Presentasi 30 April Fixxxxxx

8/13/2019 Presentasi 30 April Fixxxxxx

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THE CARDIOVASCULAR S YSTEM

CORONARY ARTERY DISEASE By : Group 3





ANATOMY AND PHYSIOLOGI THE

CARDIOVASCULAR SYSTEM

Heart

The heart is greatest in the cardiovascular system.

The heart has 2 sides:Right side & left side

The heart have 4 roows:

right atrium, left atrium,

right ventricle, left ventricle





BLOOD VESSEL

The blood vessel:

Arteries

arteriolesCapilllaries

Venules

Veins



CORONARY ARTERY DISEASE



P ATOPHYSIOLOGI

Pathophysiology disorder as the discussion of

abnormalities in other organs, the discussion of

abnormalities in the arteries is also differentiated by

the underlying process, namely: congenital

abnormalities, inflammatory disorders, degenerativedisorders, immunologic disorders, neoplasms and

other disorders is unclear pathophysiology.



TYPES AND CLASIFICATION

Acu te Coronary Syndromes

. Advanced Ischem ic Heart Disease

. B i furcat ion B lockage

Heart A ttack (Myocardial Infarct ion ) Microvessel Disease

Stent Restenosis

Total Coronary Occ lusion

http://my.clevelandclinic.org/heart/disorders/cad/mi_types.aspx

http://my.clevelandclinic.org/heart/disorders/cad/aihd-acd.aspx

http://my.clevelandclinic.org/heart/disorders/cad/bifurcationblockage.aspx

http://my.clevelandclinic.org/disorders/Heart_Attack/hic_Heart_Attack.aspx

http://my.clevelandclinic.org/services/angioplasty/instent_restenosis.aspx

http://my.clevelandclinic.org/heart/disorders/cad/totalcoronaryocclusion.aspx

http://my.clevelandclinic.org/heart/disorders/cad/totalcoronaryocclusion.aspx



http://my.clevelandclinic.org/disorders/Heart_Attack/hic_Heart_Attack.aspx

http://my.clevelandclinic.org/heart/disorders/cad/bifurcationblockage.aspx

http://my.clevelandclinic.org/heart/disorders/cad/aihd-acd.aspx

http://my.clevelandclinic.org/heart/disorders/cad/mi_types.aspx



ETIOLOGYCauses Why

Atherosclerosis Fatty plaques deposit and narrow the arteries over time Congenital defects Irregular vessel shapes can cause plaques and other debris

to become trapped narrowing the vessels Coronary artery spasm Creates a temporary vessel blockage

Dissecting aneurysm

An aneurysm creates a bulging out of the vessel wall due to

pressure. This can cause atherosclerotic plaque formation at

the site of the aneurysm, which causes further weakening of the artery wall. A blood clot may form at the site and

dislodge, increasing the chance of stroke Infectious vasculitis Inflammation of the vessels contributes to growth of plaque

in the arteries Syphilis If left untreated, syphilis can cause inflammation of the

vessels, which leads to growth of plaque in the arteries High blood levels of C-reactive

protein (CRP) CRP levels rise when there is protein (CRP) inflammation.

The inflammation process contributes to the growth of plaque in arteries



Unhealthy blood cholesterol levels. High blood pressure.

Smoking.

Insulin resistance

Diabetes

Family history of early heart disease.

Lack of physical activity

Overweight or obesity.

Age

Unhealthy diet



CLINICAL APPEARANCES

Signs and symptoms Why

MI The arteries become narrowed due to fatty plaque buildup (atherosclerosis) andnot enough oxygen reaches the heart, causing ischemia

Angina The arteries become narrowed due to fatty plaque buildup (atherosclerosis) and

not enough oxygen reaches the heart, causing ischemia. The ischemia causes

chest pain High blood pressure Atheromas grow, causing narrowing of the arteries and calcium accumulation in

the arteries Decreased peripheral pulses Decreased elasticity of the arteries and the narrowed lumen contribute to

decreased peripheral circulation Nausea and vomiting Angina

Fainting Decreased blood flow prevents oxygenation of the brain Sweating Angina

Cool extremities Decreased peripheral circulation Shortness of breath Decreased cardiac output leads to decreased lung perfusion



DIAGNOSTIC ASSESMENT

EKG (Electrocardiogram)

Blood Tests Chest X Ray

Ankle/Brachial Index

Echocardiography

Computed Tomography Scan Stress Testing

Angiogram

Electron beam computerized tomography

(EBCT): Magnetic resonance angiography (MRA):

Myocardial perfusion imaging with thallium 201during treadmill exercise



Risk factor for Coronary Artery Disease includedyslipidemia, smoking,hypertension, male gender

(women are protected untilmenopause), aging, non-white race, family history,obesity, sedimentary

lifestyle, diabetes mellitus,metabolic syndrome,elevated homocysteine, andstress.

http://cdn.nursingcrib.com/wp-content/uploads/chestpain.jpg?9d7bd4



THE THERAPY

blockers, and angiotensin converting enzymeinhibitors) to promote a favorable balance of

oxygen supply and demand.

Antilipid medications to decrease blood

cholesterol and tricglyceride levels in patientswith elevated levels.

Antiplatelet agents to inhibit thrombus

formation.Folic acid and B complex vitamins to reduce

homocysteine levels



......

Coronary angioplasty , or balloon

angioplasty

Coronary artery bypass graftoperation: Atherectomy , Laser

angioplasty



NURSING INTERVENTION Monitor blood pressure, apical heart rate, and

respirations every 5 minutes during an anginal

attack. Maintain continuous ECG monitoring or obtain a

12-lead ECG, as directed, monitor for arrhythmiasand ST elevation.

Place patient in comfortable position and administer

oxygen, if prescribed, to enhance myocardialoxygen supply.

Identify specific activities patient may engage inthat are below the level at which anginal painoccurs.

Reinforce the importance of notifying nursing staffwhenever angina pain is experienced.

Encourage supine position for dizziness caused byantianginals.



Be alert to adverse reaction related to abrupt

discontinuation of beta-adrenergic blocker and

calcium channel blocker therapy. These drug must

be tapered to prevent a “rebound phenomenon”;tachycardia, increase in chest pain, and

hypertension.

Explain to the patient the importance of anxiety

reduction to assist to control angina. Teach the patient relaxation techniques.

Review specific factors that affect CAD

development and progression; highlight those risk

factors that can be modified and controlled toreduce the risk.



TERIM K SIH T PERH TI NY

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Presentasi 30 April Fixxxxxx