Ischemic Heart Disease

(Coronary Artery Disease)

Dr. Dian Zamroni, SpJP, FIHA

Jantung

Penyakit Jantung Koroner

Normal
vessel

Minimal
Moderate
CAD
CAD
Progression

Severe
CAD

Aterosklerosis
DEFINISI :
Athero : Lemak,
Sclerosis : Pengerasan /
Penebalan

Proses aterosklerosis dimulai dari metabolisme lipid

abnormal dan terpaparnya dengan berbagai faktor risiko,
terutama bila superimpose dengan gangguan genetik
5

ATHEROGENESIS
Risk Factors
Fatty streak
Smoking
Hypertension
Hyperlipidemia

Others (diabetes, coagulation

abnormalities,
hemocysteinemia,etc)

Risk Factors
Uncontrollable

Controllable

Sex

High blood pressure

Hereditary

High blood
cholesterol

Race
Age

Smoking
Physical activity

Obesity
Diabetes
Stress and anger

ANGINA ?

Angina is pain or discomfort in the

chest that happens when some part of
the heart does not receive enough
oxygen from the blood

Patients with chest pain

15% will have myocardial infarction
30-35% will have acute coronary syndrome
(unstable angina)
45-50% will have non-cardiac pain

Supply-Demand Mismatch

Oxygen Supply
-Blood Flow
-O2 Carrying
Capacity

Oxygen Demand
-Heart rate
-Contractility
-Wall stress

PATHOPHYSIOLOGY OF ANGINA

Sarembock IJ, An Atlas of Investigation and Management Angina, Oxford 2007

PATHOPHYSIOLOGY OF ANGINA

Sarembock IJ, An Atlas of Investigation and Management Angina, Oxford 2007

Characteristics of typical angina

A

Area (location)

retrosternal, left chest, left arm, neck,

jaw, interscapular

N
G

Nature (quality)

heavy, pressure, tight

Goes (radiation)

left arm, neck, jaw, upper back

Identify factors
-Precipitating

physical/emotional stress, eating

rest, sublingual nitroglycerin

- relieving

N
A

Nitroglyserin

relief of pain in <10 minutes

Associated symptom
Duration

dyspnea, diaphoresis, nausea

>1 minute, <30 minutes

Sarembock IJ, An Atlas of Investigation and Management Angina, Oxford 2007

Radiation of Chest Pain

Sarembock IJ, An Atlas of Investigation and Management Angina, Oxford 2007

Clinical classification of chest pain

Typical angina (definite)
Substernal chest discomfort with a characteristic quality
and duration that is
provoked by exertion or emotional stress and
relieved by rest or nitroglycerin
Atypical angina (probable)
meets 2 of the above characteristics

Noncardiac chest pain

meets <=1 of the typical angina characteristics
Diamond GA. J Am Coll Cardiol 1983;1:574

Differential Diagnosis
of Chest Pain
Cardiac
ACS : Infarct,angina
MVP
Aortic Stenosis
Hypertrophic cardiomyopathy
Pericarditis
Lungs
Lung Emboli
Pnemonia
Pneumothorax
Pleuritis

Gastrointestinal
Reflux esofagus
Ruptur esofagus
Gall bladder disease
Peptic Ulcer
Pancreatitis
Vascular
Aortic dissection/aneurysma
Others
Musculoskeletal
Herpes zoster

Canadian Cardiovascular Society

Functional classification of angina
Grade

Clinical

findingsFeatures

No limitation of
ordinary activity

Ordinary physical activity (walking or climbing stairs) does

not cause angina. Angina may occur with strenuous rapid
or prolonged exertion at work or recreation

II

Slight limitation of
ordinary activity

Angina may occur with:

walking or climbing stairs rapidly
walking uphill
walking or stair climbing after meals or in the cold, in the
wind, or under emotional stress
walking more than 2 blocks on the level at a normal pace
and in normal conditions

III

Marked limitation of
ordinary activity

Angina may occur after:

walking 12 blocks on the level, or
climbing 1 flight of stairs in normal conditions at a
normal pace

IV

Unable to carry out

any physicalactivity
without discomfort

Angina may be present at rest

Continued

Continued

22

tes

TERIMA KASIH