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Coronary heart disease (CHD), also called coronary

artery disease (CAD), ischaemic heart disease, and


atherosclerotic heart disease, is the end result of the
accumulation of atheromatous plaques within the walls of
the arteries that supply the myocardium (the muscle of the
heart).

Coronary heart disease (CHD) is a preventable disease


that kills more than 110,000 people in England every year.

More than 1.4 million people suffer from angina and


275,000 people have a heart attack annually.

CHD is the biggest killer in the UK and US


affects about 14 million men and women in the United
States.

Setiap tahunnya, di Amerika Serikat:


478000 orang meninggal karena penyakit jantung koroner.
1,5 juta orang mengalami serangan jantung.
407000 orang mengalami operasi peralihan.
300000 orang menjalani angioplasti.

Di Indonesia, PJK merupakan penyebab kematian no. 1


Dari laporan WHO tahun 1999 terungkap bahwa PJK
menyebabkan kematian sebanyak 25% dari seluruh
kematian di Indonesia

Trend PJK di Scotlandia

Myocardial Ischemia
Pathophysiology
O2 demand O2 supply
Myocardial Irritability arrhythmias
Gangguan fungsi ventrikel ( fungsi ventrikel)
penurunan stroke volume
Gangguan fungsi diastole (gangguan rileksasi)
disebabkan oleh sistole yg panjang & waktu pengisian
ventrikel

Manifestasi Klinis
Angina Pectoris
Persamaan anginal (Dyspnea, fatique, sakit kepala
ringan)

Arrhythmias
Perubahan EKG
Hypotension kegagalan fungsi ventrikel

Myocardial Infarction
Pemutusan aliran darah ke otot jantung necrosis

Pathpphysiology
Acut MI
Zone of infarction
Zone of injury
Zone of ischemia

myocardial irritability aritmia & sudden death


Dysfungsi systolic & diastolic CHF atau cardiogenic
shock

Ruptur pada jaringan yg infark


Perluasan infark
Pericarditis, emboli paru & sistemik

Manifestasi Klinis
Chest pain yg hebat dg tau tanpa radiasi
Diaphoresis
Dyspnea
Mual
Muntah
Sakit kepala
Kelemahan
Ketakutan
Sudden death
NOTE : 20 S/D 25% TANPA SYMPTOM (silent MI)

PROGRAM REHABILITASI JANTUNG


Secara umum program rehabilitasi jantung bertujuan
untuk memastikan jumlah aktivitas yg diperlukan untuk
memastikan kemungkinan terbaik bagi kondisi fisik,
mental dan sosial sehingga mereka dapat hidup lagi
secara aktif & produktif sesuai dengan kemampuannya
(Jan Kellerman, 1978, WHO, 1993)
Salah satu kunci sukses dari PRJ adalah dengan
memahami landasan filosofis dari PRJ

Landasan filosofis PRJ


1. Coronary artery disease is a progressive, chronic disease
process closely aligned with certain epidemiological risk
factors
2. An exercise program for patient after heart attack or
surgical intervention is beneficial if it is individually
designed for each patient and objectively evaluated on an
ongoing basis
3. PRJ requires team approach. No one health care
professional can adequately provide all the services
needed to conduct an effective program of rehabilitation

Program Rehab Jantung dibagi menjadi 3 fase:

Phase I (in patient)


Phase II (sub acute)
Phase III (stable long-term patient)

TUJUAN PROGRAM FASE I


1. Screening patients for the appearance of complications
2. Initiating low level of activity
3. Educating patients & their family
4. Measuring the effectiveness of medication in controlling
patients cardiovascular status during activity
The emphasis during phase I is on stabilizing of the
patients conditions & ensuring that general daily
activity does not produce undesirable effect

TUJUAN PROGRAM FASE II (out patient


cardiac rehab)
kapasitas exc & daya tahan dengan cara yg aman &
progresif

Melanjutkan program exc masa transisi dg lingkungan


rumah

Mengevaluasi respon kardiovaskuler terhadap beban


kerja external mulai ringan s/d sedang

Mengajari penderita tehnik-2 untuk memonitoring sendiri


aktivitas di rumah

Memonitor efektivitas obat-2 an


Kecemasan & depresi
pengetahuan penderita perilaku hidup sehat