SESI 13 DISEASES OF CARDIOVADCULAR (PENYAKIT JANTUNG-PEMBULUH) (BAB IX) Disusun oleh dr Mayang Anggraini Naga

DESKRIPSI Pembahasan meliput tentang gangguan pada jantung, sistem kardiovaskuler, struktur dan kekhususan Bab IX “Diseases of the Cardiovascular System” disertai pelatihan cara menentukan dan memilih kode diagnoses gangguan sistem kardiovaskuler, cara pendokumetasian kode klasiifkasi ganda, tambahan dan suplementer

TUJUAN INSTRUKSIONAL UMUM Mampu memahami definisi istilah gangguan kardiovaskuler dan dampak penting dokumentasi pernyataan waktu timbulnya serangan gangguan jantung dan cara menentukan kode dan pendokumentasian dengan benar.

TUJUAN INSTRUKSIONAL KHUSUS Menjelaskan: - definisi istilah-istilah gangguan sistem kardiovaskuler - struktur dan kekhususan serta peraturan yang berlaku bagi pemilihan nomor kode gangguan sistem kardiovasluler - Cara memilih nomor kode diagnosis gangguan sistem kardiovaskuker dengan akurat Menyelesaikan nomor kode diagnoses dalam contoh

POKOK & SUBPOKOK BAHASAN - Reading: “Disorders of The Heart” - Struktur dan kekhususan Bab IX - Peraturan-peraturan yang menyertai berbagai nomor kode diagnoses. - Pelatihan pencarian kode melalui ICD-10 volume III dan pengontrolan melalui daftar tabulasi volume I

READING 4: DISORDERS OF THE HEART Heart disorder are by far the most common cause of death in developed countries . They also impair the quality of life of millions of people, restricting activity by causing pain, breathlessness, fatigue, fainting spells, and anxiety. A wide range of conditions can affect the heart by ultimately interfering with the pumping action of the heart. Genetic disorder In general, inherited or genetic factors do not play a large part in the causation of heart disorders. However, they do contribute to the hyperlipidemias that predispose a person to atherosclerosis and coronary heart disease.

Structural abnormalities in the heart are among the READING-4 (Cont.-1) Congenital defects Structural abnormalities in the heart are among the most common birth defects, but are usually treatable. They result from errors of development in the fetus and include such conditions as septal (“holes in the heart”) defects and some types of abnormal heart valves

Endocarditis is an infection of the heart valves, usually READING-4 (Cont.-2) Infection Endocarditis is an infection of the heart valves, usually occurring in people whose hearts have already been damaged by rheumatic fever or are abnormal because of some congenital or degenerative disorder. It may also affect drug addicts who inject themselves intravenously with nonsterile needles. The infection may cause deformity and malfunctioning of any of the heart valves, leading to, for example mitral insufficiency or aortic insufficiency. Some types of cardiomyopathy are triggered by viral infection.

Tumors arising from the heart tissues are rare, the most READING-4 (Cont.-3) Tumors Tumors arising from the heart tissues are rare, the most common being the benign myxoma (that grows inside one of the heart’s chamber. Occasionally a malignant sarcoma develops. Secondary tumors, spreading from cancer elsewhere in the body are several times more common than primary tumors. These metastases usually grow within the heart muscle or the pericardium, but seldom affect the valves. The tumor may produce electrocardiographic abnormality and if extensive result in congestive heart failure.

Cardiomyopathy is a general term for disease of the READING-4 (Cont.-4) Muscle disorders Cardiomyopathy is a general term for disease of the heart muscle itself. One type of cardiomyopathy is inherited, other may be caused by vitamin deficiency or alcoholic poisoning, or may be triggered by a viral infection. Myocarditis is inflammation of the heart muscle. It may be caused by a viral infection or by toxins released during a bacterial infection. Rarely, it results from drugs or radiation therapy.

Birth injury to the heart usually occur in car accidents READING-4 (Cont.-5) Injury Birth injury to the heart usually occur in car accidents through impact with the steering wheel. .The heart is compressed between the sternum and the spine and the may suffer injury ranging from mild bruising to complete rupture. In immediately fatal car accidents, up to two thirds of the victims have suffered rupture of the heart chamber. Seat belt use could probably prevent some of these deaths. Stab wounds to the heart are often fatal within minutes, but, of patients who reach the hospital the great majority survive. Bullet wounds are more serious, about 10% of people shot in the heart reach the hospital alive.

