Selamat Pagi

ATEROSKLEROSIS
Disusun oleh :
Rachmah Kurniasari,
S.Ked
110.2009.231
Pembimbing :

Dr. Ade Netra Kartika,

Aterosklerosis
Aterosklerosis adalah keadaan
pengerasan dinding
pembuluh darah.

Gambar 2.1. Penampang Potongan

Melintang Arteri

Gambar 2.2. Perbandingan Arteri normal

dengan Arteri (plak)

Aterosklerosis Koroner
Arteri

~ proses umur
- penebalan intima
- elastisitas menurun
- diameter intima
meningkat
Definisi (WHO 1958)
Perubahan variabel intima arteri yang
merupakan akumulasi fokal lemak (lipid),
komplek karbohidrat, darah, jaringan
fibrous.

Epidemiologi

Faktor Risiko
Uncontrollable

Controllable

Sex

High blood pressure

Hereditary

High blood
cholesterol

Age

Smoking
Physical activity
Obesity
Diabetes

Table 1. Risk factors for Atherosclerosis

(sumber: Harrisons Priciples Internal Medicine 14 th ed, vol 1. 1998, page:1349)

Akibat Aterosklerosis
Akibat dari
atherosklerosis
Penyempitan liang pembuluh darah
Aliran darah berkurang
Insufisiensi oksigen dan
makanan yang dialiri pembuluh darah tersebut

Kerusakan organ yang diserang

Pathogenesis of Atherosclerotic
Plaques
Endothelial damage
Protective
Protective response
response results
results in
in production
production of
of
cellular adhesion molecules
molecules
Monocytes
Monocytes and T lymphocytes attach to
to
sticky surface of endothelial cells
Migrate through arterial wall to subendothelial space
Macrophages take up oxidised LDL
Lipid-rich foam cells
Fatty streak and plaque

Proses aterosklerosis
Teori :
1. Response to injury Hypothesis
Response to injury :
2.
Monoclonal
Hypothesis
Stage A : Endothelial injury
Stage
B : Fatty streak
formation
3.
Lipogenic
Hypothesis
Stage C : Fibrosis plaque formation

Stage A : Endothelial injury

Endotel intak :
Berfungsi sbg BARRIER
menjamin aliran darah koroner
lancar
Faktor Risiko; memudahkan masuknya
lipoprotein (LDL teroksidasi) ke
dinding arteri maupun makrophag
Interaksi endothelial injury dg platelet,
monocyte dan jaringan ikat (collagen)
penempelan platelet (platelet
adherence) dan agregrasi trombosit
(platelet aggregation)

Stage B : Fatty Streak Formation

CIRCULATING : (TOTAL CHOLEST) (TOTAL CHOLEST)
(MONOCYTE)

------------------------------------------------------------------------------------------SUBENDOTHELIAL
SPACE :
(OXIDIZED LDL)

(MONOCYTE)

FREE CHOLESTEROL
MACROPHAGE
FOAM CELL
Fatty Streak STREAK

Stage C : Fibrous Plaque Formation

Terdiri dari :
A) Lipid core :
- central core cholesterol
B) Fibrous caps :
- tutup jar. Ikat
Ada 2 tipe :
1. Stable fibrous plaque
2. Unstable fibrous plaque

Stage D : Unstable Plaque Formation

Vulnerable plaque : struktur plak

tidak stabil
Mudah ruptur plaque fissure
disruption thrombus coronary
occlusion

(FIBROUS PLAQUE)
STRUKTUR PLAK
plaque)
STABIL

STRUKTUR PLAK TDK STABIL (Vulnerable

MDH RUPTUR

PLAQUE FISSURE DISRUPTION

THROMBUS
CORONARY OCCLUSION
ACUTE CORONARY SYNDROME
death)

gure 1. The 7 stages of development of an

atherosclerotic plaque.

Faxon D P et al. Circulation.

Atherosclerosis Timeline
Foam
Cells

Complicated
Fatty Intermediate
Fibrous
Lesion/
Streak
Lesion Atheroma Plaque
Rupture

Endothelial Dysfunction
From First
Decade

From Third
Decade

Adapted from Pepine CJ. Am J Cardiol. 1998;82(suppl 104).

From Fourth
Decade

Figure 3. Phases of lesion development.

Faxon D P et al. Circulation.

2004;109:2617-2625

s
se
l
pu
m
i

show
s

Coronary
Angiography
i ng i n
Narrow

coronaries

Electrocardiogram

f
so
te
Si

elec trical

m
ea
su
re
s

sp
ec
ifi
c

Screening and Diagnosis

Penatalaksanaan
1) Stenting/PCI (Percutaneus Coronary
Intervention
2) Angioplasty
3) Bypass surgery

Treatment (continued)

1) Stenting/PCI (Percutaneus
Coronary Intervention
Kawat stainless steel berbentuk tabung
membuka pembuluh darah yang tersumbat.
Stent dikecilkan hingga diameter terkecil
dimana terdapat kateter balon yang
diarahkan ke area tersumbat dilebarkan
akan melekat ke dinding pembuluh darah

2) Angioplasty
Dilakukan untuk meratakan plak dan
meningkatkan aliran darah yang
melalui endapan lemak.

3) Bypass surgery
Bypass arteri koroner grafting (CABG)
CABG me aliran darah ke jantung,

Pencegahan
Kontrol Tekanan darah.
Kontrol Kolesterol
Tidak Merokok.
Aktivitas fisik teratur
Kontrol Berat Badan

TERIMA KASIH