“patient with cardiac condition”

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1.yunika rahmania
2.fenny sutri
3.nadya sartika p
4.rolly ansa

courses : english language

lecturer : Novarita,M.Pd
 A. Background

In the hospital, we often find patients with heart health problems. Patients with
heart disease are not only elderly but also adults. which is often encountered is
hypertension. Lack of maintaining health and a healthy lifestyle can cause
problems with heart health
Heart disease is a very scary disease. Even today in Indonesia, heart disease ranks
first as a cause of death. Heart disease is often considered a disease of parental
monopoly. In the past, these diseases were suffered by parents, especially those
aged 60 years and over, because age is also a risk factor for heart disease.
However, nowadays there is a tendency for patients under the age of 40 to suffer
it too. This can occur due to changes in lifestyle, especially in modern urban
youth. When the era of globalization makes information easier to obtain,
developing countries can immediately imitate the habits of western countries
which are considered a mirror of modern life patterns.
 A. Definition of heart disease

Heart disease is a condition when the heart is damaged.

The form of the disturbance itself can vary. There are
disorders of the blood vessels of the heart, heart rhythm,
heart valves, or disorders due to birth.
The heart is a muscle that is divided into four chambers.
Two rooms are located at the top, namely the right and left
atria (foyer). Meanwhile, two more chambers are located
at the bottom, namely the right and left ventricles.
Between the right and left spaces are separated by a
muscular wall (septum) which prevents the mixing of
oxygen-rich blood with oxygen-poor blood.
 The main function of the heart is to circulate oxygen-rich
blood to all parts of the body. After all the organs of the
body use oxygen in the blood, the oxygen-poor blood
returns to the heart (right atrium), to be forwarded to the
right ventricle through the tricuspid valve. After blood fills
the right ventricle, the tricuspid valve closes to prevent
blood from returning to the right atrium. Then, when the
right ventricle contracts, oxygen-poor blood leaves the
heart through the pulmonary valve and pulmonary arteries,
and is carried to the lungs to be filled with oxygen.
B.Types of heart disease

Coronary heart disease 01

Congenital heart disease

02
Heart infection (endocarditis)
03
04
Heart failure

Arrhythmia
05
 1.Coronary heart disease, is a heart disease that occurs due to narrowing of the blood
vessels in the heart. Coronary heart disease is a condition where there is
narrowing,blockage, or coronary artery abnormality. a narrowing orThis blockage can
stop frequent blood flow to the heart musclecharacterized by pain. The condition is more
severe than the heart's pumping abilityblood will be lost, so that the heart rhythm control
system will be disrupted and then can cause death (Soeharto, 2001)

2.Congenital heart disease, a heart problem found in infancy, the most common of which
is leaky heart valves.
3.Heart infection (endocarditis), is an infection of the inner lining of the heart.his condition
is generally caused by the entry of bacteria into the bloodstream, which then infects the
damaged part of the heart. If this condition is not treated promptly, endocarditis can
damage heart valves and lead to dangerous complications
 4.Heart failure, is a failure of the heart muscle to pump
blood adequately throughout the body.These
abnormalities in the heart lead to a decrease in cardiac
output and an increase in pressure in the heart during
resting and activity positions.
5.Arrhythmia, is a heart rhythm disorder that causes an
abnormal heart rate.Arrhythmias are disorders that occur
in the rhythm of the heart. People with arrhythmias can
feel their heart rhythm is too fast, too slow, or irregular. In
fact, arrhythmias are normal in a healthy heart condition.
However, if it occurs continuously or repeatedly,
arrhythmias can indicate a problem with the heart organ.
 C.Etyologi
1.coronary heart disease
The cause of cardiovascular disease is in principle due to
by two main factors, namely:
a) Atherosclerosis
Coronary artery atherosclerosis is the most common cause
of coronary artery disease. Atherosclerosis causes the
build-up of lipids and fibrous tissue in the coronary arteries,
thereby progressively narrowing the lumen of the blood
vessels. When the lumen is narrowed, the resistance to
blood flow will increase and endanger myocardial blood flow
(Brown, 2006).
b) Thrombosis
Fat deposits and hardening of the blood vessels are
disturbed and over time result in tearing of the walls of the
blood vessels. Initially, blood clots are the body's defense
mechanism to prevent bleeding from continuing at the time
of injury.

