31 - 40 years 0 0 5 16.7 d.f =3
p = 0.472
41 - 50 years 1 3.3 5 16.7 N.S
Above 50 years 5 16.7 10 33.3
Gender 2=0.186
Male 4 16.7 11 36.7 d.f =1
p = 0.666
Female 3 10.0 12 40.0 N.S
Educational status
High school 1 3.3 5 16.7 2=0.963
HSE 1 3.3 1 3.3 d.f =3
p = 0.810
Graduate 4 16.7 14 46.7 N.S
Post graduate 1 3.3 3 10.0
Occupational status
2=4.845
Sedentary worker 4 13.3 4 13.3 d.f =2
Moderate worker 3 3.3 15 50.0 p = 0.089
Heavy worker 0 0 4 13.3 N.S

Religion
Hindu 0 0 1 3.3 2=0.652
Muslim 0 0 1 3.3 d.f =2
p = 0.722
Christian 7 23.3 21 70.0 N.S
Others - - - -
Do you have family history of heart
2=1.677
disease
d.f =1
Yes 2 6.7 13 43.3 p = 0.195
N.S
No 5 16.7 10 33.3
N.S – Not Significant

44
 The table 6 shows that none of the demographic variables had shown
statistically significant association with post test level of practice among patients with
modifiable risk factors of CAD.

45
 CHAPTER – V
DISCUSSION

This chapter discusses in detail the findings of the study derived from the
statistical analysis and its pertinence to the objectives of the study and further
discussion will exemplify these objectives were satisfied by the study. The purpose of
the study was to assess the effectiveness of planned teaching programme on
knowledge and practice regarding prevention of coronary artery disease among
patients with modifiable risk factors. The findings of the study discussed were based
on the objectives as stated.

Description of the demographic variable among patients with modifiable risk

factors of CAD
With regard to the demographic variables majority 15(50%) were aged above
50 years, 15(50%) were male and female respectively. Regarding the educational
status, majority 18(60%) were graduates, 18(60%) were moderate worker,
28(93.33%) were Christians, 29(96.67%) were married, 25(83.33%) were non-
vegetarian, 18( 60%) had no bad habits, 16(53.33%) had no known case of
hypertension, 22(73.33%) had no known case of diabetic, 16(53.33%) had family
history of heart disease, 19(63.33%) had not diagnosed with high cholesterol,
17(56.67%) were overweight 25.0 – 29.99 and 14(46.67%) had waist circumference
of more than 100 cm in males.

The first objective was to determine the pre test and post test level of knowledge
regarding prevention of coronary artery disease among patients with modifiable
risk factors of CAD
Findings of pretest analysis revealed that majority 21(70%) had moderately
adequate knowledge, 8(26.67%) had adequate knowledge and only one (3.33%) had
inadequate knowledge. Whereas in the post test after the PTP majority 25(83.33%)
had adequate knowledge and only 5(16.67%) had moderately adequate knowledge
regarding prevention of CAD among patients with modifiable risk factors.

46
The second objective was to assess the pre test and post test level of practice
regarding prevention of coronary artery disease among patients with modifiable
risk factors of CAD.
The findings also revealed that in the pretest, majority 18(60%) had
moderately adequate practice, 8(26.67%) had inadequate practice and only 4(13.33%)
had adequate practice. Whereas in the post test after the PTP, majority 23(76.67%)
had adequate practice and 7(23.33%) had moderately adequate practice.

The third objective was to assess the effectiveness of planned teaching

programme in terms of gain in knowledge and practice regarding prevention of
coronary artery disease among patients with modifiable risk factors of CAD.
The comparison tables showed that in the pretest, the mean score of
knowledge was 36.304.16 whereas in the post test the mean score of knowledge was
45.93  4.71. The calculated paired‘t’ value of t = 9.775 was found to statistically
significant at p<0.001 level. This clearly shows that the planned teaching programme
imparted to patients with modifiable risk factors of CAD had significant improvement
in the post test level of knowledge regarding prevention of coronary artery disease.

The table 3 shows that in the pretest, the mean score of practice was
11.863.30 whereas in the post test the mean score of practice was 17.562.50. The
calculated paired‘t’ value of t = 7.301 was found to statistically significant at p<0.001
level. This clearly shows that the planned teaching programme imparted to patients
with modifiable risk factors of CAD had significant improvement in the post test level
of knowledge regarding prevention of coronary artery disease.

Hence the hypothesis H1 stated earlier that “There may be a significant

improvement in the post test level of knowledge and practice regarding
prevention of coronary artery disease among patients with modifiable risk
factors of CAD” is accepted.

The findings were consistent with the study conducted by Mary P.A (2008)
conducted a study to assess the Effectiveness of planned teaching program on
prevention of coronary artery disease among older adults in a selected rural
community at Mangalore. Convenient sampling technique was used to select 30
samples. Pre-test knowledge assessment revealed that 76% of the subjects had an

47
average knowledge. The total mean percentage of the pre test knowledge score was
(60.87%) with mean and SD 18.873.19 and the mean post test knowledge score was
91.70% with meanSD 28.431.61 significance of difference between the pre test and
post test knowledge scores was statistically listed using paired‘t’ test and it was found
to be significant (t=29, P<0.05). It is found that planned teaching programme is very
effective in improving the knowledge and also practice of older adults.

The fourth objective was to correlate the post test knowledge and practice scores
regarding prevention of coronary artery disease among patients with modifiable
risk factors of CAD.
The table 4 shows that the post mean score of knowledge was 45.934.71 and
the post test practice score was 17.562.50. The calculated Karl Pearson’s Correlation
value of r = 0.570 shows a positive correlation and it was found to be statistically
significant at p<0.01 level. This clearly indicates that when the knowledge regarding
prevention of coronary artery disease among patients with modifiable risk factors of
CAD increases their practice level also increases in the post test.

Hence the hypothesis H2 stated earlier that “there will be significant

relationship between post test knowledge and practice score regarding
prevention of coronary artery disease among patients with modifiable risk
factors of CAD” is accepted.

The fifth objective was to associate the post test level of knowledge and practice
regarding prevention of coronary artery disease among patients with their
selected demographic variables.
The table 5 and figure 5 shows that the demographic variable family history of
heart disease had shown statistically significant association with post test level of
knowledge regarding prevention of coronary artery disease at p<0.05 level and the
other demographic variables had not shown statistically significant association with
post test level of knowledge among patients with modifiable risk factors of CAD.

Hence the hypothesis H3 stated earlier that “There will be significant

association of post test level of knowledge score regarding prevention of
coronary artery disease among patients with modifiable risk factors of CAD” is
accepted for family history of heart disease and it is rejected for other variables.

48
 The table 6 shows that none of the demographic variables had shown
statistically significant association with post test level of practice among patients with
modifiable risk factors. Hence the hypothesis H3 stated earlier that “There will be
significant association of post test level of practice score regarding prevention of
coronary among patients with modifiable risk factors of CAD” is rejected for all
the demographic variables.

49
 CHAPTER – VI
SUMMARY, CONCLUSION, NURSING IMPLICATIONS,
RECOMMENDATIONS AND LIMITATIONS

This chapter presents the summary, conclusion, implications,

recommendations and limitations of the study based on objectives selected.

SUMMARY

CAD, is also called Coronary arteriosclerosis, Coronary atherosclerosis.

Coronary artery disease (CAD) is the most common type of heart disease. It is the
leading cause of death in the United States in both men and women. CAD happens
when the arteries that supply blood to heart muscle become hardened and narrowed.
This is due to the build-up of cholesterol and other material, called plaque, on their
inner walls. This build-up is called atherosclerosis. As it grows, less blood can
flow through the arteries. As a result, the heart muscle can't get the blood or oxygen it
needs. This can lead to chest pain (angina) or a heart attack. Most heart attacks
happen when a blood clot suddenly cuts off the hearts' blood supply, causing
permanent heart damage. Over time, CAD can also weaken the heart muscle and
contribute to heart failure and arrhythmias. Heart failure means the heart can't
pump blood well to the rest of the body. Arrhythmias are changes in the normal
beating rhythm of the heart (Medline, 2010)

The objectives of the study were

1. To determine the pre test and post test level of knowledge regarding
prevention of coronary artery disease among patients with modifiable risk
factors of CAD.
2. To determine the pre test and post test level of practice regarding prevention
of coronary artery disease among patients with modifiable risk factors of
CAD.
3. To evaluate the effectiveness of planned teaching programme in terms of gain
in knowledge and practice regarding prevention of coronary artery disease
among patients with modifiable risk factors of CAD.

50
 4. To correlate the post test knowledge and practice scores regarding prevention
of coronary artery disease among patients with modifiable risk factors of
CAD.
5. To associate the post test level of knowledge and practice regarding
prevention of coronary artery disease among patients with their selected
demographic variables.
The study was based on the assumptions that
1. Patients will have some knowledge regarding CAD and its prevention.
2. The Planned Teaching Programme on CAD and its prevention can bring about
desired changes in the lifestyle of patients with modifiable risk factors.

The hypotheses formulated were

H1: There may be a significant improvement in the post test level of knowledge and
practice regarding coronary artery disease among patients with modifiable risk
factors of CAD.
H2: There will be a significant relationship between post test knowledge and practice
score regarding prevention of coronary artery disease among patients with
modifiable risk factors of CAD.
H3: There will be significant association of post test level of knowledge and practice
score regarding prevention of coronary artery disease among patients with
modifiable risk factors of CAD.

The review of literature was derived from primary and secondary sources,
along with professional experience and expert’s guidance from the field of medical
surgical nursing provided a comprehensive framework for the selection of problem
and for achieving the objectives of the study. It also strengthened the ideas for
conceptual framework, aided to design the methodology and develop the tool for data
collection.

The conceptual framework for the study was based on King’s Goal Attainment
theory.

The researcher adopted quantitative research approach and one group pretest
and post test only design was used to assess the effectiveness of planned teaching
programme on knowledge and practice regarding prevention of coronary artery

51
disease. The study was conducted among the patients at T.M.M Hospital, Thiruvalla,
Kerala, and whoever fulfilled the inclusive criteria of the study. The sample size was
30 who were assigned by non probability purposive sampling technique.

The tool for data collection had 3 Parts. Part I: Demographic data to collect
information on age, gender, educational status, occupational status, religion, marital
status, dietary habits, bad habits, known case of hypertension, known case of diabetes,
family history of heart disease, diagnosed with high cholesterol, BMI and waist
circumference. Part II: Structured knowledge questionnaire to assess the
knowledge of patients regarding prevention of coronary artery disease. Part III:
Check list to assess the practice of patients on prevention of coronary artery disease.

The Medical and Nursing experts validated the tool. The pilot study was
conducted at Arvinth Hospital and it was found practicable and feasible to proceed
with the main study. The reliability of the tool was established by test retest method
for assessing knowledge, ‘r’ = 0.83 and inter-rater method for assessing practice,
‘r’ = 0.87. The findings showed that the tool was found to be highly reliable to
proceed with the main study.

The ethical aspect of research was maintained throughout the study by

obtaining ethical clearance, formal permission from the respective authorities and
consent from the patients. Privacy and confidentiality was maintained throughout the
data collection period and collected data was used only for the research purpose.

The main study was conducted during august 2015. The collected data was
analyzed using SPSS version 21.

Major findings of the study

The data collected was analyzed using descriptive and inferential statistics.
Interpretation and discussion was done based on the objectives of the study, null
hypotheses, conceptual framework and research studies from literature review.
 In pretest majority 21(70%) had moderately adequate knowledge, 8(26.67%)
had adequate knowledge and only one (3.33%) had inadequate knowledge.
Whereas in the post test after the planned teaching programme majority
25(83.33%) had adequate knowledge and only 5(16.67%) had moderately

52
 adequate knowledge regarding prevention of coronary artery disease among
patients with modifiable risk factors of CAD.
 The findings also revealed that in the pretest, majority 18(60%) had
moderately adequate practice, 8(26.67%) had inadequate practice and only
4(13.33%) had adequate practice. Whereas in the post test after the planned
teaching programme majority 23(76.67%) had adequate practice and
7(23.33%) had moderately adequate practice.
 The comparison tables showed that in the pretest, the mean score of
knowledge was 36.304.16 whereas in the post test the mean score of
knowledge was 45.93  4.71. The calculated paired‘t’ value of t = 9.775 was
found to statistically significant at p<0.001 level. This clearly shows that the
planned teaching programme imparted to patients with modifiable risk factors
had significant improvement in the post test level of knowledge regarding
prevention of coronary artery disease.
 The findings also shows that in the pre test, the mean score of practice was
11.863.30 whereas in the post test the mean score of practice was
17.562.50. The calculated paired‘t’ value of t = 7.301 was found to
statistically significant at p<0.001 level. This clearly shows that the planned
teaching programme imparted to patients with modifiable risk factors had
significant improvement in the post test level of knowledge regarding
prevention of coronary artery disease.
 The relationship between post test knowledge and practice score revealed a
positive correlation and was found to be statistically significant at p<0.01
level. This clearly indicates that when the knowledge level increases their
practice level also increases.

CONCLUSION

The present study assessed the effectiveness of planned teaching programme

on knowledge and practice regarding prevention of coronary artery disease among
patients with modifiable risk factors. The results revealed that planned teaching
programme is very effective in increasing the level of knowledge and practice at p<
0.001 level. From the findings of the study, the investigator concluded that planned
teaching programme has an important role in increasing the level of knowledge and

53
practice regarding prevention of coronary artery disease among patients with
modifiable risk factors of CAD. The researcher insisted the patients with multiple
modifiable risk factors of CAD should seek medical advice and follow up care.

IMPLICATIONS

The implications drawn from the study are of importance to the field of
nursing including nursing service, administration, education and research.

Nursing Practice
 The nurse as a service provider should periodically organize and conduct mass
education programme on lifestyle modifications among patients with
modifiable risk factors of coronary artery disease using appropriately designed
audio visual aids.
 The nurse implements the information, education, communication to create
aware to the patient on causes and prevention of coronary artery diseases.
 As a service provider the nurse should design self care modules on prevention
of coronary artery diseases and improve their knowledge.

Nursing Education
 Nurses must be reinforced in-service education regarding management
coronary artery diseases, its prevention, early identification of complications
and its management.
 Nursing students have to be educated regarding prevention of coronary artery
disease.
 Nurse educators should emphasize the proper assessment and management of
CAD among patient with modifiable risk factors as well as provide
opportunity for students to apply the knowledge.

Nursing Administration
 The nurse as an administrator should design formal teaching programme on
lifestyle modifications coronary artery patients with modifiable risk factors to
improve their knowledge.
 Provide opportunities for nurses to attend training programmes.

54
  The nurse must instrumental in pointing out relevant policies of the state and
central level of ensure effective programme to educate the public and facilitate
optimal recourses allocation for implementation of the programme and create
intersectional network to control the coronary artery disease.

Nursing Research
 Nurse researchers can promote more research with regard to utilization of
different pharmacological agents in the clinical practice.
 Nurse researchers can collaborate with the other health team members in
developing evidence based nursing practice.
 Nursing researcher can encourage clinical nurses to apply the research
findings in their daily nursing care activities.

RECOMMENDATIONS
Nursing research is a widely expanding area with need for validating
conservative interventions and development of new knowledge. The study
recommends the following for achieving this end.
 A comparative study can be carried out to assess the factors leading to the
development of CAD between rural and urban population.
 A study can be conducted in larger sample for better generalization.
 A comparative study can be conducted to compare the effect of planned
teaching programme among experimental group and control group without
intervention.
 A similar study can be conducted by the different types of non
pharmacological measures.
 A study can be conducted along with medical interventions.

LIMITATIONS
 The study was confined to small number of subjects and shorter period.

55
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INTERNET RESOURCES

http://my.clevelandclinic.org/services/heart/disorders/coronary-artery-
disease/cadsymptoms
http://www.jpma.org.pk.
http://www.healthline.com/health/coronary-artery-disease/complications#Overview1
http://www.healthline.com/health/coronary-artery-disease/risk
factors#ControllableRiskFactors3
http://www.nhlbi.nih.gov/health/health-topics/topics/hbc/
http://www.texasheart.org/HIC/Topics
http:// www.heartsite.com/html/cad.html
http://www.cardiosmart.org/Heart- Condition
http://www.heartpoint.com/coronartdiseas
http://www.msdmanuals.com
http://www.bhf.org.uk/heart-health/condition
http://www.barnesjewish.org/heart-vascular

61
 APPENDIX I
LETTER SEEKING PERMISSION TO CONDUCT STUDY
From
Mr. Eby Korah
II year M.Sc(N),
Arvinth College Of Nursing
Namakkal.
Forwarded Through
Prof. Mrs.V.Kavitha M.Sc(N)
Principal,
Arvinth College Of Nursing
Namakkal.
To
The Administrator
T.M.M Hospital
Thiruvalla
Kerala
Respected Sir/Madam,
Subject: Requesting permission to conduct research in the hospital
As a part of M .Sc Nursing requirement under the fulfilment of The Tamilnadu
Dr. M.G.R Medical University, I am conducting a research on “A study to assess the
effectiveness of planned teaching programme on knowledge and practice
regarding prevention of coronary artery disease among patients with modifiable
risk factors of CAD in a private hospital, Kerala”. Kindly grant me permission to
conduct research in your esteemed hospital.
Thanking you
Yours Faithfully
(Eby Korah)

62
 APPENDIX II
LETTER SEEKING EXPERTS OPINION FOR
CONTENT VALIDITY
From
Mr.Eby Korah
II year M.Sc(N),
Namakkal.
To

Respected Madam/ Sir,

Sub: requisition for expert opinion on suggestion for content validity of the
tool.
I am Mr. Eby Korah doing my M.Sc Nursing II year specializing in Medical
Surgical Nursing at Arvinth College of Nursing. As a part of my research project to be
submitted to the Tamilnadu Dr. M.G.R University requirement for the award of
M.Sc., (N) degree, I am conducting “A study to assess the effectiveness of planned
teaching programme on knowledge and practice regarding prevention of
coronary artery disease among patients with modifiable risk factors of CAD in a
private hospital, Kerala”.
I have enclosed my data collection tool and intervention tool for your expert
guidance and validation. Kindly do the needful.
Thanking you,
Yours faithfully
(Eby Korah)
Enclosures:
1. Research proposal
2. Data collection tool
3. Intervention tool
4. Content validity form
5. Certificate for content validity

63
 APPENDIX III
LIST OF EXPERTS FOR CONTENT VALIDITY

1. Mrs. Bhuvaneshwari, M.Sc (Nursing)

Associate professor, Medical Surgical Nursing,
Sri Gokulam college of Nursing,
Salem.

2. Mrs. R. Radha., M.Sc (Nursing)

Assistant Professor, Medical Surgical Nursing,
Vivekanadha college of Nursing,
Tiruchengodu, Namakkal.

3. Mrs.D. Shankari., M.Sc (Nursing)

Assistant Professor, Medical Surgical Nursing,
Vivekanadha college of Nursing,
Tiruchengodu, Namakkal.

4. Dr. V. Raja, M.D, D.M (Cardio)

Shanmuga Heart Centre,
Namakkal.

5. Dr. P. Vishnuram,M.B.B.S., M.D (Cardio Diabetologist)

Sri Dhanvnthari’s Hospital,
Namakkal.

64
 APPENDIX IV
FORMAT FOR CONTENT VALIDITY

Name of the Expert:

Address :
Total content of the tool: Adequate /Inadequate
Kindly validate each tool and tick if it applicable

S.
No. of tool/section Agree Disagree Remarks
No

Signature of the expert with date

65
 CRITERIA CHECKLIST FOR VALIDATION OF TOOL

Instruction
Kindly go through the items regarding accuracy, relevancy and appropriateness
of the content. There are two response columns in the checklist namely agree, and
disagree. Place a tick mark against the specific column. If you disagree, to any of the
item, write your remarks and suggestion in given column.

PART- I
DEMOGRAPHIC PERFORMA
S.
Agree Disagree Remarks And Suggestion
No
1
2
3
4
5
6
7
8
9
10
11
12




66
 PART II
STRUCTURED KNOWLEDGE QUESTIONNAIRE ON PREVENTION OF
CORONARY ARTERY DISEASE AMONG PATIENTS WITH
MODIFIABLE RISK FACTORS OF CAD
S.
Agree Disagree Remarks and Suggestions
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25

67
S.No Agree Disagree Remarks and Suggestions

26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50

68
SCORE KEY FOR STRUCTURED KNOWLEDGE QUESTIONNAIRE

QUESTION NO ANSWER SCORE

1 a 1
2 a 1
3 a 1
4 b 1
5 d 1
6 b 1
7 a 1
8 a 1
9 c 1
10 d 1
11 b 1
12 a 1
13 a 1
14 c 1
15 c 1
16 c 1
17 b 1
18 a 1
19 b 1
20 b 1
21 a 1
22 b 1
23 a 1
24 a 1
25 b 1
26 a 1
27 a 1
28 a 1
29 c 1

69
QUESTION NO ANSWER SCORE
30 c 1

31 a 1

32 a 1

33 a 1

34 c 1

35 d 1

36 a 1

37 a 1

38 b 1

39 a 1

40 a 1

41 a 1

42 d 1

43 c 1

44 a 1

45 b 1

46 c 1

47 c 1

48 a 1

49 b 1

50 b 1

SCORE: 50

70
 PART III
CHECK LIST TO ASSESS THE PRACTICE ON PREVENTION OF
CORONARY ARTERY DISEASE
S. Question
Agree Disagree Remarks and Suggestions
No. No

1 1

2 2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

10 10

11 11

12 12

13 13

14 14

15 15

16 16

17 17

18 18

19 19

20 20

71
 SCORE KEY FOR PRACTICE CHECK LIST
QUESTION NO ANSWER SCORE
1 YES 1
2 YES 1
3 YES 1
4 YES 1
5 YES 1
6 NO 1
7 YES 1
8 YES 1
9 YES 1
10 YES 1
11 NO 1
12 YES 1
13 YES 1
14 YES 1
15 YES 1
16 YES 1
17 YES 1
18 YES 1
19 YES 1
20 YES 1

TOTAL:20

72
 APPENDIX V
INFORMED CONSENT FORM

I am Mr. Eby Korah M.Sc., (N), II Year student at Arvinth college of Nursing,
Namakkal, as a part of my research study on “A study to assess the effectiveness of
planned teaching programme on knowledge and practice regarding Prevention
of Coronary artery Disease among patients with modifiable risk factors of CAD
in a Private Hospital, Kerala”, is selected to be conducted. The findings of the study
will be helpful in gaining knowledge on prevention of coronary artery disease.
I hereby ask you consent and cooperation to participate in the study. The
information collected will be confidently and anonymity will be maintained.

