HEALTHY HOSPITAL SEEN FROM CULTURE perceptual

INTRODUCTION
Health development as one of national development efforts directed to achieve the awareness, willingness and ability to live healthy for every citizen in order to achieve optimal health status. And so that health becomes everybody's dream all his life. But illness is something that can not be denied though sometimes they can be prevented or avoided. The concept of healthy and sick actually not so absolute and universal because there are other factors outside the clinical reality that affecting mainly socio-cultural factors. Both understanding interplay and understanding that one can only be understood in the context of understanding the other.


Many scholars of philosophy, biology, anthropology, sociology, medicine, and other fields of science have tried to give understanding about the concept of healthy and sick evaluated from their respective disciplines. Healthy and sick problem is a process associated with the ability or inability of humans beradap-tation to the environment either through biological, psychological and socio cultural.
Act No.23, 1992 on Health states that: Health is a prosperous state of body, soul and social life that enable socially and economically unproductive. In this sense, the health should be viewed as one unified whole composed of elements of physical, mental and social and mental health within it is an integral part of health. Definition of pain: a person is said to hurt when he suffered a chronic disease (chronic), or other health problems that cause work activities / activities disrupted. Although a person sick (everyday terms) such as colds, runny nose, but if he had not bothered to carry out its activities, it is considered not ill.

HEALTH AND ILLNESS PROBLEMS
Health problems is a complex problem which is the resultant of various environmental problems that are natural or man-made problems, socio-cultural, behavioral, population, genetics, and so forth. Public health degrees are referred to as the psycho socio somatic health well being, is the resultant of four factors:
1. Environment or the environment.
2. Behavior or behavior, between the first and the second is connected with the ecological balance.
3. Heredity or offspring that are influenced by population, population distribution, and so forth.
4. Health care services such as health programs that are preventive, promotive, curative and rehabilitative.

Of the four factors mentioned above, environmental and behavioral factors that most influence (dominant) to level of community health status. Ill behavior, role and the role of patient pain is influenced by factors such as social class, ethnic origin and culture differences. So the same health threats (defined clinically), depending on these variables can cause different reactions among patients.
Understanding of illness can be explained by naturalistic etiology in terms of impersonal and systematic, that pain is one state or one thing that is caused by disruption of the human body systems. The statement about this knowledge in the classical tradition of Greece, India, China, shows a model of balance (equilibrium model) a person is considered healthy if the main elements of hot and cold in the body in a state of balance. The main elements are included in the concept of humors, ayurveda dosha, yin and yang. Department of Health has launched a new policy based on health paradigm

1. Health paradigm is
How to view or mindset that health development is holistic, proactive, anticipatory, by looking at health issues as a problem that is influenced by many factors in a dynamic and cross-sectoral, in an area that is oriented to the improvement of maintenance and protection of the population to stay healthy and healing not only people who are sick. At its core health paradigm provides the main focus of the policy are prevention and health promotion, providing support and allocation of resources to keep a healthy stay healthy but still seek immediate ill health. In principle, the policy is to put emphasis on community health activities than on treating disease. Understanding of the disease have been developed that have a biomedical and socio cultural connotations
In English the word was known disease and illness while in the Indonesian language, both understanding it is called disease. Seen from the socio cultural aspects there are big differences between these two terms. With disease or dysfunction is intended adaptation of biological processes and psikofisiologik in an individual, with the illness referred to the reaction of personal, interpersonal, and cultural to the illness or feeling uncomfortable
The doctors diagnose and treat disease, whereas patients had illness that can be caused by disease, illness was not always accompanied by organic or functional disorders of the body.
This paper is a literature review that discusses the health-illness knowledge on cultural and social aspects of human behavior, and specifically on the interaction between some of these aspects which have influence on health and disease. In a cultural context, the so-called healthy in a healthy culture is not necessarily also in other cultures. Here can not be ignored any valuation factor or factors that are closely related to the value system.