Chromosome mutations that cause chromosome
2.congenital heart disease
The etiology of congenital heart
disease is generally multifactorial.
Environmental and genetic factors
have been reported to play a role,
but often the etiology cannot be
established. Only about 20% of
cases are caused by chromosomal
abnormalities, genetic
abnormalities, and overt
environmental influences
-Genetic Abnormalities
excess or loss can manifest as congenital heart
disease. Examples of this disorder are Down's
syndrome because trisomy 21 is most commonly
seen with congenital heart disease, Edward's
syndrome (trisomy 18), and Patau's syndrome
(trisomy 13). In addition, there are Turner
syndrome (monosomy X), Klinefelter syndrome,
and cat eye. Mendelian syndrome is a single
DNA mutation that can also cause cardiac and
extracardiac disorders.
 -Environmental and Teratogen Factors
Environmental factors and teratogens can also cause congenital heart
defects. Examples are maternal diabetes which is the most common factor,
multifetal pregnancy, rubella infection in pregnancy, phenylketonuria, and
systemic lupus erythematosus (SLE). Use of certain substances such as
thalidomide, retinoic acid, lithium, alcohol, marijuana, selective drugs
serotonin reuptake. Inhibitors (SSRIs) and certain anticonvulsant drugs can
also cause congenital heart disease
 3.Heart infection (endocarditis)
Endocarditis occurs when germs enter the bloodstream and then into the heart. The germs then stick to
abnormal heart valves or damaged heart tissue, and multiply in the inner lining of the heart
(endocardium). This condition triggers inflammation of the endocardium and damage to the heart
valves.
Apart from being caused by bacteria, endocarditis can also be caused by fungi and other
microorganisms. These germs enter the bloodstream in several ways, such as:
Mouth sores. There are sores in the oral cavity when brushing teeth too hard, dental procedures, or being
bitten when chewing food, can cause bacteria to enter the bloodstream, especially if the cleanliness of
the teeth and gums is not maintained.
Other infected organs. Bacteria can enter the bloodstream and heart, from infected parts of the body, for
example due to open sores on the skin, sexually transmitted infections, or infections in the digestive
tract.
Urine catheter. Bacteria can enter the bloodstream through catheters, especially those that are placed for
a long time.
Syringes. Contaminated needles can become a medium for bacteria to enter the bloodstream, whether
through tattoos, piercings, or injection drug use
 .
4.Heart failure
Heart failure can be caused by various basic diseases of
the heart and outside the heart. Hypertension and
coronary heart disease are the main causes of heart
failure, while obesity and diabetes mellitus are also
known to increase the risk of heart failure.
Many etiologies of heart failure have been identified and
coronary heart disease is the most common cause of
heart failure cases. Myocardial infarction increases the
individual's risk for heart failure within 3 years after
infarction and the first 6 months after infarction is a
critical period with the highest level of risk. Ethnicity and
gender appear to influence the etiological variation of
heart failure in different populations. Studies show
hypertension and diabetes to be the most common risk
factors in different populations.
 5.Arrhythmia
Arrhythmias occur when the electrical impulses that
regulate your heart rate don't work properly. These
conditions can be caused by the following conditions:
Take cold medicine or allergy medicine:
Sleep apnea
Hypertension
Diabetes
Electrolyte disorders, such as potassium excess or