Nutritional disorders The heart mucle is a sensitive to severe nutritional deficiency and may become thin and flabby from simple lack of protein and calories. Thiamine (Vit. B1) deficiency which is common in chronic alcoholics, causes beriberi with congestive heart failure. Obesity is another important factor in causing heart disease, probably through its effect on other risk factors such as hypertension, diabetes, and cholesterol. Impaired blood supply The major cause of heart disease in developed countries is impaired blood supply. The coronary arteries become narrowed due to atherosclerosis and parts of the heart muscle are deprived of oxygen. The result of coronary heart disease may be angina pectoris or eventually, a myocardial infarction.

The most common toxic substance affecting the heart is READING -4 (Contl-6) Poisoning The most common toxic substance affecting the heart is alcohol. A large intake for many years may cause a type of cardiomyopathy in which the heart becomes enlarged and heart failure develops. If alcohol intake is stopped, recovery is possible. Drugs Certain drugs may disturb the heart beat, or even cause permanent damage to the heart muscle. These drugs includes the anticancer drug doxorubicin, the tricyclic antidepressants, and even many drugs used to treat heart diseases.

Many common and important heart disorders may result READING -4 (Contl-7) Other disorders Many common and important heart disorders may result from some other underlying condition, such as coronary heart disease, cardiomyopathy, or a congenital defect. Such disorders include: - cardiac arrhythmia, - some cases of heart block and heart failure. Cor pulmonale is a failure of the right side of the heart, it is a consequence of lung diseases (emphysema), which increase resistance in blood flow.

Heart disease and disorders are investigated by such technigues as: READING -4 (Cont.-8) Investigation Heart disease and disorders are investigated by such technigues as: - auscultation, - ECG, - heart imaging techniques (x-ray, - echocardiography, - coronary angiography, - CT-scanning, - MRI, - cardiac catherization, - blood tests, and - in rare cases by a biopsy of the heart muscle.

SRUKTUR & KEKHUSUSAN BAB IX\ DISEASES OF CARDI0OVASCULAR SYSTEM (i00-I99) [Hal. 471-514] Excludes: certain condition originating in the perinatal period (P00-P96) (kondisi tertentu yang timbul pada period perinatal) certain infectious and parasitic diseases (A00-B99) (penyakit infeksi dan parasitic tertentu) complications in pregnancy, childbirth & the puerperium (O00-O99) (komplikasi dari kehamilan, persalinan dan nifas)

congenital malformations, deformations & Exckudes (Lanjutan-1) congenital malformations, deformations & chromosomal abnormalities (Q00-Q99) (malformasi, deformasi dan abnormalitas kromosom yang kongenital) endocrine, nutritional and metabolic diseases (E00- E99) (penyakit endokrin, nutrisi dan metabolik) injury, poisoning and certain other consequences of external causes (S00-T98) (cedera, keracunan dan konskeuensi sebab luar lain-lain) neoplasms (C00-D48) (neoplasma)

symptoms, signs and abnormal clinical and Exckudes (Lanjutan-2) symptoms, signs and abnormal clinical and laboratory findings NEC (R00-R99) (gejala, tanda dan temuan klinik, dan laboratoris yang abnormal) systemic connective tissue disorders (M30-M36) (Gangguan sistemik jaringan ikat) transient cerebral ischaemic attacks and related syndromes (serangan iskaemi (G45.-) serebri yang sementara dan kumpulan gejala yang tertkait)

Bab IX terbagi dalam blok-blok: I00-I02 Demam reumatik akut I05-I09 Penyakit-2 jantung reumatik menahun (kronis) I10-I15 Penyakit-2 hipertensi I20-I25 Penyakit-2 jantung iskemik I26-I28 Penyakit jantung paru dan penyakit-2 sirkulasi paru I30-I52 Bentuk-2 penyakit jantung lain I60-I69 Penyakit-2 serebrovaskuler I70-I79 Penyakit-2 arteria, arterioles dan kapiler darah I80-I89 Penyakit-2 vena, saluran dan nodi limfatik NEC I95-I99 Gangguan-2 tak dirinci dan lain-2 sistem sirkulasi.