HEALTHY CONCEPT BY CULTURE COMMUNITY HOSPITAL
Healthy term contains many cargo cultural, social and professional understanding of the diverse. First from the point of view of medicine, health is closely associated with pain and disease. In fact it is not that simple, sound must be viewed from various aspects. WHO's view of various aspects of health.
WHO definition (1981): Health is a state of complete physical, mental and social well-being, and note merely the absence of disease or infirmity. WHO defines health as the notion of a perfectly good state of physical, spiritual, and social welfare of a person.
To the extent where someone can be considered complete physical?, By medical experts, medical anthropology is seen as a discipline biobudaya who pays attention to those aspects of biological and socio-culture of human behavior, particularly about ways of interaction between the two throughout the history of human life that affect health and disease. The disease itself is determined by culture: this is because the disease is the social recognition that one can not reasonably run its normal role. Ways of life and human lifestyles are phenomena that can be associated with the emergence of various diseases, besides the results of different cultures can also cause disease.
Community and traditional healers embracing two concepts of cause of illness, namely: Naturalistic and Personalistik. The cause is Naturalistic ie a person suffering from pain caused by environment, food (one meal), living habits, imbalances in the body, including trust as incoming wind chills and congenital disease. The concept of healthy pain embraced traditional healers (Battra) similar to those adopted for the local community, ie, a condition associated with a state agency or state body disorders and symptoms. Healthy for a person means a state of normal, natural, comfortable, and able to perform daily activities with a passion. While the illness is considered as a state body that is less pleasant, even perceived as an ordeal that causes a person unable to perform everyday activities as well as healthy people.
While the emergence of the concept considers Personalistik disease (illness) is caused by the intervention of an active agent that can form non-human beings (ghosts, spirits, ancestors or evil spirits), or human beings (witches, fortune-teller).
Tracing cultural values, for example concerning the introduction of leprosy and the way maintenance. Leprosy has been known by the ethnic Makasar long time. The existence of the term kaddala sikuyu (leprosy crabs) and kaddala massolong (leprosy is melted), is an expression of that support that leprosy is endemic have been in a long time among the community.
Results of qualitative and quantitative research on cultural values Soppeng district, in conjunction with leprosy (Kaddala, BGS.) In Bugis society show that arise and are strictly diamalkannya leprophobia because according to one cultural figure, in marriage advice old people there, said kaddala come included. Mentioned that if there is a violation to have sex when the wife is menstruating, they (the bride) will be cursed and suffer from leprosy / kaddala. The idea that aims to create great moral in a new family, follow the process of developing communication in society and become the concept of leprosy patients as the person in sin. Understanding the patient as a result of sins of the mother-father are suffering due leprophobia early. Low self-esteem of people with low self-esteem started families who feel tainted when one family member suffering from leprosy. Accused of sinning intercourse when the wife is menstruating for a fanatical Islam is perceived as psychosomatic trauma load is very heavy.
Parents, family is refusing her son was diagnosed with leprosy. In the study of Health Service Use in the Province of East Kalimantan and West Nusa Tenggara (1990), the results of focus group discussions in East Kalimantan showed that the child otherwise sick if crying continues, the body sweats, do not want to eat, not sleep, fussy, haggard. For adults, a person otherwise ill when he could not work, unable to walk, not malaise, chills, headache, malaise, anemia, cough, nausea, diarrhea. While the results of discussion groups in West Nusa Tenggara showed that visits sick children from the physical state of body and behavior that is if the show symptoms such as hot, cold cough, diarrhea, vomiting, itching, wounds, dental swelling, yellow body, leg and abdominal swelling .
A traditional healer who also accept the view of modern medicine, has an interesting knowledge about the problem of ill-health. For him, the meaning of illness are as follows: bodily pain means there are signs of the disease in the body such as high fever, weak eyesight, not strong working, trouble eating, disturbed sleep, and the body is weak or ill, the wish was lying or just rest. Mental illness does not exist on the signs on his body, but can be known by asking the unseen. In a healthy person, his movements agile, powerful work, the normal body temperature, eating and sleeping normally, vision light, bright eyes, do not complain listless, weak, or sick-sick body.
Sudarti (1987) outlines some regions descriptive perceptions in Indonesia about illness and disease, people assume that the pain is a state of individuals experienced a series of physical problems that cause discomfort. Sick child's behavior is marked with a fussy, crying and no appetite. Adults are considered sick if lethargic, unable to work, loss of appetite, or "dry bag" (no money). Furthermore, classifying the cause of sick society into three parts, namely:
1. Because the effects of natural phenomena (heat, cold) on the human body
2. Foods are classified into hot and cold food.
3. Supernatural (spirits, witchcraft, demons, etc..).
To treat pain that is included in the first and second groups, can be used in medicines, herbs, massage, scrape, food taboos, and help health workers. To cause pain to the three must be requested assistance shaman, Kyai and others. Thus, efforts to overcome it depends on their belief in the cause of illness. Some examples of diseases in babies and children as follows:
a. Sick with a fever and heat.
The reason is the change in the weather, rain, wrong meal, or catch a cold. Treatment is a way to compress with ice, Oyong, white pumpkin cold or influenza drug purchases. In Indramayu say cool although the symptoms of heat illness is high, so the heat down. Tampek diseases (measles) is also called sick cool because the symptoms of heat loss.
b. Sick diarrhea (diarrhea).
The cause is wrong to eat, eat nuts too much, eating spicy food, eating shrimp, fish, children increased their versatility, stale milk, dilute, and others. Birds in the example of traditional medicine with the chewed guava leaves, shoots his mother and given to his son (Bima Nusa Tenggara Barat) is another drug Sugar Salt Solution (LGG), Oralit, Ciba pills and others. Sugar Salt Solution was known simply not appropriate mixture proportions.
c. Spasm pain
Society in general stated that fever and seizures caused by a ghost. In Sukabumi called ghost pliers, while in West Sumatra caused by evil ghosts. Indramayu in treatment is to go to a shaman or put the baby down-covered bed nets.
d. Tampek illness (measles)
The reason is that children exposed to heat in, children bathed during the heat, or kesambet. In Indramayu treat mothers with children with acid membalur kawak, give to drink honey and lemon or give suwuk leaves, which according to the trust can suck disease.

