Coronary Heart Disease (CHD) is a heart disease that is mainly caused by narrowing of the coronary arteries due to atherosclerosis or spasm or a combination of both. CHD is a disease that is very scary. It is recognized that the recent developments in the field of heart disease found many new facts about CHD. However, control of traditional risk factors, particularly dyslipidemia, obesity, smoking, and hypertension is still quite relevant in reducing morbidity and mortality of CHD and other cardiovascular diseases.Definition
Coronary Heart Disease (CHD) is the circumstances in which there is an imbalance between the needs of the heart muscle with oxygen supply that is provided by the coronary arteries (Mila, 2010).
Etiology
Coronary heart disease can be caused by several things:
- Narrowing (stenosis) and contraction (spasm) of coronary arteries, but gradually narrowing will allow the development of adequate collateral as a replacement.
- Atherosclerosis, causes about 98% of cases of CHD.
- Narrowing of the coronary arteries in syphilis, Takayasu aortitis, arteritis that the various types of coronary arteries, etc..
Risk Factors
1. Smoke
Smoking can stimulate the process of atherosclerosis due to a direct effect on the arterial wall, carbon monoxide causes arterial hypoxia, nicotine causes mobilization of catecholamines that cause platelet reaction, glycoprotein tobacco can cause hypersensitivity reactions arterial wall.
2. Hyperlipoproteinemia
Diabetes Mellitus, obesity and hyperlipoproteinemia associated with fat deposition.
3. Hypercholesterolemia
Cholesterol, fat and other substances can cause thickening of the artery walls, so that the lumen of the blood vessels constrict and the process is called atherosclerosis.
4. Hypertension
Increased blood pressure is a heavy burden to the heart, causing left ventricular hypertrophy or enlargement of the left ventricle. As well as high blood pressure which cause direct trauma to the coronary arteries, thus facilitating the occurrence of coronary atherosclerosis (coronary factor).
5. Diabetes mellitus
Intolerance to glucose, known as vascular disease predisposition.
6. Obesity and metabolic syndrome
Obesity is the excess amount of body fat is more than 19% in men, and more than 21% in women. Obesity can also increase levels of cholesterol and LDL cholesterol. Risk of Coronary Heart Disease will obviously increase when the weight began to exceed 20% of ideal body weight.
Pathophysiology
If too many foods that contain cholesterol, the cholesterol levels in the blood can be excessive (called hypercholesterolemia). Excess cholesterol in the blood will be stored in the lining of the arteries, known as plaque, or atheroma (plaque major source, derived from LDL-cholesterol. While HDL carry excess cholesterol back to the liver, thus reducing the buildup of cholesterol in the vessel wall blood).
If the longer plaque increases, there will be a thickening of the artery walls, causing narrowing of the arteries. This incident is referred to as atherosclerosis (aterom presence in arterial walls, contains cholesterol and other fatty substances). This leads to atherosclerosis (thickening of the arterial wall and loss of flexibility of the artery walls). If the atheroma, which formed the thicker, can tear the artery wall lining, and a blood clot occurs (thrombus) that can block blood flow in the arteries.
This can lead to reduced blood flow and the supply of essential substances, such as oxygen to a particular area or organ, like the heart. When the coronary arteries, which supply blood to the functioning heart muscle (myocardium medical term), then the blood supply is reduced and causes of death in the region (known as a myocardial infarction).
The consequence is the occurrence of heart attacks and cause symptoms such as severe chest pain (known as angina pectoris). This condition is called coronary heart disease (CHD).
Clinical Manifestations
Symptoms of CHD:
- A few days or weeks, before the body was not powered, chest feels uncomfortable, during exercise or move hard heart beat, shortness of breath, sometimes accompanied by nausea, vomiting, and a lot of body sweat.
- Chest pain. Left chest pain (angina) and felt pain coming from inside. Patients felt chest pain, also an assortment of tingling, burning, crushed by heavy objects, slashed, hot. Chest pain is felt in the left chest with spreading to the left arm, pain in the pit of the stomach, right chest, chest pain which penetrates to the back, even to the jaw and neck.
- Heart palpitations (rapid pulse).
- cold sweat
- Energy and mind become weak, fear no reason, feeling wanted to die.
- Low blood pressure or stroke.
Signs of CHD:
- Usually high fat content, does not cause symptoms. Sometimes, if the level is very high, fatty deposits will form a buildup of fat, called xanthomas in the tendons and in the skin.
- Fever, body temperature is usually around 38 ° C.
- Nausea and vomiting, upper abdominal bloating and pain.
- Pale face.
- Skin becomes wet and cold, sweaty bodies.
- Movements became sluggish (less enthusiasm).
- Shortness of breath.
- Anxious and restless.
- Fainting.
Diagnostic Tests
Depending on the needs, various types of checks can be performed to establish the diagnosis and determine the degree of CHD. From the simple to the invasive.
1. Electrocardiographic (ECG)
Examination of the heart's electrical activity or picture electrocardiogram (ECG), is the examination support to provide indication of coronary heart disease. With this examination we can see if there is signs. Can a previous heart attack, or a narrowing of a new heart attack occurs, each of which gives a different picture.
2. Chest X-ray
From x-rays, the doctor can assess heart size, presence or absence of enlargement. In addition, it can also be seen picture of lungs. Abnormalities in coronary can not be seen in X-rays. From the size of the heart can be assessed whether a patient already in advanced coronary heart disease. Perhaps, long coronary heart disease which has continued at heart trouble. The picture usually looks enlarged heart.
3. Laboratory examination
Conducted to determine triglyceride levels as a risk factor. Of blood examination also known presence or absence of an acute heart attack to see a rise in cardiac enzymes.
5 Nursing Diagnosis for Coronary Heart Disease
1. Acute Pain related to cardiac tissue ischemia, or blockages in the coronary arteries.
2. Activity Intolerance related to imbalance between oxygen supply and demand, and the presence of necrotic tissue in myocardial ischemia.
3. Risk for Decreased Cardiac Output related to changes in the rate, rhythm, cardiac conduction, decrease preload or increased SVR, miocardial infarction.
4. Risk for Ineffective Tissue Perfusion related to decreased blood pressure, hypovolemia.
5. Risk for Fluid Volume Excess related to decreased organ perfusion (renal), increased sodium retention, decreased plasma protein.