deficiency.
Thyroid disorders, eg hyperthyroidism
Heart valve abnormalities
Congenital heart disease
Coronary heart disease
Heart attack
Cardiomyopathy
D.Symptoms
Here are other symptoms that
the patient may experience,
depending on the type of disease:
-Heart failure: Swelling of the
feet and hands, fatigue, enlarged
abdomen.
-Arrhythmia: Easily dizzy or
fainting.
-Coronary Heart: Cold, tingling
or numbness.
-Congenital Heart: Swelling,
blue skin, easy fatigue.
-Heart Infection: Fever and
cough.
1.coronary heart disease
A condition that needs to be watched out for
is if the pain in the chest appears suddenly
with cold sweats that lasts more than 20
minutes and does not decrease with rest. A
heart attack occurs when a coronary artery
becomes severely narrowed or becomes
completely blocked. Some CHD sufferers
complain of discomfort in the gut, shortness
of breath, and complain of feeling weak and
even fainting (Yahya, 2010)
Chest pain
Depressed in the chest area
Heavy feeling in the chest
Nausea or heartburn
A cold sweat
Burning feeling
2.congenital heart disease
Even though you have carried out a routine check with
ultrasound, the symptoms of congenital heart disease may not
appear until the baby is born.
Newborns with heart defects generally experience the following
symptoms:
A bluish or black tinge on the lips, skin, or fingers (cyanosis).
Looks tired and has difficulty breathing, especially when
breastfed.
Have a low weight.
Stunted growth.
Swelling of the legs, stomach, or the area around the eyes.
Have recurrent lung infections.
Frequent cold sweats.
In some cases, symptoms of congenital heart disease may appear
several years after the baby is born, such as during childhood or
adolescence. Symptoms of this condition can include:
Irregular heartbeat (arrhythmia).
Dizziness and often feeling tired, especially when exercising.
Difficulty breathing or shortness of breath.
There is swelling (edema) in the feet, ankles, or hands.
The skin appears bluish (cyanosis).
Easy to pass out or lose consciousness.
Reporting from the Mayo Clinic page,
symptoms of congenital heart disease
in babies and children that appear
after birth, include:
The baby's lips, skin, fingers, and
toes appear bluish or grayish in color.
Babies experience shortness of
breath or breathe faster than usual.
Babies have difficulty eating.
Babies experience swelling in the
legs, stomach, or the area around the
eyes.
Stunted growth and development of
the baby and low body weight.
 3.Heart infection (endocarditis)
This will depend on what germs caused the infection and heart problems you previously
had.
Common signs and symptoms of endocarditis are:
Experiencing flu-like symptoms, such as fever, chills, and chills.
Body fatigue accompanied by joint pain and muscle aches (myalgia).
Shortness of breath and chest pain.
Swollen wrist or ankle.
The body sweats at night.
A heart sound is heard because blood is rushing to the heart.
In some cases, endocarditis can also cause other symptoms, such as:
Body weight continues to decrease for no apparent reason.
There is blood in the urine, this can be seen directly or needs to be seen by a doctor
through a microscope examination.
Red spots appear on the soles of the feet or palms (Janeway lesions), red, tender spots
under the skin of the fingers or toes (Osler's nodes), or red-purple spots on the skin,
whites of the eyes, and inside the mouth (Petechiae ).
The left side of the body near the ribs becomes more sensitive.
Each person can experience different symptoms and intensity. Some people may also
experience other symptoms that were not stated
 4.Heart failure
difficulty breathing
excessive fatigue, especially during