(Signature of investigator)

I ------------------------------------------------------, here by consent to participate

and undergo the study.

Place:
Date:

(Signature of the participant)

73
 APPENDIX VI
CERTIFICATE FOR CONTENT VALIDITY

This is to certify that the tool developed by Mr. Eby Korah, M.Sc., (N) II Year
student of Arvinth College of Nursing for his study, “A study to assess the
effectiveness of planned teaching programme on knowledge and practice
regarding prevention of coronary artery disease among patients with modifiable
risk factors of CAD in a private hospital, Kerala”, is validated by the undersigned
and he can proceed with this tool to conduct the main study.

Seal: Signature with Date

74
 APPENDIX VII
CERTIFICATE OF ENGLISH EDITING

TO WHOM SO EVER MAY CONCERN

This is to certify that the dissertation work “A study to assess the effectiveness
of planned teaching programme in knowledge and practice regarding Prevention
of Coronary artery Disease among patients with modifiable risk factors of CAD
in a Private Hospital, Kerala”, done by Mr. Eby Korah, II year M.Sc., Nursing
student of Arvinth college of Nursing, Namakkal, is edited for English language
appropriateness.

Seal with Date: Signature

75
 APPENDIX VIII
CERTIFICATE OF MALAYALAM EDITING

TO WHOM SO EVER MAY CONCERN

This is to certify that the dissertation work “A study to assess the effectiveness
of planned teaching programme in knowledge and practice regarding Prevention
of Coronary artery Disease among patients with modifiable risk factors of CAD
in a Private Hospital Kerala”, done by Mr. Eby Korah, II year M.Sc., Nursing
student of Arvinth college of Nursing, Namakkal, is edited for Malayalam language
appropriateness.

Seal with Date: Signature

76
 APPENDIX IX
Topic : Coronary Artery Disease

Group : Patient admitted with modifiable risk factors

Place : Selected private hospital

Health Educator : Student teacher

Method of Teaching : Lecture cum discussion

AV Aids : Power Point presentation

GENERAL OBJECTIVES

At the end of the teaching the patient with modifiable risk factors will be able to gain in depth knowledge and develop
desirable attitude and skills in practice regarding coronary artery disease.

SPECIFIC OBJECTIVES

At the end of the teaching the patient will be able to,

 know the anatomy and physiology of heart

 understand the meaning of CAD
 describe the cause and risk factors of CAD
 enlist the clinical manifestations of CAD
 analyze the diagnosis of CAD
 follow the prevention of CAD
 enumerate the management of CAD
 prevent the complications of CAD

77
Specific Content Teacher’s Learners A. V Evaluation
Objectives Activity Activity Aids

INTRODUCTION explaining listening Power

Point
Coronary artery disease is common type of cardio vascular diseases. A common
symptom is chest pain or discomfort which may travel into shoulder, arm, back,
neck or jaw. Occasionally it may feel like heart burn. Usually symptoms occur with
exercises or emotional stress lasts less than a few minutes and get better with rest.
Shortness of breath may also occur and sometimes no symptoms are present. The
first sign may be a heart attack and the other complications include heart failure or
an irregular heartbeat.
review the ANATOMY AND PHYSIOLOGY OF HEART Explaining Listening Power What is the
anatomy and The adult heart is about the size of a closed fist and sits in the thorax on the left Point function of
physiology the heart?
of heart side of the chest in front of the lungs. The normal heart rate is 60-80 beats/minute.
The heart is designed as a pump with four chambers - right atrium (RA), right
ventricle (RV), left atrium (LA), and left ventricle (LV). The two atria are the
smaller, upper chambers of the heart and the two ventricles are the larger, lower
chambers of the heart. The heart also has four valves. The tricuspid valve is
between the right atrium and right ventricles. The pulmonary valve is between the
right ventricle and the pulmonary artery. The mitral valve is between the left atrium,

78
Specific Content Teacher’s Learner’s A.V Evaluation
Objectives Activity Activity Aids

and the left ventricle and the aortic valve is between the left ventricle and the aorta.
The aorta carries pure blood to all parts of the body at the same time impure blood is
collected by inferior venacava from lower parts of the body and superior venacava
from upper parts of the body, pulmonary arteries carries impure blood to lungs, pure
blood from lungs to heart is carried by pulmonary vein and heart muscles get pure
blood by coronary artery and impure blood by coronary veins. The function of the
heart is to supply blood to whole parts of the body.

DEFINITION Explaining Listening Power What is the

know the Point meaning of
Coronary artery disease (CAD) is also known as ischemic heart disease (IHD)
meaning of CAD?
CAD atherosclerotic heart disease, atherosclerotic cardiovascular disease. Coronary artery
disease is a group of disease that includes angina pectoris, atherosclerosis and
myocardial infarction and leads to sudden death.

describe the RISK FACTORS Explaining Listening Power W hat are the
causes and Point modifiabile
Coronary artery disease has a number of well determined risk factors. These are
risk factors risk factors of
of CAD classified into two major categories, CAD?
I. MODIFIABLE RISK FACTORS

79
 Specific Content Teacher’s Learner’s A.V Evaluation
Objectives Activity Activity Aids

 UNHEALTHY BLOOD CHOLESTEROL Explaining Listening Power What is mean by

Point atherosclerosis?
This includes high LDL cholesterol (sometimes called “bad” cholesterol)
and low HDL cholesterol (sometimes called “good” cholesterol).
LDL level less than 100mg/dl is optimal and HDL level above 60mg/dl is
desirable.
High blood cholesterol is a condition in which you have too much
cholesterol in your blood. The higher level of LDL cholesterol in the blood,
greater the chance of getting heart disease. The higher level of HDL in your
blood lowers the chance of getting heart disease. Coronary artery disease is
condition in which plaque builds up inside the coronary (heart) arteries.
Plaque is a waxy substance made up of cholesterol, fat, calcium, and other
substances found in the blood. When plaque buildup in the arteries the
condition called atherosclerosis.

 HIGH BLOOD PRESSURE

Blood pressure is considered high if it stays at or above 140/90mmHg over
time. If you have diabetes or chronic kidney disease, high blood pressure is
defined as 130/80mmHg or higher (the mmHg is millimeter of mercury-the
Unit used to measure blood pressure). High blood pressure can cause the

80
 Specific Content Teacher’s Learner’s A.V Evaluation
Objectives Activity Activity Aids

coronary arteries to narrow and stiffen, so it will increases the work load of the
heart. Your blood pressure should remain consistently at or below 120/80
mmHg.
 SMOKING, ALCOHOLISM, DRUG ABUSE
Explaining Listening Power What are the
 Smoking can damage and tighten blood vessels, lead to unhealthy Point chemicals
contained in
cholesterol levels, and raise blood pressure. Smoking also can limit
smoking?
how such oxygen reaches the body's tissues.
 The chemicals like cyanide, benzene, formaldehyde, menthol, acetyl,
tar, carbon monoxide gas, ammonia etc in tobacco smoke harm your
blood cells. They also can damage the function of your heart and the
structure and function of your blood vessels. This damage increases
your risk of atherosclerosis. Over time, plaque hardens and narrows
your arteries. This limits the flow of oxygen rich blood to other parts of
the body.
 Alcoholism: Heavy drinkers can have the risk of coronary artery
disease.
 Drug Abuse
Cocaine is associated with a number of cardiovascular diseases,
including MI, heart failure, cardiomyopathies, arrhythmias, aortic

81
Specific Content Teacher’s Learner’s A.V Evaluation
Objectives Activity Activity Aids

dissection, and endocarditis. Identifying patients with acute disease is

challenging. This review describes the relationship between cocaine
and various cardiovascular diseases, as well as appropriate diagnostic
evaluation and therapies.
 DIABETES Explaining Listening Power What is the
Point normal glucose
With this disease, the body’s blood sugar level is too high because the
level of an adult?
body doesn’t make enough insulin.
 Normal blood glucose level of an adult is 80-120mg/dl
 Random blood sugar level 100-140mg/dl.
Diabetes is treatable, but even when glucose levels are not under control
it greatly increases the risk of heart disease and stroke. That's because
people with diabetes, particularly type 2 diabetes, often have the following
conditions that contribute to their risk for developing cardiovascular disease.
1. HIGH BLOOD PRESSURE
High blood pressure has long been recognized as a major risk factor for
cardiovascular disease. Studies report a positive association between
hypertension and insulin resistance. When patients have both hypertension
and diabetes, which is a common combination, their risk for cardiovascular
disease doubles.

82
 Specific Content Teacher’s Learner’s A.V Aids Evaluation
Objectives Activity Activity

2. ABNORMAL CHOLESTEROL AND HIGH

TRIGLYCERIDE
Patients with diabetes often have unhealthy cholesterol levels
including high LDL ("bad") cholesterol, low HDL ("good") cholesterol,
and high triglycerides. This triad of poor lipid counts often occurs in
patients with premature coronary heart disease. It is also characteristic of
a lipid disorder associated with insulin resistance called atherogenic
Explaining Listening Power
dyslipidemia, or diabetic dyslipidemia in those patients with diabetes.
Point
3. OBESITY
Obesity is a major risk factor for cardiovascular disease and has been
strongly associated with insulin resistance. Weight loss can decrease
cardiovascular risk, decrease insulin concentration and increase insulin
sensitivity. Obesity and insulin resistance also have been associated
with other risk factors, including high blood pressure.
4. LACK OF PHYSICAL ACTIVITY
Physical inactivity is another modifiable major risk factor for insulin
resistance and cardiovascular disease. Exercising and losing weight can
prevent or delay the onset of type 2 diabetes, reduce blood pressure and
help reduce the risk for heart attack and stroke. It's likely that any type
of moderate and/or vigorous intensity, aerobic physical activity whether

83
 Specific Content Teacher’s Learner’s A.V Evaluation
Objectives Activity Activity Aids

sports, household work, gardening or work-related physical activity is

similarly beneficial.
 OBESITY AND CORONARY ARTERY DISEASE
Until recently the relation between obesity and coronary heart disease
was viewed as indirect, i.e., through covariates related to both obesity and Explaining Listening Power
Point
coronary heart disease risk, including hypertension; dyslipidemia,
particularly reductions in HDL cholesterol; and impaired glucose
tolerance or non–insulin-dependent diabetes mellitus. Insulin resistance
and accompanying hyperinsulinemia are typically associated with these co
morbidities. Although most of the co morbidities relating obesity to
coronary artery disease increase as BMI increases, they also relate to body
fat distribution. Long-term longitudinal studies, however, indicate that
obesity as such not only relates to but independently predicts coronary
atherosclerosis. This relation appears to exist for both men and women
with minimal increases in BMI.
In a 14-year prospective study, middle-aged women with a BMI >23 but
<25 had a 50% increase in risk of nonfatal or fatal coronary heart disease,
and men aged 40 to 65 years with a BMI >25 but <29 had a 72%

84
 Specific Content Teacher’s Learner’s A.V Evaluation
Objectives Activity Activity Aids

increased risk..
Explaining Listening Power What is the
 METABOLIC SYNDROME
Point meaning of
Metabolic syndrome is the name for a group of risk factors that metabolic
syndrome?
raises your risk of both CHD and type2 diabetes. If you have three or
more of the five metabolic risk factors, you have metabolic syndrome.
The risk factors are:
 A large waistline (a waist measurement of 35 inches or more for
women and 40 inches or more for men).
 A high triglyceride level (or you’re on medicine to treat high
triglycerides). Triglycerides are a type of fat found in the blood.
 A low HDL cholesterol level (or you're on medicine to treat low HDL
cholesterol). HDL sometimes is called "good" cholesterol. This is
because it helps remove cholesterol from your arteries.
 High blood pressure (or you’re on medicine to treat high blood
pressure).
 A high fasting blood sugar level (or you're on medicine to treat high
blood sugar).

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 UNHEALTHY DIET
An unhealthy diet can raise your risk for CAD. Foods that are high in
saturated and trans fats, cholesterol, sodium (salt) and sugar can
worsen other risk factors of CAD.
II. NON MODIFIABLE RISK FACTORS
Explaining Listening Power What are the
 OLD AGE
Point non
Genetic or life style factors cause plaque to build up in the arteries as modifiable
risk factors of
aging begins. At the time of middle aged or older, enough plaque has
CAD?
built up to cause signs and symptoms. In men, the risk for CAD
increases after age of 45. In women, the risk for CAD increases after the
age of 55.
 GENDER
Men are generally at great risk of coronary artery disease. However,
the risk for women increases after menopause.
 FAMILY HISTORY FOR EARLY HEART DISEASE
The risk for CAD increases if a father or a brother was diagnosed
with CAD before 55 years of age, or if a mother or a sister was
diagnosed with CAD before 65 years of age.

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CLINICAL MANIFESTATIONS
enlist the Explaining Listening Power What are the
 Angina
clinical Point clinical
manifestations The most common symptom of coronary artery disease is angina manifestations
of CAD of CAD?
(also called angina pectoris). Angina is often referred to as chest pain. It
is also described as chest discomfort, heaviness, tightness, pressure,
aching, burning, numbness, fullness, or squeezing. It can be mistaken for
indigestion or heart burn. Angina is usually felt in the chest but may also
felt in the left shoulder, arms, neck, back, or jaw.
Types Of Angina
 Stable Angina:
A type of angina brought on by an imbalance between the heart’s need
for oxygen rich blood and the amount available. It is “stable” which
means the same activities bring it on; it feels the same way each time;
and is relieved by rest and or by oral medications. Stable angina is a
warning sign of heart disease and should be evaluated by a doctor. If the
pattern of angina changes, it may progress to unstable angina.
 Unstable Angina:
This type of angina is considered as an acute coronary syndrome it
may be a new symptom or a change from stable angina. The angina may
occur more frequently, occur more easily at rest, feels more severe, or

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last longer. Although this angina can often be relieved with oral
medications, it is unstable and may progress to a heart attack. Usually
more intense medical treatment or a procedure is required. Unstable
angina is an acute coronary syndrome and should be treated as an
emergency.
 Variant Angina(Also Called Prinzmetal’s Angina ):
Explaining Listening Power What is the
This type of angina is not common and almost always occurs when a point common
symptom of
person is at rest –during sleep. They are at increased risk for coronary
acute myocardial
spasm if they have underlying coronary artery disease, smoke, or use infarction?
stimulants or illicit drugs (such as cocaine). If a coronary artery spasm
is severe and occurs for a long period of time, a heart attack can occur.
 Acute Myocardial Infarction
Myocardial infarction (MI) or acute myocardial infarction (AMI),
commonly known as a heart attack occurs when blood flow stops to
part of the heart causing damage to the heart muscle. The most
common symptom is chest pain or discomfort which may travel into
the shoulder, arm, back, neck, or jaw. Often it is in the center or left
side of the chest and lasts for more than a few minutes.
The discomfort may occasionally feel like heartburn. In some

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patients, coronary artery disease is first diagnosed when they present with the
severe pain and hemodynamic disturbance of acute infarction, usually as a
result of sudden thrombotic occlusion of an atherosclerotic coronary artery.
 Dyspnoea
Dyspnoea, shortness of breath or breathlessness is the feeling or feelings
associated with impaired breathing. Dyspnoea can be due to obstruction to the
flow of air into and out of the lungs. For some patients, dyspnoea is the only
sensation experienced during myocardial ischemia, so-called ‘angina
equivalent’.More often, dyspnoea occurs together with angina – many patients
experience their tightness across the chest both as a pain and as a sense of
restriction in breathing.
 Arrhythmias
Explaining Listening Power What is
Cardiac arrhythmia, also known as cardiac dysrrhythmia or irregular point mean by
arrhythmias?
heartbeat, is a group of conditions in which the heartbeat is irregular, too fast,
or too slow. These arrhythmias are usually detected during the investigation of
a patient with chest pain or dysponea and it is less common form patients to
present with palpation or dizzy spells as the primary symptom.

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Analyze the DIAGNOSTIC INVESTIGATIONS OF CAD

diagnosis of Explaining Listening Power How can it
CAD I. MEDICAL HISTORY point be
diagnosed?
During the medical history, the doctor will focus on areas such as:
Chest pain or other symptoms of heart disease. Your doctor will ask you
to describe your pain. Also, he or she will want to know where the pain
starts and if it spreads to other parts of your body. Your doctor will also
ask when the pain happens. Tell your doctor about other symptoms, such
as nausea, vomiting, shortness of breath, dizziness, fainting, rapid
heartbeat, irregular heartbeat, or skipped heart beat along with chest
pain.

 Personal Health History.

Your doctor will ask questions about your health and lifestyle. He or
she will ask about your cholesterol levels, blood pressure, exercise
habits, stress level, and other areas of your life. Tell your doctor if you
smoke or if you have diabetes or any other health problems.
 Family Medical History
Your doctor will want to know if one or more of your close relatives
have or had early coronary artery disease. Tell your doctor if you have a
family history of heart attack, heart failure, abnormal heart rhythms,

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sudden death, diabetes, high cholesterol, and high blood pressure.

II. PHYSICAL EXAMINATION
The physical examination is usually normal, and is most useful in
providing evidence of alternative diagnoses such as chest wall pain
and other musculoskeletal pains and it helps to rule out other
manifestations.
III. RESTING ELECTROCARDIOGRAM
The ECG is often normal. The ECG may also show changes
suggestive of other diagnoses including pericarditis, LV hypertrophy, Explaining Listening Power Why resting
point electrocardiogram
right heart strain, and atrial fibrillation. does in the
IV. CHESY XRAY diagnosis of
CAD?
This is usually normal, but if there is cardiac failure there may be
increased cardiothoracic ratio and/or pulmonary venous congestion.
V. BLOOD TEST
 Complete Blood Count- to detect any anemia
 Cardiac markers - proteins used to monitor damage to cardiac
tissue, typically cTnI, cTnT, CKMB, and myoglobin.
a. Cardiac troponin T (cTnT) - protein released from
myocardium due to tissue damage (cardiac specific).

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Reference range: below 0.1ng/ml.

Explaining Listening Power point What is the normal
b. Cardiac troponin I (cTnI) - protein released from myocardium
referance range of
due to tissue damage (cardiac specific). Reference range: below cardiac troponin I?
0.07ng/ml.
c. Creatine kinase (CK) - enzyme released from variety of muscle
and other tissues indicating non specific tissue damage.
d. Creatine kinase MB (CKMB) - CK enzyme found in highest
concentration in heart, also in other tissue. Reference range:
below 10ng/ml.
e. Myoglobin - protein released from multiple sources indicating
non specific tissue damage. Reference range: below170ng/ml.
f. LDH – it is most often measured to check for tissue damage. The
protein LDH is in many body tissues especially the heart, liver,
kidney muscles, brain etc.
 Natriuretic Peptides - the two main biomarkers used in the
diagnosis of heart failure are B-type natriuretic peptide (BNP) and its
amino terminal-related fragment NT-proBNP; myocardial stretch
causes elevations of these peptides which are diagnostic and
prognostic in the setting of heart failure.

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 A Lipid Profile including HDL, LDL, triglycerides and glucose

measurements are also routine as they may require management in their
own right.
VI. RADIO ISOTOPE MYOCARDIAL PERFUSION SCANNING
Explaining Listening Power What are the
A myocardial perfusion scan uses a small amount of a radioactive Point uses of
thallium
chemical to see how well blood flows to the muscles of the heart (the
scan?
myocardium). Some doctors call this a “thallium or MIBI” scan. Often this
scan is performed after gentle exercise to see how the heart muscles respond
under stress. Myocardial perfusion scan can be used to find out the cause of
unexplained chest pain brought on by exercise. Test may also be done to:
 Show blood flow patterns to the heart walls.
 See whether the heart (coronary) arteries are blocked and by how
much.
 Determine the extent of injury to the heart.

VII. Coronary Calcification Score

The use of fast electron-beam CT scanning allows non-invasive
calculation of a coronary calcification score, much more accurately than the
old method of fluoroscopy to detect coronary calcification.

