Functional Impairment Kardiovaskuler

Most Common Signs & Symptoms of CARDIOVASCULAR DISEASE 1. Chest pain or discomfort. 2. Neck and/or arm pain or discomfort 3. Palpitation 4. Dyspnea 5. Syncope 6. Fatigue 7. Cough 8. Cyanosis 9. Edema 10. Claudication

PEMERIKSAAN - ECG; - X-ray (imaging); - echocardiography; - CT-scan; - cardiac catherization; - test darah dan - biopsy jantung. AUSCULTATION Aus”cul.ta’tion (L, auscultare=to listen to)  Mendeteksi & mengkaji suara (bunyi) yang ditimbulkan oleh berbagai organ tubuh  untuk membantu penentuan keadaan Fisik organ yang terkait (untuk organ jantung, & paru).

Ausculation (Lanjutan) Ausculation Procedure Dasar: beberapa organ tubuh menimbulkan suara (bunyi) pada saat menjalankan fungsinya, di antaranya: 1. Suara gerak fluid (cairan) (lambung, usus). 2. Gerak buka-tutup katup jantung. 3. Aliran udara melalui saluran napas, paru Hadirnya suara abnormal = gangguan/ penyakit pada jaringan terkait. 4. Suara detak jantung janin dalam kandungan ibu termasuk salah satu pemeriksaan rutin saat kehamilan.

HEART IMAGING TECHNIQUES Di antaranya: * Chest X-ray * Echocardiography Car”di.og’gra.phy (1) Analisis aksi jantung: dengan instrumen yang merekam gerak jantung. (2) Gambaran deskristip jantung. Ech’o- = Pantulan suara (gema) Coronary ang”gi.og’ra.phy  Aggeion (Y = vessel) (1) Menentukan struktur (susunan) p. darah/ p. limfe tanpa bedah/operasi (2) Ro  dengan suntikan zat radio-opaque. CT Scanning (CAT, CAT Axial T) (computerized tomography) MRI

Heart Imaging (Lanjutan -2) Cardiac Catheterization Blood Tests Biopsy otot jantung (jarang) ECG, EKG  E.lec”tro.car”di.og’graphy (Y, elektron; Y, kardia; Y, Grapheien) = Teknik perekaman (recording) khusus dan interpretasi. Electrocardiogram (E.lec”tro.car’di.o.gram”) = Hasil rekaman (gram = gambar) pemeriksaan teknik EKG Electrocardiographe (E.lec”tro.car’di.o.graphe” = Instrumen perekam grafik (gambar) permanent yang dihasilkan oleh aliran listrik voltage rendah dari denyut (detak) jantung pada bagian-bagian tubuh.

CORONARY HEART DISEASE Timbul bila ada ATHEROMA (deposit lemak/Plaque di rongga pembuluh darah ARTERIA CORONARIA (arteri yang mensuplei darah ke jantung). Atheroma menimbulkan penyempitan ruang pembuluh  mengurangi volume aliran darah (+CO2) ke tempat tujuan. Gejala: - Serangan ANGINA, timbul bisa saat: - Latihan fisik - Emosional stres - Kerusakan bisa fatal/permanent.

CORONARY HEART DISEASE (Lanjutan) Terapi: (1) Rubah gaya hidup (2) Obat-2  mengurangi serangan/ sumbatan (3) Bila disertai Hypertension/ cholesterol tinggi  obat khusus.

Risk Factors & Coronary Artery Disease Modifiable Risk Factors: Physical inactivity; cigarette smoking; elevated serum cholesterol; high blood pressure. No-modifiable Risk Factors: Age; male sex; family history; race. Contributing Factors Obesity; discriminatory medicine; response to stress; diabetes; hormonal status; alcohol consumption.

Non-atherosclerotic Causes of Coronary Artery Obstruction Kawasaki’s disease Coronary embolism: Infective endocarditis Prosthetic valves Cardiac myxoma Cardiopulmonary bypass Coronary arteriography Insulin resistance syndrome (hyperinsulinemia)

Non-atherosclerotic Causes of Coronary Artery Obstruction (Lanjutan) Trauma to cor. arteria: Penetrating & Non-penetrating Arteritis: Syphilis, polyarteritis nodosa, lupus erythematosus, rheumatoid arthritis Connective tissue disease Radiotherapy

Terapi Penyakit Coroner (Lanjutan-3) Operasi: * Angioplasty (Balon Catheter) * Coronary Bypassed Prevensi: * Faktor penyebab risiko >> - familiar, oleh karenanya:  Cegahlah! (1) Rokok  meningkatkan atheroma (2) Obesity  meningkatkan atheroma  Strain meninggi pada otot jantung, butuh O2 >> (3) > fat pada diet  Atheroma (herediter, >> diet) (4) Kurang latihan fisik (olahraga), bila teratur latihan akan menurunkan kebutuhan O2.

TYPE OF ANGINA PECTORIS Serangan sakit daerah dada akibat ischemia pada jaringan otot jantung. Insidens tepat angina pectoris belum diketahui, ditemukan serangan umum pada usia 65 > 65 tahun, > pria dari wanita. TYPES of ANGINA PECTORIS Chronic (stable) angina (classic, exertional angina, timbul saat stress emotional atau fisik), mudah diatasi dengan istirahat dan nitroglycerin. Keadaan konstan selama 60 hari. Apabila dalam 60 hari timbul kembali = New onset.

