Oleh:

Atherosclerosis: Penyakit Yang Progresif Monocyte LDL-C Adhesion molecule Macrophage Foam cell Oxidized LDL-C Plaque rupture Smooth muscle cells CRP Although atherosclerosis was formerly considered to be a bland lipid accumulation disease, it is now recognized to be a progressive, multifaceted condition1 Endothelial dysfunction, characterized by the impairment of vasodilator function, may be the earliest stage of coronary atherosclerosis and is triggered by one or more injurious factors such as elevated LDL-C, hypertension, or cigarette smoking2,3 The resultant inflammatory cascade leads to the incorporation of oxidized LDL-C into macrophages and the formation of plaque-forming foam cells1,4 Smooth muscle cell migration and proliferation and the deposition of fibrous tissue increase plaque size and alter the structure of the lesion so that it becomes covered with a fibrous cap. When the plaque ruptures, the thrombogenic contents of its core are exposed to the circulating blood1,3 References: 1. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105:1135-1143. 2. Al Suwaidi J, Hamasaki S, Higano ST, et al. Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation. 2000;101:948-954. 3. Ross R. Atherosclerosis—an inflammatory disease. N Engl J Med. 1999;340:115-126. 4. Libby P. Current concepts of the pathogenesis of the acute coronary syndromes. Circulation. 2001;104:365-372. Plaque instability and thrombus Oxidation Inflammation Endothelial dysfunction CRP=C-reactive protein; LDL-C=low-density lipoprotein cholesterol. Libby P. Circulation. 2001;104:365-372; Ross R. N Engl J Med. 1999;340:115-126.

Klasifikasi Angina Pektoris Menurut CCS Klas I : Aktivitas sehari-hari tidak timbul angina Klas II : Pembatasan ringan dari aktivitas sehari- hari Klas III : Aktivitas sehari-hari sangat terbatas Klas IV : Tidak mampu melakukan aktivitas fisik dan angina timbul saat istirahat

Gejala Klinis SKA Nyeri dada khas Faktor pencetus : Aktivitas, stress, udara dingin, sesudah makan

Diagnosis SKA Gejala klinis berupa nyeri dada Gambaran elektrokardiografi Cardiac Biochemial Marker : CK MB, Troponin)

Tata Laksana Penderita SKA Terapi antiiskemia Terapi antiplatelet Penggunaan Prosedur Invasif

Terapi Anti Iskemia Nitrat Morphine Sulfate Penyekat Reseptor Antagonis Kalsium

Terapi Antiplatelet Aspirin Thienopyridine - Ticlopidine - Clopidogrel Penghambat Reseptor GP IIb/IIIa - Abciximab - Eptifibatide - Tirofiban dan Lamifiban

Terapi Antitrombin UFH (Unfractioned Heparin) LMWH (Low Molecular Weight Heparin) Direct Trombin Inhibitor

Prosedur Invasif

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