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VIII. Stress Echocardiography

This observes changes in regional wall motion and overall LV function
during exercise and/or pharmacological stress.
Follow the
prevention of PREVENTION
CAD You can prevent and control many coronary artery disease (CAD) risk Explaining Listening Power What are the
point preventive
factors with lifestyle changes and medicines. Examples of these controllable measures of
risk factors include high blood cholesterol, high blood pressure, overweight CAD?
and diabetes.
Only a few risk factors such as age, gender and family history can't be
controlled.
To reduce your risk of CAD and heart attack, try to control each risk
factor as you can. The good news is that many lifestyle changes help control
several CAD risk factors at the same time. For example, physical activity
may lower your blood pressure, help control diabetes and prediabetes,
reduce stress, and help control your weight.
o LIFESTYLE CHANGES
A healthy lifestyle can lower the risk of CAD. If you already have CAD,
a healthy lifestyle may prevent it from getting worse. A healthy lifestyle
includes,

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A. Following a healthy diet

B. Being physically active
C. Maintaining a healthy weight
D. Quitting smoking
E. Managing stress

Explaining Listening Power What type of

A. FOLLOWING A HEALTHY DIET
Point diet can be
A healthy diet is an important part of a healthy lifestyle. To lower your risk followed to
prevent
of CAD and heart attack, you and your family should follow a diet that is:
CAD?

i. Low in saturated and trans fats: Saturated fats are found in some
meats, dairy products, chocolate, baked goods, and deep-fried
andprocessed foods. Trans fats are found in some fried and processed
foods. Both types of fat raise your low-density lipoprotein (LDL), or
"bad," cholesterol level.
ii. High in the types of fat found in fish and olive oil: These fats are rich
in omega-3 fatty acids. Omega-3 fatty acids lower your risk of heart
attack, in part by helping prevent blood clots.
iii. High in fiber: Fiber is found in whole grains, fruits, and vegetables.

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A fiber-rich diet not only helps lower your LDL cholesterol level, but
also provides nutrients that may help protect against CAD.
iv. Low in salt and sugar: A low-salt diet can help you manage your
blood pressure. A low-sugar diet can help you prevent weight gain
and control diabetes and prediabetes.
B. Being Physically Active
i. You don't have to be an athlete to lower your risk of CAD. You can
benefit from as little as 30 minutes of moderate-intensity aerobic
activity per day.
ii. For major health benefits, adults should do at least 150 minutes (2.5
Explaining Listening Power How much
hours) of moderate-intensity aerobic activity or 75 minutes (1 hour Point time an
average man
and 15 minutes) of vigorous-intensity aerobic activities like
has to do
swimming, cycling, walking etc for each week. exercise?
iii. Another option is to do a combination of both. A general rule is that
2 minutes of moderate-intensity activity counts the same as 1 minute
of vigorous-intensity activity.
iv. The more active you are, the more you'll benefit. If you're obese, or
if you haven't been active in the past, start physical activity slowly
and

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v. build up the intensity over time.

C. Maintaining Healthy Weight

Explaining Listening Power How will
i. Following a healthy diet and being physically active can help you point you maintain
healthy
maintain a healthy weight. Controlling your weight helps you to
weight?
control CAD risk factors.
ii. If you're overweight or obese, try to lose weight. Eat smaller
portions and choose lower calorie foods. Don't feel that you have to
finish the entrees served at the restaurants. Many restaurant portions
are oversized and have too many calories for an average person.
iii. For overweight children and teens, slowing the rate of weight of just
5 to 10 percent of your current weight can lower your risk of
CAD.To lose weight, as well as for diabetic patients should reduce
your calorie intake and take high fiber rich diet.
iv. Avoid the use of junk foods (Pizza, Pepsi etc), fast foods and high fat
containing diet.

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D. QUITTING SMOKING Explaining Listening Power What is

point passive
i. If you smoke, quit. Smoking can raise your risk of CAD and heart smoking?
attack and worsen other CAD risk factors. Talk with your doctor
about programs and products that can help you quit smoking. Also,
try to avoid secondhand smoke, i.e.; passive smoking.
ii. You can help your children avoid smoking or quit smoking. Talk
with them about the health effects of smoking. Teach them how to
handle peer pressure to smoke.
METHODS OF QUITTING SMOKING
Nicotine Replacement Therapy:
It is one of the important methods to quit from smoking. Nicotine
replacement therapy uses products that supply low doses of nicotine. These
products do not contain the toxins found in smoke. The goal of therapy is to
cut down on cravings for nicotine and ease the symptoms of nicotine
withdrawal. Nicotine replacement therapy is more helpful for people who
smoke more than 15 cigarettes a day. It is not yet proven to help people who
smoke fewer than 10 cigarettes per day.
Facts about using nicotine replacement therapy:
 You have 10 times higher chance of quitting permanently if you do
not

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cheat on the first day of use. The more cigarettes you smoke,
the higher the dose you may need to start.
 Adding a counseling program will make you more likely to
quit.
 Do not smoke while using nicotine replacement. It can cause
nicotine to build up to toxic levels.
 Nicotine replacement helps prevent weight gain while you are
using it. You may still gain weight when you stop all nicotine
use.
 The dose of nicotine should be slowly decreased.
TYPES OF NICOTINE REPLACEMENT THERAPY
Nicotine supplements come in many forms: Explaining Listening Power What are the
point types of
 Gum nicotine
 InhalersLozenges replacement
therapy?
 Nasal spray
 Skin patch
All of these work well if they are used correctly. People
are more likely to use the gum and patches correctly than
other

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forms.
Nicotine Patch
Explaining Listening Power How we want
 All nicotine patches are placed and used in similar ways: point to use the
nicotine
 A single patch is worn each day. It is replaced after 24 hours. patch?
 Place the patch on different areas above the waist and below the
neck each day.
 Put the patch on a hairless spot.
 People who wear the patches for 24 hours will have fewer
withdrawal symptoms.
 People who smoke fewer than 10 cigarettes per day should start with
a lower dose patch (for example, 14 mg).
Nicotine Gum Or Lozenge
You can buy nicotine gum or lozenges without a prescription. Some people
prefer lozenges on the patch, because they can control the nicotine dose Tips
For Using The Gum:
 If you are just starting to quit, chew 1 - 2 pieces each hour. Do not
chew more than 20 pieces a day.
 Chew the gum slowly until it develops a peppery taste. Then, tuck it
between the gum and cheek and store it there. This lets the nicotine
be absorbed.

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 Wait at least 15 minutes after drinking coffee, tea, soft drinks, and
acidic beverages before chewing a piece of gum.
 People who smoke more than 25 cigarettes per day have better
results with the 4 mg dose than with the 2 mg dose.
Nicotine Inhaler Explaining Listening Power How we have
point to use nicotine
 The nicotine inhaler looks like a plastic cigarette holder. It requires inhaler?
a prescription in the United States.
 Insert nicotine cartridges into the inhaler and "puff" for about 20
minutes. Do this up to 16 times a day.
 The inhaler is quick-acting. It takes about the same time as the gum
to act. It is faster than the 2 - 4 hours it takes for the patch to work.
 Most of the nicotine vapor does not go into the airways of the lung.
Some people have mouth or throat irritation and cough with the
inhaler
It can help to use the inhaler and patch together when quitting.
Nicotine Nasal Spray
The nasal spray provides a quick dose of nicotine to satisfy a craving
you are unable to ignore. Levels of nicotine peak within 5-10 minutes
afterusing spray.

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 It may be used along with the patch.

 The spray can irritate the nose, eyes, and throat. These side effects
often go away in a few days.
Side Effects And Risks:- Explaining Listening Power What are the
All nicotine products may cause side effects. Symptoms are more likely point side effects of
nicotine
when you use very high doses. Reducing the dose can prevent these replacement
symptoms. therapy?
Side effects include:
 Headaches
 Nausea and other digestive problems
 Problems getting to sleep in the first few days, most often with
the patch. This problem usually passes.
E. MANAGING STRESS
Learning how to manage stress, relax, and cope with problems can
improve your emotional and physical health. Having supportive people in
your life with whom you can share your feelings or concerns can help
relieve stress
 Organize Yourself:
Take better control of the way you're spending your time and

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energy so you can handle stress more effectively.

 Control Your Environment by controlling who and what is
surrounding you:
In this way, you can either get rid of stress or get support for
yourself. Explaining Listening Power
Point
 Love yourself by giving yourself positive feedback:
Remember, you are a unique individual who is doing the best you
can.
 Reward yourself by planning leisure activities into your life:
It really helps to have something to look forward to.
 Exercise your bdy since your heart and lungs regularly, a minimum
of three days per weekfor 15-30 minutes. This includes such
activities as walking, jogging, cycling, swimming, aerobic etc
 Relax yourself by taking your mind off your stress and
concentrating on breathing and positive thoughts.
Dreaming counts,along with medication,progreesive
relaxation,exercise,listening to relaxing music, communicating with
and loved ones, etc.

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 Rest yourself as regularly as possible. Explaining Listening Power

Point
Sleep 7-8 hours a night. Take study breaks. There is only so much
your mind can absorb at one time. It needs time to process and
integrate information. A general rule of thumb: take a ten minute
break every hour. Rest your eyes as well as your mind
 Be Aware of Yourself.
Be aware of distress signals such as insomnia, headaches, anxiety,
upset stomach, lack of concentration, colds/flu, excessive tiredness,
etc. Remember, these can be signs of potentially more serious
disorders (i.e., ulcers, hypertension and heart disease).
 Feed Yourself / Do Not Poison Your Body.
Eat a balanced diet. Avoid high calorie foods that are high in fats
and sugar. Don't depend on drugs and/or alcohol. Caffeine will keep
you awake, but it also makes it harder for some to concentrate.
Remember, a twenty minute walk has been proven to be a better
tranquilizer than some prescription drugs.
 Enjoy Yourself.
It has been shown that happier people tend to live longer, have less
physical problems, and are more productive. Look for the humor in
Life when things don’t make sense. Remember , you are

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very special and deserve only the best treatment from yourself.
Explaining Listening Power What are the
MANAGEMENT
enumerate point drugs used in
managemet Drug management the
of CAD management
Various drugs can be used to treat coronary artery disease, including:
of CAD?
 Cholesterol-modifying medications: By decreasing the amount of
cholesterol in the blood, especially low-density lipoprotein (LDL, or
the "bad") cholesterol, these drugs decrease the primary material that
deposits on the coronary arteries.Your doctor can choose from a
range of medications, including statins, niacin, fibrates and bile acid
sequestrants.
 Aspirin: Your doctor may recommend taking a daily aspirin or other
blood thinner. This can reduce the tendency of your blood to clot,
which may help prevent obstruction of your coronary arteries. If
you've had a heart attack, aspirin can help prevent future attacks. There
are some cases where aspirin isn't appropriate, such as if you have a
bleeding disorder or you're already taking another blood thinner, so
ask your doctor before starting to take aspirin.
 Beta blockers: These drugs slow your heart rate and decrease your
blood pressure, which decreases your heart's demand for oxygen. If
you've had a heart attack, beta blockers reduce the risk of future

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attacks. Explaining Listening Power

point
 Nitroglycerin: Nitroglycerin tablets, sprays and patches can control
chest pain by opening up your coronary arteries and reducing your
heart's demand for blood.
 Angiotensin-converting enzyme (ACE) inhibitors and angiotensin
II receptor blockers (ARBs): These similar drugs decrease blood
pressure and may help prevent progression of coronary artery disease.
If you've had a heart attack, ACE inhibitors reduce the risk of future
attacks and all the mediations have to be taken regularly.

SURGICAL MANAGEMENT
 Angioplasty and stent placement (percutaneous coronary
revascularization): Your doctor inserts a long, thin tube (catheter)
into the narrowed part of your artery. A wire with a deflated balloon is
passed through the catheter to the narrowed area. The balloon is then
inflated, compressing the deposits against your artery walls. A stent is
often left in the artery to help keep the artery open. Some stents
slowly release medication to help keep the artery open.

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 Coronary Artery Bypass Surgery.

A surgeon creates a graft to bypass blocked coronary arteries using
a vessel from another part of your body. This allows blood to follow
around the blocked or narrowed coronary artery. Because this requires
open-heart surgery, its most often reserved for cases of mulitple
narrowed coronary arteries.
Explaining Listening Power point What are the
prevent COMPLICATIONS complication
complicatio- of CAD?
Coronary artery disease (CAD) is impaired blood flow in your
ns of CAD
coronary arteries. These arteries supply blood to the heart. When blood flow
the heart is reduced, the heart is not able to to its job as well as it should.
This can lead to following major complications.
 CARDIAC FAILURE
The triad of dyspnoea, fatigue and dependent edema suggests overt
cardiac failure. In industrialized countries, coronary atherosclerosis is
the commonest cause of cardiac failure.
 SUDDEN DEATH
It is now recognized that in a proportion of patients the first major
complication of coronary artery disease is sudden collapse and death, due to
acute myocardial infarction and/or ventricular arrhythmias. The absence of

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premonitory symptoms emphasizes the need for a population approach to

primary prevention
CONCLUSION
As coronary artery disease is growing as significant problem in
developing countries, prevention is most effective measure to combat this
killer. Thus identifying knowledge regarding preventive measures has almost
importance to bring change in health behavior of patients.
If stress the need for health workers to put efforts in planning and
conducting educational programme to enhance awareness of general
population regarding modifiable risk factors of disease. Also, people should
be encouraged to bring out health behavior changes as early as possible in
order to promote healthy heart.

REFERENCES:

1. Population nutrient intake goals for preventing diet related chronic diseases.”WHO.
2. http://www.nhlbi.nih.gov/health/healthtopics/topics/hbc/
3. http://www.healthline.com/health/coronary-artery-disease/risk factors#controllableriskfactors.

4. http://my.clevelandclinic.org/services/heart/disorders/coronary-artery-disease/cadsysymptoms

5. http://www.healthline.com /health/coronary-artery –disease/complications.

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S\p_‘n®p≈ k¶o¿ÆXIfpw, Xmfw sX‰n® lrZb
anSn∏pw Bbncn°pw.
{i≤n®p
l r Z b Ø n s ‚ lrZbØns‚ LS\bpw {]h¿Ø\hpw hnhcn°pI ]h¿ t]mbn‚ v lrZbØns‚
sIm≠ncn°pI
LS\bpw {]h¿ {]mb]q¿Ønbmb Hcp a\pjy lrZbØn\v Npcp´n {]h¿Ø\w
Ø\hpw Hch ∏nSn® apjvSnbpsS hen∏ap≠v. CXv s\©ns‚ CSXp hnhcn°pI
temI\w hiØv izmktImiØn\v ap≥]nembpw ÿnXnsNøp∂p.
km[mcW lrZbanSn∏v 60˛80 _o‰vkv/an\n‰mWv. \mev
AdIfp≈ Hcp ]ºpt]msebmWv lrZbw cq]I¬∏\
sNbvXncn°p∂Xv. CSXv heXv sh≥{Sn°nƒkv, CSXv
heXv F{Snbw F∂nßs\ \mev AdIƒ D≠v .
lrZbØns‚ ta¬ AdIsf F{Snbw F∂pw Iogv Ad
Isf sh≥{Sn°n¬ F∂pw hnfn°p∂p. lrZbØn¬ \mev
hm¬hpIƒ IqSnbp≠v. heXv F{SnbØn\pw heXv sh≥
{Sn°nfnepw CSbnep≈ hm¬hmWv. ss{SIkv]nUv heXv
sh≥{Sn°nfn\pw ]ƒadn [a\n°pw CSbnep≈ hm¬

110
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
hmWv ssa{S¬hm¬hv. Atbm¿´°pw CSXv sh≥{Sn°n
fn\pw CSbnep≈ hm¬hmWv Atbm¿SnIv hm¬hv.
Atbm´ icocØns‚ hnhn[ `mKßfnte°v ip≤c‡w
FØn°p∂ [a\nbmWv.
AtXkabw icocØns‚ At[m`mKØp \n∂pw
C≥^ocnb¿ hn\mImhbpw intcm`mKØp \n∂v kp∏o
cnb¿ hn\mImhbpw Aip≤c‡w tiJcn®v lrZbØn
te°v FØn°p∂p. Aip≤c‡w izmktImißfn¬
FØn°p∂Xv ]ƒa\n B¿´dnbw ip≤ c‡w izmktIm
ißfn¬ \n∂v lrZbØnte°v FØn°p∂Xv ]ƒa\dn
shbn\pamWv. lrZbt]inIƒ°v ip≤c‡w \¬Ip∂Xv
sImtdmWdn [a\nbpw Aip≤c‡w tiJcn°p∂Xv
sImtdmWdn kncbpamWv. icocØns‚ F√m `mKßfn
te°pw c‡w FØn°pI F∂XmWv lrZbØns‚
[¿Ωw.
\n¿ΔN\w hnhcn°pI {i≤n®p ]h¿ t]mbn‚ v 2 tImtdmWdn
B¿ lrZb[a\n
lrZb[a\n tcmKw (CAD) F∂m¬ CkvInanIv sIm≠ncn°pI
CAD s‚ A¿∞w tcmKw CAD
lrZb tcmKw (IHD)AØntdmkv ¢ ntdm´nIv lrZb
a\knem°pI
tcmKsa∂pw AØntdmkv¢ntdm´nIv Im¿Untbmhmkv
Iem¿ tcmKsa∂pw Adnbs∏Sp∂p. sImtdmWdn B¿´dn
Unkokv F∂m¬ B≥P\ s]IvtSmdnkv, AØntdmkv
¢ntdmknkv, atbmIm¿Unb¬ C≥{^m£≥ F∂o tcmK
ßfpsS Iq´amWv. CXv s]s´∂p≈ acWØnte°v \bn
°pIbpw sNøp∂p.
A]ISLSI߃ {i≤n®p ]h¿ t]mbn‚ v CAD s‚ XncpØm\m
hnhcn°pI
tImtdmWdn B¿´dn tcmKØn\v hy‡ambn \n¿ sIm≠ncn°pI ImØ B]¬LSI
߃ GsX√mw
Æbn°s∏´n´p≈ ]e hnja LSIßfpap≠v. apJyambn

111
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
Chsb c≠mbn Xcw Xncn®ncn°p∂p.
1.am‰w hcpØmhp∂ B]XvLSI߃
c‡Ønse A\mtcmKyIcamb sImgp∏v.
CXn¬ Db¿∂ Afhn¬ Xmgv∂ km{μXbp≈
sImgp∏v (NoØ sImgp∏pw) Ipd™ Afhn¬ km{μX
IqSnb sImgp∏pw AYhm \√sImgp∏pw ASßnbncn
°p∂p.
\√sImgp∏v (HDL) 60 mg/dl \v apIfnepw NoØ
sImgp∏v (LDL) 100 mg/dl \v Xmgv∂pw Ccn°p∂XmWv
BtcmKy{]Zw. c‡Øn¬ sImgp∏ns‚ Afhv Db¿∂
tXmXn¬ ImWs∏Sp∂ Ahÿbv°v ]dbp∂t]cmWv
A[nI c‡s°mgp∏v. NoØs°mgp∏ns‚ Afhv c‡
Øn¬ IqSnbncn°ptºmƒ lrt{Zmlkm≤yX IqSpX
emWv. AtXkabw \√ sImgp∏ns‚ Afhv c‡Øn¬
IqSnbncn°ptºmƒ lrt{ZmK km≤yX Ipdbp∂p. hnhcn°pI {i≤n®p ]h¿ t]mbn‚ v AØntdmk¢otdmknkv
sIm≠ncn°pI F∂mse¥v?
lrZb[a\nIfn¬ tπKv ASn™pIqSp∂ Ahÿ
bv°v ]dbp∂ t]cmWv lrZb[a\n tcmKw. c‡Øn¬
ASßnbncn°p∂ Im’yw, sImgp∏v apXemb LSI߃
ASßnb hgphgp∏p≈ Hcp ]Zm¿∞amWv tπIv. B´dn
bn¬ tπIv ASn™pIqSp∂ Ahÿbv°v ]dbp∂
t]cmWv AØntdmkv ¢ntdmknkv.
 Db¿∂ c‡kΩ¿±w : 140/90 mmhg epw IqSpXembn
Hcp Imebfhnte°v c‡kΩ¿±w ImWs∏Sp∂
Ahÿbv°v Db¿∂ c‡kΩ¿±w F∂p ]dbp∂p. Hcp
hy‡n°v {]talhpw, hr°tcmKhpw Ds≠¶n¬ c‡k
Ω¿±w 130/80 mmhg ¬ IqSpXemsW¶n¬ Db¿∂ c‡
kΩ¿±ambn IW°m°p∂p. Db¿∂ c‡kΩ¿±w

112
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
lrZb[a\nIfpsS kt¶mNØn\pw ZrVXbv°pw ImcW
{i≤n®p
amhpIbpw Cu {]{Inb lrZbØns‚ tPmen`mcw h¿≤n hnhcn°pI sIm≠ncn°pI ]h¿ t]mbn‚ v
∏n°pIbpw sNøp∂p. Hcp hy‡nbpsS c‡kΩ¿±w
km[mcWbmbn 120/80 mmhg bntem AXn¬ Ipdthm
Bbncn°Ww.
]pIhen, aZy]m\w, ab°pacp∂v D]tbmKw
 c‡°pgepIfpsS kt¶mNØn\pw, ZrUXbv°pw
ImcWamIp∂Xn\m¬ A\mtcmKyIcamb sImgp∏ns‚
Afhv h¿≤n°pIbpw c‡kΩ¿±w Dbcp∂Xn\pw,
]pIhen ImcWamIp∂p. tImißfnte°v FØs∏Sp∂
HmIvknPs‚ Afhv Ipdbp∂Xn\pw CXv ImcWamIp∂p.
]pIhen
]pIbnebn¬ ASßnbncn°p∂ sskss\Uv,
s_≥kn≥, t^m¿amensslUv, sa≥t¥mƒ, Aknss‰¬,
Sm¿, Im¿_¨ tamtWmIvsskUv, Kymkv, AtamWnb
F∂o cmkhkvXp°ƒ c‡tImißsf \in∏n°p∂p.
Chbv°v lrZbØns‚ {]h¿Ø\w XIcmdnem°m\pw
c‡°pgepIfpsS LS\bnepw {]h¿Ø\Ønepw am‰w
hcpØphm\pw Ignbpw. CXv AØntdmkv¢ntdmknkv
D≠m°m\p≈ km[yX h¿≤n∏n°pw. Imem¥cØn¬
tπ‰v I´nbmIpIbpw c‡°pgepIƒ Npcpßp∂Xn\v
ImcWamIpIbpw sNøpw. HmIvknP≥ kºpjvSamb
c‡w icocØns‚ CXc`mKßfn¬ FØnt®cp∂Xn\v
CXv ImcWamIp∂p.
 aZy]m\w
AanX aZy]m\nIƒ°v lrZb[a\n tcmKw
hcphm\p≈ km≤yX IqSpXemWv.

