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    Cardiac Prevention and Rehabilitation

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    Ikhsan Amadea
    Cardiac Prevention and Rehabilitation focuses on managing cardiovascular risk factors such as smoking, hypertension, dyslipidemia, diabetes, obesity, and physical inactivity to reduce cardiovascular events. Studies show regular exercise lowers blood pressure and improves vascular health. The natural history of cardiovascular disease involves the development and progression of atherosclerosis over time due to risk factors, ultimately leading to events like heart attack or stroke if left unmanaged. Guidelines recommend a multifaceted approach focusing on risk factor control through lifestyle changes and medication to lower risk.

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    Cardiac Prevention and Rehabilitation

    Uploaded by

    Ikhsan Amadea
    141 views20 pages
    Cardiac Prevention and Rehabilitation focuses on managing cardiovascular risk factors such as smoking, hypertension, dyslipidemia, diabetes, obesity, and physical inactivity to reduce cardiovascular events. Studies show regular exercise lowers blood pressure and improves vascular health. The natural history of cardiovascular disease involves the development and progression of atherosclerosis over time due to risk factors, ultimately leading to events like heart attack or stroke if left unmanaged. Guidelines recommend a multifaceted approach focusing on risk factor control through lifestyle changes and medication to lower risk.

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    Cardiac Prevention and Rehabilitation focuses on managing cardiovascular risk factors such as smoking, hypertension, dyslipidemia, diabetes, obesity, and physical inactivity to reduce cardiovascular events. Studies show regular exercise lowers blood pressure and improves vascular health. The natural history of cardiovascular disease involves the development and progression of atherosclerosis over time due to risk factors, ultimately leading to events like heart attack or stroke if left unmanaged. Guidelines recommend a multifaceted approach focusing on risk factor control through lifestyle changes and medication to lower risk.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    141 views20 pages

    Cardiac Prevention and Rehabilitation

    Uploaded by

    Ikhsan Amadea
    Cardiac Prevention and Rehabilitation focuses on managing cardiovascular risk factors such as smoking, hypertension, dyslipidemia, diabetes, obesity, and physical inactivity to reduce cardiovascular events. Studies show regular exercise lowers blood pressure and improves vascular health. The natural history of cardiovascular disease involves the development and progression of atherosclerosis over time due to risk factors, ultimately leading to events like heart attack or stroke if left unmanaged. Guidelines recommend a multifaceted approach focusing on risk factor control through lifestyle changes and medication to lower risk.

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    © All Rights Reserved
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    of 20

    Cardiac Prevention and Rehabilitation

    Dede Kusmana, MD, PhD, FACC Professor of Cardiology Head of Department of Cardiology and Vascular Medicine Faculty of Medicine University of ndonesia !ational Cardiovascular Center

    -ac#ground

    ncidence of Cardiovascular disease highly correlated "ith prevalence of ris# factors $hyperlipidemia, hypertension, dia%etes, smo#ing, o%esity, sedentary lifestyle, &p$a', fi%rinogen, homocystein, Chlamydia, H(Pilory infection')* )$+hi%ly UF* ,Hu%ungan #adar homosistein plasma dengan asam folat dan vitamin - serum penderita penya#it 0antung #oroner di 1+* 2antung Harapan Kita3 $4esis'*FKU 5.678''* $9otto A, Po"nall H* ,Manualof lipid
    ./

    disorders3* -altimore: ;illiam < ;il#ins5 .666* p*=>(??@'* $-erlinder 2A, !ava% M, Fogelman AM, Fran#s 2+, Demer &&, Ad"ards PA, et al* ,Atherosclerosis: -asic mechanism, oBidation, inflamantion and genetics3* Circulation .66@56.:/C77(6='

    Cardiovascular events in U+ decreased %y management of ris# factors :


    /CD $+top smo#ing' @CD $plus eBercise and lipid management'))
    ))9oldman &, Cost Affectiveness
    perspective in coronary heart disease, AM2 .66>,..6$supll ?'58??(C>

    +mo#ing prevalence on various studies


    Smoker percentage Author Ranti, ISF West Java Mar)ono, J Rasa+, A /alim, 0
    2oe+hi ,armajo et al, Monica %1&&,Jakarta 2oe+hi ,armojo, et al Monica %11",Jakarta

    Subject Man eneral population Worker ,octor, emplo)ee Stu+ent %' %1 )o eneral population eneral population !"#$$ * !'#( -.#& '" '1#1 '-#1 Woman %#"& * * * !#! '#1 -#!

