Sari Pustaka Soraya Olyfia 03010258

Pembimbing:
DIAGNOSIS AND dr. Arif Gunawan, Sp.PD, MARS

THERAPY OF
Soraya Olyfia
ARTERY CORONARY 030.10.258
DISEASE IN TYPE 2 Sri gusfita
030.11.278
DIABETES Made Ayu Laksmie R.
MELLITUS 030.12.152
INTRODUCTION
Cardiovascular disease (CVD) is the major cause of morbidity

and mortality for individuals with diabetes and is the largest
contributor to the direct and indirect costs of diabetes. The
common conditions coexisting with type 2 diabetes
(hypertension and dyslipidemia) are clear risk factors for CVD,
and diabetes itself confers independent risk.
Prevalence of Cardiac Disease
among Diabetics
Diabetes mellitus has been well described as a cardiovascular
risk factor in developed countries. In the Framingham study,the
incidence of cardiovascular disease among diabetic men was
twice that among nondiabetic men, and similarly was three times
more elevated in diabetic women compared to nondiabetic
women
In a recent metaanalysis by Berry et al. reviewing the lifetime
risks of cardiovascular disease, 18 studies involving 257,384
men and women were reviewed. Patients were stratified by
blood pressure, cholesterol level, smoking status, and diabetes
status and by age group as well as gender and race
Prevalence of Cardiac Disease
among Diabetics
Furthermorethe differential impact of diabetes on coronary artery
disease mortality in men and women has been the subject of
multiple studies; Lee et al. reported the relative risk of coronary
heartdisease mortality to be 2.5 in women, compared to 1.85 in
men
CLASSIFICATION
1. Stable angina pectoris
2. Acute coronery syndrome
- Unstable angina pectoris
- Myocardial infarction without ST segment elevation (NSTEMI)
- Myocardial infarction with ST segment elevation (NSTEMI)
CLINICAL MANIFESTASION
1. Stable angina pectoris
- Quality dull pain, like : * Taste crushed / weight in chest
* Pain radiating to the left arm, neck, shoulder and
chin
* Chest pain <20 minutes
2. Acute coronery syndrome
Suddenly at rest, sleep, symptoms occur much longer than stable angina
pectoris, rest or medications usually can not relieve symptoms
CLINICAL MANIFESTASION
a. Unstable angina pectoris
without an increase in cardiac marker enzyme (CK-MB, troponin) with or
without ECG changes indicate ischemia (ST segment depression, T wave
inversion and ST segment elevation transients).
b. Myocardial infarction without ST segment elevation (NSTEMI)

Ischemia occurring severe enough to lead to myocardial damage
characterized by an increase in markers of cardiac enzyme (CK-MB, troponin).
c. Myocardial infarction with ST segment elevation (NSTEMI)

This type is more dangerous and a state of emergency, this type can be
known through the EKG shows changes called ST segment elevation. ST
segment elevation is an indication of damage to the heart muscle which is quite
large (occurring due to total occlusion of the coronary arteries).
DIAGNOSIS
Blood pressure measurement should bedone by a trained

individual and follow the guidelines established for the general
population
Blood pressure should be measured at every routine visit.

Patients found to have elevated blood pressure should have
blood pressure confirmed on a separate day.
THERAPY
NON Pharmacological
- The DASH study evaluated the impact of healthy dietary patterns in

individuals without diabetes and has shown antihypertensive effects similar
to those of pharmacological monotherapy.
- Lifestyle therapy consists of restricting sodium intake, reducing excess
body weight, increasing consumption of fruits, vegetables, and low-fat
dairy products, avoiding excessive alcohol consumption (no more than 2
servings per day in men and no more than 1 serving per day in
women)(13);and increasing activitylevels.
- Nonpharmacological therapy is reasonable in individuals with diabetes
and mildly elevated blood pressure (SBP .120 mmHg or DBP .80 mmHg).
If the blood pressure is conrmed to be 140mmHg systolic and/or 90
mmHg diastolic, pharmacological therapy should be initiated along with
nonpharmacological therapy
THERAPY
Pharmacological
In people with diabetes, inhibitors of the renin-angiotensin system

(RAS) may have unique advantages for initial or early treatment of
hypertension.
In patients with congestive heart failure (CHF), including subgroups

with diabetes, ARBs have been shown to reduce major CVD
outcome.
In type 2 diabetic patients with signicant diabetic kidney disease,
ARBs were superior to calcium channel blockers for
reducingheartfailur
In type 2 diabetic patients with signicant diabetic kidney disease,
ARBs were superior to calcium channel blockers for reducing heart
failure
CONCLUSION
Diabetes mellitus is associated with an increased risk of

cardiovascular death and a higher incidence of cardiovascular
diseases including coronary artery disease. The substantial rise in
prevalence of diabetes will ultimately lead to a huge increase in
the demand for primary, secondary, and tertiary healthcare
services globally. The need for appropriate screening and cardiac
testing is crucial to help better manage the end result
(cardiovascular disease) of this global epidemic.
REFERENCE
1. Wong P, Fuller PJ, Gillespie MT, Milat F. Bone Disease in

Thalassemia: A Molecular and Clinical Overview. Endocr Rev;
10(1210): 2015-1105
2. Sabath DE, Harvey A. A Multiplex Approach to the Molecular
Diagnosis of -Thalassemia
3. Vanichsetakul, Preeda. Thalassemia: Detection,
Management,Prevention & curative treatment. The Bangkok
Medical Journal:2011

Sari Pustaka Soraya Olyfia 03010258

Uploaded by

Copyright:

Available Formats

Sari Pustaka Soraya Olyfia 03010258

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Sari Pustaka Soraya Olyfia 03010258

Uploaded by

Copyright:

Available Formats

Pembimbing:

DIAGNOSIS AND dr. Arif Gunawan, Sp.PD, MARS

Cardiovascular disease (CVD) is the major cause of morbidity

b. Myocardial infarction without ST segment elevation (NSTEMI)

c. Myocardial infarction with ST segment elevation (NSTEMI)

Blood pressure measurement should bedone by a trained

Blood pressure should be measured at every routine visit.

- The DASH study evaluated the impact of healthy dietary patterns in

In people with diabetes, inhibitors of the renin-angiotensin system

In patients with congestive heart failure (CHF), including subgroups

Diabetes mellitus is associated with an increased risk of

1. Wong P, Fuller PJ, Gillespie MT, Milat F. Bone Disease in

You might also like