113
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
 ab°pacp∂v D]tbmKw D]hmkØn¬
{i≤n®p
sImss°bn≥ t]mep≈ ab°pacp∂pIfpsS hnhcn°pI sIm≠ncn°pI ]h¿ t]mbn‚ v km[mcW c‡
D]tbmKw ]ehn[amIp∂ lrZb[a\n tcmK߃°v Ønse ]©km
ImcWamIp∂p. DZmlcWØn\v lrZbkv X w`\w, cbpsS Afhv
atbmIm¿Unb¬ C≥^£≥, AcnØvanbmkv, F{X
Im¿Untbmatbm∏Xokv , Atbm´nIv UnkIv j ≥
Chsb√mw ab°pacp∂ns‚ D]tbmKhpw ]ehn[
amIp∂ lrZb[a\n tcmKßfpw XΩnep≈ _‘sØ
hnhcn°p∂p.
{]talw
Cu tcmKmhÿbn¬ c‡Ønse ]©kmc
bpsS Afhv IqSp∂Xv icocØn\mhiyamb C≥kpen≥
icocØn¬ D≠m°mØXpsIm≠mWv.
 {]mb]q¿Ønbmb a\pjys‚ icocØnse
km[mcW •qt°mkns‚ Afhv 80˛120 mg/dl BWv.
 dm≥Uw ªUvjpK¿ seh¬ 100˛140 mg/dl BWv.
{]talw NnIn’mhnt[bamWv. F∂m¬ •qt°mkv
seh¬ \nb{¥WmXoXambm¬ AXv lrt{Zml
km≤yX h¿≤n∏n°p∂p. c≠mw Xcw {]talw
Xmsg∏dbp∂ tcmKßtfmSv IqSnt®cptºmƒ lrt{ZmKw
hcphm\p≈ km≤yX h¿≤n∏n°p∂p.
1. Db¿∂ c‡kΩ¿±w
hfsc ap≥]pXs∂ Db¿∂ c‡kΩ¿±w
lrt{ZmKØn\p≈ apJyImcWambn Xncn®dn™n´p≠v.
C≥kpen≥ dknÃ≥kv, Db¿∂ c‡kΩ¿±w Ch XΩn
ep≈ {InbmflIamb _‘sØ°pdn®v ]T\߃ sh
fns∏SpØp∂p≠v. Hcp hy‡nbn¬ Db¿∂ c‡kΩ¿±

114
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
hpw Ub_‰okpw Hcpan®v hcptºmƒ AXv lrt{ZmKw hnhcn°pI {i≤n®p ]h¿ t]mbn‚ v
hcphm\p≈ km≤yX Cc´n∏n°p∂p. sIm≠ncn°pI
2. Ak¥penXsImgp∏pw Db¿∂ ss{S•nkssdUpw
{]taltcmKnIfn¬ km[mcWbmbn Db¿∂
NoØs°mgp∏pw Xmgv∂ \√ sImgp∏pw Db¿∂ ss{S•n
kssdUv ASßnb A\mtcmKyIcamb sImgp∏ns‚
Afhv Db¿∂ tXmXn¬ ImWs∏Sp∂p. {]mcw`Znibn
ep≈ lrt{ZmKnIfn¬ Cu aq∂v A\mtcmKyIcamb sIm
gp∏pIfpw ImWs∏Sp∂p. {]taltcmKnIfn¬ sIm
gp∏ns‚ Ak¥penXmhÿbpw C≥kpen≥ {]Xn
tcm[hpw Iq´nt®¿∂p≠mIp∂ tcmKmh ÿbmWv AØn
tdmP\nIv Unkven∏nUoanb AYhm Ub_‰nIv Unkv
en∏nUoanb.
3. AanXhÆw
AanXhÆw lrt{ZmKØn\p≈ apJyImcW
ßfn¬ H∂mWv. AXv C≥kpen≥ {]Xntcm[hpambn
At`Zyambn _‘s∏´ncn°p∂p. icoc`mcw Ipdbp∂Xv
lrt{ZmK km≤yX Ipd°p∂tXmsSm∏w C≥kpens‚
km{μX Ipdbv°pIbpw C≥kpens‚ {]h¿Ø\£aX
Iq´pIbpw sNøp∂p. AanXhÆhpw C≥kpen≥ {]Xn
tcm[hpw Db¿∂ c‡kΩ¿±w t]mep≈ LSIßfp
ambn tbmPn®p \n¬°p∂p.
4. hymbmaØns‚ A`mhw
hymbma°pdhv lrt{ZmKØn\pw C≥kpen≥ {]Xn
tcm[Øn\pw ImcWamIp∂ hyXnbm\w hcpØmhp∂
LSIßfn¬ apJyamb H∂mWv. hymbmahpw icoc`mcw
Ipdbp∂Xpw ss‰∏v _n {]talsØ {]Xntcm[n°pIbpw,

115
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
AI‰n\n¿ØpIbpw c‡kΩ¿±w Ipd°pIbpw
{i≤n®p
AXpaqew lrt{ZmlsØ XSbpIbpw sNøp∂p. hnhcn°pI sIm≠ncn°pI ]h¿ t]mbn‚ v
hymbmasØt∏mse Xs∂ GXp XcØnep≈ anXam
btXm Xo{hambtXm Bb imcocnI Ne\ßtfm, Km¿
lnI tPmenItfm, Im¿jnItheItfm, tPmen kw_
‘amb imcocnI A≤zm\tam CtXXcØn¬ {]tbm
P\{]ZamWv.
AanXhÆhpw lrt{ZmKhpw
CXphtc°pw AanXhÆhpw lrt{ZmKhpw
XΩn¬ Hcp _‘hpan√ F∂mWv IcpXnbncp∂Xv.
F∂m¬ Chbn¬ H∂v apJm¥ncw ]cnWma hyXnbm
\Øm¬ tcmKkm≤yX hfsc IqSpXemWv. C≥kpen≥
{]Xntcm[hpw AXns\ ]n≥XpS¿∂p hcp∂ ssl∏¿
C≥kpenanb tcmKhpw apIfn¬ ]cma¿in°s∏´
tcmKßfpw ]ckv]c]qcIßfmWv. F¶nepw AanX
hÆØn\pw lrt{ZmKØn\pw ImcWamIp∂ an°
klImcWßfpw _n Fw sF IqSp∂Xn\\pkcn®v
IqSpIbpw AXv icocØnse sImgp∏ns‚ hnXcW
hpambn _‘s∏´pw Ccn°p∂p. At\I \mfpIfmbp≈
]T\w kqNn∏n°p∂Xv AanXhÆw lrt{ZmKßfnte°v
\bn°pI am{Xa√ kz¥ambn AØnkv¢ntdmknkv
ap≥Iq´n Adnbn°pIbpw sNøp∂p. Cu _‘w
kv{Xo]pcpj∑mcn¬ shfns∏Sp∂ BMI hyXnbm\w
hy‡am°p∂p. ]Xn\meph¿jsØ ]ptcmKa\amb
]T\Øn¬ BMI 23 ¬ IqSpXepw 25 ¬Ipdhpap≈ a≤y
hbkv I cmb kv { XoIfn¬ lrt{ZmKw hcphm\p≈
km≤yX 50% hpw 40˛65 hb n\p≈nep≈ ]pcpj∑mcn¬

116
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
BM1 25 ¬ IqSpXepw 29¬ Ipdhpw Bbh¿°v 72%
lrt{ZmKkm≤yX IW°m°p∂p.
{i≤n®p
 ] c n W m a t c m K e £ W s s h I e y w (Metabolic hnhcn°pI sIm≠ncn°pI ]h¿ t]mbn‚ v ]cnWmatcmK
Syndrome) e£WsshIeyw
F∂m¬ F¥v?
ssS∏v 2 ˛ {]talhpw lrt{ZmKhpw hcm\p≈ km≤yX
Iƒ h¿≤n∏n°p∂ Hcp Iq´w B]¬LSI ImcWßsf
]dbp∂ t]cmWv sa‰mt_mfnIv kn≥t{Umw. Hcp
hy‡n°v A©n¬ aq∂v sa‰mt_mfnIv B]¬LSI߃
Ds≠¶n¬ B hy‡n°v sa‰mt_mfnIv kn≥t{Umw
Ds≠∂p ]dbmw. B ImcW߃ Xmsg∏dbp∂p.
1. AanX AchÆw, kv{XoIfn¬ 35\pw ]pcpj∑mcn¬
40\p apIfnep≈ AchÆw .
2. Db¿∂ ss{S•nkssdUv tXmXv (Db¿∂ ss{S•n
kssdUv Ipdbv°p∂Xn\v acp∂v D]tbmKn°p∂h¿)
ss{S•nkssdUv F∂m¬ c‡Øn¬ I≠phcp∂ Hcp
{]tXyIXcw sImgp∏mWv.
3. Xmgv∂ \nebnep≈ \√ sImgp∏ns‚ Afhv (Xmgv∂
\nebnep≈ \√ sImgp∏v Db¿Øm≥ acp∂v Ign°p∂
hy‡n). HDL sImgp∏ns\ \√ sImgp∏v F∂v hnfn°
s∏Sp∂p Fs¥∂m¬ CXv NoØ sImgp∏ns\ [a\n
Ifn¬ \n∂pw ZqcoIcn°phm≥ klmbn°p∂p.
4. AanXc‡kΩ¿±w (AanXc‡kΩ¿±Øn\v acp∂v
Ign°p∂ hy‡n).
5. D]hmkØn¬ c‡Øn¬ Db¿∂ ]©kmcbpsS
Afhv ({]talØn\v acp∂v Ign°p∂ hy‡n).

117
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
 A\mtcmKy`£W{Iaw
A\mtcmKyIcamb `£W{Iaw lrt{ZmKsØ
£Wn®p hcpØpw. ]qcnXsImgp∏v, hyXnbm\w hcp
Øp∂ sImgp∏v, sImfkvt{Smƒ, D∏v, ]©kmc F∂nh
A[nIambn ASßnbn´p≈ `£W]Zm¿∞ßfpsS
D]tbmKw lrt{ZmKw hcphm\p≈ km≤yXsb hnfn®p
hcpØp∂p. {i≤n®p
hnhcn°pI sIm≠ncn°pI ]h¿ t]mbn‚ v am‰w hcpØm≥
2 hyXnbm\w hcpØm≥ ]‰mØ B]XvLSI߃ ]‰mØ lrZb[a\n
 hm¿≤Iyw tcmKØns‚
hm¿≤IytØmSv ASp°ptºmƒ PohnXNcy B]Øv LSI߃
Ifmepw ]mcºcyImcWßfmepw tπIv [a\nIfn¬ GsX√mw?
ASn™p IqSp∂p. a≤yhbknepw, hm¿≤IyØnepap≈
hy‡nIfn¬ BhiyØn\v tπIv [a\nIfn¬ ASn™p
IqSn tcmKe£W߃ {]ISn∏n°p∂p. 45 hb n\v
apIfnep≈ ]pcpj∑m¿°pw 55 hb n\v apIfnep≈
kv{XoIƒ°pw lrt{ZmKw hcm\p≈ km≤yX IqSpX
emWv.
enwKw
km[mcWKXnbn¬ lrt{ZmKw hcm\p≈ km≤yX
]pcpj∑mcn¬ hfsc IqSpXemWv. F¶nepw B¿Øhhn
cmaØn\v tijw kv { XoIfn¬ lrt{ZmKkm≤yX
h¿≤n°p∂p.
IpSpw_]mcºcyw ˛ sNdp∏Ønse lrt{ZmlImcWw.
]nXmhnt\m ktlmZct\m 55 hb n\v ap≥]v
I≠p]nSn°s∏Sp∂ lrt{ZmKtam amXmhn\pw
ktlmZcn°pw 65 hb n\v ap≥]v I≠p]nSn°s∏Sp∂
lrt{ZmKßtfm lrt{ZmKw hcm\p≈ km≤yX
h¿≤n∏n°p∂p.

118
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
tcmKe£W߃ hnhcn°pI {i≤n®p ]h¿ t]mbn‚ v lrZb[a\n
sIm≠ncn°pI tcmKØns‚
1. s\©pthZ\
tcmKe£W߃
s\©pthZ\bmWv lrt{ZmKØns‚ apJy GsX√mw?
e£Ww. (B©\s]Ivs‰mdnkv) B©\sb an°
t∏mgpw s\©p thZ\sb∂v ]cma¿in°s∏Sp∂p.
CXns\ s\©nse AkzÿX, `mcw, hen®n¬,
kΩ¿±w, thZ\, Fcn®n¬, achn∏v, \ndhv, sRcp°w
F∂nhbmbn hnhcn°s∏Smdp≠v. CXv Zl\t°tSm
s\s©cn®ntem Bbn sX‰n≤cn°s∏Smdp≠v. Bs©
bn\ km[mcWbmbn s\©nemWv A\p`h s∏Sp∂Xv.
F¶nepw CSXv tXmƒ, ssIIƒ, IgpØv, ]pdw As√
¶n¬ XmSn ChnsSbpw IqSn A\p`hs∏Smdp≠v.
hnhn[Xcw As©bn\
 ÿncXbp≈ As©bn\ (Stable Angina)
lrZbØn\mhiyamb HmIvknP≥ kar≤amb
c‡hpw, e`yambp≈ c‡Øns‚ Afhpw XΩnep≈
k¥pe\w \jvSs∏Sptºmgp≠mIp∂ thZ\bmWnXv.
CXns\ ÿncXbp≈Xv F∂v hnfn°m≥ ImcWw Cu
{]n{Inb Bh¿Øn®p hcp∂Xp sIm≠mWv . CXv
Ft∏mgpw Htc coXnbn¬ A\p`hs∏Sp∂p. CXv hn{ia
Ømtem acp∂n\mtem amdp∂p. ÿncXbp≈ s\©p
thZ\ lrt{ZmKØns‚ Hcp ap∂dnbn∏mWv. CXv Hcp
tUmIvSdpsS klmbw tXtS≠ AhÿbmIp∂p.
s\©pthZ\bpsS coXn amdpIbmsW¶n¬ AXv
Aÿncs\©pthZ\bmbn cq]m¥cw {]m]nt®°mw.

119
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
 Aÿnc s\©pthZ\ (UnStable Angina)
Cu hn[ap≈ s\©pthZ\sb AIyq´v sImdm
Wdn kn≥{Uw F∂p ]dbp∂ ]pXpe£W ambpw
AYhm ÿncs\©pthZ\bn¬ \n∂p≈ Hcp hyXn
bm\ambpw IW°m°s∏Sp∂p. CXv CSbv°nS bv°v
D≠mhpIbpw, IqSpXembpw AXnITn\ambn A\p`
hs∏Sp∂Xv hn{iathfIfnepw, Ipsd t\ctØ°v
\o≠p \n¬°p∂Xpw BIp∂p. CXv acp∂n\m¬ Ipd
bp∂Xpw, CXv ÿncXbn√mØXn\m¬ lrZb
LmXØnte°v hyXnNen°mhp∂XpamWv. Ft∏mgpw
AXymlnX sshZy klmbw A\nhmcyamWv.
 thcnb‚ v B≥Pn\ (Variant Angina)({]n≥kv s a‰¬kv
B≥Pn\)
CXv AXy]q¿ΔambXpw, D≠mIp∂Xv hn{ima
thfIfnepw {]tXyIn®v Dd°kabØpw Bbncn°pw.
ab°pacp∂v, ]pIhen apXemb Zp»oeap≈h¿°pw
[a\otcmK߃ D≈h¿°pw lrZbt]iohenhv D≠m
Iphm\p≈ km≤yX hfsc IqSpXemWv. lrZb [\an
IfpsS hen®n¬ Zo¿Lt\cw ITn\ambn A\p`
hs∏´m¬ AXv lrZbkvXw`\Ønte°p≈ hgnØn
cnhmIpw.
2. AIyq´v atbmIm¿Unb¬ C≥{^m£≥ {i≤n®p
hnhcn°pI AIyq´v
sIm≠ncn°pI ]h¿ t]mbn‚ v
AIyq´v atbmIm¿Unb¬ C≥{^m£≥ F∂m¬ atbmIm¿Unb¬
lrZbkvXw`\w F∂v Adnbs∏Sp∂p. lrZbt]inI C≥{^m£s‚
fnte°p≈ c‡{]hmlw XS s∏SpItbm \nebv°p km[mcW
Itbm sNøptºmƒ lrZbt]inIfnse tImi߃ e£W߃
Fs¥√mw?
\in°pIbpw lrZbw \nebv ° pIbpw sNøp∂

120
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
AhÿbmWnXv . apJye£Wsa∂m¬ ssIIfn
te°pw tXmfnte°pw ]Scp∂ s\©pthZbmWv.
3. izmkwap´v
izmkXS w, izk\Øn\p≠mIp∂ _p≤nap´v
Chbp ambn _‘s∏´Xns\ Unkv \ nb AYhm
izmkwap´v F∂p ]dbp∂p. izmktImiØn¬ izk\
Øn\pw D®izk\Øn\pw XS w D≠mIp∂Xp sIm
≠mWv Unkv\nb D≠mIp∂Xv. IqSpXembpw Unkv
\nb s\©pthZ\bvs°m∏w D≠mImdp≠v, Nne¿°p
s\©n\v IpdpsI hen®nepw izmkXS hpambn
A\p`hs∏Sp∂p.
4. AcnØvanbmkv
Im¿UnbmIv AcnØvanb, Im¿UnbmIv Unkv
AcnØoanb AYhm {IamXoXamb lrZbkv]μ\w
F∂o t]cpIfn¬ Adnbs∏Sp∂p. lrZbanSn∏ns‚
{Iaw sX‰nbXpw hfsc Db¿∂Xpw As√¶n¬ Ipd
™Xpamb Hcp Iq´w tcmKamWnXv. CXv km[mcW
bmbn s\©pthZ\tbm izmkwapt´m D≈ tcmKnIsf
]cntim[n°ptºmƒ am{XamWv I≠p]nSn°s∏
Sp∂Xv.
lrZb[a\ntcmKØns‚ tcmK\n¿Æbw
\n¿ÆbcoXnIƒ
AhtemI\w
1. sshZy]cntim[\m Ncn{Xw hnhcn°pI {i≤n®p ]h¿ t]mbn‚ v CXv Fßs\
sIm≠ncn°pI \n¿Æbn°mw.
sNøpI. Cu AhkcØn¬ tUmIvS¿ IqSpXembn Du∂¬
\¬Ip∂Xv s\©pthZ\bv°pw lrt{ZmKkw
_‘amb a‰v e£W߃°pamWv . tUmIv S ¿
\nßfpsS sshjaysØ°pdn®v Bcmbptºmƒ

121
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
FhnsSbmWv D≠mIp∂Xv, Ftßms´¶nepw ]Scp
∂pt≠m, Ft∏mfmWv D≠mIp∂Xv thsd GsX¶nepw
e£W߃ CtXmS\p_‘n®v A\p`hs∏Sp∂pthm
F∂o Imcy߃ hniZoIcn°pI.
2. hy‡nKX BtcmKyhnhcWw
tUmIv S ¿ \nßtfmSv BtcmKysØ°pdn®pw
PohNcy tb°pdn®pw Bcmbptºmƒ \nßfpsS
jpK¿seh¬, sImfkvt{Smƒ, hymbmaioew, ªUv
{]j¿, am\knI ]ncnapdp°w Ch hnhcn°pI. GsX
¶nepw Zpx»oeßfp s≠¶n¬ AXpIqSn hnhcn°pI.
3 IpSpw_mtcmKyhnhcWw
IpSpw_Ønse B¿s°¶nepw lrt{ZmK
]›mØeap ≠mbncpt∂m F∂v tUmIvS¿°v Adnbp
hm≥ Xm¬]cy ap≠mIpw. tUmIv S tdmSv lrt{Zm
KØns‚ ]›mØew lrZbkvXw`\w, s]s´∂p≈
acWw, {]talw, c‡ kΩ¿±w, Db¿∂ sImfkvt{Smƒ
F∂nh hniZoIcn °pI.
4. tZl]cntim[\
km[mcWbmbn imcocnI]cntim[\m^ew
k¥penXamcn°pw. CXv ]Xnhmbn D]Icn°p∂Xv ico
cthZ\, s\©pthZ\ F∂nhbmep≠mIp∂ a‰v tcmK
e£W߃ I≠p]nSn°m\pamWv.
5. C.kn.Pn (E.C.G) lrZb[a\n tcmKw
\n¿Æbn°m≥
C.kn.Pn an°hmdpw t\m¿a¬ Bbncn°pw. CXv hnhcn°pI {i≤n®p
]h¿ t]mbn‚ v CeIvt{Sm
lrZb AdIfnep≠mIp∂ hyXnbm\w I≠p]nSn°p sIm≠ncn°pI Im¿Untbm{Kmw
hm≥ klmbn°p∂p. D]tbmKn°p∂Xv
F¥n\v?