activities
swelling in several parts of the
body
urinating too often at night
Dizzy
palpitations (the heart beats faster)
 dry cough
 5.Arrhythmia
There are several types of arrhythmias
that are most often encountered, namely:
-Atrial fibrillation, which is a condition
when the heart beats faster and
irregularly.
-AV block, which is a condition when the
heart beats more slowly.
-Supraventricular tachycardia, which is a
condition when the heart beats too fast.
-Ventricular extra systole, which is a
condition when there is another pulse
outside of the beat
-Ventricular fibrillation, which is a
condition when the heart only vibrates.
Arrhythmias can occur without causing symptoms,
so sometimes the sufferer doesn't realize it.
Symptoms of arrhythmias include:
Heart beats faster than normal (tachycardia)
Heart beats slower than normal (bradycardia)
Dizzy
Fainting
Get tired quickly
Hard to breathe
Chest pain
 E.Diagnostic test
A number of these inspection methods include:
Electrocardiography (EKG)
An EKG is a test that records the heart's electrical signals.
This test can detect abnormalities in the rhythm and
structure of the heart. The doctor can run the EKG while
the patient is resting or exercising.
In this examination, the doctor will ask the patient to lie
down, and attach 12-15 electrodes to his body. Then, a
machine connected to the electrodes will record the
patient's heart's electrical signal.
Echocardiography
Echocardiography is an examination that uses sound waves
(ultrasound) of the heart. Echocardiography helps doctors
evaluate the condition of the patient's heart muscles and
valves.
The doctor can perform echocardiography by moving a
transducer across the patient's chest. In other cases, the
doctor may use a smaller transducer to be inserted into the
esophagus.
Pressure test (stress test)
A pressure test is a check for the condition of the heart when the patient's
heart rate increases. To increase the heart rate, the patient will be asked to
pedal a stationary bicycle or run on a treadmill.
Holter monitoring
In this examination, the patient will be asked to wear a device on the chest
called a Holter monitor. The Holter monitor will record the electrical
activity of the heart for 1-3 days.
Tilt table test
If the patient's symptoms of heart disease make him faint, the doctor will
run a tilt table test. In this test, the patient is lying on a table which is then
moved from a horizontal to a vertical position. As the table moves, the
doctor will monitor the patient's heart rate, blood pressure, and oxygen
levels. A tilt table test helps doctors find out if a patient has fainted due to
heart disease or other conditions.
CT scan of the heart
This examination uses X-rays to display images of the patient's heart and
coronary arteries. This examination can be done to detect calcium buildup in
the coronary arteries.
MRI of the heart
In this examination, the patient will be asked to lie on an examining table, then put into an MRI
machine. During the examination, a magnetic field inside the MRI machine will display an image
of the patient's inside. Then, the image will be analyzed by a doctor to diagnose the type of heart
disease you are experiencing.
Cardiac catheterization
Cardiac catheterization is the act of inserting a small tube (catheter) through a blood vessel in the
thigh or arm. With the help of X-rays, the doctor will direct the catheter up to the heart. This
procedure can help the doctor determine if there is any blockage or narrowing in the artery.
F.Treatment and prevention
1.Management of coronary heart disease (CHD) generally involves
changes in lifestyle that can be combined with drugs or medical
procedures.