DISEASE EVENTS
The disease is a complex phenomenon which adversely affect human life. Human behavior and way of life can be a cause of various diseases both in age and in the primitive society that are very advanced civilization and culture.
Viewed from the aspect of disease is biological abnormalities various human organs, while in terms of societal ill considered a behavioral deviation from normative social situation. Deviations can be caused by abnormalities of organs biomedical or human environment, but also can be caused by emotional disorders and psychosocial individuals concerned. Emotional and psychosocial factors are essentially the result of environmental or human ecosystems and human or cultural customs.
The concept of disease incidence by health sciences depending on the type of disease. In general, this conception is determined by various factors such as parasites, vectors, humans and their environment. Anthropologists from the definition of health that may be mentioned to the ecology-oriented, concerned with the reciprocal relationship between humans and the natural environment, illness behavior and the ways the disease affects the behavior of its cultural evolution through the feedback process (Foster, Anderson, 1978).
The disease can be viewed as an element in the human environment, as seen in sickle-cell trait (sickle-cell) among the population of West Africa, an adaptive evolutionary changes, which provide relative immunity to malaria. Sickle cell trait was not a threat, even a desirable characteristic because it gives high protection against the Anopheles mosquito bites.

For the people of Dani in Papua, the disease can be a positive social symbol, which are given specific values. Aetiology of disease can be explained by magic, but also as a result of sin. Social symbol can also be a source of disease. In modern civilization, the relationship between symbols of social and health risks often seem obvious, such as teenage smoking.
A study of the relationship between psychiatry and anthropology in the context of social change written by Rudi schoo (1994), based on his own experiences as a psychiatrist, one of the following case: A woman who was old enough reumatiknya treated only with vitamins and fish oil alone and believe the illness will cured. According to the patient's illness caused by "dirty blood" therefore the only way of healing is by eating clean food, that is `mutih '(plus the vitamins necessary to prevent vitamin deficiency) until the blood becomes clean again. For a doctor's opinion does not make sense, but that's the fact that there is in society.

HEALTHY CONCEPTS - ILLNESS

A. Understanding
1. Healthy according to WHO 1974
Health is the perfect state of physical, mental, social, not just freedom from disease, disability and weakness.
2. Law treatments were: N0. 23/1992 on health
health is a prosperous state of the body (physical), soul (spiritual) and social that allows every person living in a socially and economically productive.
3. Pepkin's
Health is a state of dynamic balance between form and function of the body that can make adjustments, so that it can overcome the interference from outside.


4. According to Law No.3/1961 mental health is a condition that allows the development of physical, intellectual, emotional and optimal development of a person's current state of harmony with others.
5. Social health is an ability to live together with the community surrounding.
6. Physical health is a state where physical form and function, there is no disturbance to enable development psychological, and social and can carry out daily activities optimally.