122
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
6. s\©ns‚ FIvktd (Chest Ex-Ray)
CXv km[mcW t\m¿aembncn°pw ]t£ lrZbkvXw
`\ap≠mIp∂ AhkcØn¬ lrZbAdIfpsS hen
∏Øn¬ hyXnbm\w kw`hn°pIbpw ]ƒan\dn knc
Ifn¬ kt¶mNw D≠mhpItbm sNøpw.
7. c‡]cntim[\
 kºq¿Æc‡\n¿Æbw ˛ A\oanbbpsS kmao]yw
Adnbphm≥.
 Im¿Unbmkv am¿t°gv k v ˛ lrZbtImißfpsS hnhcn°pI {i≤n®p ]h¿ t]mbn‚ v Im¿UnbmIv
\misØ \nco£n°p∂Xn\p≈ t{]m´o\pIƒ, {]tXy sIm≠ncn°pI tat°gvkv
In®v cTnT, cTnT, CKMB atbmt•m_n≥. GsX√mamWv.
 Im¿UnbmIv{St∏mWn≥Sn˛ lrZbt]in\miw kw`
hn°ptºmƒ ]pds∏Sphn°p∂ t{]m´o≥, sd^d≥kv
td©v ˛ < 01 ng/ml
 Im¿UnbmIv {Snt∏mWn≥ sF ˛ lrZbt]io\mi
Øm¬ ]pds∏Sphn°p∂ t{]m´o≥ d^d≥kv td©v
<07 ng/ml
 {Inbm‰n≥ Int\kv ˛ {]tXyI ImcWØme√msX
hnhn[Xcw aknepIfpw IeIfpw \in°ptºmƒ
]pds∏Sphn°p∂ F≥sskw.
 {Inbm‰n\n≥ Int\kv Fw._n ˛ kn.sI F≥sskw
IqSpXembn ImWs∏Sp∂Xv lrZbØnepw a‰v IeI
fnepamWv. d^d≥kv td©v <10 ng/ml .
 atbmt•m_n≥ ˛ ]e `mKØp\n∂pap≈ t{]m´os‚
]pdwX≈¬ kqNn∏n°p∂Xv {]tXyI ImcWw IqSm
sXbp≈ IeIfpsS \miamWv. d^d≥kv td©v <170
ng/ml .
123
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
 F¬.Un.F®v ˛ IeIfpsS \misØ Af°p∂Xn\v CXv hnhcn°pI {i≤n®p ]h¿ t]mbn‚ v
D]Icn°p∂p. lrZbØnepw, Icfnepw, hr° Ifnepw, sIm≠ncn°pI
t]inIfnepw, Xet®mdnepw ImWs∏Sp∂ {]tXyI
Xcw t{]m´o≥ BWv F¬.Un.F®v.
 t\{Snbpd´nIv s]]vss‰Uvkv ˛ lrZbkvXw`\w \n¿Æ
bn°m\p]tbmKn°p∂ {][m\amb c≠v _tbmam¿°p
IfmWv _n.ssS∏v. t\{Snbpd´nIv s]]vss‰Uvv NT- pro
B-Type t\{Snbpd´nIv s]]vss‰Uv. lrZbt]inIfpsS
hen®n¬ Cu s]∏ss‰bnUpIfpsS Afhv Db¿ØpI
bpw AXv lrZbkvXw`\Øns‚ tcmKw \n¿Æbn°m≥
klmbn°p∂p.
 en∏nUv s{]m^bn¬ ˛ CXn¬ \√ sImfkvt{Smƒ, NoØ
sImfkvt{Smƒ, ss{S•nkss‰Uvkv, •qt°mkv F∂nh
Af°m≥ D]tbmKn°p∂p.
8. tdUntbm sFtkmtSm∏v ˛ atbmIm¿Unb¬ s]¿^yq
j≥ kvIm\nwKv ˛ CXn¬ sNdnb tXmXnep≈ tdUntbm
BIvSohv sIan°¬kv D]tbmKn®v lrZbt]inIfnte
°v {]thin°p∂ c‡Øns‚ Afhv Af°phm≥
D]Icn°p∂p. CXns\ ""Xmenbw AYhm Fw.sF.
_n.sF'' kvIm≥ F∂pw hnfn°p∂p. km[mcWbmbn
eLphymbmaØn\p tijw Fßs\ hymbmatØmSv
lrZbt]inIƒ {]XnIcn°p∂p F∂dnbm\mWv CXv
D]tbmKn°p∂Xv. hymbmaw aqeap≠mIp∂Xpw hnhc
WmXoXhpamb s\©pthZ\bpsS ImcWw I≠p]nSn
°m\pw CXv D]Icn°p∂p.
a‰p]tbmK߃
 lrZbt]inIfnte°p≈ c‡{]hmlØns‚ coXn
ImWn°p∂p.

124
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
 lrZb[a\nIƒ XS s∏´n´pt≠m, AXv F{X am{Xw.
 lrZbØn\v kw`hn®ncn°p∂ \miØns‚ Afhv
I≠p]nSn°m\pw
9. sImtdmWdn Im¬kn^nt°j≥ kvtIm¿
Hcp thKXtbdnb CeIvt{Sm¨ _ow D]tbmKn®v sIm
tdmWdn Im¬kn^nt°j≥ kvtIm¿ I≠p]nSn°p∂p.
10.kv{Skv Ft°mIm¿Untbm{K^n ˛ hymbmaw sNøp
tºmƒ lrZbt]inIƒ°p≠mIp∂ Ne\Ønep≠m
Ip∂ hyXnbm\tØbpw, CSXv sh≥{Sn°nfns‚ {]h
¿Ø\tØbpw \nco£n°p∂Xn\v D]Icn°p∂p.
lrZb[a\ntcmKØn {]Xntcm[w hnhcn°pI {i≤n®p ImUns‚
]h¿ t]mbn‚ v
s‚ {]Xntcm[am¿§ sIm≠ncn°pI
acp∂pIfmepw PohnXssien hyXnbm\ßfmepw {]Xntcm[
߃ ]n¥pScpI.
lrt{ZmKkw_‘amb At\I B]XvLSIßsf XS am]n\nIƒ
bphm\pw \nb{¥n°phm\pw Ignbpw. C{]Imcap≈ GsX√mw
h¿°v DZmlcWamWv Db¿∂ c‡kΩ¿±w, Db¿∂
c‡Ønse sImgp∏v, AanXhÆw, {]talw F∂nh.
{]mbw, enwKw, ]mcºcyw apXemb LSI߃ \ap°v
am‰phm≥ Ignbp∂n√.
B]XvLSIßsf \nb{¥n°phm≥ {ian°p∂Xn
eqsS lrZb[a\n tcmKtØbpw lrZbkv X w`\
tØbpw AI‰n\n¿Øm≥ Ignbpw. PohnXssienbn
ep≈ am‰ßƒ°v lrZb[a\o tcmKLSIßsf Htc
kabw \nb{¥n°phm≥ Ignbpw. hymbmawaqew c‡
kΩ¿±w Ipdbv°phm\pw, {]talw \nb{¥n°phm\pw
am\knI ]ncnapdp°Øn\v Abhp hcpØphm\pw
icoc`mcw \nb{¥n°phm\pw km[n°pw.

125
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
PohnXssien hyXnbm\w
BtcmKyIcamb PohnXssienbneqsS lrZb hnhcn°pI {i≤n®p ]h¿ t]mbn‚ v ImUv \nb{¥n°p
sIm≠ncn°pI ∂Xn\mhiyamb
[a\n tcmKkm≤yX Ipdbv°phm≥ Ignbpw. lrt{Zm
PohnXssien
KnIƒ BtcmKyIcamb PohnXssien kzoIcn °p∂
hyXnbm\߃
XneqsS lrt{ZmK k¶o¿ÆX Ipdbv°phm≥ Ignbpw. GsX√mw?
BtcmKyIcamb PohnX ssienbn¬ ASßn
bncn°p∂Xv
a) BtcmKyIcamb `£W{Iaw.
b) hymbmaw
c) icoc `mc \nb{¥Ww
d) ]pIhen Dt]£n°pI
e) am\knI]ncnapdp° \nb{¥Ww
a) BtcmKyIcamb `£W{Iaw
BtcmKyIcamb PohnXssienbpsS apJyLSI
amWv BtcmKyIcamb `£W{Iaw. lrt{ZmK km
≤yX Ipdbv°p∂Xn\mbn \nßfpsS IpSpw_hpw
Xmsg∏dbp∂ `£W{Iaw A\ph¿Ønt°≠XmWv.
1. Xmgv∂ sImgp∏p≈ `£Ww : ]qcnX sImgp∏v AS
ßnbncn°p∂ `£W]Zm¿∞ßfmWv ]mep¬∏∂
߃, hdpØXpw s]mcn®Xpamb `£Ww, Nps´SpØ
Xv, tNm°te‰pIƒ, amwkw. hdpØ Blmcßfn¬
A]qcnX sImgp∏v [mcmfambn ASßnbncn°p∂p. ap
Ifn¬]d™ncn°p∂ c≠pXcw sImgp∏pIfpw icoc
Øn¬ NoØs°mgp∏v (F¬.Un.F¬) Iq´phm≥ CSbm
°p∂p.
2. a’yØnepw HenshÆbnepw ASßnbncn°p∂
ap¥nbXcw sImgp∏v : Chbnep≈ sImgp∏pIfn¬
HtaKm˛3 IqSpXembn ASßnbncn°p∂p. Ch c‡w

126
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
{i≤n®p
I´nbmImsX Im°p∂p. Ch lrZbkv X w`\w hnhcn°pI ]h¿ t]mbn‚ v lrZb[a\ntcmKsØ
sIm≠ncn°pI {]Xntcm[n°m≥
km≤yX Ipd°p∂p.
3. \mcv IqSpXep≈h GXpXcw
]gw, ]®°dn, ]bdph¿§ßƒ F∂nhbn¬ \mcv `£W{Iaw
IqSpXembn ASßnbncn°p∂p. \mcv kar≤amb Ahew_n°Ww?
`£W{IaØneqsS c‡Ønse NoØs°mgp∏v
(LDL) Ipd°pIbpw lrt{ZmKsØ XSbphm≥ tijn
bp≈ ]e t]mjILSIßfpw e`yam°pIbpw
sNøpw.
4. D∏v, ]©kmc Ch Ipd™ `£Ww
BlmcØn¬ D∏ns‚ Awiw Ipdhmbm¬ c‡
kΩ¿±sØ Ipdbv ° phm≥ km[n°pw. ]©km
cbpsS Afhv Ipd™ `£W{IaØneqsS {]tal
sØ \nb{¥n°phm≥ Ignbpw.
b) hymbmaw
1 lrt{ZmKsØ XSbphm≥ ImbnI XmcamtI≠Xn√.
Znhkhpw 30 an\n‰v anXambn hymbmaw sNbvXm¬ aXn.
2 Db¿∂ imcocnI £aX ssIhcn°m≥ {]mb]q¿Øn
bmbh¿ 150 an\n‰v (2.5 Hrs) anXamb hymbma{Iahpw,
As√¶n¬ 75 an\n‰v (1.15 Hrs) Xo{hhymbma{Iahpw
A\ph¿Øn°Ww.
3 as‰mcp km≤yX Ch c≠pw IqSns®øp∂XmWv. c≠p
an\n‰v anXamb hymbmahpw 1 an\n‰v Xo{hhymbmahpw
\¬Ip∂ KpWw XpeyamWv.
4 IqSpX¬ hymbmaw IqSpX¬ KpWw sNøpw. Ign™
Imeßfn¬ \n߃ Aektcm XSnb∑mtcm BsW
¶n¬ sNdnb coXnbn¬ hymbmaw XpS¿∂m¬ IqSpX¬
{]tbmP\w e`n°pw.
127
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
c) BtcmKyIcamb icoc`mcw \ne \n¿ØpI. hnhcn°pI
{i≤n®p
]h¿ t]mbn‚ v BtcmKyIcamb
1 t]mjIkar≤amb BlmccoXnbpw, hymbma{Iahpw sIm≠ncn°pI icoc`mcw
A\ph¿Øn®m¬ icoc`mcw \nb{¥n°phm≥ Ignbpw. Fßs\
icoc`mcw \nb{¥n°p∂XneqsS lrt{ZmKsØ {]Xn \ne\n¿Ømw?
tcm[n°phm≥ Ignbpw.
2 AanX`mcw Ipd°pI. anXamb `£Ww Dt]£n°pI.
\ap°v e`n°p∂ Blmcw apgph\mbpw Ign°Wsa
∂n√. km[mcW Hcmƒ°v th≠Xn¬ A[nIw Itemdn
tlm´¬ `£WØn¬ ASßnbncn°p∂p.
3 Iuamc°mcpw Ip´nIfpw XßfpsS AanXhÆw 5%
apX¬ 10% Ipdbv°pIbmsW¶n¬ lrt{ZmKkm≤y
Xsb AI‰n \n¿ØWw.
4 `mcw Ipdbv°p∂Xn\pw, {]taltcmKnIfpw Xmgv∂
Afhnep≈ Itemdnbp≈Xpw \mcv A[nIw ASßn
bXpamb `£Ww Ign°Ww.
5 A[nIsImgp∏v ASßnbncn°p∂ t_°dn Blm
c߃ Hgnhm°Ww.
d) ]pIhen Dt]£n°pI
1 ]pIhen°mcmsW¶n¬ AXpt]£n°pI. ]pIhen
lrt{ZmKkm≤yX h¿≤n∏n°pIbpw AXn\v ImcWam
Ip∂ a‰v LSIßsf AXv k¶o¿Æam°pIbpw
sNøp∂p. ]m ohv kvtam°nwKv, AYhm sk°‚ v
lm‚ v kvtam°nwKv Hgnhm°pI.
2 Ip´nIƒ ]pIhen°p∂Xv XSbphm\pw AXpt]£n
°phm\pw Ahsc klmbn°phm\pw Ignbpw. ]pIh
enbpsS tZmjhißsf ]d™v a\ nem°pI.

128
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
]pIhen Dt]£n°m\p≈ am¿§ßƒ {i≤n®p
hnhcn°pI ]h¿ t]mbn‚ v sk°‚ v lm‚ v
 \nt°m´n≥ dotπkvsa‚ v sXdm∏n. sIm≠ncn°pI
kvtam°nwKv
]pIhen Dt]£n°phm\p≈ am¿§ßfn¬ {][m F∂m¬ F¥v?
\amWnXv. CXn¬ D]tbmKn°p∂ ]Zm¿∞߃ sNdp
Afhn¬ \nt°m´n≥ {]Zm\w sNøp∂hbmWv. Ch
]pIbnebn¬ ASßnbncn°p∂ hnj]Zm¿∞ hnap
‡amWv. \nt°m´n\p th≠nbp≈ AanXamb A`n\n
thiw Ipd°pI F∂XmWv AXns‚ e£yw. Znhkhpw
15 knKd‰n¬ IqSpX¬ hen°p∂hcnemWv CXp ^e
{]Zw. 10 knKd‰n¬ Ipdhv hen°p∂hcn¬ Cu sXdm∏n
^e{]Zsa∂v sXfnbn°s∏´n´n√.
\nt°m´n≥ dotπkvsa‚ v sXdm∏n D]tbmKnt°≠
coXnIƒ
1 BZyZn\ D]tbmKØn¬ h©n°mXncn°pIbmsW
¶n¬ ]Ønc´nbne[nIw km≤yXbp≠v CXv ÿncambn
\ndpØphm≥. F{Xb[nIw hen°p∂pthm A{Xb
[nIw tUmkv \n߃ XpSßWw.
2 CtXmsSm∏w Iu¨kenwKv IqSn Dƒs∏SpØpIbmsW
¶n¬ Dt]£n°phm\p≈ km≤yX h¿≤n∏n°pw.
3 Cu sXdm∏n D]tbmKn°ptºmƒ ]pI hen°cpXv. CXv
\nt°m´ns‚ Afhv A]ISIcamw hn[w Db¿Øpw.
4 Cu sXdm∏n `mcw IqSp∂Xv XSbpw. \nt°m´ns‚ D]
tbmKw \n¿Øp∂Xv `mch¿≤\bv°v ImcWamIpw.
5 \nt°m´ns‚ Awiw kmh[m\Øn¬ Ipdbvt°≠Xm
Ip∂p.

129
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
hnhn[ßfmIp∂ \nt°m´n≥ dotπkvsa‚ v sXdm∏n {i≤n®p hnhn[Xcw
hnhcn°pI ]h¿ t]mbn‚ v
CXv ]ecoXnbnep≠v. sIm≠ncn°pI \nt°m´n≥
1 Kw dotπkvsa‚ v
sXdm∏nbpsS
2 C≥slbve¿ coXnIƒ GsX√mw?
3 temsk©kv
4 \mk¬ kvt{]
5 kvIn≥ ]m®v
Ch icnbmb coXnbn¬ D]tbmKn®m¬ ^e
{]ZamWv . km[mcWbmbn BfpIƒ D]tbmKn
°p∂Xv KΩpw ]m®kpamWv.
\nt°m´n≥ ]m®v
1 F√mØcØnepap≈ \nt°m´n≥ ]m®kpw D]tbmKn
°p∂Xv Htc coXnbnemWv.
2 Hmtcm Znhkhpw Hmtcm ]m®v D]tbmKn°Ww. 24 aWn
°qdpIƒ°p tijw CXv am‰n thsdm∂v D]tbmKn
°Ww.
3 IgpØn\p Xmsgbpw Acbv°v apIfnepw ]ebnSßfn
embn CXv D]tbmKn°Ww.
4 tcmaclnX {]tZiØv Cu ]m®v D]tbmKn°Ww.
5 24 aWn°q¿ apgph\pw ]m®v [cn°p∂ hy‡nIfn¬
]n≥am‰ e£W߃ Ipdhmbncn°pw.
6 10 knKd‰n¬ Ipdhv D]tbmKn°p∂hcn¬ Ipd™
tUmkv D]tbmKn°Ww. (DZm. 14 an√n)
\nt°m´n≥ Kw (temsk©v)
CXv tUmIvSdpsS Ipdn∏n√msX hmßphm≥
Ignbpw. Nne¿ temsk©kn\v apIfn¬ ]m®kv

130
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
Xncs™Sp°pw. CXn\v \nt°m´n≥ tUmkv \nb{¥n hnhcn°pI {i≤n®p ]h¿ t]mbn‚ v \nt°m´n≥ Kw
sIm≠ncn°pI Fßs\ \mw D]
°phm≥ Ignbpw.
\nt°m´n≥ Kw D]tbmKnt°≠ Nne ]SnIƒ tbmKn°Ww?
1 XpS°°m¿ aWn°qdn¬ 1˛2 FÆw Kw D]tbmKn
°Ww. Hcp Znhkw 20 FÆØn¬ IqSpX¬ D]tbmKn
°cpXv.
2 s]∏dncpNn hcp∂Xphsc kmh[m\w Nhbv°pI.
AXn\ptijw tamW°pw Ihnfn\pw CSbn¬ \nt£
]n°pI. AXv \nt°m´n≥ hens®Sp°m≥ klmbn°pw.
3 Nmb, Im∏n, tkm^v‰v {UnwKvkv ChbpsS D]tbmKØn
\ptijw 15 an\n‰v Ign™v Kw D]tbmKn°Ww.
4 25 knKd‰v Zn\w{]Xn D]tbmKn°p∂hcn¬ 4mg tUm
kmWv 2mg tb°mƒ IqSpX¬ ^e{]Zw.
\nt°m´n≥ C≥slbne¿
1 CXv πmÃnIv knKd‰v tlmƒU¿ t]msebncn°pw. Ata
cn°bn¬ CXn\v tUmIvSdpsS Ipdn∏v BhiyamWv.
2 CXn\p≈nte°v \nt°m´n≥ Im{SnUvPv Ib‰n 20 an\n´v
t\cw hen°pI. CXv Znhkw 16 {]mhiyw XpScpI.
3 CXv s]s´∂v {]h¿Øn°pw. KΩpw CXpw {]h¿Øn°p
hms\Sp°p∂ kabw XpeyamWv. ]m®v {]h¿Øn°p
hms\Sp°p∂ kabtØ°mƒ 2˛4 aWn°q¿ thKw {]
h¿Øn°pw.
4 izmktImiØnse izmk\mfnIfnte°v \nt°m´n≥
[qfnIƒ FØmdn√. Nne¿°v hmbnepw, sXm≠bnepw
sNmdn®n¬ D≠mImdp≠v.

