acute myocardial infarction

CHAPTER I

INTRODUCTION

I. BACKGROUND

Healthy Indonesia 2010 vision is a picture of Indonesian society in the future to be achieved through health development by community, nation and state are marked with the population live in the environment and healthy lifestyle behaviors, have the ability to reach out to quality health services in a fair and equitable and have a degree of health as high in all regions of Indonesia.

The rapid technological advances currently affects the customs and daily necessities to the public. Besides the population growth of Indonesia has brought a wide range of diverse needs. Given the increasingly sophisticated technology, all the patterns and habits of life is strongly influenced by these advances. For example, on food, with the advanced technology, so much food in the form of bottled or canned or in plastic, produced with a variety of content in it. Habits of the people consume these foods without selecting the composition of the content of these foods may cause an unfavorable impact on health. For example, many foods that contain cholesterol and fat, because society has made such foods as food, so they no longer pay attention to what she consumes a result of over fishing.. With so many are buried in the body's cholesterol will affect the work of the heart and can lead to heart disease. The heart is an organ that is vital to life because the heart works as pumping blood throughout the body and if the cardiac disorder then all our activities will be disrupted either through the bio, psycho, social and spiritual can even lead to death.

One type of heart disease is common are acute myocardial infarction (AMI). Acute myocardial infarction is the necrosis of heart muscle due to disruption of blood flow. (S. Aaron, in Noer Syaifoellah. 1996: 1089). Acute myocardial infarction is decreased blood flow through one or more coronary arteries, causing myocardial ischemia or necrosis (Dongoes, Moorhouse, Geisller. 1999: 83).

Of the two terms above can be concluded that acute myocardial infarction is a condition in which the heart muscle is experiencing ischemia or even necrosis due to a decrease in blood supply that involves one or more of the coronary arteries caused by various disturbances in blood flow.

In developed countries like the United States, heart disease, especially acute myocardial infarction is the commonest cause of death. In Indonesia since last ten years acute myocardial infarction is more frequently found, especially with the facilities and units diagostik-coronary intensive care units are more spread out evenly.Coronary heart disease is still a leading cause of death in developed countries. In Indonesia, according to the latest Household Health Survey (2001), from 100 deaths, 25 of them caused by cardiovascular disease (25.6%) (National Cardiovascular Center Harapan Kita, Internet.)

"Acute myocardial infarction is an emergency that requires careful handling during acute and vigilant. More than two thirds of patients died of acute myocardial infarction before getting treatment, most died suddenly of ventricular fibrillation, which occurs 10-20 times more frequently in the first four hours after the attack than the next 20 hours. "

From there it would need a comprehensive and thorough handling of the health officer in this case nurses, With this comprehensive nursing care is expected to reduce mortality from heart disease, especially disease is acute myocardial infarction. Acute myocardial infarction is important to discuss because it causes high mortality and morbidity

 II. Goal

The purpose of making this Research are as follows:

a. Fulfilling assignments in study English language VI.

b Increase knowledge related to the theme given by the method

learning "student centered learning."

c. Providing experience and increased knowledge about acute myocardial infarction.

CHAPTER II
DISCUSSION

Obesity and overweight are the most common metabolic disorder that affects humans and is one a metabolic disorder of the longest recorded in history, is now a health problem a very serious. Communities do not regard obesity as a disease but a natural thing, even because of their ignorance thinking obesity as a sign of prosperity.

Metabolic abnormalities that occur in obesity seems associated with the large layer of fat, increase body fat have anything to do with increased cardiovascular disease. Apparently, there is a metabolic relationship between obesity, blood sugar and blood lipid levels are closely related with the trend in the complications of atherosclerosis such as acute myocardial infarction.

