CTEV (Congenital Talipes Equinovarus) or Clubfoot

clubfoot is a general term used to describe a common deformity in which the feet change / bend of the state or the normal position. Some of foot deformities including talipes deformity of the ankle called the talus derived from the word (which means ankle) and plague (which means the foot). Deformities of the foot and ankle are sorted depending on the position of the ankle and foot abnormalities. Talipes deformity are:

  • Talipes varus: inversion or bend into the>
  • Talipes valgus: eversion or bending outward
  • Talipes equinus: plantar flexion of the fingers which is lower than the heel
  • Talipes calcaneus: dorsiflexion where the radius is higher than a heel
clubfootMost clubfeet which is a combination of several positions and the highest incidence rate is the type of talipes equinovarus (TEV) in which the foot down and into the arched position with varying degrees of severity. Unilateral clubfoot is more common than other types of bilateral and can occur as abnormalities associated with other syndromes such as chromosomal aberration, artrogriposis (general immobility of the joints), cerebral palsy or spina bifida.

Frequency of clubfoot from the general population is 1: 700 to 1: 1000 live births in which the boy two times more often than women. Based on the data, 35% occurred in monozygotic twins and only 3% in dizygotic twins. This emphasizes the role of genetic factors

The exact cause of clubfoot is not known until now. Some experts say that the disorder was caused by an abnormal position or limited movement in the womb. Another expert said that the abnormality occurs due to abnormal embryonic development of the current developments towards flexion and foot eversion at month 7 of pregnancy. Growth is impaired in these phases will cause a deformity which is influenced also by the intrauterine pressure.

Evaluation of diagnostic
This deformity can be detected early during the prenatal ultrasonography or detected at birth.

Therapeutic management
Rapid growth during the period of the infant allows for the handling of remodeling. Treatment begins when abnormalities are obtained and consisted of three stages, namely:
1) correction of deformity,
2) correction to maintain normal muscle balance is achieved,
3) observation and follow-up to prevent the return of the deformity.
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Correction of CTEV is with manipulation and serial application of the "cast" that starts from birth and continue until the goal is achieved correction. This correction is supported also by stretching exercises of the structure of the medial side of foot and exercise a weak contraction of the structure on the lateral side. Manipulation and the use of "cast" is repeated on a regular basis (from several days to 1-2 months at intervals of 1-2 months) to accommodate the rapid growth in this period. If manipulation is not effective, surgical correction to improve the structure of the redundant, extend or tendon transplant. Then ektremitas will be in the "cast" until the goal is achieved correction.

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Some cases showed a positive response to treatment, whereas some other cases show that the response time or do not respond at all to Treatment. Parents should be informed that the results of the Treatment is not always predictable and depends on the severity of the deformity, the child's age at intervention, the development of bones, muscles and nerves. Long-term foot function after Treatment is generally good but the study results show that the correction as adults will show a 10% foot smaller than usual.

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Anemia In Infants

Anemia is a disease characterized by too few red blood cells (erythrocytes) in the blood.

Anemia in the newborn may result from:
  • Blood loss
  • Destruction of red blood cells are excessively
  • Impaired red blood cell formation.

The loss of large amounts of blood during the birth process can occur if the placenta is detached from the uterine wall prematurely (placental abruption) or if there is a tear in the umbilical cord.
Infants looked very pale, low blood pressure and shortness of breath.

Anemia in premature infants is usually caused by blood loss (due to repeated blood tests for laboratory tests) and a reduced red blood cell formation.
Under normal circumstances, the bone marrow did not form new red blood cells for 3-4 weeks after birth. Anemia will worsen as the baby's growth rate is faster than the rate of formation of new red blood cells. But premature babies usually do not show symptoms of anemia and this situation will disappear by itself within 1-2 months.

Destruction of red blood cells occurs in:
  • Hemolytic disease in newborns: a large number of red blood cells are destroyed by antibodies produced by the mother during the fetus in the womb
  • Babies with deformities of the red blood cells, such as spherocytosis (spherical red blood cells)
  • Abnormalities of hemoglobin (oxygen carrying protein in red blood cells), such as sickle cell disease or thalassemia
  • Infection for the baby in the womb (eg toxoplasmosis, German measles, cytomegalovirus disease, herpes simplex or syphilis).
If blood cells are destroyed, hemoglobin is converted to bilirubin. High levels of bilirubin in the blood (hyperbilirubinemia) causes jaundice and in severe cases, can cause brain damage (kern icterus).

Anemia due to iron deficiency can occur in infants aged 3-6 months if given cow's milk or infant formula is not fortified with iron.

  • If blood loss occurs during the birth process, immediately given a blood transfusion.
  • If the cause is the destruction of red blood cells is excessive, replace transfusion, where the baby's blood is replaced with fresh blood. Red blood cells are damaged, bilirubin and antibodies from the mother's body dumped.
  • In iron deficiency anemia are given extra iron.
  • If symptoms of severe anemia, a blood transfusion.
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    Biliary Atresia

    Biliary atresia is a condition where the bile ducts are not formed or does not develop normally. Biliary atresia is a liver disease in children who contributed to 50-60% of liver transplants. The function of the biliary system is to remove metabolic wastes from the liver and transports bile salts needed to digest fats in the small intestine. In biliary atresia there clogging the flow of bile from the liver to the gallbladder. This can cause liver damage and cirrhosis of the liver, which if untreated can be fatal. The incidence of biliary atresia throughout the world 1: 10,000 live births. Biliary atresia is a liver disease in children who contributed to 50-60% of liver transplants.

    The cause is a combination of various things such as viral infections especially reovirus and rotavirus, genetic disorders, toxic material that interferes with the growth of the biliary tract and the presence of perinatal bile duct damage during delivery.

    Symptoms usually occur within 2 weeks after birth, which are:
    • Dark-colored urine baby
    • Pale stools
    • Yellow skin
    • Do not gain weight or slow weight gain
    • Enlarged liver.

    By the time the baby reaches the age of 2-3 months, will arise the following symptoms:
    • Impaired growth
    • Itching
    • Fussy
    • High blood pressure in the portal vein (blood vessels that carry blood from the stomach, intestines and spleen to the liver).

    Type of biliary atresia
    There are 3 (three) types of biliary atresia:
    1. Type I, atresia of the common bile duct;
    2. Type II atresia of the duct while hepatikus
    3. Type III obstruction or blockage of the bile duct more upstream in the liver tissue at the porta hepatis and the channel above the porta hepatis.
    Most patients with biliary atresia, including the type III, which is as much as 90%.


    Pathophysiology of biliary atresia is not known with certainty. According to figures histopatologik, it is known that biliary atresia occurs because of prolonged inflammatory processes that cause extrahepatic biliary ducts are progressively damaged. In the advanced state of the inflammatory process spread to the intrahepatic biliary ducts, so it will experience a progressive damage.

    Diagnosis based on symptoms and physical examination.
    On abdominal examination, palpable enlarged liver.

    Regular checks carried out:
    • Blood tests (there are elevated levels of bilirubin)
    • abdominal ultrasound
    • X-ray abdomen (liver appears enlarged)
    • Cholangiography
    • Liver biopsy
    • laparotomy (usually done before the baby is 2 months old).