131
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n

\nt°m´n≥ \mk¬ kvt{]

1 CXv \nt°m´ns‚ AanXXzcsb aYn°pamdv s]s´∂v
{]h¿Øn°pw. \nt°m´n≥ kvt{] D]tbmKn®v A©mw
an\n‰n\p≈n¬ \nt°m´n≥ seh¬ D∂XnbnseØWw.
2 CXv ]m®nt\msSm∏w D]tbmKn°mdp≠v.
3 CXv sXm≠bnepw, aq°nepw sNmdn®nep≠m°pw. CXv
c≠p ZnhkØn\p≈n¬ amdpIbpw sNøpw.
hnhcn°pI {i≤n®p \nt°m´n≥
]m¿iz^e߃ ]h¿ t]mbn‚ v
sIm≠ncn°pI dotπkvsa‚ v
F√m \nt°m´n≥ D¬∏∂߃°pw ]m¿iz^e߃
sXdm∏nbpsS
D≠v. Db¿∂ tUmkp]tbmKn°ptºmgmWv ]m¿iz^
]m¿iz^e߃
e߃ A\p`hs∏Sp∂Xv, Ipd°ptºmƒ AXv kzbta
Fs¥√mw?
A{]Xy£amhpIbpw sNøpw.
]m¿iz^eßfn¬ Dƒs∏´h
1. XethZ\
2. Hm°m\hpw Zl\{]iv\ßfpw
3. Dd°an√mbva
e)am\knI]ncnapdp°\nb{¥Ww
am\knI ]ncnapdp°sØ°pdn®p≈ Ah
t_m[w, hn{iaw, {]iv\ßfpambp≈ CgpInt®c¬ Ch
apJm¥ncw \nßfpsS imcocnIhpw am\knIhpamb
BtcmKysØ ]cnt]mjn°phm≥ km[n°pw. \ΩpsS
{]iv\ßsf A\p`mh]q¿Δw ]cnKWn°p∂ kplrØp
°fpambp≈ klhmkw am\knI ]ncnapdp°w Hcp
]cn[nhsc eLqIcn°pw.

132
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
\ΩsfØs∂ Nn´s∏SpØpI. hnhcn°pI {i≤n®p am\knI]ncnapdp°w
]h¿ t]mbn‚ v
1 \nßfpsS kabhpw Du¿÷hpw th≠pwhÆw Nneh sIm≠ncn°pI Ipdbv°phm\p≈
gn°p∂XneqsS \nßfpsS am\knI ]ncnapdp°hpw coXnIƒ
\nb{¥n°mw. GsX√mw?
2 ]cnkc\nb{¥WØneqsS Bcv AYhm F¥v \nß
sf \nb{¥n°p∂psh∂v Xocpam\n°m\mhpw.
3 \n߃ sNøp∂Xv G‰hpw \√Xv F∂v \nßsf
Øs∂ t_m≤ys∏SpØpI.
4 Hgnhpkabw ^e{]Zamw hn[w D]tbmKs∏SpØpI.
5 icocØnse tImißfnte°v {]mWhmbphpw, Du¿
÷hpw FØn°pamdv BtcmKyhpw D¬]mZ\£a
Xbpw D≠m°p∂Xn\v hymbmaw sNøpI.BbXn\m¬
lrZbØn\pw izmktImiØn\pw ]Xnhmbn
Bgv N bn¬ aq∂p Znhkw 15˛30 an\n‰v hymbmaw
\¬IpI. \SØw, ssk¢nwKv, \o¥¬ F∂nh Cu
hymbmaØn¬ s]Sp∂hbmWv.
6 \nßfpsS am\knI ]ncnapdp°sØ ad∂v izk\Øn
epw, ]ptcmKa\mflNn¥Ifnepw apgpIpI
7 icocØn\v ]Xnhmb hn{iaw A\phZn°pI. 6˛8 aWn
°q¿ DdßpI. ]T\mh[nsbSp°pI. 10 an\n‰v CSthf
Hcp aWn°qdn¬ \nßfpsS a\kn\pw IÆpIƒ°pw
hn{iaw \¬IpI.
8 \Ωsf°pdn®v t_m[hm∑mcmIpI.
9 icocsØ t]mjn∏n°pI/icocsØ aen\s∏Sp
ØcpXv. kaoIrXmlmcw Ign°pI. sImgp∏pw ]©
kmcbpw IqSpXep≈ `£Ww Ign°mXncn°pI.
elcn]Zm¿∞ßfn¬ B{ibn°mXncn°pI.
133
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
10 \nßfn¬ B\μw Is≠ØpI. k¥pjvS\mb Hcp
hnhcn°pI {i≤n®p ]h¿ t]mbn‚ v lrZb[a\n
hy‡n Zo¿Lmbpt mSpw, imcocnI hnjaXIfn√msX sIm≠ncn°pI tcmK\nhmcWØn\p
bpw, D’mlIcmbncn°pw. D]tbmKn°p∂
lrZb[a\n \nb{¥Ww (NnIn’m{Iaw) acp∂pIƒ
tcmK\nhmcWw lrZbNnIn’bv°v ]ehn[amIp∂ acp∂pIƒ GsX√mw?
Xn´s∏SpØpI Ch tNmZn°p∂p≠v.
♦ sImgp∏v hyXnbm\ acp∂pIƒ.
NoØs°mgp∏ns‚ Afhv c‡Øn¬ Ipdbv°pI
hgn CØcw acp∂pIƒ lrZb[a\n°pfnse ASn™p
IqSnbncn°p∂ tπ‰ns\ Ipdbv°p∂p. DZm:Ãm‰n≥kv,
\nbmkn≥ sd^t{_‰kv
♦ Bkv]ncn≥
c‡Øns‚ I´nIpdbv°phm\mbn CXv D]tbmKn
°p∂p. CXv c‡w I´]nSn°p∂Xv XSbpIbpw AXn
\m¬ lrZb[a\nIfnep≠mIp∂ XS ßƒ C√mXm
IpIbpw sNøp∂p. lrZbmLmXap≈ Hcp hy‡nbn¬
ho≠pw AXp≠mImXncn°m≥ Bkv]ncn≥ klm
bn°pw. lotam^oenb D≈ hy‡nIfn¬ CXv ^e
{]Za√.
♦ _o‰tªmt°gvkv
Cu acp∂v lrZbkv]μ\w, c‡kΩ¿±w F∂nh
Ipdbv°pIbpw AXn\m¬ lrZbØns‚ HmIvknPs‚
BhiyIX IpdbpIbpw sNøp∂p. Cu acp∂ns‚ D]
tbmKw lrZbkvXw`\Øns‚ km≤yX Ipdbv°pw.
♦ ss\t{Sm•nkdn≥
Cu acp∂v lrZb[a\nIsf hnIkn∏n°p∂Xn
\m¬ lrZbØns‚ c‡Øns‚ BhiyIX Ipdbp

134
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
∂XneqsS s\©pthZ\ Ipdbv°pIbpw sNøp∂p.
♦ B≥PntbmsS≥kn≥ I¨sh¿´nwKv tlm¿tam¨
(F.kn.C) C¬ln_nt‰gvkv B‚ v B≥Pn tbmsS≥
kn≥ II dnktπ¿ tªm°¿ (ARBs).
CØcw acp∂pIƒ c‡kΩ¿±w Ipd°pI hgn
c‡ [a\nIfpsS inYneoIcW tXmXv XSbpIbpw
sNøp∂p.
F.kn.C (ACE). C≥ln_nt‰gvkns‚ D]tbmKw
lrZb[a\n tcmKw `mhnbn¬ hcp∂Xv XSbpIbpw
sNøp∂p. hnhcn°pI {i≤n®p ]h¿ t]mbn‚ v B≥PntbmπmÃn
ikv{X{Inb \nhmcWw. sIm≠ncn°pI F∂mse¥v?
♦ B≥PntbmπmÃnbpw Ã≥Uv CSepw (PTCR).
CXn¬ Npcpßnb [a\nbnte°v Hcp I\w Ipd™
Syq_v (IØn‰¿) CSp∂p. CXneqsS Npcpßnb _eq¨
A‰Øv LSn∏n® Hcp hb¿ [a\nbpsS Npcpßnb `m
KtØ°v ISØnhnSp∂p. F∂n´v Cu _eq¨ hnIkn
∏n°p∂p. CXn\m¬ A[a\nbn¬ ASn™p IqSnbncn
°p∂ ]Zm¿∞߃ ssI°pgens‚ `nØnbnte°v
AacpIbpw sNøp∂p. Cu c‡[a\nIƒ Xpd
∂ncn°m≥ Cu Ã≥UpIƒ AhnsSØs∂ CSmdmWv
]Xnhv. Nne Ã≥UpIƒ Nne acp∂pIƒ ]pds∏Sphn
°pIbpw CXv [a\nIsf Xpd∂ncn°m≥ klmbn°p
Ibpw sNøp∂p.
♦ tImtdmWdn B¿´dn ss_∏mkv ikv{X{Inb
CXn¬ k¿P≥ icocØns‚ a‰p `mKØp\n∂v
FSp°p∂ c‡IpgepIƒ hgn •m^v‰v D≠m°pIbpw
tªm°mb `mKØnep≈ c‡w hgnXncn®p hnSpIbpw

135
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
sNøp∂p. CXn\m¬ [a\n ASbpItbm, Npcpßp {i≤n®p ImUns‚
Itbm, sNbvX `mKsØ adnIS∂v c‡w IS∂p t]m hnhcn°pI sIm≠ncn°pI ]h¿ t]mbn‚ v
k¶o¿ÆXIƒ
Im≥ km[n°p∂p. CXv km[mcWbmbn aq∂n¬ IqSp
GsX√mw?
X¬ [a\nIƒ AS™ hy‡nIfnemWv sNøp∂Xv.
tImwπnt°j≥kv
c‡[a\nIfneqsSbp≈ c‡{]hmlw XS s∏
Sp∂XmWv lrZb[a\n tcmKw F∂p ]dbp∂Xv. Cu
c‡°pgepIfmWv lrZbØn\v c‡w \¬Ip∂Xv.
lrZb `nØnbnte°p≈ c‡{]hmlw Ipdbptºmƒ
AXv lrZbØns‚ {]h¿Ø\sØ _m[n°pIbpw sN
øp∂p. CXv ]ehn[amb tcmKmhÿbnte°pw \bn
°p∂p.
♦ lrZbkvXw`\w
izmkwap´v, Xf¿®, B{inX \ocpho°w F∂nh
aq∂pw IqSnt®cp∂ AhÿbmWv lrZbkvXw`\w.
hyhkmbnI cmPyßfn¬ tImdWdn AØntdmkvIo
tdmknkv BWv lrZbkvXw`\Øns‚ apJyImcWw.
♦ s]s´∂p≈ acWw.
atbmI¿Unb¬ C≥{^m£≥, sh≥Sn°pem¿
AcnØnanbmkv aqew D≠mIp∂ s]s´∂v Ipg™p
hoWp≈ acWw lrZb[a\nIfpsS tcmKßfpsS apJy
k¶o¿ÆXbmsW∂v Ct∏mƒ Xncn®dnbs∏´n´p≠v.
{]mcw`e£WßfpsS A`mhw {]mYanI {]Xntcm[
\Øns‚ P\Iob kao]\Øns‚ A\nhmcyXsb
bmWv kqNn∏n°p∂Xv.

136
 \n¿±njvS
D≈S°w Sot®gvkv tetWgvkv F.hn. FbvUvkv Chmeypthj≥
e£y߃
BIv‰nhn‰n BIv‰nhn‰n
D]kwlmcw
hnIkzccmPyßfn¬ lrZb[a\n tcmKßfpsS
hym]\w hfsc {][m\s∏´ {]iv\ambn hf¿∂p hcp
∂Xn\m¬, {]Xntcm[amWv Cu sImebmfntbmSv s]m
cpXphm\p≈ ^ehØmb am¿§w. {]Xntcm[coXnIsf
]‰nbp≈ tcmKnIfpsS ⁄m\w AdnbpIhgn tcmKnI
fpsS PohnXssienbn¬ ImXemb am‰w sIm≠phcm≥
km[n°pw.
tcmKØns‚ \nb{¥n°m≥ Ignbp∂ B]Øv
LSIßsf°pdn®p≈ s]mXpkaqlØns‚ Ah
t_m[w hf¿Øphm≥ DXIp∂ coXnbnep≈ ]T\
in_ncw kwLSn∏n°p∂Xn\p BtcmKy{]h¿Ø
I¿°v Hcp sh√phnfnbmbncn°Ww. IqSmsX Btcm
KyIcamb lrZbw D≠mtI≠Xn\v BtcmKyIcamb
kwkvImcØnte°v hyXnbm\w D≠mtI≠Xn\v P\
ßsf t{]m’mln∏nt°≠Xv A\nhmcyamWv.
d^d≥kv
Population nutrient intake goals for preventing diet
related chronic diseases. WHO.
http://www.nhlbi.nih.gov/health/healthtopics/topics/
hbc/
http://www.healthline.com/health/coronary-artery-
disease/risk factors#controllableriskfactors.
http://my.clevelandclinic.org/services/heart/disorders/
coronary-artery-disease/cadsymptoms
http://www.healthline.com/health/coronary-artery-
disease/complications.

137
 APPENDIX XI
PART I: DEMOGRAPHIC VARIABLES
Structured questionnaire regarding demographic data from the patients
Instruction:
Place a tick mark in the corresponding space for 12 questions given below:
1. Age in years
a) 21-30 years [ ]
b) 31-40 years [ ]
c) 41-50 years [ ]
d) Above 50 years [ ]
2. Gender
a) Male [ ]
b) Female [ ]
3. Educational status
a) High school [ ]
b) HSE [ ]
c) Graduate [ ]
d) Post graduate [ ]
4. Occupational status
a) Sedentary worker [ ]
b) Moderate worker [ ]
c) Heavy worker [ ]
5. Religion
a) Hindu [ ]
b) Muslim [ ]
c) Christian [ ]
d) others [ ]
6. Marital status
a) Single [ ]
b) Married [ ]
c) Widower [ ]

138
7. Dietary habits
a) Vegetarian [ ]
b) Non vegetarian [ ]
8. Bad Habits
a) Alcoholic [ ]
b) Smoker/tobacco [ ]
c) Drug abuse [ ]
d) None [ ]
9. Known case of hypertension
a) Yes [ ]
b) No [ ]
10. Known case of diabetic
a) Yes [ ]
b) No [ ]
11. Do you have family history of heart disease
a) Yes [ ]
b) No [ ]
12. Do you diagnosed with high cholesterol
a) Yes [ ]
b) No [ ]
 BMI measures
a) Underweight <18.5 [ ]
b) Normal 18.5-24.9 [ ]
c) Overweight 25.0-29.99 [ ]
d) Obese 30.0-39.9 [ ]
e) Over 40 [ ]
 Waist circumference
a) More than 100cm in males [ ]
b) More than 88cm in females [ ]
c) Less than 100cm in males [ ]
d) Less than 88cm in females [ ]

139
 PART II: STRUCTURED KNOWLEDGE QUESTIONNAIRE REGARDING
PREVENTION OF CORONARY ARTERY DISEASE
Instruction:
The tool consists of 50 questions and each question consists of multiple options and one is the
appropriate answer. Place a tick mark in the corresponding space given below.

Anatomy& Physiology
1. The heart is normally situated in the
a) Thoracic cavity [ ]
b) Peritoneal cavity [ ]
c) Auricular cavity [ ]
d) Cellular cavity [ ]
2. The normal heart beat per minute
a) 60-80 beats per minute [ ]
b) 50-60 beats per minute [ ]
c) 90-100 beats per minute [ ]
d) 110-120 beats per minute [ ]
3. The blood supply of the heart muscle is by
a) coronary artery [ ]
b) femoral artery [ ]
c) pulmonary artery [ ]
d) carotid artery [ ]
4. The function of heart is to
a) Store blood [ ]
b) Supply blood and nutrients to whole parts of the body [ ]
c) Remove carbon dioxide from whole body [ ]
d) Maintenance of hormonal levels [ ]
5. The heart consist of
a) One chamber [ ]
b) Two chambers [ ]
c) Three chambers [ ]
d) Four chambers [ ]

140
Definition
6. Coronary artery disease includes
a) Failure of lungs, bronchitis, atelectasis [ ]
b) Angina pectoris, atherosclerosis & myocardial infarction [ ]
c) Swelling of the heart muscle ,failure of heart, endocarditis [ ]
d) Failure of the brain, brain edema, meningitis [ ]
7. The physiology of Coronary artery disease is
a) Coronary artery getting blocked by fatty deposits [ ]
b) Food passage getting blocked [ ]
c) Heart reduces in its size [ ]
d) Change in chest cavity [ ]
Risk Factors
8. The risk factors of coronary heart disease are broadly classified into
a) Non modifiable and modifiable factors [ ]
b) Primary and secondary factors [ ]
c) First degree and second degree factors [ ]
d) Acute and chronic [ ]
9. The chance of coronary artery disease increases when one
a) Do regular exercises [ ]
b) Loses weight [ ]
c) Is having family history of heart disease [ ]
d) Maintain healthy diet
10. The coronary artery disease is common in the age of
a) <25 years [ ]
b) 26-35 years [ ]
c) 36-45 years [ ]
d) Above 45 years [ ]
11. The risk factors of coronary artery disease that cannot be modified are
a) Stress, smoking, lack of physical activity [ ]
b) Age, gender, family history of heart disease [ ]
c) Hypertension, diabetes, obesity. [ ]
d) Alcoholism, drug abuse, metabolic syndrome [ ]
141
12. Bad cholesterol is known as
a) LDL cholesterol [ ]
b) HDL cholesterol [ ]
c) Triglycerides [ ]
d) Glyceraldehydes [ ]
13. The optimal level of HDL and LDL is
a) HDL level above 60mg/dl and LDL less than 100 mg/dl [ ]
b) HDL level below 10 mg/dl and LDL greater than 200 mg/dl [ ]
c) HDL level above 120mg/dl and LDL less than 500mg/dl [ ]
d) HDL level above 300mg/dl and LDL less than750mg/dl [ ]
14. High blood pressure is considered as risk factor for CAD because
a) Increases the workload of lungs [ ]
b) Speed up the softening of the veins [ ]
c) Increases the work load of the heart [ ]
d) Decreases the work load of the heart [ ]
15. In a middle aged man the term hypertension is used when his
blood pressure is above
a) 130/80 mm of Hg [ ]
b) 120/80 mm of Hg [ ]
c) 140/90 mm of Hg [ ]
d) 150/100 mm of Hg [ ]
16. Harmful effect of smoking is due to the presence of
a) Carbon dioxide, nitrogen, sacrine, phosphate etc. [ ]
b) Caffeine, sugar, aldosterone, catecholamine etc. [ ]
c) Nicotine, Carbon monoxide, benzene, formaldehyde etc. [ ]
d) Potassium, cholesterol, water etc. [ ]
17. Smoking can affect the blood circulation by
a) Kinking the blood vessels [ ]
b) Constricting the blood vessels [ ]
c) Dilating the blood vessels [ ]
d) None of the above [ ]

142
18. The main cause for increased blood sugar level is
a) Body does not make enough insulin [ ]
b) Decreased bile secretion [ ]
c) Decreased thyroid secretion [ ]
d) Decreased HCL secretion [ ]
19. The normal blood sugar level of an adult is
a) 60-110mg/dl [ ]
b) 80-120 mg/dl [ ]
c) 70-110 mg/dl [ ]
d) 140-160 mg/dl [ ]
20. In the following types of diabetes which is having more risk for CAD
a) Type 1 diabetes [ ]
b) Type 2 diabetes [ ]
c) Pre diabetes [ ]
d) Gestational diabetes [ ]
21. People who are overweight are prone to get coronary artery disease
because obesity increases the
a) Fat deposition in the blood vessels [ ]
b) Increases metabolic activity in the body [ ]
c) Retention of waste products in the body [ ]
d) Increased expulsion of waste products from the body [ ]
22. The following risk factor is not included in metabolic syndrome
a) A large waist line [ ]
b) Increased hemoglobin level [ ]
c) Increased blood sugar level [ ]
d) Increased cholesterol level [ ]
Clinical Manifestations
23. An angina pectoris is
a) Abdominal pain [ ]
b) Chest pain [ ]
c) Low back pain [ ]
d) Ear pain [ ]
143
24. An acute myocardial infarction is due to
a) Decreased blood flow, damages cardiac muscle [ ]
b) Increased blood flow to the lungs [ ]
c) Decreased blood flow damages the brain [ ]
d) Decreased blood flow to the lungs [ ]
25. The term which gives meaning of dyspnea
a) Difficulty in sleeping [ ]
b) Difficulty in breathing [ ]
c) Difficulty in walking [ ]
d) Difficulty in swallowing [ ]
26. The meaning of cardiac arrhythmias is
a) Irregular heart beat [ ]
b) Absence of breathing [ ]
c) Irregular shape of heart [ ]
d) Irregular size of the heart [ ]
Diagnostic Evaluations
27. The investigation done to rule out unhealthy cholesterol level is
a) Lipid profile [ ]
b) Blood glucose [ ]
c) ESR [ ]
d) Complete blood count [ ]
28. In below mentioned, which is the cardiac marker
a) Cardiac troponin T [ ]
b) Natriuretic Peptides [ ]
c) Lipid Profile [ ]
d) Blood glucose [ ]
Prevention
29. Saturated fats are found in
a) Rice, wheat, dhal [ ]
b) Vegetables, fruits, green leaves [ ]
c) Dairy products, chocolates, deep fried and processed foods [ ]
d) Cereals, pulses, whole grains [ ]
144
30. In the following which food is having omega 3 fatty acids
a) Meat [ ]
b) Cheese [ ]
c) Fish [ ]
d) Vegetables [ ]
31. Fiber is rich in
a) Whole grains, Fruits and vegetables [ ]
b) Fish, egg, meat
c) Milk, water, oil [ ]
d) Cereals, pulses, nuts [ ]
32. A low salt diet can help you to manage
a) Blood pressure [ ]
b) Temperature [ ]
c) Blood sugar [ ]
d) Respiration [ ]
33. Low sugar diet can help you to prevent
a) Weight gain and diabetes mellitus [ ]
b) Weight loss and diabetes mellitus [ ]
c) Prevents excessive sweating [ ]
d) Increases sweating [ ]
34. The kind of food should be avoided in order to reduce the chance
of getting coronary artery disease?
a) Vegetables [ ]
b) High fiber diet [ ]
c) High caloric diet [ ]
d) None of the above [ ]
35. In the following, which is to be included in your diet?
a) Salt and sugar [ ]
b) Fried foods [ ]
c) Junk foods [ ]
d) Omega 3 fatty acids [ ]
145
36. Following CAD, the habit of smoking
a) Should be quit completely [ ]
b) Restricted to once in a week [ ]
c) Restricted to once in a month [ ]
d) Should be continued as before [ ]
37. Important method to quit from smoking is
a) Nicotine replacement therapy [ ]
b) Divert attention through interesting hobbies [ ]
c) Taking medication [ ]
d) Yoga and meditation [ ]
38. The goal of nicotine replacement therapy is
a) To prevent liver disease [ ]
b) To cut down on cravings of nicotine and ease the symptoms
of withdrawal [ ]
c) To reduce the odor of smoking [ ]
d) To reduce acidity [ ]
39. After CAD, Doing exercise is
a) Part of your life (compulsory) [ ]
b) Whenever you feel like doing [ ]
c) No need to exercise at all [ ]
d) None of the above [ ]
40. The benefits of doing exercise
a) Reduces cholesterol, and maintains body weight [ ]
b) Increase your blood pressure [ ]
c) Increase to get chance of getting CAD [ ]
d) Increases the blood sugar level [ ]
41. Average person should need to exercise daily at least
a) 30 minutes per day [ ]
b) 30 minutes per month [ ]
c) 2 hours per day [ ]
d) 1 hour per day [ ]