Acute myocardial infarction is myocardial necrosis due to blood flow to the heart muscle affected. Generally, acute myocardial infarction preceded by the presence of coronary artery atherosclerosis. Sizes that are used to determine a person is overweight or obese is by measuring circle waist circumference. waist (waist circumference) is associated with metabolic disease and cardiovascular disease. To find out if there is a correlation between body mass index with lipid profile in patients with acute myocardial infarction.

Criteria diagnosis of acute myocardial infarction using the WHO criteria, and besides that all patients were examined lipid profile consisting of total cholesterol, HDL cholesterol, LDL cholesterol, triglyceride levels and indices IMT body mass (BMI) according to WHO classification 1998, which consist of normal BMI from 18.5 to 24.9 kg/m2, overweight if BMI > = 25 kg/m2, obese if BMI> 30 kg/m2.

1. DEFINITIONS

Acute myocardial infarction is accompanied by acute coronary occlusion with prolonged ischemia that ultimately lead to cell damage and death (infarction), myocardial. Ischemia itself is a state of transition and reversible in myocardial due to an imbalance between supply and needs that cause hypoxic myocardial infarction.

Acute myocardial infarction is necrosis miocard blood flow disturbances to the heart muscle (S. Aaron, in Sjaifoellah Noer, 1996: 1098).

Of the two terms above can be concluded that Miocard Acute Myocardial ischemia is a condition in which the heart muscle or even necrosis caused by blood vessel disorders or decreased blood flow to the heart muscle. The left ventricle is the heart space of the most vulnerable to ischemia and myocardial infarction, because of the unique characteristic of oksigenisasi. First, left ventricular oxygen demand is great because of the large systemic resistance to the ejection and the large muscle mass.

B.  ETIOLOGY

Consisting of factors that can not be modified and which can still be modified.
a. Risk factors that can not be modified, namely:
1) Age.
Associated with the process of degeneration / decrease in the ability of the heart muscle and increased susceptibility to coronary atherosclerosis disease.

2) sex / gender.

Many studies showed that patients with acute myocardial infarction is usually male, aged over 40 years and had atherosclerosis of the coronary arteries. Whereas in women, the protective effect of estrogen is considered as an explanation for the existence of immunity in the age before menopause.

3) Descendants and family history.
Positive family history of coronary heart disease (relative or parents) increases the risk of this disease.

b. Risk factors can still be modified, namely:
1) Increased serum lipid levels.
2) Hypertensi.
3) Smoking.
4) Impaired glucose tolerance.
5) A diet containing lots of saturated fat, cholesterol and calories.

identified five risk factors to heart disease as follows:
1). Hypercholesterolemia> 275 mg / dl
2). Cigarette smoking> 20 cigarettes / day
3). Obesity> 120% of ideal body weight
4). Hypertension> 160/90 mmHg
5). Monotonous lifestyles and high psychologic stress

Of etiology and risk factors that cause disease in acute myocardial infarction can be concluded that acute myocardial infarction can occur either in men or women but men have a greater risk of having acute myocardial infarction plus supporting factors that can still be changed, such as smoking, history of hypertension, high levels of psychological stress suffered by most men.
 

C. KLASIFIKASI CLASSIFICATION

1. Based morphologic

By morphological, acute myocardial infarction can occur transmural or sub-endokardial, What distinguishes the two types of acute myocardial infarction is the pathogenesis and clinical course of both

1). Acute myocardial infarction Subendokardial.

"Regional myocardial subendokardial is an area very sensitive to ischemia and infarction. acute myocardial infarction caused by blood flow decreased subendokardial relatively long periods of time as a result of changes in the degree of coronary artery narrowing or triggered by conditions such as hypotension, hemorrhage and hypoxia.

acute myocardial infarction, necrosis only occurs on the inside wall of the ventricles and is generally in the form of patches. “Degree of necrosis may be increased if accompanied by increased myocardial oxygen demand, eg due to tachycardia or ventricular hypertrophy."
2). Transmural acute myocardial infarction

"In 90% cases of transmural acute myocardial infarction associated with coronary thrombosis. Thrombosis often occurs on the area which narrowed arteriosklerotik. Other causes are rarely found. Transmural acute myocardial infarction on the heart muscle wall and occurs in a coronary artery distribution area with a picture konfluens."