    Kasai operation, according to the name of the Japanese doctor who discovered the technique of the operation, then the technique was performed bypass surgery which makes bile duct from the liver directly into the duodenum or the duodenum. Successful Kasai operation, particularly in type I biliary atresia and a little on the type II. Whereas in type III, the Kasai operation is not very satisfactory results. As a result, the disease will progress to cirrhosis of the liver in which liver texture is soft and supple previously become hard like stone.
    In all organic disease that has reached the final stage, there is no other way to treatment than do organ transplants in this case the liver or liver transplant. Special liver transplant in infants is actually relatively easy to find a donor, which is one of the parents, could be the father or mother of the baby. Depending on the results of examination of whether the father or mother of the most close and match blood groups and other test results such as MHC type I, type II MHC, etc..

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    Coronary Heart Disease (CHD)

    A. Definition.
    Coronary heart disease (CHD) / coronary artery disease (heart disease artherostrofik) is a specific manifestation and arterosclerosis in the coronary arteries. Plaque formed on the branching arteries aterion toward the left, right coronary artery and the artery is rather rare in sirromflex. Blood flow to distal obstruction can be permanent or temporary which is caused by the accumulation of plaque or clots. Developed collateral circulation around the obstruction arteromasus that inhibits the exchange of gases and nutrients to the myocardium.
    The failure of collateral circulation to provide adequate oxygen supply to the cell that results in coronary artery disease, impaired blood flow due to obstruction is not permanent (angina pectoris and angina preinfark) and permanent obstruction (miocard infarct)

    B. Causes, Mechanisms, and Symptoms of Coronary Heart Disease (CHD)

    C. Risk and incidence
    Coronary artery disease is the most prevalent health problem and is the leading cause of death in the USA. Although epidemiological data indicate changes in risk and mortality of this disease remains a challenge for health workers to conduct prevention and treatment efforts. Ischemic heart disease experienced by many individuals aged 40-70 years old with a mortality rate of 20%.
    Risk factors associated with coronary heart disease can be logically classified as follows:

    1. Personal atherogenic properties.
    Atherogenic properties include blood lipids, blood pressure and diabetes mellitus. These factors together play a major role in determining the speed artero - genensis (Kaplan & Stamler, 1991).

    2. Living habits or environmental factors not been determined arbitrarily.
    Lifestyles that predispose individuals to coronary heart disease is a diet too rich in calories, saturated fat, cholesterol, salt as well as by physical inertia, weight gain is out of control, cigarette smoking and alcohol abuse (Kaplan & Stamler, 1991).

    3. Small risks and other factors.
    Because of the risk factors that set these days do not seem to explain the overall difference in mortality due to coronary heart disease, then there is a suspicion that there is a major risk factor bernar completely unknown there.
    Various risk factors that exist among other oral contraceptives, host susceptibility, age and gender (Kaplan & Stamler, 1991).

    D. Pathophysiology
    Coronary heart disease and myocardial micardiail an ischemic response of myocardium caused by coronary artery narrowing is permanently or not permanently. Oxygen is needed by myocardial cells, for which aerobic metabolism Adenosine Triphospate in free energy for the heart at rest require the 70% oxygen. The amount of oxygen in the heart need to work on call as Myocardial Oxygen Cunsumption (MVO2), expressed by the acceleration of the heart, contraction miocardial and pressure on the heart wall.

    Normal heart can easily adjust to the increased demands of oxygen tension and contraction of view adds acceleration to suppress the volume of blood to the heart of the partitions. At the heart of the obstructed blood flow miocardial, the blood supply can not meet the demands that occur. State of lethal or partial obstruction can cause a condition resembling anoxia and aerobic glycolysis seeks to meet the need of oxygen.


    Analgesic is a drug or compound that is used to relieve pain or pain without losing consciousness. Awareness of pain consists of two processes, namely the acceptance of pain stimuli in the brain and emotional reactions and the individual against these stimulants. Barrier of pain medication (analgesic) affect the first process to heighten awareness of the feelings of pain threshold, while narcotics suppress psychis reactions caused by pain stimuli.

    The pain in most cases only a symptom, whose function is to protect and give the alarm about the presence of disturbances in the body, such as inflammation (rheumatoid, gout), germ infections or muscle spasms.
    The cause of pain is mechanical stimuli, physical, or chemical that can cause tissue damage and release of certain substances called mediators of pain that is located on free nerve endings in the skin, mucous membranes, or tissue- tissues (organs) other. From this place the stimulus flowed through sensory nerves to the Central Nervous System (CNS) through the spinal cord to the thalamus and then to the center of a big pain in the brain, where the stimulus is felt as pain. Mediators of pain the most important is histamine, serotonin, plasmakinin-plasmakinin, and prostaglandin-prostagladin, and potassium ions.
    Based on the occurrence of pain, the pain can be combated in several ways, namely:
    1. Hinder the formation of stimulus in the peripheral pain receptors, by peripheral analgesics or local anesthetic.
    2. Hinder the distribution of pain stimuli in sensory nerves, for example by local anesthetic
    3. Blockade of central pain in the Central Nervous System with central analgesics (narcotics) or general anesthetic.
    In the treatment of pain with analgesics, psychological factors play a role, such as patience and resources of individuals receiving pain from the patient. In general analgesic is divided into two groups, namely non-narkotinik analgeti or non-opioid analgesics or integumental analgesics (eg asetosal and paracetamol) and narcotic analgesics or opioid analgesics or visceral analgesics (eg morphine).

    Narcotics analgesics
    These substances have a strong power blocking pain once the level of employment is located in the Central Nervous System. Generally reduced consciousness (relieving properties and lull) and cause uncomfortable feelings (euphoria). Can lead to tolerance and habits (habituation) as well as psychological and physical dependence (addiction addiction) with abstinensia symptoms when treatment is stopped. Because of the dangers of this addiction, then most of central analgesics such as narcotics included in the Narcotics Act and its use is strictly controlled .
    Chemically, these drugs can be divided into several groups as follows:
    1. Natural and synthetic opiate alkaloids morphine and codeine, heroin, hidromorfon, hidrokodon, and dionin.
    2. Morphine substitutes consisting of:
    a. Pethidine and its derivatives, fentanyl and sufentanil
    b. Methadone and its derivatives: dekstromoramida, bezitramida, piritramida, and d-ptopoksifen
    c. Fenantren and its derivatives also include pentazosin levorfenol.
    Morphine antagonists are substances that can fight the side effects of narcotic analgesics without reducing labor analgesic and is mainly used in overdose or intoksiaksi with these medications. These substances themselves are also efficacious as an analgesic, but can not be used in therapy, because he himself cause side effects similar to mrfin, including respiratory depression and psychotic reactions. Frequently used is nalorfin and naloxone.
    Side effects of morphine and other central analgesics at usual doses are gastric disturbances, intestinal (nausea, vomiting, obstipasi), as well as other central effects such as restlessness, sedation, drowsiness, and mood changes to euphoria. At higher doses the effects occurred more dangerous is respiratory depression, decreased blood pressure, and impaired blood circulation. Finally, can occur coma and respiratory standstill.