146
42. Purpose of BMI is to rule out
a) Diabetes [ ]
b) Hypertension [ ]
c) Infections [ ]
d) Obesity [ ]
43. The people who are overweight should avoid taking
a) Raw vegetables [ ]
b) Boiled food stuffs [ ]
c) Fried foods [ ]
d) Fiber rich diet [ ]
44. Obesity can be reduced by
a) Regular exercise and diet control [ ]
b) Regular exercise and no diet control [ ]
c) Diet control without regular exercise [ ]
d) Irregular exercise and no diet control [ ]
45. The average hours of sleep per day for an adult is
a) Less than 6 hours [ ]
b) 6-8 hours [ ]
c) 10 hours [ ]
d) 12 hours [ ]
46. In order to prevent the risk for CAD, Diabetic patients are
recommended to have
a) Fat rich diet [ ]
b) Sodium rich diet [ ]
c) Low carbohydrate [ ]
d) High carbohydrate [ ]
47. Stress can be induced by
a) Developing social interactions [ ]
b) Planning adequate time for rest and sleep [ ]
c) Isolating from family members [ ]
d) Being physically active [ ]

147
Management
48. Medications to be taken after the disease is
a) Regularly as prescribed [ ]
b) Only when you get pain [ ]
c) Stop once the pain subsides [ ]
d) No need to take at all [ ]
49. The surgical treatment for coronary artery disease is
a) Mitral valvoplasty [ ]
b) Coronary angioplasty [ ]
c) Mitral valve replacement [ ]
d) Heart transplantation [ ]
50. Major complication of CAD is
a) Cardiac arrhythmias [ ]
b) Cardiac failure [ ]
c) Cardiac myopathy [ ]
d) Myocardial infarction [ ]

148
 PART III: CHECK LIST TO ASSESS THE PRACTICE ON PREVENTION OF
CORONARY ARTERY DISEASE
Instructions:
These questions seek information about practice regarding prevention of coronary artery
disease. Place a tick mark in corresponding column according to your response.
S.
QUESTIONS YES NO
No.
1 Are you taking foods low in saturated and transfat?
2 Are you taking foods rich in Omega 3 fatty acids such as fish
and olive oil?
3 Are you including vegetables and fruits regularly in your diet?
4 Are you taking fiber rich diet?
5 Are you avoiding high calorie foods in your diet?
6 Are you taking sugar and salt rich diet?
7 Are you performing daily exercises/walking?
8 Are you doing aerobics activities like swimming, cycling etc?
9 Are you checking your body weight regularly?
10 Are you maintaining healthy weight?
11 Are you taking food frequently from hotel?
12 Are you avoiding junk foods and fast foods in your diet?
13 Are you aware of harmful effects of smoking?
14 Do you avoid smoking/ tobacco?
15 Do you follow any other stress relieving techniques?
16 Do you plan your leisure time activities?
17 Are you taking adequate rest in between your work schedule?
18 Are you mingling with your family members and friends
frequently?
19 Are you undergoing regular health checkups?

20 Are you taking any medications to control the risk factors of

coronary artery disease?

149
PART-II: SCORE KEY FOR STRUCTURED KNOWLEDGE QUESTIONNAIRE

QUESTION NO ANSWER SCORE

1 a 1
2 a 1
3 a 1
4 b 1
5 d 1
6 b 1
7 a 1
8 a 1
9 c 1
10 d 1
11 b 1
12 a 1
13 a 1
14 c 1
15 c 1
16 c 1
17 b 1
18 a 1
19 b 1
20 b 1
21 a 1
22 b 1
23 a 1
24 a 1
25 b 1
26 a 1
27 a 1

150
QUESTION NO ANSWER SCORE

28 a 1

29 c 1
30 c 1
31 a 1
32 a 1
33 a 1
34 c 1
35 d 1
36 a 1
37 a 1
38 b 1

41 a 1
42 d 1
43 c 1
44 a 1
45 b 1
46 c 1
47 c 1
48 a 1
49 b 1
50 b 1

SCORE: 50

151
 PART-III: SCORE KEY
QUESTION NO ANSWER SCORE
1 YES 1
2 YES 1
3 YES 1
4 YES 1
5 YES 1
6 NO 1
7 YES 1
8 YES 1
9 YES 1
10 YES 1
11 NO 1
12 YES 1
13 YES 1
14 YES 1
15 YES 1
16 YES 1
17 YES 1
18 YES 1
19 YES 1
20 YES 1

TOTAL: 20

152
 APPENDIX XII

`mKw ˛ 1: ÿnXnhnhc°W°pIƒ
tcmKnbpsS ÿnXnhnhc°W°pIƒ kw_‘n®v Nn´s∏SpØnb tNmZymhen

\n¿t±i߃ :
Xmsg sImSpØncn°p∂ 12 tNmZy߃°v icnbpØcØn¬ (√) ASbmfs∏SpØpI.
1 {]mbw (h¿jØn¬)
a) 21 ˛ 30 hb v
b) 31 ˛ 40 hb v
c) 41 ˛ 50 hb v
d) 50 hb n\v apIfn¬
2 enwKw
a) ]pcpj≥
b) kv{Xo
3 hnZym`ymk tbmKyX
a) sslkvIqƒ
b) lb¿ sk°‚dn
c) _ncpZw
d) _ncpZm\¥c_ncpZw
4 tPmen hnhcw
a) eLp tPmen°mc≥
b) anX tPmen°mc≥
c) ITn\m[zm\n
5 aXw
a) lnμp
b) apkvenw
c) {InkvXy≥
d) a‰p≈h¿
6 sshhmlnI tbmKyX
a) AhnhmlnX≥
b) hnhmlnX≥
c) hn[h
7 Blmc coXn
a) kky`p°v
b) amwk`p°v
8 Zp»oe߃
a) aZy]m\n
b) ]pIhen/apdp°v
c) ]pIhenbpw aZy]m\hpw
d) apIfnteXv GXpa√.

153
9 c‡kΩ¿±w \n¿Æbn°s∏´n´pt≠m
a) D≠v
b) C√
10 {]talw \n¿Æbn°s∏´n´pt≠m
a) D≠v
b) C√
11 IpSpw_Øn¬ lrZbtcmK ]mcºcyapt≠m
a) D≠v
b) C√
12 c‡Øn¬ Db¿∂ sImgp∏ns‚ Afhv \n¿Æbn°s∏´n´pt≠m
a) D≠v
b) C√
* BMI AfhpIƒ
a) A≠¿shbv‰v < 18.5
b) km[mcW 18.5 - 24.9
c) AanX`mcw 25 - 29.99
d) AanXhÆw 30 - 39.9
e) 40¬ IqSpX¬
* AchÆw
a) BWpßfn¬ 100 sk‚nao‰dn¬ IqSpX¬
b) s]Æpßfn¬ 88 sk‚nao‰dn¬ IqSpX¬
c) BWpßfn¬ 100 sk‚nao‰dn¬ Ipdhv
d) s]Æpßfn¬ 88 sk‚nao‰dn¬ Ipdhv

`mKw ˛ 2: lrZb[a\ntcmK {]XntcmZhn⁄m\Øn¬ A[njvTnXambn Nn´s∏SpØs∏´

tNmZymhen.
Cu tNmZymhenbn¬ 50 tNmZy߃ ASßnbncn°p∂p. Hmtcm tNmZyØn\pw H∂ne[nIw
DØc߃ sImSpØncn°p∂Xn¬ H∂p am{XamWv icnbmb DØcw. sImSpØncn°p∂ IfØn¬
icnbpØcw am¿°v (√) sNøpI.
LS\bpw {]h¿Ø\hpw
1 km[mcWbmbn lrZbw ÿnXn sNøp∂Xv FhnsS
a) s\©d
b) DZc Ad
c) t\{X Ad
d) tImi Ad
2 Hcp an\n‰n¬ km[mcWbp≈ lrZbanSn∏v
a) 60˛80 XhW
b) 50˛ 60 XhW
c) 90 ˛ 100 XhW
d) 110˛ 120 XhW

154
3 lrZbt]inIƒ°v c‡w FØn°p∂Xv
a) lrZb[a\n
b) load¬ [a\n
c) ]ƒa\dn [a\n
d) Itcm´nSv [a\n
4 lrZbØns‚ {]h¿Ø\w F¥mWv
a) c‡w kw`cn°pI
b) ip≤c‡w icocØns‚ hnhn[ `mKßfn¬ FØn°pI
c) icocØn¬ \n∂v Im¿_¨ UtbmIvsskUv \o°w sNøpI
d) tlm¿tamWns‚ Afhv \ne\n¿ØpI.
5 lrZbØn\v F{X AdIfp≠v
a) Hcp Ad
b) c≠v Ad
c) aq∂v Ad
d) \mev Ad
\n¿hN\w
6 lrZb[a\ntcmKØn¬ Dƒs∏´n´p≈h
a) izmktImi XIcmdv, t{_mss¶‰okv, A‰eIvSm‰nkv.
b) s\©pthZ\, AØntdm¢okvtdmknkv, atbmIm¿Unb¬ C≥{^m£≥.
c) lrZbt]inbpsS ho°w, lrZbkvXw`\w, Ft‚mIm¿ssU‰nkv
d) akvXnjvImLmXw, Xet®mdnse \o¿s°´v, sa\n©‰nkv
7 lrZb[a\ntcmKØns‚ {]h¿Ø\w Fßs\
a) lrZb[a\nIfn¬ sImgp∏v ASn™pIqSn D≠mIp∂ XS w
b) `£W\mfnbn¬ D≠mIp∂ XSkw
c) lrZbØns‚ Npcp߬
d) s\©dbn¬ D≠mIp∂ hyXnbm\w
B]ØvLSI߃
8 lrZb[a\ntcmKØns‚ B]ØvLSIßsf Fßs\ XcwXncn®ncn°p∂p
a) am‰w hcpØmhp∂Xpw am‰w hcpØm≥ ]‰mØXpamb LSI߃
b) ss{]adn sk°‚dn LSI߃
c) H∂mw Un{Kn, c≠mw Un{Kn LSI߃
d) Xo{hambXpw Zo¿LImeambn´p≈ LSI߃
9 lrZb[a\n tcmKØns‚ km[yX h¿≤n°p∂Xv Ft∏mƒ?
a) {Iaamb hymbmaw sNøp∂XneqsS
b) Xq°w Ipdbv°ptºmƒ
c) lrZbtcmKØns‚ IpSpw_]mcºcyw D≈t∏mƒ
d) BtcmKyIcamb `£W{IaØneqsS

155
10 lrZb[a\n tcmKw km[mcWbmbn D≠mIp∂Xv GXv hb n¬
a) < 25 hb n¬
b) 26˛35 hb n¬
c) 36˛45 hb n¬
d) 45 hb n\p apIfn¬
11 am‰w hcpØm≥ ]‰mØ lrZb[a\n tcmKØns‚ B]Øv LSI߃ BWv
a) am\knI ]ncnapdp°w, ]pIhen, imcoc[zm\Øns‚ Ipdhv.
b) {]mbw, enwKw, lrZbtcmKØns‚ IpSpw_]mcºcyw.
c) c‡kΩ¿±w, {]talw, AanXhÆw
d) aZy]m\w, ab°pacp∂p]tbmKw, t]mjW]cnWma hnjbIamb tcmKw
12 NoØ sImgp∏v F∂phnfn°p∂Xv GXns\
a) km{μX Ipd™ sImgp∏v (LDL)
b) km{μX IqSnb sImgp∏v (HDL)
c) ss{S•nkssdUvkv
d) •nkdm¬UnsslUv
13 km{μX IqSnb sImgp∏ns‚bpw km{μX Ipd™ sImgp∏ns‚bpw tXmXv
a) HDL s‚ tXmXv >60mg/dl, LDL < 100 mg/dl
b) HDL < 10 mg/dl, LDL >200mg/dl
c) HDL > 120mg/dl, LDL < 500mg/dl
d) HDL > 300mg/dl, LDL < 750mg/dl
14 c‡kΩ¿±w lrZb[a\ntcmKØns‚ B]ØvLSIambn IW°m°m≥ ImcWw
a) izmktImiØns‚ {]h¿Ø\`mcw h¿≤n∏n°p∂p.
b) RcºpIfpsS inYneoIcWw Iq´p∂p.
c) lrZbØns‚ {]h¿Ø\`mcw Iq´p∂p.
d) lrZbØns‚ {]h¿Ø`mcw Ipdbv°p∂p.
15 a[yhbkvIcmb BfpIƒ°v c‡kΩ¿±w Ds≠∂v ]dbp∂Xv c‡kΩ¿±w GXn¬ IqSpX
emIptºmƒ BWv?
a) 130/80 mm of Hg
b) 120/80 mm of Hg
c) 140/90 mm Hg
d) 150/100 mm of Hg
16 ]pIhen°v Zqjyhi߃ D≠mIp∂Xv AXn¬ F¥v ASßnbncn°p∂Xp sIm≠mWv
a) Im¿_¨ UtbmIvsskUv, ss\{SP≥, km{In≥, t^mkvt^‰v apXembh
b) I^o≥, jpK¿, B≥tUmÃntdm¨, Im‰ntImeman≥ apXembh
c) \nt°m´n≥, Im¿_¨ tamtWmIvsskUv, _≥ko≥, t^m¿am¬Unss^Uv
d) s]m´mkyw, sImgp∏v, sh≈w apXembh

156
17 ]pIhen c‡Nw{IaWsØ _m[n°p∂Xv Fßs\
a) c‡Ipgen¬ sI´phogpI
b) c‡°pg¬ NpcpßpI.
c) c°°pg¬ hnIkn°pI.
d) apIfn¬ ]d™sXm∂pa√.
18 c‡Ønse ]©kmcbpsS Afhv IqSm≥ {][m\ImcWw
a) icocØn¬ Bhiym\pkcWw C≥kpen≥ D¬]mZn∏n°mXncn°ptºmƒ
b) ss_¬ D¬]mZn∏n°s∏Sp∂Xv Ipdbptºmƒ
c) ssXtdmbnUv tlm¿tamWns‚ D¬]mZ\w Ipdbptºmƒ
d) F®v kn F√ns‚ D¬]mZ\w Ipdbptºmƒ
19 {]mb]q¿Ønbmb Hcp hy‡nbpsS c‡Ønse ]©kmcbpsS Afhv
a) 60 - 110 mg/dl
b) 80 - 120 mg/dl
c) 70 - 110 mg/dl
d) 140 - 160 mg/dl
2-0 Xmsg∏dbp∂ {]talßfn¬ GXmWv lrZbL[a\ntcmKØns‚ {][m\ B]ØvLSIw
a) ssS∏v 1 {]talw
b) ssS∏v 2 {]talw
c) {]o Ub_‰nIv
d) {]khImeØp≠mIp∂ {]talw
21 AanXhÆap≈h¿°v lrZb[a\n tcmKw hcm≥ km[yX IqSpXemsW∂v ]dbp∂Xv
F¥psIm≠v?
a) c°°pgen¬ sImgp∏v ASn™pIqSp∂XpsIm≠v
b) Zl\{]{Inb IqSp∂XpsIm≠v
c) D]tbmKiq\yamb ]Zm¿∞߃ icocØn¬ sI´n°nS°p∂Xn\m¬
d) hnk¿÷y߃ IqSpXembn ]pdwX≈s∏Sp∂XpsIm≠v
22 t]mjIW]cnWma hnjbIcamb tcmKØn¬ Dƒs∏SmØ B]XvLSIw GXmWv
a) henb AchÆw
b) Db¿∂ lotamt•m_ns‚ Afhv
c) c‡Ønse Db¿∂ ]©kmcbpsS Afhv
d) Db¿∂ sImgp∏ns‚ Afhv
tcmKe£W߃
23 B≥sP\ s]IvtSmdnkv F∂m¬ F¥v?
a) hbdpthZ\
b) s\©pthZ\
c) ]pdw thZ\
d) sNhnthZ\

157
24 Xo{hamb atbmIm¿Unb¬ C≥{^m£≥ D≠mIp∂sX¥p sIm≠v
a) c‡Nw{IaWw Ipdbp∂Xn\m¬ lrZbt]inIƒ \in°p∂p.
b) IqSpX¬ c‡w izmktImiØnte°v {]hln°p∂Xn\m¬
c) c‡Nw{IaWw Ipdbp∂Xn\m¬ Xet®mdns‚ {]h¿Ø\w XIcmdnemIp∂p
d) izmktImiØnte°p≈ c‡{]hmlw Ipdbp∂p
25 Unkv\nb F∂ hm°ns‚ A¿∞w
a) Dd°an√mbva
b) izmkwap´v
c) \S°m\p≈ _p≤nap´v
d) hngpßp∂Xn\p≈ {]bmkw
26 Im¿UnbmIv AcnØnanb F∂ hm°ns‚ A¿∞w
a) {Iaw sX‰nb lrZbanSn∏v
b) izk\an√mbva
c) lrZbØns‚ BIrXnbn¬ D≠mIp∂ hyXnbm\w
d) lrZbØns‚ hen∏Øn¬ D≠mIp∂ hyXnbm\w
tcmK\n¿Æbw
27 c‡Ønse A\mtcmKyamb sImgp∏ns‚ Afhv \n¿Æbn°s∏Sp∂Xn\v \SØs∏Sp∂
]cntim[\.
a) en∏nUv s{]mss^¬
b) c‡Ønse ]©kmcbpsS Afhv
c) C F v B¿
d) Iwπo‰v ªUv Iu≠v.
28 Xmsg ]dbp∂Xn¬ GXmWv Im¿UnbmIv am¿°¿
a) Im¿UnbmIv {Snt∏mWn≥ Sn
b) \{Snbq‰nIv s]∏vss‰Uvkv
c) en∏nUv s{]mss^¬
d) c‡Ønse ]©kmcbpsS Afhv
{]Xntcm[\nhmcWw
29 ]qcnX sImgp∏v ImWs∏Sp∂ `£W߃
a) Acn, tKmXºv, ]cn∏v
b) ]®°dnIƒ, ]g߃, Ce°dnIƒ
c) ]mep¬∏∂߃, anTmbnIƒ, hdpØXpw Nps´SpØXpamb `£W߃
d) ]bdph¿§ßƒ
30 Xmsg∏dbp∂hbn¬ HtaK 3 (sImgp∏v) IqSpX¬ \¬Ip∂ `£Ww GXv
a) Cd®n
b) ]m¬°´n
c) ao≥
d) ]®°dnIƒ