In accordance with a healthy understanding of the above can be concluded that health consists of three dimensions: physical, psychological and social can be interpreted more positively, in other words that a person is given the opportunity to develop the broadest capabilities brought from birth to obtain or interpret healthy .
Although there are a lot of the definition, the concept of health is not standard or standard and is absolutely unacceptable and the public. What is considered normal by someone still might be considered abnormal by others, each person / group / community has its own benchmark in interpreting health. Many people live healthy despite lacking economic status, living place that is dirty and noisy, they do not complain of interference even after weighed badanya below normal weight. This explanation shows that the concept is relatively healthy varied widely among people, although in one room / area.
Healthy can not be interpreted something static, settled on a particular condition, but healthy things to be considered a dynamic phenomenon. Health as a spectrum is a condition between the body and mental flexibility that is engaged in a range that is always fluctuating or swinging toward and away from the peak of happiness in life than a perfectly healthy state.
Healthy as a spectrum, Pepkins defines health as the state of dynamic equilibrium of the body and its functions as a result of the dynamic adjustment of the forces that tend to be disturbed. Body someone works actively to defend themselves in order to stay healthy, so health should always be maintained. Here are steps health spectrum:

Positive Health
Better Health
Freedom from Sickness
Spectrum
Health
Unrecognized Sickness
Mild Sickness
Severe Sickness
Death

Concept of Illness
A. Understanding
1. Perkins defines pain as an unpleasant situation that happened to someone so that someone aktivtas cause disruption of daily activities both physical, spiritual and social
2. R. Susan defining illness is the lack of harmony between the environment and individuals.
3. Home Oxford Dictionary defines pain as a condition of the body organ or part of the body where its function is disturbed or deviant.

Healthy situation - Sick
A. Continuum Healthy - sick
The health status of a person is located between the two poles of "optimal health and" death ", which are dynamic. When the health of someone moving kekutub death then someone was in the area of pain (illness area) and when moving towards healthy health status (optimal well being), then someone in the area of health (wellness area).

Healthy deaths

Illness Wellness area area

B. Maintaining the health status
1. In accordance with the nature of a dynamic healthy-sick, then the person can be divided into optimal health, a little healthier, a little sick, very sick and died.
2. When someone in the area needs to be healthy then primary prevention (primary prevention), which include health promotion and specific protection is to prevent illness.
3. When someone in the area of pain needs to be secondary and tertiary prevention is early diagnosisand promt treatment, disability limitation and rehabilitation.

C. Factors that influence ill health perunbahan
A. Blum, suggests there are 6 factors that affect the healthy-sick status, namely:
1. Political factors include safety, pressure, oppression, etc..
2. Human behavioral factors including human needs, human habits, customs.
3. Include genetic heredity, disability, ethnicity, risk fator, race, etc..
4. Factor health services, including the attempts promotive, preventive, curative and rehabilitative.
5. Environmental factors include air, water, rivers etc..
6. Socioeconomic factors including education, employment etc..