TYPE OF ANGINA PECTORIS (Lanjutan -1) Nocturnal angina (serangan membangunkan pasien malam hari) Post-infarction angina Pre-infarction angina (unstable) = progresive angina or crescendo angina (unpredictable) Prinzmetal’s (variant) angina (gejala sama, serangan timbul akibat spasme arteria coronary) Resting angina (decubitus) (paroxysmal, tidak terpengaruh oleh exercise, tidak hilang dengan istirahat)

CAUSE of MYOCARDIAL ISCHEMIA DECREASED OXYGEN SUPPLY Vessels: Artherosclerotic narrowing Inadequate collateral circulation Spasm due to smoking, emotion, or cold Coronsry arteritis; hypertension; hypertrophic cardiomyopathy INCREASED OXYGEN DEMAND Hyperthyroidism; Arterovenous fistula; Thyrotoxicosis Exercise/exertion; Emotion/excitement; Digestion of large meal

CAUSE of MYOCARDIAL ISCHEMIA (Lanjutan-1) Circulation Factors Blood Factors Arrhythmia (Tensi darah menurun) Anemia Hypoxemia Aortic stenosis Polycetemia (viscosity meninggi) Hypotention

CAUSES of MYOCARDIAL INFARCTION (Lanjutan.2) Coronary thrombus (Blood clot) Atheroslerosis Aortic stenosis Rheumatic heart disease Endocarditis Prosthetic mitral or aortic valve Prolonged vasospasm Hypotension (inadequate myocardial blood flow) Dislodged calcium plaque from calcified aortic or mitral valve.

CAUSES of MYOCARDIAL INFARCTION (Lanjutan.3) Excessive metabolic demand Vasculitis, Aortitis Aortic root or coronary artery dissection Pengguna kokain.

BLOOD PRESSURE LEVELS for ADULTS * SYSTOLIC DIASTOLIC CATEGORY (mm Hg) (mmHg) Normal < 130 < 85 High Normal 130-139 85-89 Hypertension: Stage 1 (mild) 140-159 90-99 Stage 2 (moderate) 160-179 100-109 Stage 3 (severe) 180-209 110-119 Stage 4 (very severe) = /> 210 =/> 120 * For adult aged 18 years and older not taking antihypertension drugs and not acutely ill (From the 5Th Report of the Joint National Committee on Detection, Evaluation and Treatment of High Blood Pressure (JNCW) Arch Intern Med. 153; 154-183, 1993).

RISK FACTORS of PRIMARY (ESSENTIAL) HYPERTENSION MODIFIABLE High sodium intake (causes water retention, increasing blood volume) Obesity (associated with increased intravascular volume) Hypercholestrolemia & increased serum triglycerides levels Smoking (nicotine restricts blood vessels) Chronic abuse of alcohol (increases plasma catecholamines) Continues emotional stress (stimulates sympathetic nervous system) Sedentary lifestyle

RISK FACTORS of PRIMARY (……) (Lanjutan-1) NONMODIFIABLE - Positive family history - Age (advanced), - Sex (male), - Race (black) (Adapted from Walsh. E. Management of persons with vascular problems. Medical-Surgical Nursing: Concepts & Clinical Practice., ed 5, 1995)

CAUSES of SECONDARY HYPERTENSION Coartation of the aorta Pheochromocytoma (a rare catecholamine secreting tumor) Alcohol abuse Pregnancy induced Thyrotoxicosis Increased intracranial pressure from tumors or trauma. Collagen disease

CAUSES of SECONDARY HYPERTENSION (Lanjutan-1) Endocrine disease: Acromegaly Diabetes Hyperthyroidism; hypothyroidism Renal disease (e.g. connective tissue diseases, diabetic retinopathy) Effects of drugs (e.g. oral contraceptives, cyclosporine, cocaine) Acute Stress: Surgery Psychogenic (hyperventilation) Alcohol withdrawal Burns, Pancreatitis Sickle cell crisis

Causes of Secondary Hypertension (lanjutan-2) Neurogenic Disorders: Brain tumor Respiratory acidosis Encephalitis Sleep apnea Guillain-Barre syndrome Quadriplegia Lead poisoning (Adapted from Kaplan NM; Systemic hypertension: mechanisms and diagnosis. In Braunwald E. heart Disease: A Textbook of Cardiovascular Medicine ed. 4. 1992)

CAUSES OF ORTHOSTATIC HYPOTENSION Volume depletion (DM, sodium or potassium depletion) Venous pooling (pregnancy, varicosities of the leg) Side effects of medication (anti-hypertensives) Prolonged immobility Starvation Performing the Valsalva maneuver Sluggish normal regulatory mechanisms (anatomic variation, altered body chemistry) Secondary to other conditions (endocrine or metabolic disorders, disease of central or peripheral nervous system)

TEKANAN DARAH sesuai POSISI BADAN Standing Sitting Supine BP = 140/80 BP = 124/76 BP = 104/68 Pulse = 80 Pulse = 86 Pulse = 98

ASTHMA CARDIALE Sulit bernapas akibat adanya timbunan cairan di paru sehingga menimbulkan bronchospasm dan napas berbunyi wheezing. Kondisi timbul akibat reduksi efisiensi pompa jantung kiri (pada gagal jantung)  kongesti dan meningkatkan tekanan di dalam sirkulasi darah paru dan timbunan cairan.

Asthma Cardiale (Lajutan) Penyebab memang berbeda dengan asthma bronchiale, namun dua kondisi ini menunjukkan gejala yang sama yakni: - napas wheezing, - sulit dan sesak bernapas. Pada X-ray bisa nampak cairan di paru. Terapi ditujukan kepada gagal jantung. Bisa juga diberi bronchodilatator.