158
31 \mcv IqSpXembn ASßnb `£Ww
a) [m\y߃, ]g߃, ]®°dnIƒ
b) ao≥, ap´, Cd®n
c) ]m¬, sh≈w, FÆ
d) ]bdph¿§ßƒ, ISe
32 D∏v Ipdhp≈ Blmcw Ign°p∂Xv GXns\ \nb{¥n°m\mWv
a) c‡kΩ¿±w
b) Dujvamhv
c) c‡Ønse ]©kmc
d) izk\w
33 ]©kmc Ipdhp≈ Blmcw Ign°p∂Xv GXv tcmKsØ XSbm≥ klmbn°p∂p.
a) Xq°w IqSp∂Xn\pw {]talhpw
b) Xq°w Ipdbp∂Xn\pw {]talhpw
c) AanXamb hnb¿∏ns\ XSbm≥
d) hnb¿∏ns\ Iq´p∂Xn\pw
34 lrZb[a\n tcmKkm≤yX Ipdbv°m≥ GXpXcw `£W߃ Dt]£n°Ww
a) ]®°dnIƒ
b) IqSpXembn \mcv ASßnb `£Ww
c) A[nIambn Du¿÷w Xcp∂ `£Ww
d) apIfn¬ ]d™sXm∂pa√
35 Xmsg∏dbp∂hbn¬ `£WØn¬ Dƒs∏SptØ≠h
a) D∏pw ]©kmcbpw
b) hdpØ `£W߃
c) t]mjImwiw Ipd™ Blmcw
d) HtaK 3 sImgp∏v ASßnb `£W߃
36 lrZb[a\n tcmKw h∂Xn\p tijw ]pIhenioew
a) ]q¿Æambn Dt]£n°Ww
b) BgvNbn¬ H∂mbn ]cnanXs∏SpØpI
c) amkØn¬ H∂mbn ]cnanXs∏SpØpI
d) ap≥]nesØt∏mse \n¿_m[w XpScpI
37 ]pIhen ioew \n¿Øm≥ apJyambpw D]tbmKn°p∂ sXdm∏n
a) \nt°m´n≥ dntπkvsa‚ v sXdm∏n
b) Xm¬]cyP\Iamb ioeßfneqsS {i≤Xncn°pI
c) acp∂v sImSpØpsIm≠v
d) tbmKbpw [ym\hpw sIm≠v

159
38 \nt°m´n≥ dotπkvsa‚ v sXdm∏nbpsS apJye£yw?
a) Icƒ tcmKsØ {]Xntcm[n°m≥
b) \nt°m´ns‚ AXnImw£bw hnSpX¬ e£Wßfpw Ipdbv°pI
c) ]pIhenbpsS Zp¿K‘w Ipd°m≥
d) Zl\t°Sv am‰m≥
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160
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161
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162
 ABSTRACT
Coronary artery disease (CAD), is also called Coronary arteriosclerosis, Coronary
atherosclerosis. Coronary artery disease (CAD) is the most common type of heart disease). Most
heart attacks happen when a blood clot suddenly cuts off the hearts' blood supply, causing
permanent heart damage. Over time, CAD can also weaken the heart muscle and contribute to
heart failure and arrhythmias. Heart failure means the heart can't pump blood well to the rest
of the body. Arrhythmias are changes in the normal beating rhythm of the heart.
According to existing knowledge, CAD epidemics are essentially preventable. For
example, CAD mortality has fallen one-third to one-half in the last three decades in majority of
developed countries. The reasons for the accelerated decline in CAD mortality from 1980-1990
were analysed. They found that 25% of the decline was due to primary prevention, 29% due to
secondary prevention and 43% was due to improvements in treatments of patients. This
demonstrates that modification of risk factors related to lifestyle in the entire nation, rather than
advances in management of few with overt CAD is largely responsible for dramatic decline of
CAD mortality in the developed countries. This is clear proof that the average of CAD reduced
with appropriate measures.
The main objective of the study is to assess the effectiveness of planned teaching
programme on knowledge and practice regarding prevention of coronary artery disease among
patients admitted with modifiable risk factors of CAD in private hospital, Kerala. One group pre
test and post test design was used for this study. The independent variable in this study is
prevention of coronary artery disease. The dependent variable in this study is knowledge and
practice. The study was conducted at T.M.M Hospital, Thiruvalla, which is a 400 bedded
multispecialty hospital.

Sample includes patients with modifiable risk factors of CAD at T.M.M Hospital, who
fulfils the inclusion criteria were selected by non probability purposive sampling technique.
Planned teaching on knowledge and practice on prevention of coronary artery disease.

The comparison of pre-test and post test mean score of knowledge revealed a “t” value
was t = = 9.775 which showed a high statistical significance at p<0.001. The comparison of pre
test and post test mean score of practice revealed a “t” value was t=7.301 which showed a high
statistical significance at p<0.001. Hence the study concluded that planned teaching programme

163
has improved the level of knowledge and practice on prevention of coronary artery disease
among patients with modifiable risk factors of CAD.

There was a significant improvement of knowledge and practice among patients with
modifiable risk factors of CAD at T.M.M Hospital after planned teaching as an intervention.
Thus planned teaching on prevention of coronary artery disease was an effective intervention in
the enhancement of knowledge and practice among patients with modifiable risk factors of CAD.

The present study conducted by the investigator, mainly focused on the planned teaching
programme to improve the knowledge and practice on prevention of coronary artery disease and
was found effective and also the researcher insisted the patients with multiple modifiable risk
factors of CAD should seek medical advice and follow up care.

164
CORONARY ARTERY
DISEASE
 INTRODUCTION
 Coronary artery disease is common type of cardio vascular
diseases.
 A common symptom is chest pain or discomfort which may
travel into shoulder, arm, back, neck or jaw, may feel like
heart burn.
 Shortness of breath may also occur and sometimes no
symptoms are present..
ANATOMY AND PHYSIOLOGY OF
HEART
 DEFINITION
Coronary artery
disease is a group
of disease that
include angina
pectoris,
atherosclerosis
and myocardial
infarction and
leads to sudden
death.
 RISK FACTORS
Coronary artery
disease has a
number of well
determined risk
factors. These are
classified into two
major categories
1. Modifiable risk
factors
2. Non modifiable
risk factors
 The higher level
of LDL
cholesterol in the
blood, greater the
chance of getting
heart disease.
 The higher level
of HDL in your
blood lowers the
chance of getting
heart disease.
 1.MODIFIABLE RISK FACTORS
I.UNHEALTHY
BLOOD
CHOLESTEROL
 This includes high
LDL cholesterol and
low HDL
cholesterol .
 LDL level less
than 100mg/dl is
optimal and HDL
level above 60mg/dl
is desirable.
II. HIGH BLOOD
PRESSURE
 Blood pressure is
considered high if it
stays at or above
140/90mmHg over
time.
 High blood pressure
can cause the coronary
arteries to narrow and
stiffen.
III. SMOKING

 Smoking can damage

and tighten blood
vessels, lead to
unhealthy cholesterol
levels, and raise blood
pressure.
IV. DIABETES

 Normal blood
glucose level of an adult
in fasting 70-99mg/dl
 After meals less than
140mg/dl
 Random blood
glucose level 100-
140mg/dl.
V. LACK OF PHYSICAL
ACTIVITY
 Exercising and losing
weight can prevent or
delay the onset of type 2
diabetes, reduce blood
pressure and help reduce
the risk for heart attack
and stroke.
VI.OBESITY AND
CORONARY ARTERY
DISEASE
Obesity and coronary
heart disease risk,
including
 Hypertension
 Dyslipidemia,
 Reductions in HDL
 Impaired glucose
tolerance or NIDDM.
VII. METABOLIC SYNDROME
If you have three or more
of the five metabolic risk
factors, you have
metabolic syndrome. The
risk factors are:
 A large waistline.
 A high triglyceride level
 A low HDL cholesterol
level.
 High blood pressure.
 A high fasting blood
sugar level.
VIII. UNHEALTHY
DIET
Foods that are high
in
 Saturated and
trans fats
Cholesterol
 Sodium (salt)
 Sugar can worsen
other risk factors of
CAD.
 2. NON MODIFIABLE RISK FACTORS

A) OLD AGE
 In men, the risk for
CAD increases after
age of 45.
 In women, the risk
for CAD increases after
the age of 55.
B) GENDER
 Men are generally at
great risk of coronary
artery disease.

 The risk for women

increases after
menopause.
C) FAMILY HISTORY
FOR EARLY HEART
DISEASE
The risk for CAD
increases
 If a father or a
brother was diagnosed
with CAD before 55
years of age,
 If a mother or a
sister was diagnosed
with CAD before 65
years of age.
 CLINICAL MANIFESTATIONS
 ANGINA
Angina is often referred to as
chest pain.
It is also described as
 chest discomfort
 heaviness
 tightness
 pressure
 aching
 burning
 numbness
 fullness
 squeezing.
Types Of Angina

 stableangina
 unstable angina
 variant angina also
called Prinzmetal's
angina
 ACUTE MYOCARDIAL
INFARCTION
Acute myocardial
infarction occurs when blood
supply stops to the part of the
heart leads damage to
the heart muscle.
 DYSPNOEA
Dyspnoea, shortness of
breath or breathlessness is
the feeling or feelings
associated with impaired
breathing.
 ARRHYTHMIAS
Cardiac arrhythmias is a
condition in which the
heart beat is irregular, too
fast, or too slow.
DIAGNOSTIC INVESTIGATIONS OF CAD
 MEDICAL HISTORY

 Personal Health History

 Family Health History

.
 PHYSICAL EXAMINATION
 RESTING
ELECTRO
CARDIOGRAM
The ECG is often
used to find out any
variation in the heart’s
electrical activity.
 CHEST XRAY
.
 BLOOD TEST
 Complete Blood
Count
 Cardiac markers
 Natriuretic
peptides
 Lipid profile
 Glucose
measurements
 RADIO ISOTOPE MYOCARDIAL
PERFUSION SCANNING

Test may also be done to:

 Show blood flow

patterns to the heart
walls.
 See whether the heart
(coronary) arteries are
blocked and by how
much.
 Determine the extent
of injury to the heart.
 CORONARY
CALCIFICATION
SCORE
The use of fast
electron-beam CT
scanning allows non-
invasive calculation of
a coronary calcification
score.
 STRESS ECHO
CARDIOGRAPH
This observes changes
during exercise and/or
pharmacological
Stress.
PREVENTION
 LIFESTYLE
CHANGES
. A healthy lifestyle
includes:
 Following a healthy
diet
 Being physically
active
 Maintaining a
healthy weight
 Quitting smoking
 Managing stress
 FOLLOWING A
HEALTHY DIET
Follow a diet that is:
 Low in saturated
and trans fats
 High in the types of
fat found in fish and
olive oil
 High in fiber
 Low in salt and
sugar
 BEING
PHYSICALLY ACTIVE
 You can benefit from as
little as 30 minutes of
moderate-intensity aerobic
activity per day.
 Adults should do at least
150 minutes of moderate-
intensity aerobic activity or
75 minutes of vigorous-
intensity aerobic activities.
 A general rule is that 2
minutes of moderate-
intensity activity counts the
same as 1 minute of
vigorous-intensity activity.
 MAINTAINING
HEALTHY WEIGHT
 Follow a healthy
diet and be
physically active
 Reduce your
calorie intake and
take high fiber rich
diet.
 Avoid the use of
junk foods, fast
foods and high fat
containing diet.
 QUITTING SMOKING
 METHODS OF QUITTING SMOKING
NICOTINE
REPLACEMENT
THERAPY
Nicotine replacement
therapy uses products that
supply low doses of
nicotine.
Facts About Using Nicotine
Replacement Therapy:
 The more cigarettes you
smoke, the higher the dose
you may need to start.
 Adding a counseling
program will make you
more likely to quit.
 Do not smoke while using
nicotine replacement..
 Nicotine replacement
helps prevent weight gain
while you are using it.
 Dose of nicotine should
be slowly decreased.
TYPES OF NICOTINE
REPLACEMENT
THERAPY
 Gum
 Inhalers
 Lozenges
 Nasal spray
 Skin patch
Nicotine Patch
 Place the patch on
different areas above the
waist and below the neck
each day.
 Put the patch on a
hairless spot.
Nicotine Gum Or Lozenge
Tips For Using The Gum:
 If you are just starting
to quit, chew 1 - 2
pieces each hour. Do
not chew more than 20
pieces a day.
 Chew the gum slowly
until it develops a
peppery taste. Then,
tuck it between the gum
and cheek and store it
there. This lets the
nicotine be absorbed.
Nicotine Inhaler
 Insert nicotine
cartridges into the
inhaler and "puff" for
about 20 minutes. Do
this up to 16 times a
day.
Nicotine Nasal Spray
 The nasal spray
provides a quick dose
of nicotine to satisfy a
craving you are unable
to ignore.
 Levels of nicotine
peak within 5 - 10
minutes after using the
spray.
Side Effects And Risks
 Headaches
 Nausea and other
digestive problems
 Problems getting to
sleep in the first few
days, most often with
the patch.
 MANAGING STRESS
 Organize Yourself
 Control Your Environment
 Love yourself
 Enjoy Yourself.
 Reward yourself
 Exercise Your Body.
 Relax and rest yourself
 Be Aware of Yourself.
 Feed Yourself / Do Not
Poison Your Body.
 MANAGEMENT
1.DRUG MANAGEMENT
 Cholesterol-
modifying Medications
 Aspirin
 Beta Blockers
 Nitroglycerin
 ACE Inhibitors And
Angiotensin II Receptor
Blockers (ARBS)
2. SURGICAL MANAGEMENT

Angioplasty And Stent

Placement (Percutaneous
Coronary Revascularization)
Coronary Artery Bypass
Surgery. (CABG)
 COMPLICATIONS

COMPLICATIONS
 Cardiac Failure
 Sudden Death
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 k½À±w
 Fcn¨nÂ
 achn¸
\ndhv F¶nhbmbn hnhcn ¡s¸Smdp-v.
hnhn[Xcw Bs©bn\

 ØncXbpÅ Bs©bn\

 AØnc Bs©bn\
 thcnbâv Bs©bn\
 AIyq«v atbmImÀUnbÂ
C³{^m£³
lrZbt]inIÄ¡v càw e`n¡msX hcpt¼mÄ
t]inIÄ \in¡p¶p. CXmWv AIyq«v atbm
ImÀUnb C³{^m£³.
 izmkwap«v
izmk XSÊw, izk\¯n\p-mIp¶
_p²nap«v Asæn CXpambn _Ôs¸«
AhØbmWv CXv.
 Acn¯vanbmkv
lrZbanSn¸nsâ {Iaw sXänbtXm hfsc
DbÀ¶tXm Asæn hfsc IpdªtXm Bb
Hcp tcmKamWnXv.
 tcmK \n˨bw
sshZy]cntim[\ Ncn{Xw
 hyànIX tcmK Ncn{Xw
 IpSpw_tcmKhnhcWw
.
 tZl ]cntim[\
 C.kn.Pn

lrZb AdIfnep-mIp¶
sshZypX {]hml hyXnbm\w
I-p]nSn¡m³ klmbn¡p¶p.
 s\©nsâ FIvktd
.
 cà]cntim[\
 k¼qÀ® cà\nÀ®bw
ImÀUnbmIv amÀt¡gvkv
t\{Snbpd«nIv s]]vssäUvkv
en¸nUv s{]mss^Â
¥qt¡mknsâ Afhv
 tdUntbm sFtkmtSm¸v atbmImÀUnb s]À^yqj³
kvIm\nwKv

lrZbt]inIfnte¡pÅ cà{]hml¯nsâ
tXmXv Af¡phm³
 tImtdmWdn [a\nIÄ
XSÊs¸«n«pt-m, Ds-¦nÂ
F{Xam{Xw
lrZb¯n\v kw`hn¨ncn¡p¶
\mi¯nsâ Afhv I-p]nSn¡m\pamWv
Cu sSÌv sN¿p¶Xv.
 tImtdmWdn
ImÕn^nt¡j³
kvtImÀ
thKXtbdnb CeIvt{Sm¬ _ow
D]tbmKn¨v tImtdmWdn
ImÂkn^nt¡j³ kvtImÀ I-p
]nSn¡p¶p.
kv{Skv Ft¡m
ImÀUntbm{K^n
hymbmaw sN¿pt¼mtgm acp¶p
aqetam lrZbt]inIÄ¡p-mIp¶
hyXnbm\s¯ \nco£n ¡m³ Cu sSÌv
sN¿p¶p.
{]Xntcm[w
PohnX ssien
hyXnbm\w
BtcmKyIcamb PohnXssien F¶mÂ:
 BtcmKyIcamb Blmc{Iaw
 icnbmb hymbmaw
 icoc`mc \nb{´Ww
 ]pIhen Dt]£n¡pI
am\knI ]ncnapdp¡ \nb{´Ww
 BtcmKyIcamb
`£W{Iaw
CXn DÄs¸Sp¶ Blmc§Ä:
 sImgp¸p Ipdª `£Ww
 aÕy¯nepw Hensh®bnepw
AS§nbncn¡p¶ \Ã sImgp¸v
 \mcv IqSpXepÅ Blmcw
 D¸v, ]©kmc Ch Ipdª
`£Ww
 hymbmaw
Znhkhpw 30 an\näv anXambn
hymbmaw sN¿pI.
DbÀ¶ imcocnI £aX ssIhcn¡m³
{]mb]qÀ¯nbmbhÀ 150 an\näv (2.5
aWn¡qÀ) anXamb hymbma{Iahpw
Asæn 75 an\näv (1.15 aWn¡qÀ)
Xo{hhymbma {Iahpw
A\phÀ¯n¡Ww..
 icoc`mc \nb{´Ww
 BtcmKyIcamb
Blmc{Iahpw hymbmahpw
A\phÀ¯n¡pI
 Ipdª Itemdn \ÂIp¶
Blmc§fpw \mcv IqSpXepÅ
Blmc§fpw Ign¡pI.
 ]pIhen Dt]£n¡pI
 ]pIhen Dt]£n¡phm\pÅ amÀ¤§Ä
\nt¡m«n³ dot¹kvsaâ v
sXdm¸n
CXn D]tbmKn¡p¶ ]ZmÀ°§Ä
sNdnb Afhn \nt¡m«n³ {]Zm\w
sN¿p¶p.
\nt¡m«n³ dot¹kvsaâ v
sXdm¸ntb¡pdn¨pÅ Nne
hkvXpXIÄ:
IqSpX knKcäv hen¡p¶hÀ¡v DbÀ¶
tUmkv \ÂIWw.
Iu¬kenwKv sImSp¡pI.
Cu sXdm¸n sN¿pt¼mÄ
]pIhen¡cpXv.
Cu sXdm¸n `mcw hÀ²n¡p¶Xv
XSbp¶p.
Cu sXdm¸nbn \nt¡m«nsâ tUmkv
kmh[m\w Ipd¨p sIm-phcp¶p
hnhn[Xcw \nt¡m«n³
dot¹kvsaâ v sXdm¸nIÄ
 \nt¡m«n³ Kw
 C³tleÀ
 temsk©kv
 \mk kvt{]
 kvIn³]m¨v
\nt¡m«n³ ]m¨v
 Igp¯n\p Xmsgbpw Ac¡v
apIfnepambn ]ebnS§fnembn CXv
D]tbmKn¡Ww
tcmaclnX {]tZi¯v ]m¨v
D]tbmKn¡Ww.
\nt¡m«n³ Kw AYhm temk©kv
D]tbmKnt¡- coXnIÄ:
Bcw`¯n 1þ2 F®w Hmtcm
aWn¡qdnepw Nhbv¡Ww. Hcp
Znhkw 20 F®¯n IqSm³
]mSnÃ.
IpcpapfInsâ ckw hcp¶Xphsc
Cu Kw Nhbv¡pI. F¶n«v CXv
tamWbntem Np-n\p Iosgtbm
hbv¡pI. CXpaqew \nt¡m«n³
icoc¯nte¡v BKncWw sN¿s¸Sp¶p.
\nt¡m«n³ C³tleÀ
\nt¡m«n³ ImÀ{SnPUvPv
C³tledn h¨Xn\p tijw Hmtcm
20 an\nänepw Hmtcm ]^v
hoXw FSp¡pI. Hcp Znhkw 16
]^n IqSpX FSp¡cpXv..
\nt¡m«n³ \mk kvt{]
CXv \nt¡m«nsâ AanX Xzcsb
aYn¡pamdv s]s«¶v {]hÀ¯n¡p¶p.
 \nt¡m«n³ kvt{] D]tbmKn¨v
A©v an\nän\pÅn \nt¡m«nsâ
Afhv D¶Xnbnse¯pw.
]mÀiz^e§Ä
XethZ\
Hm¡m\hpw Zl\{]iv\§fpw
Dd¡anÃmbva.
 am\knI ]ncnapdp¡ \nb{´Ww
 \½sf¯s¶ Nn«s¸Sp¯pI.
 ]cnkc \nb{´Ww
 \½sf¯s¶ kvt\ln¡pI
 icocs¯ ]cn]men¡pI
hymbmaw sN¿pI
 icoc¯n\v icnbmb hn{iaw sImSp¡pI
kzbw a\Ênem¡pI.
 NnInÕm {Iaw
sImgp¸v hyXnbm\ acp¶pIÄ
 Bkv]ncn³
 _oäm t»mt¡gvkv
 ss\t{Sm ¥nkdn³
 B³PntbmsS³kn³
I¬thÀ«nwKv tlmÀtam¬
C³ln_ntägvkpw B³PntbmsS³kn³
II dnk]vtägvkv t»mt¡gvkv
(ARBs)
ikv{X{Inb \nhmcWw

B³Pntbm ¹mÌnbpw ̳Uv CSepw

(PTCR)
tImtdmWdn BÀ«dn ss_¸mkv
ikv{X{Inb
 COMPLICATIONS

k¦oÀ®XIÄ
 lrZbkvXw`\w
 s]s«¶pÅ acWw