D. Prevention Level
In a further development to address health issues including disease prevention known three stages:
Primary prevention: health promotion (health promotion) and special protection (specific protection).
Secondary prevention: early diagnosis and immediate treatment (early diagnosis and the prompt treatment), restrictions on disability (disability limitation)
Tertiary Prevention: rehabilitation.
1. Primary prevention has not been done on the individual's illness, the efforts were:
a. Promotion of health / health promotion aimed at improving the body's resistance to health problems.
b. Special protection (specific protection): specific efforts to prevent the transmission of certain diseases, eg, by immunization, increasing the skills of adolescents to prevent the solicitation and use of narcotics to cope with stress and others.
2. Secondary prevention performed during the individual's onset of illness
a. Early diagnosis and immediate treatment (early diagnosis and prompt treatment), the main purpose of this action is one) to prevent the spread of disease when the disease is a contagious disease, and 2) to treat and stop the disease process, heal the sick and prevent the occurrence of complications and disability .
b. Restrictions disability (disability limitation) at this stage the defects that occur overcome, especially to prevent the disease become sustainable until the cause of the flaw is much worse.
3. Tertiary Prevention
a. Rehabilitation, in this process sought to be defective in pain do not become barriers so that individuals who suffer from can function optimally physically, mentally and socially.
The third scheme of prevention efforts that can be seen in the figure two. In the course of the disease picture of two processes are distinguished on a) the phase prior to the sick: that is marked by a balance between agents (germs of disease, hazardous materials), the host / body and environment and b) phase, people started getting sick: who eventually recover or die.
Figure two: The level of disease prevention (source: Leavel and Clark, 1958)
Health promotion through interventions at the host / body of people such as eating a balanced nutritious diet, healthy behavior, improve the quality of the environment to prevent diseases such as eliminating the breeding of disease germs, reduce and prevent air pollution, eliminate the breeding of disease vectors such as standing water become breeding places of Aedes mosquitoes, or against a disease agent such as for example by giving an antibiotic to kill germs.
Special protection is done through specific actions such as immunization or protection in hazardous industrial materials and noise. To conduct mouthwash-gargle with flour to prevent condensation of caries in teeth. Whereas against germs such as washing hands with an antiseptic solution before surgery to prevent infection, wash hands with soap before eating to prevent diarrheal diseases.
Early diagnosis through screening processes such as breast cancer screening, cervical cancer, the presence of certain diseases during pregnancy, so that treatment can be done during the early and due to the bad will be prevented.
Sometimes the boundaries of the three stages of prevention is not obvious that there are overlapping activities can be classified in the special protection and but also can be classified in the early diagnosis and treatment of precancerous lesions as soon as treatment in the womb may include early treatment can also special protection.
In addition to the prevention of primary, secondary and tertiary health care among physicians, nurses and public health practitioners known as the five levels of prevention, also known as the four phases of activities to address public health problems, the four stages (Rossenberg, Mercy and Annest, 1998) is:
What is the problem (surveillance). Identify the problem, what's the problem, when it happens, where, who the person is, how it happened, when did that happen if anything to do with the season or period.
Why did it happen (Identification of risk factors). Why is it easier to happen to anyone in particular, what factors increase the incidence (risk factors) and what factors reduce the occurrence of (protective factor).
What works carried out (evaluation of interventions). On the basis of the two previous steps, can the design effort needs to be done to prevent problems, deal with patients and perform immediate relief efforts and assistance to help victims and assess the success of the action in preventing and tackling the problem.
How to expand effective interventions (for implementing large scale). Once known effective interventions, further action is how to implement interventions in various places and settings, and develop resources to implement them.
Figure 3. Four stages of public health activities
Problem
Response
Source: Rossenberg, and Annest Mercy, 1998

Coronary Heart Disease

Myocardial oxygen demand can be met if there is a balance between supply and oxygen demand. Decrease in myocardial oxygen supply may be harmful to myocardial function. Coronary heart disease caused by an imbalance between myocardial oxygen supply and demand. When myocardial oxygen demand increases, the oxygen supply must also increase. Increased oxygen demand occurs on: tachycardia, increase myocardial contractility, hypertension, hypertrophy, and dilatation of the ventricles. To increase the supply of oxygen in a sufficient amount of coronary artery flow should be improved.

Four factors that affect cardiac oxygen demand:

* The frequency of heart rate
* Power contraction
* Muscle Mass
* Voltage ventricular wall

The imbalance between supply and oxygen demand can be caused:

* Narrowing of coronary arteries (atherosclerosis), which is the most common cause.
* Decrease in blood flow (cardiac output).
* Increased myocardial oxygen demand
* Coronary artery spasm.

Suply demand



Suply demand



Suply demand

Pathogenesis

Coronary artery atherosclerosis is a cause of coronary artery disease are most commonly found. In coronary atherosclerosis, there is accumulation of lipids and fibrous tissue in the coronary artery so that narrow the coronary artery lumen.

Mechanisms of atherosclerosis:

* In the tunica intima containing lipid deposits occur much cholesterol.
* Occur complex atherosclerotic plaque consists of fat, fibrous tissue, collagen, calcium, cellular debris and capillaries.
* Changes degenerative artery wall.
* Coronary artery luminal narrowing.