Living a healthy lifestyle can improve heart health. The

example is:
-Quit smoking.
-Reduce or stop consuming alcohol.
-Eat foods with balanced nutrition.
-Reduces stress.
-Maintain ideal body weight.
-Get regular exercise.
 2.congenital heart disease

In worrisome or severe cases, the baby or child needs immediate medical attention and care, including:
1. Take drugs
The doctor can give several types of drugs that will help the heart work. The goal, to prevent the formation of
blood clots or to help control an irregular heartbeat. Prescription medications are beta blockers or arrhythmia
drugs. In infants, the drug may be given is acetaminophen or paracetamol.
2. Cardiac catheterization procedure
Apart from being performed as a test, this procedure can also be performed as a treatmentfor congenital
heart defects. Usually this is done for fairly simple conditions, such as an atrial septal defect and a patent
ductus arteriosus that doesn't improve on its own.
3. The surgical process
A surgeon will perform direct surgery on the heart. This treatment is performed to treat complex heart defects
that have not been treated effectively with previous treatments.These surgical procedures include heart
transplantation (replacing a damaged heart with a healthy heart), palliative surgery (inserting a tube as an
additional route for blood), and inserting special instruments to help the ventricles of the heart.
4. Other supportive care
Congenital heart disease in infants or children may make them need special treatment. This is because they
may be late in growth or have difficulty controlling their emotions. Apart from doctors and health professionals,
the role of parents and the people around them is needed to support children to have a better quality of life.
 3.Heart infection (endocarditis)
In general, the methods of treating heart disease
include:
-Lifestyle changes. Living a healthy lifestyle can
prevent heart disease from getting worse. Some
ways that can be done, among others, by doing
30 minutes of light exercise a day, eating foods
low in fat and low in sodium, quitting smoking,
and limiting the consumption of alcoholic drinks
The drugs used to treat heart disease depend on the type of heart disease
itself. Several classes of drugs commonly used in the treatment of heart
disease include:
a.ACE inhibitors - function to inhibit the body from producing angiotensin,
thereby lowering blood pressure. For example captopril and ramipril.
b.Angiotensin II receptor blockers - work by blocking the effects of
angiotensin and thereby lowering blood pressure. For example losartan.
c.Anticoagulants - function to prevent blood clots by inhibiting the action of
blood clotting factors. For example, heparin and warfarin.
d.Antiplatelets - Like anticoagulants, antiplatelets prevent blood clots from
forming in different ways. For example, aspirin and clopidrogel.
e.Calcium antagonists - work by regulating the levels of calcium that enter
the heart muscle and blood vessels, thereby dilating the blood vessels. For
example amlodipine and nifedipine.
 Medical Procedures. In some cases, the doctor will perform a surgical procedure so that the
patient's condition does not worsen. For example, if the patient's artery is almost or completely
closed, the doctor will place a stent or ring into the artery, so that the patient's blood flow
returns to normal. The procedure performed depends on the type of heart disease and the
degree of heart damage experienced by the patient. Another procedure that is often done is
heart bypass surgery. This surgical procedure is performed by transplanting another blood
vessel, so that blood flows through the new blood vessel.
 4.Heart failure
Treatment of heart failure can be in the
form of administering drugs, surgery, or
implant equipment.
a.Drugs
Medicines given by doctors aim to
increase the strength of the heart
muscle, reduce the workload of the
heart, and relieve symptoms, such as
shortness of breath. Several types of
drugs used by people with heart failure
include:
-Diuretics, such as spironolactone and
furosemide.
-Beta blockers, such as carvedilol and
bisoprolol.
-ACE inhibitors, such as lisinopril,
perindopril, and ramipril.
-ARB, such as candesartan, valsartan,
and telmisartan.
-Digoxin.
-Ivabradine.
b.Operation
Some of the surgical procedures that can be
done to treat heart failure include:
-Heart valve surgery, to repair or replace a
damaged heart valve that causes heart failure.
-Bypass surgery, or angioplasty, is performed by
creating new blood flow, so that blood can flow
without passing through blocked blood vessels.
In addition to heart bypass surgery, narrowing of
the heart arteries can also be treated by placing
a heart ring.
-Heart transplant surgery, which is a procedure
to replace a damaged heart with a new heart
obtained from a donor.
 5.Arrhythmia
Arrhythmia treatment aims to treat irregular
heart rhythms. The method used depends on
the type of heart rhythm disturbance you are
experiencing, whether it is too fast or too slow.
The methods of treating arrhythmias include:
a.Drugs
The drugs that doctors prescribe to treat
arrhythmias are anti-arrhythmic drugs. The
doctor will also prescribe warfarin to reduce the
risk of blood clots.
b.Ablation
The doctor performs a heart ablation procedure
with a cardiac catheterization procedure. This
procedure is done by inserting one or more
catheters in the blood vessels leading to the
heart. The electrodes located at the end of the
catheter will destroy a small portion of the
tissue in the heart that causes heart rhythm
disturbances, so that the heart rhythm returns
to normal.
with it.
 c.Pacemaker
The doctor will place the pacemaker under the skin, just under the
collarbone. The pacemaker functions to restore a heart rhythm that is
too slow to normal.
d.ICD
An implantable cardioverter-defribilator (ICD) is a small device that is
placed on the chest. This tool is used in patients who are at risk of
sudden cardiac arrest. This implant tool will detect signs of cardiac
arrest and automatically conducts electricity to deal with it.

As explained above, many factors cause arrhythmias. Therefore,

prevention depends on the cause of the arrhythmia. In general,
artimia can be prevented by maintaining a healthy heart, namely by:
-Quit smoking.
-Eat healthy foods.
-Maintain ideal body weight.
-Get regular exercise.
-Limit consumption of alcoholic and heavy drinks
-Avoid taking drugs without a doctor's instructions.
Thankyou..............
Medical Infographics