AHTEROSKLEROSIS AND

AORTIC DISESASE
 dari barn lahir ader de veur co-a fahn
essel busa

-
Deta !
-

-
 ATEROSKLEROSIS
DISFUNGSI ENDOTEL PEMBENTUKAN SEL BUSA LDL -> Low
density Lipoprotein
Perigheten ROS
RUPTUR PLAK ATAU REGRESI PLAK

INFLAMASI MIGRASI DAN PROLIFERASI SEL OTOT POLOS PEMBULUH DARAH

DISFUNGSI ENDOTEL
• Disfungsi endotel terjadi akibat peningkatan produksi ROS, peningkatan ET-1, penurunan sintesis dan aktivitas NO
• Peningkatan LDL plasma, meningkatkan konsentrasi LDL yang terperangkap di intima
• Reaksi oksidatif menginduksi sel endotel untuk mengekspresikan molekul adhesi leukosi
INFLAMASI
• Sel endotel mensintesis sitokin inflamasi dan meningkatkan ekspresi MCP-1 dan molekul adhesi
• Monosit bergerak di sepanjang permukaan endotel, lalu melekat dan ekstravasasi
• Monosit berdiferensiasi menjadi makrofag aktif dan meningkatkan ekspresi reseptor scavanger dan TLR
Singh RB, Mengi SA, Xu YJ, et al. 2002. Pathogenesis of atherosclerosis: A multifactorial process. Exp Clin Cardio; 7: 40-53.
Hansson G. 2005 'Inflammation, Atherosclerosis, and Coronary Artery Disease'. N Engl J Med ; 352, no.(16), April: 1685-95.
 ↓ jdinflorensi/cederejaing
ATEROSKLEROSIS
Totalhana utera anti platelete
PEMBENTUKAN SEL BUSA
• Makrofag melalui reseptor scavanger menginternalisasi dan menghancurkan LDL teroksidasi
• Kematian sel busa dan pelepasan kandungan lemak menyebabkan pembentukan inti nekrotik

MIGRASI DAN PROLIFERASI SEL OTOT POLOS PEMBULUH DARAH

• Sel busa menghasilkan sitokin, GF, dan MMP menyebabkan pengerahan sel otot polos ke
lokasi lesi Isicsi ferblahrya fibrous tissue
• Pertumbuhan plak menyebabkan hipoksia jaringan lokal, menyebabkan neovaskularisasi
RUPTUR PLAK
• Erosi dari plak menyebabkan Inti nekrotik yang kaya lipid trombogenik terpapar ke
trombosit yang bersirkulasi. Menimbulkan agregasi trombosit dan trombosis intravaskular
.

REGRESI PLAK
• Regresi plak meliputi pengangkatan lipid dan bahan nekrotik, pemulihan fungsi endotel
perbaikan daerah yang rusak, serta penghentian proliferasi sel otot polos pembuluh darah

Apahila rupture bina did plan Singh RB, Mengi SA, Xu YJ, et al. 2002. Pathogenesis of atherosclerosis: A multifactorial process. Exp Clin Cardio; 7: 40-53.
Hansson G. 2005 'Inflammation, Atherosclerosis, and Coronary Artery Disease'. N Engl J Med ; 352, no.(16), April: 1685-95.
Aorta: its course and the direction of blood flow

• Ascending aorta:

• Descending aorta: thoracic aorta and abdominal aorta

• The aorta ends by dividing into two major blood vessels, :

common iliac arteries and a median sacral artery
-

S nominate
-

Arteri
 There are two subclavian arteries: one on the
\

intens
left and one on the right. These large blood
vessels supply blood to the left and right arms

The left and right subclavian arteries are not

identical. The left subclavian artery branches
-
off directly from the aorta. As a result, this
artery is more commonly affected by
problems than the right subclavian artery

The right subclavian artery usually arises as a

branch off the brachiocephalic artery. Both
the right and left subclavian arteries give rise
to the vertebral arteries
 -
alte
balit
Cedua sisi wbuh
by same
 Perychab tersening Stenulis auto subclanken
\ adalah authrosclerosis

• Although atherosclerosis is the most

common cause of blockage in the
subclavian artery, other rare disorders, such
as vasculitis, can also cause problems.
-rading penbuluh darah
• Chest radiation for cancer treatment can
result in scarring of the vessel wall, which
can cause narrowing of the subclavian
artery.