2. Based on the location on the ventricular myocardial wall.
1). Inferior acute myocardial infarction ventricular.

Coronary Artery The right coronary artery involved with reciprocal changes (conductivity ECG) II, III, aVF.

2). Lateral ventricular acute myocardial infarction.

Artery which left circumflex coronary artery involved with reciprocal changes (conductivity ECG) I, aVL.
3). Ventricular anterior acute myocardial infarction

Involved artery Arterial left anterior descending with reciprocal changes (conductivity ECG) V2 - V4.
4). Acute myocardial infarction septal.

Coronary artery left anterior descending artery involved with reciprocal changes (conductivity ECG) V1 - V2.
5). Acute myocardial infarction apical.

Coronary artery left anterior descending artery involved with reciprocal changes (conductivity ECG) V5 - V6.
6). Posterior acute myocardial infarction

Coronary artery left circumflex artery involved with reciprocal changes (conductivity ECG) V1 - V2 .

3. Based on their location.

Extensive infarction involving a large part of the ventricle is represented in accordance with its location, namely:
1). Anteroseptal infarction
2). Anterolateral infarction
3). Inferolateral infarction
4). Infarction biventrikuler / posterior right ventricular infarctio

D. COMPLICATIONS.

1. Infarct expansion

Could result from delays in treatment or inappropriate treatment, such as excessive activities so that the heart muscle oxygen demand also increases.

2. Arrhythmias

Can be either tachy-and bradyaritmia. Often occurs within the first week after acute myocardial infarction and cardiac output and lead to reduced coronary ferfusi and raise MVO2.

3. Heart muscle dysfunction (heart failure, shock)

Often found as congestive heart failure (CHF) and cardiogenic shock. Congestive heart failure is a serious complication of acute myocardial infarction (cause mortality rate nearly doubled) and must be addressed. Cardiogenic shock, approximately 12% of clients with acute myocardial infarction. This condition occurs due to extensive acute myocardial infarction and mortality of approximately 90-95%.

4. Myocardial rupture

Ventricular free wall rupture is usually rapidly became worse. Tamponade and death may occur before the emergency operation may be implemented or even considered. Interventrikularis septal rupture or papillary muskulus systolic marked with a loud noise and accompanied by the occurrence of congestive heart failure are difficult to overcome. Saering septal rupture can be overcome, but Ruptured papillary muskulus require emergency surgery.

REFERENS

Alwi, Idrus. 2006.Infark Miokard Akut Dengan Elevasi ST. dalam Buku Ajar Ilmu Penyakit Dalam. Jakarta: FKUI. Hal: 1616.

Brown, Carol T. 2005. Penyakit Aterosklerotik Koroner. dalamPatofisiolog i Konsep Klinis                Proses-Proses Penyakit Edisi 6 Volume 1. Jakarta: EGC. Hal 589- 599.

Harun, S., 2000. Infark Miokard Akut. dalam Buku Ajar Ilmu Penyakit Dalam Jilid I edisi    3. Jakarta: FKUI. Hal: 1090-1108. (patogenesis)

Harun, Sjaharuddin, Idrus Alwi. 2000. Infark Miokard Akut Tanpa Elevasi ST. dalam          Buku Ajar Ilmu Penyakit Dalam. Jakarta: FKUI. Hal: 1626.

Isselbacher, J Kurt. 2000. Harrison Prinsip-Prinsip Ilmu Penyakit Dalam Edisi 13 Volume 3. Jakarta : EGC.

Price, Sylvia Anderson. 2005. Penyakit Aterosklerotik Koroner. dalam Patofisiologi :          konsep klinis proses-proses penyakit Edisi 6. Jakarta : EGC. Hal 589-590