Ada 8 kode ber (*): [471] I32* Pericarditis pd penyakit terklasifikasi di bagian lain I39* Endocarditis dan gangguan katub pada penyakit terklasifikasi di bagian lain. I41* Myocarditis pd penyakit terklasifikasi di bagian lain I43* Cardiomyopathy pd peny. terklasifikasi di bg lain I52* Gangguan-2 lain jantung pada penyakit terkla- sifikasi di bagian lain I68* Cerebrovascular disorders pd peny. terklasifikasi .. I79* Penyakit arteria, arteriole dan kapiler pd peny. … I98* Gangguan-gangguan lain sistem kardiovascular… (Bila code ber-* ini digunakan maka pasangannya harus diberi/ber-! dagger ) Jantung Reumatik, Hipertensi, Angina Pectoris dan Infark Miokardium

Perhatian perlu diberikan pada proses pengkodean bagi diagnosis: Demam reumatik yang dikelompokan di bawah Penyakit Sistem Sirkulasi. Kode-2 disediakan untuk: yang disertai dan tidak disertai keterlibatan jantung  I00 dan I01 Baca excludes: …di bawah I01 Kode hypertension dibedakan untuk yang esensial, ginjal dan jantung dan yang sekunder Kode angina pectoris membedakan yang stable dan yang unstable. Kode infark miokard dibedakan sesuai waktu timbulnya akut atau kronik serta letak infark di otot jantungnya.Kronik iskemik jantung mempunyai nomor code tersendiri.

Perhatian perlu diberikan pada proses pengkodean (lanjutan-1) Emboli Paru, Perikarditis, Gangguan Mitral, Miokarditis, Kardiomiopati dan Gagal Jantung Kode emboli paru membedakan apakah disertai gangguan jantung atau tidak. Kode pericarditis membedakan akut atau kronik. Kode I32* untuk pericarditis pada penyakit yang terklasifikasi di Bab lain Gangguan katub mitral membedakan apakah rematik atau nonrematik Kode I41* Myocarditis perlu dilengkapi dengan nomor berdagger untuk menjelaskan penyebabnya

Perhatian perlu diberikan pada proses pengkodean (lanjutan-2) Cardiomyopathy dikelompokan ke dalam 2 code untuk membedakan penyakit penyebab. Tachycardia dan gangguan irama jantung harus dibedakan dengan kode terkait di bab R. Gagal jantung, perhatikan nomor kode gagal jantung bila akan digunakan untuk “Cause of death” (ICD- Volume 2)

CVD – CVA, Stroke dan Gangguan Sirkulasi Limfe Baca aturan pemanfaatan nomor-2 code untuk CVD- CVA & stroke Stroke harus dibedakan apakah emboli, thrombosis, perdarahan atau spasm pembuluh darah cranial. Baca aturan di bawah I69 (Sequelae of CVD) Kode artherosclerosis, aneurysma dibedakan sesuai site lokasi gangguannya. Perhatikan nomor kode untuk phlebitis, thromosis vena, varices.

CVD-CVA …… Gangguan Sirkulasi Limfe (Lanjutan) Kode haemorrhoid dirinci pada digit ke-4 untuk menjelaskan site pembuluh haemorrhoid. Esophageal varices dilengkapi rincian ada perdarahan atau tidak. Lymphadenitis dibedakan yang spesifik dan nonspecific. Hipotensi dirinci apakah akibat luar obat atau tidak. Gangguan sistem sirkulasi postprosedural menduduki nomor kode tersendiri Disediakan kode I98.0* yang harus dilengkapi dengan causanya.

SOAL-SOAL LATIHAN Cari nomor kode pada istilah yang dicetak tebal dan diberi garis bawah pada materi Reading 4 Istilah No. ICD-10 pain, breathlessness, fatigue, fainting spells, No: anxiety. No: hyperlipidemias No: atherosclerosis No: coronary heart disease. No: endocarditis No: rheumatic fever No: mitral insufficiency No: aortic insufficiency No: cardiomyopathy No:

SOAL-SOAL LATIHAN (Lanjutan-1) Istilah No. ICD-10 benign myxoma No: malignant sarcoma No: electrocardiographic No: cardiomyopathy No: vitamin deficiency or alcoholic poisoning, No: myocarditis No: Injury No: Birth injury to the heart No: mild bruising. No: stab wounds to the heart No:

SOAL-SOAL LATIHAN (Lanjutan-2) Istilah No. ICD-10 bubllet wounds No: thiamine (Vit. B1) deficiency beriberi No: congestive heart failure. No: obesity No: hypertension, No: diabetes No: cholesterol. No: coronary heart disease No: angina pectoris No: myocardial infarction. No:

SOAL-SOAL LATIHAN (Lanjutan-3) Istilah No. ICD-10 anticancer drug doxorubicin, No: tricyclic antidepressants No: heart failure No: cardiac arrhythmia, No: heart block No: cor pulmonale No: emphysema No: Apakah semua istilah di atas bisa ditemukan nomor kodenya di ICD-10? Bila ada yang tidak dapat ditemukan, jelaskan mengapa.