• The subclavian arteries can also be

compressed in vascular thoracic outlet
syndrome Meri pl
->
nahr
.

vergan tagn
,

compress of arti subcation

 • A common symptom is muscle cramping
\ -

with arm use due to insufficient blood flow.

-

• The arm muscles may become painful or

fatigued with physical activity. Symptom
severity can depend on whether a person is
left- or righthanded, and which arm is used
more in daily life. Apabila yo
-> tersumbat di darch
veryon dominan-nyernt
• Rare symptoms include dizziness, vertigo
(room spinning), or fainting.
• In patients who have had prior - CABG,
subclavian artery stenosis can cause chest
pain if the bypass graft was a branch of the
subclavian artery. In general, if the
narrowing is mild, then it may not cause
any symptoms hiti dan naa
tergen
-
Hinis-pertdan thenan di
ch Pulse di Gao-kni
\ schit ahen lebin reder

↓35
• The blood pressure may be different
between the left and right arms, with
the affected arm having a falsely low
-

reading.
• The pulses throughout the affected arm
may also be reduced.
• The blood pressures measured in the
left and right arms should normally be
within about 10–15 mmHg of one
-

another. Larger differences between

the left and right arm readings may
indicate subclavian artery stenosis
 Malahnhan Jenni Wedne
\ veryon ->
di
halaw ada beda 15
- subclavia
syncton
When significantly different arm blood
pressures are identified, further testing can be
done to help clarify the problem and guide
potential treatments Tes uth
relinat
vena dan arteri
• USG Doppler
• computed tomographic angiography (CTA)
and/or magnetic resonance angiography
(MRA).
• An angiogram test
Stern's - Pergempi katetevisani ->
orgiografi
Arteri racialis /auteri femoralis
 -> Penyempitan aorta
Coarctation of the Aorta
duchs Arteriosus
\ Regenpinter istrus
worte
,
• CoA is considered as part of a generalized
o arteriopathy, and not only as narrowing of
-

the aorta (at the isthmus).

• It occurs as a discrete stenosis or as a long,
hypoplastic aortic (arch) segment.
• Typically, CoA is located in the area where

/
the ductus arteriosus inserts, and only in
-

rare cases occurs ectopically

• Presentation is driven by the degree of
narrowing, length of narrowed arterial
tissue (discrete to long-segment), and
timing of ductus arteriosus closure
Maank he palaal

Tjd di dehat pet haten ductus Arteriosus

 - 16-20 tahn
Associated lesions Aartic
Bicuspic value
• Associated lesions include BAV (up to 85%),
ascending aortic aneurysm, SubAS, or hambaten
-nat
SupraAS, (supra)mitral valve stenosis
(including parachute mitral valve), Shone
complex, or complex congenital heart
-
defects.
0 • CoA can be associated with Turner
-

syndrome and Williams Beuren syndrome.

-

• Extracardiac vascular anomalies have been

reported in CoA patients including
anomalous origin of the right subclavian
artery (in 45% of cases), collateral arterial
circulation, and intracerebral aneurysms (in
up to 10%
 Clinical presentation and natural
history
• Signs and symptoms depend on the severity
of CoA.
• Patients with severe CoA usually present
with signs and symptoms early in life, while
-

particularly mild cases may not become

evident until adulthood, where CoA is
detected in the work-up of arterial
hypertension.
the
Muncul pel usia 10-20
 Clinical presentation and natural
• • history
Patients with CoA who reach
adolescence demonstrate very good
long-term survival up to age 60 years.
• Long-term morbidity
-
is common,
however, largely related to aortic
-