CHD RISK FACTORS

Risk factors irreversible:

* Age
* Gender
* Family history / genetic
* Race

Reversible risk factors:

* Hyperlipidemia, hypercholesterolemia
* Hypertension
* Smoking
* Diabetes mellitus
* Obesity
* Stress psychologic
* Type of personality
* Lack of sports activities

Clinical manifestations

* Without symptoms
* Angina pectoris
* Acute Myocardial Infarction
* Arrhythmias
* Suck heart
* Sudden deaths

PATOFISOLOGI

Ischemia

Ischaemia is a condition of oxygen shortage is temporary and reversible. Decrease in oxygen supply will improve the mechanism of anaerobic metabolism. Long ischemia can cause muscle death or necrosis. State that continued necrosis can cause death of heart muscle (myocardial infarction). Ventriekel left is the living heart of the most susceptible to ischemia and infarction, due to left ventricular oxygen demand greater for contraction. Anaerobic metabolism is not very effective addition to the energy produced is not large enough also enhances the formation of lactic acid that may reduce the PH cell (lactic). Ischaemia is typically marked changes in ECG: T inversion, and ST segment depression.

Combined effects of hypoxia, decrease in energy supply, as well as acidosis can quickly disrupt the function of the left ventricle. Strength of contraction in the affected areas susceptible to interference, muscle fibers shorten, as well as its velocity decreases. Changes in these contractions can be caused decrease in cardiac output. Ischemia can cause pain as the result of excessive accumulation of lactic acid. Angina pectoris is chest pain that accompanies myocardial ischemia.

Angina pectoris can be divided: of angina pectoris stable (stable of angina), angina pectoris unstable (unstable wind), a variant of angina (angina prinzmetal).

Stable angina pectoris: chest pain belonging to stable angina is the pain that arises when performing activities. The pain of not more than 15 minutes and lost the rest.

Unstable angina pectoris (UAP): The chest pain arising UAP at rest, the pain lasts for more than 15 minutes and an increase in pain.

Variant angina: Unstable angina is caused by coronary artery spasm.

Infarction

Ischemia lasting more than 30 minutes can cause irreversible cell damage and muscle death (necrosis). Part of experiencing myocardial necrosis or infarction will cease to contract permanently.

Nursing care

* Review: a complaint of pain, disease history, risk factors.
* Physical examination: TTV, peripheral perfusion, capillary reffil, arterial pulsation, heart sounds: S3, S4, murmurs, lung sounds: Ronchi, whezing.
* Response psychological: depression, anxiety, worry.
* ECG: T inversion, ST depression
* Laboratory: Routine blood, cardiac enzymes, lipid profile.
* Echocardiogram
* Kateterisasi heart
* Photo thoracic

Nursing Diagnosis

* Decrease in cardiac tissue perfusion
* Changes in breathing pattern
* Changes in comfort; pain
* Intolerance activity
* Anxiety

Management of

* The most effective management is to detect and mitigate risk factors.
* Reducing cardiac oxygen demand by decreasing heart work
* Increase the oxygen supply of heart
* Coronary revascularization

Coronary revascularization

Coronary revascularization is a way to improve vascularities blood vessels to the heart. Three mechanisms revaskkularisasi

Coronary were: PTCA (Percutaneous Transluminal Coronary Angioplasty), revascularization with CABG surgery, therapy Thrombolytics.

PFS REHABILITATION PROGRAM

Rehabilitation of heart disease is a series of efforts to help cure the patient in order to return quickly to normal life. Rehabilitation aims to restore the PFS physical condition, mental and social one as optimal as possible so that achieved self ability to run activities at home or occupation.

Phase I Program

Courses are given in all patients who are still in care at the hospital. Program implemented as soon as possible in patients with stable hemodynamics since the ICCU, inpatient unit, until the patient home. Length of training: 7-14 days. Types of exercise: 5 minute warm-up that includes exercises arm muscles, legs, hips in a rhythmic and repetitive. Components of core exercises is the road / bike with a load that can be gradually increased according to response to exercise. The exercise ended with cooling for 5 minutes.

Phase II Program

Is an advanced program whose implementation as soon as possible after the patient's home. Length of training: 6-8 weeks 3x/minggu held for one hour. Types of exercise: warm-up for 5-10 minutes of stretching, followed by riding a stationary bike and walking for 30-45 minutes. The exercise ended with cooling for 10 minutes.

Phase III Program

Is a long term program with a community base. Conducted after the patients completed the Phase II program through the heart exercise test and achieve aerobic capacity. Length of training: 1-3 months

Pathophysiology

Risk Factors


Atherosclerosis


PSS Myocardial Blood Supply


Myocardial ischemia


Necrosis / infarction


PSS myocardial contractility


PSS Bulk Heart


Heart Failure


Death