    Effects of morphine on the Central Nervous System in the form of analgesia and narcosis. Analgesia by morphine and other opioids has been incurred before the person is sleeping and analgesia often occur without sleep. Small doses of morphine (15-20 mg) caused euphoria in patients who are suffering pain, sorrow and anxiety. Conversely, the same dose in normal people often creates a feeling of dysphoria worry or fear is accompanied by nausea, and vomiting. Morphine also cause drowsiness, can not concentrate, difficulty thinking, apathy, decreased motor activity, decreased visual acuity, ektremitas tersa weight, body feels hot, hot itchy and dry mouth, respiratory depression and miosis. The hunger is lost and can not always accompanied by vomiting nausea. In a quiet environment people are given a therapeutic dose (15-20 mg) of morphine will fall asleep quickly and soundly with a dream, slow breath and miosis.
    Between pain and analgesic effects (respiratory depressant effects as well) contained morphine and other opioid antagonism, that pain is an antagonist faalan for analgesic effect and respiratory depressant effects of morphine. When pain is experienced for some time before administration of morphine, analgesic effects of these drugs are not so great. Conversely, if the stimulus of pain inflicted after reaching maximum analgesic effect, morphine dose required to abolish the pain was much smaller. Patients who are experiencing severe pain and require mofin with large doses to relieve pain, respiratory depression can be resistant to morphine. But when the pain was suddenly gone, then most likely symptoms of respiratory depression by morphine.

    Peripheral analgesics (non-narcotic)
    Drugs this drug is also called peripheral analgesics, because it does not affect the Central Nervous System, do not lose consciousness or lead to addiction. All the peripheral analgesic antipyretic also have work: lower body temperature in febrile conditions, it is also known antipyretic analgesics. Usefulness based on the excitement of the heat regulating center in the hypothalamus, resulting in peripheral vasodilatation (in skin) with the increase in spending a lot of heat and accompanied by the release of sweat.
    Chemical classification of peripheral analgesics are as follows:
    1. salicylates, salicylate, Na-salicylate, asetosal, salisilamida, and benirilat
    2. Derivatives of p-aminofenol: fenasetin and paracetamol
    3. Derivatives pirozolon: antipirin, aminofenazon, dipiron, phenylbutazone danturunan-derivatives
    4. Derivatives antranilat: glafenin, mefenamic acid, and acid nifluminat.

    Side effects that usually emerge are disturbances of the stomach-intestine, blood damage, liver damage, and kidney as well as allergic skin reactions. These side effects occur mainly on the use of long or in large doses, then you should not use these analgesics continuously.

    Analgesics are drugs that reduce or eliminate pain without losing consciousness. While antipyretics is a drug that can lower high-temperature body. Thus, analgesic-antipyretic drug dalah which reduces pain and simultaneously reduce high body temperature.
    As a mediator of pain, among others, are as follows:
    1. Histamine
    2. Serotonin
    3. Plasmokinin (including bradykinin)
    4. Prostaglandins
    5. Potassium Ion

    Analgesics given to patients to reduce pain that can be caused by various stimuli mechanical, chemical, and physical that goes beyond a certain threshold value (the value of pain threshold). The pain is caused by the release of pain mediators (eg bradykinin, prostaglandins) from the damaged tissue which then stimulates pain receptors in the peripheral nerve endings or elsewhere. From these places later excitatory pain forwarded to the pain center in the cerebral cortex by sensory nerves through the spinal cord and thalamus.

    Compressed as to relieve the pain

    Body parts are often wracked complaints of pain are the neck, legs, and arms. In addition to medication and therapy, first aid can be done to compress. Of its kind, compress divided into two, namely the cold and warm compresses, which has the following benefits:

    Warm Compresses
    • Can be done by attaching a rubber bag filled with warm water or a towel that has been soaked in warm water, to the painful body part.
    • There should be followed by movement exercises or massage.
    • Physiological effects of a warm compress is the softening of fibrous tissue, making the body more relaxed muscles, reduce or eliminate pain, and facilitate the supply of blood flow.

    Cold Compress
    • The use is a bag of ice cubes (cold pack), could also be a towel dipped in cold water.
    • Physiological effects are vasoconstriction (narrowing of blood vessels) and a decrease in metabolic, help control bleeding and swelling due to trauma, reduce pain, and decrease the activity of nerve endings in the muscles.

    Compress should be careful because it can cause skin tissue had necrosis (cell death). It is recommended to perform a cold compress no more than 30 minutes.

    Rational Treatment

    According to the World Health Organization (WHO, 1987), the use of drugs said to be rational if it meets the criteria:
    • According to indications of disease
    • Available at all times at affordable prices
    • Given the correct dosage
    • Route of administration by giving the appropriate time interval
    • Duration of the right
    • Given drug should be effective, with guaranteed quality and safety.

    Thus the use of drugs said to be rational if it satisfies several requirements as follows:
    • Accuracy of diagnosis
    • Accuracy of the drug indication
    • The accuracy of the selection of drugs: therapeutic class, drug type, usefulness, safety, risk SE, price and quality.
    The term rational in the treatment if the treatment is done correctly, ie correct diagnosis, appropriate indications, right drug, right dose, method and duration of administration, proper assessment of the condition of the patient, proper information and appropriate follow-up.
    Symptoms The Irrational Drug Use
    • Prescribing excess (over-prescribing)
    - Cough common cold were given antibiotics
    - Provision of vitamins in children with an ideal weight
    • Prescribing less (under prescribing)
    - Giving antibiotics for 3 days
    - Patients with diarrhea were not given ORS
    • Prescribing compound (muliple prescribing)
    - Children were given CTM fever cough runny nose, Ephedrine,Glycerin Guaiacolat ( GG ), sedatives
    • Prescribing the wrong (incorrect prescribing)
    - Children 4 years with cholera given Tetracycline
    - Injection vitamin B12 for people with stiff

    The Impact of Irrational Drug Use
    • Quality treatment and care
    • The cost of treatment services
    • Possible side effects and other effects are not expected (resistance, the risk of disease transmission, injecting drug penggunakaan not lege artis, and the danger of allergic / anaphylactic shock)
    • Psychosocial conditions.
    Factors influencing the occurrence of Irrational Drug Use
    Recipes Maker :
    • The lack of SOPs
    • Experience everyday practice
    • Information from pharmaceutical companies
    • Pressure from patients dal; am the form of a request to prescribe certain drugs based on the patient's own choice
    • Recipes maker are less sure of the diagnosis is established. .
    • Lack of time for doctors / nurses / midwives to carry out careful examination because of the many patients waiting to be examined.

    Patient / community
    • Some patients feel belim recovered from his illness when not injected
    • Some parents ask their children with diarrhea patients were injected, or given antibiotics or antidiarrheal.

    System planning and management of drug
    • Limited funding
    • Limited number of medications available
    • Planning and procurement of drugs does not fit the needs of drugs in health centers
    • Wisdom of the drug and health services
    • Delegation of authority to conduct the practice of medicine is not based on knowledge of the drug.
    • Health services delivering drugs to patients without a prescription

    • • The unceasing drug information in the form of advertising
    • • Competition practice
    More generally irrational use of drugs that will give the general characteristics as follows:

    • Where the drug is actually an indication of its use in medical non-existent or vague.
    • Selection of the wrong drug for specific disease indications
    • Way of drug administration, dose, frequency and duration of administration are not appropriate.
    • Use of medications with potential toxicity or side effects is greater when other drugs similar usefulness (efficacy) with the potential effect is smaller as well.
    • The use of expensive drugs when cheaper alternatives with the same benefits and security available.
    • Does not provide treatment that is already known and accepted usefulness and safety.
    • Providing treatment with drugs that expediency and safety is still questionable.
    • Use of drugs that primarily based solely on individual experience without reference to sources of scientific information is feasible, or only based on information sources that can not be ascertained truth.
    • Use of drugs that do not consider the patient's condition, such as whether there are contraindications, whether dose adjustment should be made in connection with the patient's condition.