    Total

    !'#!( "&,( !'#( -.#& !'#!' "%#' ".#-

    Average

    $-#-!

    "#1!

    ""#1(

    -ac#ground

    +tudy in 2a#arta revealed : Prevalence of hypertension "as lo"er in heavy physical activity $./*>D' compare to moderate $CC*7D' or lo" $C?*/D' group $pE>*>>?', Hypercholesterolemia $.?*/D : @>*7D : ?=*>D' $pE>*>>>?'*
    non(regular eBercise $//*8D', not eBercise $@7*?D' $pE>*>@

    AC9 a%normality in regular eBercise $.6*>D',

    ndonesia in Crisis situation Ho" do "e manage

    Kusmana, D.(Medical Journal of Indonesia, vol. 10 No.1. Jan Mar 2001)

    Physical Activity , atherosclerotic process and %lood pressure reduction*

    Ornish D, Life-style modification regressed atherosclerosis process. (Circ

    !!"#"$%

    &ieba'er# Ris( factor intervention moderate physical e)ercise delayed atherosclerosis process. (*+CC, !!,#-"% .ambrecht,R # /nd'rance e)ercise improved 'ltra str'ct're of s(eletal m'scle on heart fail're patient.(*+CC !!0#-!% 1pataro . 2eta +nalysis from " st'dies ( n 3 4.44 s'b5ects, n 3 -.4 , f cont%, sho6ed physical e)ercise blood press're red'ction on hypertension 7 18P decreased -9 mm.g, and D8P -" mm.g, in mild hypertension - 4 mm.g and -" mm.g respectively.(2ed 1ci 1port /)erc !! %

    !atural History of Cardiovascular Disease


    Coronary thrombosis Myocardial infarction Arrhythmia & Myocardial damage

    Sudden death

    CV Death Stro e

    Myocardial Ischemia CHD

    Silent Angina Hibernation

    Remodeling

    Atherosclerosis

    Ventricular dilatation

    !VH Endothelial dysfunction RIS" #AC$%R hy&ercholesterolemia' blood &ressure' Diabetes' smo ing' thrombosis' fibrinogen Congestive heart failure

    HEA!$H

    End stage Heart disease

    Death

    Figure3 Risk 4actor, en+othelial +)s4unction an+ cerebro*car+iovascular +eath


    Kusmana, D. Pen aru! "ida#$s"o% mero#o# diser"ai ola!ra a "era"ur, dan$a"au %en aru! #er&a fisi# "er!ada% da'a survival %endudu# di Ja#ar"a ( %eneli"ian K)*)+, selama 1- "a!un. (Diser"asi) 2002. %. 1/

    Pathophysiology Atherosclerosis
    Endothelial dysfunction :

    Monocyte &ipid*+luster

    Endothelial barrier Monocyte

    /ubintima Endothelial permeability Monocyte migration Endothelial adhesion Monocyte adhesion ,- .m

    " , (01

    Vesselwall
    Ross R, NEngl J Med34 !"###$ %&usis 'J, Nature 4 ( !)

    Monocyte transmigration
    $

    +natomy of the +therosclerotic Pla:'e


    Fibrous cap Lumen Lipid Core Shoulde r

    Intima
    Media Elastic lamin Internal External

    2atri) 2etabolism and ;ntegrity of the Pla:'e<s =ibro's Cap


    is s e h t Syn
    Brea kdow n
    Colla#en-de#radin# Fibrous cap Proteinases C -!"L + + + + + +
    IL-1 TNF- MCP-1 M-CSF

    IFN-

    Lipid core
    Libby P. Circulation 1995;91:2 !!"2 5#.

    Tiss$e%Factor Procoa#$lant

    >hrombosis of a Disr'pted +theroma, the Ca'se of 2ost +c'te Coronary 1yndromes, Res'lts from7
    $ea%enin& o'

    the 'ibrous cap


    (hrombo&enicit

    y o' the lipid core

    Illustration courtesy o' )ichael *. +a,ies- ).+.

