Rampengan, Starry H.
(2014)
MANAGEMENT OF CORONARY ARTERY DISEASE IN BPJS ERA.
In: Makassar Cardiovascular Update XIII 2014.
Abstract
Coronary Artery Disease (CAD) is most commonly due to the arrowing of
the coronary arteries sufficiently to prevent adequate blood supply to the
myocardium. The narrowing is usually caused by atherosclerosis.
Atherosclerosis is a process that can involve many of the body's blood
vessels with a variety of presentations. When it involves the coronary
arteries it results in coronary artery disease, the cerebral a1teries;
cerebrovascular disease (transient ischemic attack, stroke), the aorta; aortic
aneurysms, the ilea-femoral and popliteal arteries; peripheral vascular
disease, the mesenteric arteries; intestinal ischemia.
Coronary artery disease is the single most common cause of death in the
developed world, responsible for about 1 in every 5 deaths. It is estimated
that more than 16 million Americans have CAD and 8 million have had a
myocardial infarction (Ml). Every year approximately 1 million will have a
new myocardial infarction. Based on data from the Framingham trial nearly
50% of males and 30% of females over the age of 40 will develop coronary
artery disease.
Coronary artery disease can present in a variety of ways. The classical
presentation is with chest discomfort. Chest discomfort resulting from
myocardial ischemia secondary to coronary artery disease is called angina
pectoris (squeezing of the chest). Discomfort is diffuse and not localized
and may radiate down the arms, as low as the umbilicus and up to the
lower jaw. This may be associated with shortness of breath (dyspnea). This
discomfort is the result of myocardial ischemia however it is one of the last
manifestations to appear. Due to the myocardium's complete reliance on
coronary blood flow for energy supply, within a few beats of coronary
occlusion, diastolic and systolic dysfunction set in and the
electrocardiogram begins to register abnormalities before the patient begins
to experience angina pectoris. This explaini:; why patients may describe
associated shortness of breath when they experience angina. The
association of both symptoms together indicates that the myocardium fed
by the narrowed vessel is sizable.
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