    Ovarian cancer

    Ovarian cancer is a malignant tumor of the ovary are often found in women aged 50-70 years. Ovarian cancer can spread to other parts, pelvis and abdomen through the lymphatic system and spread through the vascular system to the liver and lungs.

    The cause of ovarian cancer is not known with certainty. However, many theories that explain the etiology of ovarian cancer, including:
    1. Incessant ovulation hypothesis
    The theory states that there is damage to ovarian epithelial cells for wound healing at the time of ovulation. The healing process of epithelial cells are disrupted can lead to the process of transformation into tumor cells.
    2. Hypothesis androgen
    Androgens have an important role in the formation of ovarian cancer. It is based on the experiment results that contain epithelial ovarian androgen receptor. In experiments in vitro, androgens can stimulate the growth of normal ovarian epithelium and ovarian cancer cells.

    Every day, normal ovary will form several small cysts called follicles de Graff. In mid-cycle, dominant follicle with a diameter of more than $ 2.8 cm will release the mature oocyte. Follicle rupture would be the corpus luteum, which when cooked has a structure of 1.5 to 2 cm with cysts in the middle. If fertilization does not occur in the oocyte, the corpus luteum will experience a progressive fibrosis and shrinkage. However, when fertilization occurs, the corpus luteum will first swell and then gradually decreases during pregnancy.
    Ovarian cysts originating from the normal ovulation process called functional cysts and are always benign. Cysts can be either follicular and luteal sometimes called Theca-lutein cysts. Cysts can be stimulated by gonadotropins, including FSH and HCG. Multiple functional cysts can be formed due to gonadotropin stimulation or excessive sensitivity to gonadotropins.
    In tropoblastik gestational neoplasia (hydatidiform mole and choriocarcinoma) and sometimes in multiple pregnancies with diabetes, causing a condition called HCG hiperreactif lutein. Patients in the treatment of infertility, ovulation induction using gonadotropins (FSH and LH) or sometimes clomiphene citrate, ovarian hyperstimulation syndrome can cause, especially when accompanied with HCG administration.
    Neoplasia cyst can grow from excessive cell proliferation and uncontrolled in the ovaries and can be malignant or benign. Malignant neoplasia which can be derived from all types of cells and ovarian tissue. So far, the most common malignancy originating from the surface epithelium (mesothelium) and most of the partial cystic lesions. Similar type of benign cyst with malignancy is serous and mucinous cistadenoma. Other malignant ovarian tumors that can be composed of cystic areas, including this type granulosa cell tumor of sex cord cells and germ cell tumors from primordial germ cells. Teratomas derived from germ cell tumor that contains elements from the three embryonic germ layers; ektodermal, endodermal, and mesodermal.
    Endometrioma is a cyst containing blood from ectopic endometrium.

    Risk Factors

    • High-fat diet
    • Smoke
    • Alcohol
    • Perineal use of talc powder
    • History of breast cancer, colon, or endometrial
    • Family history of breast or ovarian cancer
    • Nulliparous
    • Infertility
    • Early menstruation
    • Never given birth

    Signs & Symptoms

    Common symptoms are varied and not specific. At an early stage in the form:
    • Irregular menstruation
    • Menstrual tension continues to rise
    • Menorrhagia
    • Tenderness in the breast
    • Early menopause
    • Discomfort in the abdomen
    • Dyspepsia
    • Pressure in the pelvis
    • Frequent urination
    • Flatulenes
    • Feeling of fullness after eating small meals
    • Increasing abdominal girth

    Primary ovarian cancer staging according to FIGO (Federation InternationalofGinecologies and Obstetricians) in 1987, is:

    STAGE I -> growth limited to ovaries
    1. Stage 1A: growth limited to one ovary, no ascites containing malignant cells, no growth on the outer surface, capsule intact.
    2. Stage 1B: growth limited to both ovaries, no ascites, contain malignant cells, no tumor on external surface, capsule intact.
    3. Stage 1C: tumors with stage 1a and 1b, but there is a tumor or a second outer surface of the ovary or capsule rupture or by ascites containing malignant cells or with positive peritoneal washings.

    STAGE II -> Growth in one or two ovaries with extension to the pelvis
    1. Stage 2A: expansion or metastasis to the uterus, or fallopian
    2. Stage 2B: expansion of other pelvic tissues
    3. Stage 2C: 2a and 2b tumor stage but on the surface of the tumor with one or both ovaries, capsule ruptured, or with ascites containing malignant cells with positive peritoneal washings.

    STAGE III -> tomor on one or both ovaries with peritoneal implants outside the pelvis or positive retroperitoneal. Tumor confined within the small pelvis but cell histology proved to extend to the bowel or omentum.
    1. Stage 3A: tumor confined in the small pelvis with negative nodes but histologically and microscopically confirmed there is a growth (seeding) surface of the abdominal peritoneum.
    2. Stage 3B: a tumor on one or both ovaries with peritoneal implants surface and proved microscopically, the diameter exceeds 2 cm, and lymph nodes negative.
    3. Stage 3C: implants in abdoment with a diameter> 2 cm or lymph node positive retroperitoneal or inguinal.

    STAGE IV -> growth on one or both ovaries with distant metastases. When the pleural effusion and positive sitologinya results in stage 4, as well as metastasis to the liver surface.

    Enforcement of Medical Diagnosis

    The majority of ovarian cancer stems from a cyst. Therefore, if a woman found an ovarian cyst have to do further tests to determine whether the cyst is benign or malignant (ovarian cancer).

    The characteristics cysts that are malignant are the circumstances:
    • Rapidly enlarging cyst
    • Cysts in adolescence or postmenopausal
    • Cysts with thick walls and are not sequential
    • Cyst with solid parts
    • Tumors of the ovary

    Strengthens the case for further investigation towards ovarian cancer such as:
    • Ultrasound with Doppler to determine blood flow
    • If necessary, a CT-Scan / MRI
    • Examination of tumor markers such as Ca-125 and Ca-724, beta - HCG and alfafetoprotein

    All of the above checks have not been able to confirm the diagnosis of ovarian cancer, but only as a handle to perform surgery.

    Colon Cancer (Colorectal Cancer)

    Colon cancer is a cancer in the colon.
    Colon cancer is the second leading cause of death in the United States after lung cancer (ACS 1998)
    These diseases including the deadly disease because the disease is often not known until a more severe level. Surgery is the only way to change the Colon cancer.

    Changes in Pathology
    Tumors occur in a place which roughly follow the colon in part (Sthrock 1991 a):
    • 26% in the caecum and ascending colon
    • 10% in colon transfersum
    • 15% in colon desending
    • 20% in the sigmoid colon
    • 30% in the rectum
    The figure below illustrates the occurrence of cancer of the sigmoid and right colon and reduce the incidence of disease in the rectum in 30 years (Sthrock).
    Colon carcinoma mostly produce adenomatus polyps. These tumors usually grow not detected until symptoms appear slowly and looked dangerous. The disease is spread in several metode.Tumor might spread in a certain spot on the inner lining of the stomach, reach the serosa and mesenteric fat. Then tumors begin to attach to the organ that is around, then extends into the lumen of the colon or spread to the spleen or the circulatory system. This circulation system directly into the primary tumor through the blood vessels of the colon by the spleen, after the tumor cells enter the circulatory system, typically cells move into the liver. The second place is a place far later metastases to the lungs. Metastases to other places including:
    - Adrenal gland
    - Kidney
    - Leather
    - Bones
    - Brain
    The addition to direct infection and spread through the lymphatic and circulatory system, colon tumors can also spread to parts peritonial tumor before surgery has not been done. The spread occurs when the tumor is removed and the cancer cells from tumor rupture into the cavity peritonial.