    Smoking, hyperlipidemia, hypertension, hyperglycemia Endothelial dysfunction Activation of NF-kB

    (
    Adhesion molecules TNF-a

    (
    I$-,

    (
    Interleukins

    !"#$

    (
    I$-/

    + A%-,

    '-selectin

    I A%-,

    I$-.

    %atri& metalloproteinases Inflammation 'la(ue desta)ili*ation Acute phase proteins

    Serum amyloid-A

    -'

    Fi)rinogen

    !i&o&rotein )a* $otal Homocysteine $otal Cholesterol )$C* #ibrinogen t+,A antigen $C-HD! ratio CR, CR, ( $C-HD! ratio

    "

    Relative ris of future myocardial infarction

    Cardiovascular Risk Profiles and follow up decisions**


    $o3 -isk4 56akarta Score 7 , 8 e9g, age "# , normal 3eight, normal )lood pressure, normal cholesterol, normal sugar, no smoking , good physical fitness 5 : / %ets8

    -etest at intervals suggested in ta)le ,2

    %oderate -isk4 56akarta Score 0 - " 8 e9g,normal 3eight, either one of ;ypertension St ,, cholesterol : 01< mg=dl , sugar : 0## mg=dl, no smoking, age 2#, average physical fitness 5.> %ets8

    ounsel to lo3er the risk profile through risk factor modification , drugs -etest at one year If still moderate, reapeat every one year depend on E&ercise E ? result 5&ositive .high ris , negative @moderate risk

    If lo3, follo3 the Ta)le ,2

    High Ris / )0a arta Score 1 2* e3g' obese, ;ypertension St 0 , cholesterol : 01< mg=dl, sugar : 0## mg=dl, smoking, age 2#, lo3 physical fitness 5 7 2 %ets8

    ounsel to lo3er the risk through modification risk factor9 !rugs , depend on E&ercise E ? result 5positive @high risk, negative.moderate ris 8 -etest at one year

    ,ositive Re&eat to 4 5ee s' if still &ositive &erform Dobutamine stres test or $halium or MSC$

    oronary arteriography

    ?iat 2ene(an Proses +teros(lerosis


    Pengendalian fa(tor risi(o (onvensional 2ene(an la5' (as(ade inflamasi .s CRP melal'i olahraga +ntibodi tnf@, CDA$

    *a(arta

    *a(arta

    '2' 3uidelines

    1mo(ing Cessation Lipid 2anagement Physical activity Beight management +spirinCother +ntithrombotic agents +C/ inhibitors 8eta bloc(ers 8lood press're control Diabetes 2anagement 1tro(e 1pecific7 +trial =ibrillation 2anagement, Dr'g and +lcohol +b'se 2anagement

    Adapted from Smith, irculation <041, ,<<2

    >atala(sana Prevensi Primer


    Prioritas #ardiologi preventif ialah : Pasien yang telah ter%u#ti menderita P2K atau penya#it ateros#leroti# lainnya ndividu sehat yang memili#i risi#o tinggi untu# menderita P2K atau penya#it ateros#leroti# lainnya, oleh #arena #om%inasi %er%agai fa#tor risi#o, seperti mero#o#, hipertensi, dislipidemia $pening#atan #adar #olesterol total dan &D&, penurunan #adar HD&, dan pening#atan trigliserida', pening#atan #adar gula darah, terdapat ri"ayat #eluarga yang mengalami P2K, prematureGdini, atau yang memili#i hiper#olesterolemia %erat, atau %entu# lain dari dislipidemia hipertensi dan dia%etes melitus* Kera%at de#at penderita P2K dini atau penya#it ateros#lerosis dan individu sehat dengan risi#o tinggi* ndividu(individu lain yang di0umpai %er#aitan dengan pra#te##lini# sehari(hari*

    >abel =a(tor Risi(o ;ndependen Dtama Pero(o( .ipertensi Pening(atan (adar (olesterol ser'm total (dan LDL% ?adar (olesterol .DL ser'm rendah Diabetes 2ellit's Dsia lan5't

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