Management of Coronary Heart Disease

Prevent Coronary Heart Disease:

• Regular blood pressure check • Do not smoke • Check for diabetes mellitus and control blood

sugar if diabetic • Maintain normal weight • Diet low in cholesterol and saturated fat • Regular exercise • Reduce the impact of stress by relaxation

do regular checks

Stable angina pectoris

• Therapy 1 Eliminating ballast factor 2 Reduce the risk factors 3 When the attack can be used 4 inhibitors Beta 5. calcium antagonists 6 combination

• Myocardial revascularization can be done in two ways: - PCI (percutaneous coronary intervention) - CABG (Coronary Artery Bypass Surgery)

Unstable Angina Pectoris

• Therapy 1. Nitroglycerin subligual high doses. 2 .To frokfikaksis nitroglycerin paste may be used,

high doses of nitrates or calcium antagonists. 3 .If there are heavy with atherosclerosis, then given a combination of nitrates, calcium antagonists and inhibitors Beta. 4. Percutanous Transluminal coronary angioplasty (PTCA) or coronary by pass Graff Surgery (CBGS)

• Surgery The principle aims to: - Give more blood to the heart muscle - Improve coronary artery obstruction.

• There are 4 basic types of surgery: 1. Ventricular aneurysmectomy: Reconstruction of the left

ventricular damage 2. Coronary arteriotomy: Fixing directly to the coronary artery

obstruction 3. Internal thoracic mammary: Against myocardial

revascularization. 4. Coronary artery baypass grafting (CABG): The result was

satisfactory and safe that is 80% -90% can cure angina and mortabilitas only 1% in cases without compilation.

• Other recent methods in addition to surgery are: 1. Percutanecus transluminal coronary angioplasty (PCTA) 2. ratational Percutaneous coronary angioplasty (PCRA) 3. Laser angioplasty

Acute Myocardial Infarction

• Relieve pain and anxiety. • Prevent and treat early complications (30-40%) as

serious as heart failure, arrhythmias, thrombo-embolism, pericarditis, rupture m. papillary, ventricular aneurysm, right ventricular infarction, recurrent ischemia and sudden death.

• 2,5-10 mg morphine sulfate given IV. The drug is widely used in inferior infarction with chest pain and sinus bradycardia. Dose of 25-50 mg may be repeated after 2-4 hours slowly.

• In anterior infarction chest pain with sinus tachycardia and a systolic blood pressure above 100-100 mm Hg B-blockers can be used. Small doses of B-Blockers start with 1/2 - 5 mg Inderal. IV.

Treatment of Acute Myocardium Infarction before in the hospital:

• Monitor, do ABC. Prepare yourself to perform CPR and defibrillation • Give oxygen, aspirin, nitroglycerin, and morphine if needed • If there is, check the 12-lead ECG; if there is ST elevation: Inform the hospital early with transmission or interpretation, ranging checklist fibrinolytic therapy, early Inform the hospital to prepare for handling STEMI

Assessment in the Emergency Room immediately (<10 min)

- Check vital signs, oxygen saturation evaluation - Attach the IV line - Check and read EKG 12-sandapan - Perform a history and physical examination that focused & fast - Perform checklist fibrinolysis therapy, see if there are contraindications - Check the cardiac enzymes, electrolytes, and coagulation - Get a chest X-ray examination of the portable (<30 min)

General administration of immediate emergency diruang • Begin administration of oxygen 4 L / min; maintain O2 saturation> 90% • Aspirin 160-325 mg (if not already given) • Nitrate sublingual, spray, or IV • Morphine IV if pain is not relieved by nitroglicerin.