    Complications occurred in connection with the increase in growth at the tumor site or through the spread of metastases which include:
    •  bowel perforation caused by peritonitis
    •  abscess formation
    •  fistula formation in the urinary bladder or vagina
    Usually the tumor and surrounding blood vessels invade the cause perdarahan.Tumor grow into the large intestine and gradually helps the large intestine and in the end not at all. Extension of tumor beyond the stomach and may be pressing on disekitanya organs (uterus, urinary bladder, and ureters) and the cause of the symptoms covered by the cancer.

    Causes of Colon cancer is unknown. Diet and reduction of the circulation time of the colon (feces forward flow) which includes the causative factor. Appropriate precautionary instructions recommended by the American Cancer Society, The National Cancer Institute, and other cancer organizations.
    Foods must contain at suspected chemical substances that cause cancer of the colon. These foods also reduce the circulation time in the stomach, which accelerates colon cancer causes. Foods that are high in fat, especially animal fat from red meat, causing the secretion of acid and anaerobic bacteria, causing the incidence of cancer within the colon. The meat in frying and in baked can also contain chemicals that cause cancer. Diet with refined carbohydrates that contain fiber in large quantities can reduce the circulation time in the colon. Some groups suggested a diet that containing little animal fat and high in vegetables and fruits (eg, Mormons, Seventh Day Adventists).
    Foods to avoid:
    • Red meat
    • Animal fats
    • Fatty foods
    • Meat and fish fried or grilled
    • Carbohydrates are filtered (example: the filtered juice)
    Food should be consumed:
    • Fruits and vegetables are particularly Craciferous Vegetables from the cabbage group (such as broccoli, brussels sprouts)
    • Grain rice is intact
    • Liquid water is sufficient, especially
    Since most tumors produce Colon adenoma, the main factor causing harm to the Colon cancer adenoma. There are three types Colon adenomas: tubular, villous and tubulo villous (will be discussed in polyps). Although most of the Colon cancers derived from adenomas, only 5% of all adenomas become manigna Colon, villous adenomas have a high potential to become manigna.
    Factors leading to adenoma or benign tumor of unknown manigna clustered polyposis is a hereditary autosomal dominant gene spread. Risk of cancer in polyposis femiliar place close to 100% of persons aged 20-30 years.
    People who have had ucerative colitis or Crohn's disease are also at risk of Colon cancer. The addition of risk at the beginning of a younger age and higher rates of colon involvement. Risk of Colon cancer will be 2 / 3 times greater if a family member suffering from the disease

    Approximately 152,000 people in the United States diagnosed with Colon cancer in 1992 and 57,000 people die from this cancer in the same year (ACS 1993). Most of the clients on Colon cancer has the same frequency between men and women. Cancer in the right colon usually occurs in women and Ca in the rectum usually occurs in males.

    Transcultural alternative.
    Colon Ca incident on the USA seems to have a setback from all other nations except in African men and greater amerika.Kejadian happened to these cancers occur in industrial areas to the west and partly Japanese and African firlandia this is thought to relate to diet . Regions whose inhabitants have a low incidence of colon have a high dietary Ca of fruits, vegetables, fish and some meats.

    Tags : cancer colon, colorectal cancer symptoms, screening colorectal cancer, colorectal screening, treatment colorectal cancer, rectal cancer, bowel cancer, metastatic colorectal cancer, colorectal cancer stage, colorectal cancer surgery, cancer colorectal symptomes, test cancer colorectal, prognosis colorectal cancer, colorectal cancer incidence, colorectal cancer guidelines

    COPD (Chronic Obstructive Pulmonary Disease)

    Definition COPD (Chronic Obstructive Pulmonary Disease) is:
    1. Clinical syndrome of chronic dyspnea with expiratory airflow obstruction due to bronchitis and or emphysema
    2. Chronic lung disease characterized by airflow resistance of the airways due to chronic bronchitis or emphysema and pulmonary
    3. Chronic Obstructive Pulmonary Disease [COPD] is a lung disease with obstruction of lung airflow that lasts long.

      Diagnosis of COPD

      A common complaint in COPD :
      • Shortness of breath
      • Chronic Cough
      • Productive sputum

      Confirmed by spirometry test:
      • VEP1 (FEV 1) post bronkhodilator = <80%, and VEP1/KVP (FEV1/FVC) = <70% 

      Types of COPD:
      Chronic Bronchitis and Emphysema.
      Inchronic bronchitis there is inflammation in the airway wall so as to produce too much mucus. As a result of airway narrowing that affected the air exchange in the lungs. In chronic bronchitis there is also damage to the cilia that function to clear excess mucus in the airways.
      In emphysema, there was enlargement and extensive damage to the alveoli, resulting in disruption of air exchange in the lung.

      Chronic bronchitis
      Syndrome a chronic productive cough (at least 3 consecutive months and at least for 2 years) with no other identifiable cause.
      Pathological diagnosis characterized by enlargement of airspaces distal to bronchioli terminal (terminal bronchi) is accompanied by alveolar wall destruction.

      History and physical examination
      • Chronic productive cough
      • Shortness of breath (Tachypnea)
      • Breathing with the lips contract
      • History of smoking which means
      • Alpha-1 antitrypsin deficiency in non-smokers
      • On chest percussion hiperesonansi
      • Respiratory sound may be weakened

      Chest X-ray photographs
      • Low and flat diaphragm -->Useful for acute exacerbations to exclude complications such as pneumonia or pneumothorak

      ECG changes
      • Low QRS voltage
      • If there is cor pulmonale occur deviations in delivery II, III and aVF

      Examination of lung function
      • FEV1 and all measurements of expiratory air is reduced Residual volume (RV) and total lung capacity increases
      • Vital Capacity (KV) is reduced
      Examination AGD
      • Pa CO2 increased
      • Hemoglobin saturation decreased
      • Respiratory acidosis
      Factors that influence the incidence of chronic bronchitis and emphysema
      1. Smoking
      • Hyperplasia of mucous glands bronchi
      • Respiratory tract epithelial metaplasia skuamus
      • Inhibition activity of the hair cells vibrate, alveolar macrophages, surfactant
      2. Infection
      Most bacteria are Haemophilus influenzae and Streptococcus pneumonia

      3. Pollution
      Chemicals that can cause bronchitis are: N2O, Hydrocarbons, Aldehydes, Ozone, O2
      4. Offspring
      Not known except dipengaruhnya deficiency of alpha-1 anti-trypsin is a disorder inherited in an autosomal recessive ang
      5. Social and Economy
      Patients with chronic bronchitis mortality more in lower socioeconomic groups