complications and longstanding

e

hypertension. -> Hipertensi berkepanjangan

-

• The natural course may be complicated

by
-
left heart failure, intracranial
haemorrhage (from berry aneurysm),
-

IE, aortic rupture/dissection,

premature coronary and cerebral
artery disease, and associated heart
defects.
 DIAGNOSTIC WORK UP
Ich kensi extric atas bunch
•
• A blood pressure gradient between upper and lower
extremities (systolic >_20 mmHg) indicates significant
CoA -Lochsic Aorte
• Weak or absent
-
pulses in the lower extremities or
radiofemoral pulse delay also indicate significant
coarctation
• Other findings consist of a suprasternal thrill
-

(proximal obstruction), an interscapular (systolic)

murmur, or continuous murmurs (due to collateral
vessels). In the case of a pinpoint CoA, murmurs may
be completely absent.
• Chest X-ray findings may be characterized by rib
notching of the third and fourth (to the eighth)
•
ribs due to the collaterals.
• Echocardiography provides information
regarding site, structure, and extent of CoA, LV
function and LVH, associated cardiac
abnormalities, and aortic and supra-aortic
vessel diameters
• CMR and CCT
• Imaging of intracerebral vessels is indicated in
the case of symptoms and/or clinical
manifestations of aneurysms/rupture.
• Cardiac catheterization with manometry (a
peak-to-peak gradient >_20 mmHg) indicates a
haemodynamically significant CoA
•

-
-

-
• TD normal
->
-
• In native CoA, as well as re-coarctation with
appropriate anatomy, stenting has become
the first-choice treatment in many ACHD
• centres.The use of covered stents is Adult Congenital
-

Heart Disena

preferred Start
relebuchen
harge
• Balloon angioplasty in adults is only
indicated for re-dilatation of previously
stented aortas.
rasch hatter ditro dan Gallon
• While paediatric surgical techniques
include resection and end-to end
anastomosis, resection and extended end-
to-end anastomosis, prosthetic patch
aortoplasty, subclavian flap aortoplasty,
interposition of a (tube) graft, and bypass
tube (jump) grafts, only the latter two are
generally feasible in adults
 ~Pengembungen dinding penbuluh darh, bat newahng
a

AORTIC ANEURSYM
•
tict Megades
dinding penkten

-> ternet
• = der
Eeris
↓
rude
prech
 •
-

archi
Marjory
-

- jarigm hat nicsarys

da hejols

↑ die pant

Abdominal
• = aortic
Aneurgan

of
Canderung
Mergers · Adaga masa di prof
usin 200th
norte & art ,
pulroalis
nee

-
 -
-

- -

en

-
Swarn setah

Sahit dada
Y

~Elit rapas

) bina
ade masss
pulsatile
 -

-
 -

C
-
-

Abdominal
Heart rate
Part severe
-
Shock
-
Rach pain
Pain in
grin
-

-
Rasa fidah myaman
--
-

-
O
dipernt
 - norte peal
• Aortic dissection is defined as disruption of the medial layer
- -

provoked by intramural bleeding, resulting in separation of the

-

aortic wall layers and subsequent formation of a TL and an FL

-

True False
Th
with or without communication. Luver zuren
a

• Inmost cases, an intimal tear is the initiating condition, resulting

a -Intima lager far
in tracking of the blood in a dissection planewithin the media.
• This process is followed either by an aortic rupture in the case of
adventitial disruption or by a re-entering into the aortic lumen
through a second intimal tear. The dissection can be either
antegrade or retrograde.
 As des
As-Arch-Des - -
-

D
 dada
Als-s Nyeri he his

Sperti tartindit
↓ -
Seperti tertusul
tersaynt
-> Orset Like " -

Augurgitasi
 -

Tension preumothorax - snawn

99
rafas
hedergeren
Aartic regurgitass
Murmur diastolic
- -

-
 -

-
Perchedahe
-
-

vasodilator
->

tensi
Amlodipine + hang
merikan

Bilfiazen
- Member ther dige
vasodilator perbulat