Coronary Heart Disease

(CHD)
Agus Santosa
Coronary Heart Disease (CHD)

50% of all cardiac deaths

result from CHD
 Mortality From Diseases of the
Heart by Race/Ethnicity
(Deaths/100,000)

Age Hispanic Asian Native Black White

Amer.
45-64 166 99 224 426 244

>65 1336 870 1128 2181 2079

Coronary Heart Disease

The major underlying cause is

atherosclerosis.
Atherosclerosis is a slow,
progressive disease which
begins in childhood and takes
decades to advance
Coronary Heart Disease

Plaque (the build-up of

lipid/cholesterol) in the artery
wall forms as a response to
injury to the endothelium in the
artery wall.
arteriosklerosis
 Risk Factors for
Coronary Heart Disease
 Age:
 Male > 45 years

 Female > 55 years or premature menopause

without estrogen replacement therapy
 Family History of premature disease
 Male first-degree relative <55 years
 Female first-degree relative < 65 years)
Risk Factors for
Coronary Heart Disease
 Hypertension
 Appears to weaken the artery wall at
points of high pressure leading to
injury and invasion of cholesterol.
 Cigarette Smoking
 #1 cause of preventable death in US
 1 in 5 CHD deaths attributable to
smoking
Risk Factors for
Coronary Heart Disease

Diabetes
 50% of deaths related to DM is
due to CHD
Risk Factors for
Coronary Heart Disease

Inactivity
 Sedentary person has 2x risk
for developing CHD as a person
who is active.
Risk Factors for
Coronary Heart Disease
Obesity
Risk Factors for
Coronary Heart Disease
 Abnormal Blood Lipids
 LDL Cholesterol (low density
lipoprotein)

 HDL Cholesterol (high density

lipoprotein)
Blood Lipid Classification
Cholesterol:
<200 mg/dl Desirable
200-239 mg/dl Borderline high-risk
>240 mg/dl High-risk
HDL Cholesterol
<40 mg/dl Low
>60 mgl/dl High, negates one
risk factor
LDL Cholesterol
<100 mg/dl Desirable
100 – 129 mg/dl Above optimal
130-159 mg/dL Borderline High
>160 mg/dl High Risk
Symptoms
 Chest pain or discomfort (angina) is the most common
symptom. You feel this pain when the heart is not
getting enough blood or oxygen. How bad the pain is
varies from person to person.
 It may feel heavy or like someone is squeezing your
heart. You feel it under your breast bone (sternum),
but also in your neck, arms, stomach, or upper back.
 The pain usually occurs with activity or emotion, and
goes away with rest or a medicine called nitroglycerin.
 Other symptoms include shortness of breath and
fatigue with activity (exertion).
Tests
 Many tests help diagnose CHD. Usually, your doctor will order
more than one test before making a definite diagnosis.

 Electrocardiogram (ECG)
 Laboratorium: Hb, Ht, Leko, Trombo, Natrium, Kalium, Ureum,
Kreatinin, Gula darah sewaktu, SGOT, SGPT,CK-MB, hsTroponin
 CT angiography -- a noninvasive way to perform coronary
angiography
Teraphy
Surgery
 Angioplasty (also known as percutaneous coronary intervention
or PCI). In this operation a collapsed balloon is threaded through
the blood vessels until it reaches the arteries of the heart. The
balloon is inflated to widen the narrowed coronary artery. A stent
(flexible mesh tube) is sometimes inserted to help keep the artery
open afterwards. The stent sometimes releases a drug that helps
to keep the blood vessel open. You should be able to go home
the day after the operation.
 Coronary artery bypass graft (CABG). In this operation, the
surgeon takes a piece of blood vessel from your leg or chest and
uses it to bypass the narrowed coronary arteries. The bypass
provides the heart with more blood. This is open-heart surgery
and requires a longer stay in hospital.
 PCI Procedural refinements: Stents

Expandable metal mesh tubes that buttresses the

dilated segment, limit restenosis.
Drug eluting stents: further reduce cellular
proliferation in response to the injury of dilatation.
Coronary Artery Bypass Grafting (CABG)
Handling in CHD Patients

LDL-C Diet & Life Drug

Levels Habits Therapy
<100 mg/dL Yes No

100-129 Yes Clinical

mg/dL Judgment
>130 mg/dL Yes Yes
Handling for CHD
 Physical Activity
 prescribed by physician for patients with
CHD
 When aerobic activity is appropriate,
activity that places moderate stress on
the cardio-respiratory system can be
included.
Handling for CHD

Weight Control
 5-10# weight loss
Diet Therapy of High Blood
Cholesterol

Soluble Fiber
 10-20 g/day
Nursing diagnose

 Acut Pain
 Decrease of cardiac output
 Anxiety
 Inefective of breath pattern