      • In the lung there is a balance between proteolytic enzymes elastase and anti-elastase to prevent tissue damage
      • Sources elastase: PMN cells, alveolar macrophages
      • Sources elastase influenced by: cigarette smoke, infection
      • Anti-elastase in the form of the enzyme alpha-1 anti-trypsin
      • When anti-elastase elastase increases, decreases
      • Because there is an imbalance between elastase and anti-elastase is elastin lung tissue damage and emphysema occur
      • Refinement sal. respiration occurs PPOM
      • In chronic bronchitis airway constriction occurs in small and large because the process of hypertrophy, hyperplasia of mucous glands
      • In emphysema narrowing due to reduced lung elastisistas
      • In the lung there is an interesting balance between the pressure of lung tissue with a pull out into the
      • Exit by intra-pleural pressure and chest wall muscles
      • Into the lung elasticity B
      • Balance they form a functional residual capacity
      Management COPD

      There are four components of the management of COPD according to WHO 1998

      • Assessment and monitoring of disease
      • Reduce risk factors
      • Stable COPD Therapy
      • Therapy of acute exacerbations

      When described then management of these become:
      1. Stop smoking
      2. Pharmacologic Therapy
      3. Oxygen therapy
      4. Mechanical ventilation
      5. Rehabilitation
      6. Nutrition
      7. Surgery
      8. Vaccination
      9. Education

      The objectives of the management of COPD are:
      1. Prevent disease progression
      2. Eliminate complaints
      3. Increase activity tolerance
      4. Improve health status
      5. Prevent and treat exacerbations
      6. Prevent and treat complications
      7. Reduce mortality

      How to Prevent and Treatment Cervical Cancer

      It has been described in previous articles what is cervical cancer. And how to detect cervical cancer. Then how to prevent and treatment of cervical cancer as follows:

      Preventing Cervical Cancer

      Although cervical cancer is scary, but we all can prevent it. You can do a lot of precautionary measures before ultimately infected with HPV and cervical cancer. Some practical ways you can do in everyday life include:

      Have a healthy diet, rich in vegetables, fruit and cereal to stimulate the immune system. For example, consume a variety of carotene, vitamins A, C, and E, and folic acid can reduce the risk of cervical cancer.
      • Avoid smoking. Nicotine makes all the mucous membranes of body cells react or become aroused, both the mucosal throat, lungs, and cervix.
      • Avoid vitamin C deficiency
        Lifestyle of high fat foods will make people forget the other nutrients, like beta carotene, vitamin C, and folic acid.
        In fact, all three nutrient deficiencies can cause cervical cancer arise. Beta carotene, vitamin C, and folic acid can improve or strengthen diserviks mucosa.
      • Avoid having sex too early
        Sexual intercourse should ideally be done after a woman is completely cooked. The size of maturity is not only seen it already menstruating or not. But it also depends on the maturity of the cells contained in the mucosal lining of the inner skin of the body cavity.
        Generally new mucosal cells mature after the woman is aged 20 years and over. So, a woman having sex in their teens most vulnerable when it is done under the age of 16. It deals with the maturity of mucosal cells in the cervix of the woman. At a young age, the mucosal cells of the cervix not ripe.
      • Avoid having sex during menstrual period proved to be effective to prevent and inhibit the formation and development of cervical cancer.
      • Avoid sex with many partners. Cervical cancer can also appear in women who have multiple sex partners. When you have sex only with their partner, and her partner did not have sex with someone else, then it will not lead to cervical cancer. When changing partners, it is associated with the possibility of contracting venereal disease, one of the Human Papilloma Virus (HPV).
      • Undergo routine Pap smear tests regularly. Current Pap smear can be done even at the health center at an affordable price.
      • Alternative Pap smear is a test IVA with a cheaper cost of Pap smears. The goal for the early detection of HPV infection.
      • Giving the HPV vaccine or vaccination to prevent HPV infection.
      • Perform cleaning of intimate organs or vagina known as a toilet. This can be done alone or can be also with the help of expert doctors. The goal is to clean the female sex organs of dirt and disease.
      • Use of estrogen.
        The same risk will occur in late postmenopausal women. Because stimulation of the endometrium will be longer, so endometriumnya will more often exposed to estrogen. So it's very possible the cancer occurred.
        No wonder that women who use estrogen uncontrolled highly susceptible to cancer. Generally, the menopausal women in developed countries use estrogen to prevent osteroporosis and heart attacks.

        However, its use is very risky because estrogen stimulates the endometrial wall thickening and stimulate endometrial cells that turn into cancer properties

      Cervical Cancer Treatment

      If infected with HPV, do not worry, because the currently available range of treatments that can control HPV infection. Treatment aims to kill some cells that contain the HPV virus. Another way is to remove the damaged or infected with electric surgery, laser surgery, or cryosurgery (remove the abnormal tissue by freezing).

      If cervical cancer has reached an advanced stage, it will be done chemo therapy. In some severe cases may also be performed hysterectomy is the surgical removal of the uterus or womb in total. Aim is to remove cervical cancer cells that have been developed on the body.

      However, prevention is better than cure. Therefore, how to prevent HPV infection and cervical cancer? Here are some ways you can do to prevent cervical cancer.

      Detection of Cervical Cancer

      How do I detect that a woman at risk for cervical cancer?. The easiest way to find out by cytological examination of the cervix. This examination is currently popular is the Pap smear or Papanicolaou smear taken from the Greek name of the doctor who discovered this method of George N. Papanicolaou. In addition, there are also various other methods for early detection of cervical cancer or HPV (human papillomavirus) infection as well as follows:

      1. IVA Inspection (Visual Inspection with Acetic Acid).
      This examination by applying the cervix and then daubed with 5 percent acetic acid, wait for 3 minutes. Last seen with the naked eye if there is no change in color or white color does not appear, then the result is negative. This examination can be done in the clinic and the cost is relatively inexpensive at around 10 thousand to 20 thousand.

      2. Pap Smear
      This examination should be performed by women who have had sexual intercourse and performed regularly. You do this by taking cervical lymph then daubed on the slide and in-fixation with a certain liquid and then viewed with a microscope. Can later be seen whether they are abnormal cervical cells or not after as compared with normal cervical cells. The cost ranges from 60 thousand to 100 thousand.

      3. Examination of Thin prep
      This examination has an accuracy and precision is higher than the pap smear. You do this by taking the sap of the cervix and then dipped into a bottle containing a liquid fixation and centrifuged until a homogeneous, then taken a bit to daubed on the slides and performed the examination. Can diagnose pre-cancerous cells and cervical cancer cells, but the price offered is also more expensive and could reach three times the price of pap smears.

      4. Colposcopy Examination
      This examination using colposcopy to see abnormalities of the cervix. This tool uses a powerful beam and binocular microscope with a magnification of 5 to 40 times. Currently colposcopy has become the primary method of cervical cancer screening in several European countries. This method should be done by experts who understand. Previous medical personnel will enter the liquid to give color to the cervical canal, then perform a colposcopy and abnormal cells will appear. These areas will be sampled to find out what causes it.

      There is nothing wrong with all the early examination of cervical cancer, you can perform checks anywhere and can be tailored to your financial condition. The most important thing is prevention is better and it can only be done by early detection of cervical cancer

      How to prevent and treatment Cervical Cancer

      Cervical Cancer

      Cervical cancer is a disease caused by a malignant tumor on the cervix as a result of uncontrolled growth of tissue and surrounding normal tissue damage

      The cause of cervical cancer has not clearly known but there are some risks and predisposing factors that stand out, among others:
      1. Age first had sexual intercourse
      Research shows that the more young women have sexual intercourse the greater get cervical cancer. Married at the age of 20 years is considered still too young
      2. The number of pregnancy and parturition
      Cervical cancer most often found in women who parturition. The more often partus the more likely the risk of having cervical Cancer.
      3. Number of marriages
      Women who frequent sexual intercourse and multiple partners have a major risk factor of cervical kankers this.
      4. Viral infections
      Infection with herpes simplex virus (HSV-2) and papilloma virus or condyloma viruses acuminata suspected as factor in cervical cancer
      5. Social Economy
      Cervical carcinoma often found in lower socioeconomic groups may be socio-economic factors closely related to nutrition, immunity and personal hygiene. In the lower socioeconomic groups generally lack the quantity and quality of food does this affect the body's immunity.
      6. Hygiene and circumcision
      Presumably the influence of easy occurrence of cervical cancer in women whose partners have not been circumcised. This is because the non sircum male penile hygiene is not maintained so much a collection-a collection of smegma.
      7. Smoking and the IUD (intrauterine device)
      Smoking will stimulate the formation of cancer cells, while the use of an IUD will have an effect on the cervix that is originated from the erosion diserviks who later became a strep infection that is continuous, as this can trigger the formation of cervical cancer.

      Classification of cervical cell growth will cancer

      1. Dysplasia
      Mild dysplasia occurred in one-third portions of the basal epidermis. Severe dysplasia occurred in two thirds epidermihampir indistinguishable from carcinoma in situ.

      2. Carcinoma Stage in situ
      In situ carcinoma epithelial cell changes occur in all layers of the epidermis into squamous cell carcinoma. Carcinoma in situ ectoservical growing area, transitional cell and squamous columnar endocervical reserve cells.

      3. Mikroinvasif  Carcinoma Stage.
      In Mikroinvasif Carcinoma, in addition to changes in the degree of increased cell growth of tumor cells also penetrate the basal membrane and invasion of the stoma so far no more than 5 mm from the basement membrane, these tumors are usually asymptomatic and only found on cancer screening.

      4. Invasive Carcinoma Stage
      In invasive carcinoma of the prominent changes in the degree of cell growth and cell shape varies. Growing invasive appeared in the area posterior or anterior cervical lip and extends the three departments of the posterior or anterior fornix majors, majors parametrial and corpus uteri.

      5. Shape abnormalities in the growth of cervical carcinoma
      Growth eksofilik, kool-shaped flowers, growing towards the vagina and can fill half of the vagina without infiltration into the vagina, growth form is easy to necrosis and hemorrhage.

      Endofilik growth, usually in the form of ulcer lesions and progressive growth extends to the fornix, posterior and anterior to the corpus uteri and parametrial.
      The growth of nodules, usually found in endocervical lesions which gradually transformed into ulcers.

      1. Preclinical stage
      Indistinguishable from ordinary chronic cervicitis
      2. Beginning Stage
      Lesions appear most often around osteum externum
      3. Half-up Stage
      It has been about the most or the entire lip porsio
      4. Advanced stage
      Occurs destruction of cervical tissue, so it seems like ulcers with a network of fragile and bleed easily.

      Clinical Symptoms

      1. Bleeding
      Nature can intermenstruit or contact bleeding, sometimes bleeding just happens to the next stage. On the type of bleeding occurs intraservikal slow.
      2. Typically resembles water, sometimes there sebeluma onset of bleeding. In more advanced stages of hemorrhage and infection with more whitish fluid that comes out smelling so.

      Diagnostic tests

      1. Cytology / Pap Smear
      Profits, cheap can check out the parts that are not visible.
      Weakness, can not determine the precise localization.
      2. Schillentest
      Epithelial carcinoma of the cervix did not contain glycogen because it does not bind iodine. If porsio iodine then given a normal epithelial carcinoma will be colored brown, while the exposed carcinoma colorless.
      3. Coloscopy
      Check by using a tool to view the cervix with light and raised 10-40 times.
      Advantages: can see clearly the areas concerned so easy to do a biopsy.
      Weaknesses: only can check the area that looks just the porsio, are abnormalities in the squamous columnar junction
      4. Colpomicroscopy
      Seeing the vaginal smear (Pap smear) with magnification up to 200 times
      5. Biopsy
      With a biopsy can be found or specified types the cancer.
      6. Conisation
      By way of remove tissue containing mucous membranes and cervical squamous epithelium and gland. Conisation done when the results of cervical cytology in doubt and does not seem obvious abnormalities.

      How to prevent and treatment Cervical Cancer

      How to detect Cervical Cancer.

      Causes, Mechanisms, and Symptoms of Coronary Heart Disease (CHD)

      Coronary heart disease (CHD) is a disorder caused by constriction or inhibition of the arteries carrying blood to the heart muscle. When the narrowing becomes severe they can lead to heart attacks. The narrowing of the arteries to the brain can cause strokes. The heart muscle of oxygen and nutrients are transported by the blood through the major coronary arteries that branch into a network of smaller vessels are efficient. While the arteries to the brain that carry the same substance.

      The heart serves to pump blood throughout the body. For that heart muscle needs oxygen and nutrients. Oxygen and nutrients are transported by the blood through specialized blood vessels called coronary arteries. Problems will arise if by any reason there is obstruction or abnormalities in the coronary arteries, so it is not enough blood supply, which means also a lack of supply of oxygen and nutrients to the heart to move normally. The situation above is known as coronary heart disease (CHD). If the blocked blood flow in arteries leading to the brain, a stroke will occur. With the body getting older and worse by a variety of risk factors such as the right had high blood pressure, smoking, cholesterol levels, abnormal blood vessels become obsolete, and the arteries become narrow, rigid, elastic and not clogged, just like rust on a water pipe corrosion . This is what causes CHD.

      The causes of blocked or Blocked Coronary Artery Blood Flow in
      Obstructed or blocked arteries can be caused by deposition of calcium, cholesterol and other fatty substances, known as plaque (plaque). This process starts when a young age and years of growing at a rate varies in each person, in accordance with the presence of `risk factors'. In that period these deposits gradually accumulate which eventually diameter in coronary artery blood which can still be passed more and more narrow, until the vessels can not pass the blood according to the needs of the heart muscle. Obstruction of blood flow as above referred to as fixed blockage.

      According to Dean Ornish, there are other mechanisms in addition to clogging plaque that can also reduce blood flow to the heart. Among the most important is spasm (coronary artery spasm) and coagulation (clumping platelete-clotting). Various studies have found that factors known as risk factors can lead to plaque formation, spasticity, and clotting. All of the above mechanisms that cause coronary heart disease or heart attacks, are interdependent, that is, events that affect one another in a way that diverse.

      Processes and Mechanisms Blockage
      At first the normal artery, blood flow is not blocked, but by a variety of risk factors occurs:
      • Plaque, this can cause the artery becomes blocked / partial obstruction. This plaque in a long time to grow steadily, resulting in total blockage.
      • Spasm, this process causes the arteries to constrict and the flow of space and lived most severe occur when a total cessation of blood.
      • Clot Platelete also called clumping ', in this case there is a process of clotting of the various substances in the blood. This process can continue in such a way as to impede blood flow totally.
      • The combination of two or more events above. If the combination occurs, generally with a total blockage occurs rapidly (100%) in coronary arteries.

      Signs or symptoms of existence of blockage (CHD) Do not let happen to you:

      Because each person is different, the physical response to the development of CHD is also different. Not all people with CHD have a particular symptom or manifestation, but a common manifestation according to the American Health Assosioation (AHA) is as follows:
      • No symptoms. Many of those who have clari. PFS did not feel there is something unpleasant or signs of a disease. In this medical condition called silent ischernia. They are diseased with diabetes is very susceptible to silent ischemia.
      • Angina. Formally called angina pectoris. Angina generally indicated by chest pain while doing any physical movements or exercise.
      • Unstable Angina (unstable angina). Chest pain suddenly felt when in a resting state is more severe or occur suddenly.
      • Heart attack. When blood flow to the arteries pass completely blocked coronary heart attack or myocardial infarction (MI).

      Need to Know About Heart Attacks

      Heart attack is a serious medical event & requires emergency action. A heart attack occurs when blood flow to the heart is suddenly blocked, usually as a result of a blood clot or plaque inside blood vessels.

      Lack of blood vessels leading to the heart can cause damage to the heart muscle tissue, which if not quickly treated can make the heart muscle tissue is damaged & dead. Medical terminology for heart attack is myocardial infarction.

      The blood vessels that supply blood & oxygen to the heart called the coronary arteries. Therefore, a disease that causes hardening & narrowing of the coronary arteries is called coronary heart disease (CHD). Most heart attacks occur in people who have coronary heart disease (CHD).

      Symptoms of heart attack
      Not all heart attacks begin with sudden pain in the chest as seen in movies or television. In one study, for example, 1 / 3 of patients who had experienced a heart attack feels no pain in his chest, patients are usually elderly patients, or women who suffer from diabetes.

      Signs & symptoms of a heart attack can also be different for each person. Many heart attacks are preceded by discomfort or pain is mild, there are even people who have no symptoms at all.

      Here is a common symptom is felt during a heart attack:
      1. Pain in chest
      The most common symptom is felt during a heart attack is chest pain. This includes a new pain or perceived pain is often felt but with different patterns.

      Most of the time heart attacks occur, the pain arises in the middle of the chest or on the left side of the chest that lasts for several minutes or disappear & reappear. The pain can feel like pressure, squeeze or chest pain, whether mild or severe.

      Symptoms of angina can be similar to the symptoms of a heart attack. Angina is chest pain that occurs in people who have coronary heart disease, usually occurs when they are active activity. The pain of angina, may occur for a few minutes & will disappear when they are resting.

      Chest pain that does not go away even after rest, can be a sign of a heart attack. We recommend that every heart attack is felt sent to the doctor.

      2. Other symptoms are often felt in the moments before or during a heart attack are:
      • Discomfort in your upper body, either in the arm (can be either one or both), back, neck, chin, or upper abdomen. Shortness of breath, can occur before or during chest pain arises. Nausea, vomiting, sudden dizziness & arise in a cold sweat.
      • Difficulty sleeping, feeling extremely tired or lack energy.

      Not everyone who had a heart attack will experience the same symptoms. But more and more of the above symptoms are felt, the greater the likelihood of experiencing a heart attack.

      Life after suffering a heart attack
      If you have previously suffered a heart attack, then it is arguably the heart has been damaged. This can affect the heart rhythm and the strength to pump & drain the blood.

      People who have suffered a heart attack are also at risk for having another heart attack or other conditions such as stroke, kidney problems & peripheral vascular disease.

      But there are some things you can do to reduce the risk of experiencing these health problems. For example, by cardiac rehabilitation, a program of health maintenance by way of lifestyle changes to improve heart health & quality of life.

      Changes made include the use of drugs, dietary changes, increased physical activity, smoking cessation & stress management. The doctor will also give advice on daily activities are carried out, including setting work activities, travel, sexual activity or sport.

      In order not to have a heart attack
      There are several factors that can increase the risk for heart attack. Risk factors exist that we can control, but there also can not be controlled.

      Risk factors that can not be controlled are:

      1. Age
      The risk for heart disease will have increased in men after age 45 years & in women after age 55 years (after menopause).
      2. Family history
      The risk for having heart disease will also increase when a father or brother had a history of men who have heart disease diagnosed before age 55 years or mother or sister who had heart disease diagnosed before age 65 years.
      3. Pre-eclampsia
      Developing pre-eclampsia also increases the risk for having heart disease. Pre-eclampsia is a condition that occurs during pregnancy, marked by the rise in blood pressure & presence of excess protein in urine. Pre-eclampsia is often associated with risk of various diseases of the heart, such as coronary heart disease, heart attack, heart failure & high blood pressure.

      While the risk factors that can be controlled are: While the risk factors that can be controlled are:

      • Smoke
      • High blood pressure
      • High cholesterol levels
      • Overweight & obesity
      • Unhealthy eating patterns (eg eating foods high in salt, fat & cholesterol) Lack of physical activity
      • High levels of sugar in the blood due to diabetes

      Ways to prevent heart disease & heart attacks is by controlling the above risk factors by:

      1. Stop smoking
      Smoking is a major cause of various diseases such as heart disease & lung cancer. So if this time includes one of the people who smoke, quitting smoking is the best way to avoid the occurrence of heart attacks.

      2 Doing regular exercise
      If you want to keep the heart healthy, then do regular exercise is very important to do. Exercise will improve blood flow and helps keep the heart to work effectively.

      For those who do not have a history of heart disease, regular moderate exercise for 30 minutes a day at least 5 times a week is recommended. Examples of these sports is to walk fast or climb a hill.

      3. Adjust your diet
      To be heart healthy, low fat diet rich in fiber are encouraged, such as whole wheat or various kinds of vegetables & fruits. Limit your salt intake is also up to no more than 6 grams (1 teaspoon) a day. Consume too much salt will increase blood pressure.

      Also avoid eating foods high in saturated fat content, because it can increase blood cholesterol levels. Foods that are high in saturated fat include are: meat, sausages, offal, butter, cream, cheese, cakes & biscuits and foods containing palm oil / palm oil.

      To lower cholesterol, you should consume foods that contain unsaturated fats, such as fish oil, avocados, nuts, or sunflower oil from olives.

      4. Limit alcohol consumption
      Consuming alcohol in large quantities can cause blood pressure to rise, as well as cholesterol levels. Therefore, by not consuming alcohol or limit alcohol consumption according to the recommended is the appropriate way to reduce the risk of having high blood pressure or heart attack.

      The number of recommended alcohol consumption limits are: in men 3-4 units / day, while the women 2-3 units / day. 1 unit of alcohol is equivalent to a small glass of wine / wine.

      5.  Losing weight
      There are many benefits associated with weight loss. If it can achieve an ideal body weight according to height, it can help lower cholesterol & blood pressure. By losing weight, then the risk for heart disease will also decline and life expectancy will also increase.

      One way is successful enough to lose weight is by exercising at least 30 minutes every day, eat smaller amounts of & eat healthy snacks between meals. Gradual weight loss of 0.5 kg / week is recommended.

      6. Other conditions
      Some other conditions that may increase the risk for heart attack is hypertension & diabetes. That is to keep these conditions are always controlled can also help reduce your risk of heart attack.

      This includes, taking drugs that doctors routinely administered, a healthy diet & control to the doctor regularly.

      Causes, Mechanisms, and Symptoms of Coronary Heart Disease (CHD)