bluuebunny/crossref_metadata_2025 huggingface dataset:
Management of Diastolic Heart Failure
Authors: Rampengan Starry H.
Published: September 2018

The diastolic heart failure also referred to as heart failure with preserved left ventricular systolic function (preserved ejection fraction). The difference between systolic and diastolic HFs is a pathophysiological one and isolated forms of left ventricular dysfunction are rarely observed. In diastolic HF left ventricular systolic function is normal or only slightly impaired, and the typical manifestations of HF result from increased filling pressure caused by impaired relaxation and compliance of the left ventricle. The management should include antihypertensive treatment, maintenanceof the sinus rhythm, prevention of tachycardia, venous pressure reduction, prevention of myocardial ischemia and prevention of diabetes mellitus. Treatment of diastolic HF is aimed to stop the progression of the disease, relieve its symptoms, eliminate exacerbations and reduce the mortality. The predisposing factors for diastolic dysfunction include elderly age, female sex, obesity, coronary artery disease, hypertension and diabetes mellitus. The European Society of Cardiology specifies the type of therapy in diastolic HF based on: angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, non dihydropyridine calcium channel blockers, diuretics.
Electrical Alternans
Authors: Yuniadi Yoga
Published: September 2018

Seorang perempuan, 50 tahun datang ke poli Aritmia dengan keluhan berdebar. Rekaman EKG 12-sadapan diperlihatkan pada gambar di bawah ini:Irama dasar rekaman EKG di atas adalah irama sinus yang dibuktikan dengan morfologi gelombang P yang berasal dari lokasi nodus sinoatrial yaitu negatif di aVR dan positif di sadapan II, III dan aVF. Perhatikan di sadapan aVF pada denyutan 1 interval PR memanjang hingga 280 mdet menunjukkan suatu blok AV derajat 1. Yang menarik adalah denyutan ke 2 dan ke 4 merupakan suatu atrial premature beat dengan morfologi QRS yang berbeda dari morfologi QRS pada denyutan 1. Sebaliknya denyutan ke 3 dan ke 5 yang merupakan denyut sinus pun memiliki kompleks QRS yang berlainan. Terlihat jelas bahwa perubahan morfologi QRS itu hanya tampak pada sadapan ekstremitas tetapi kurang terlihat pada sadapan prekordial.
Preoperative and predischarge predictors for persistent pulmonary hypertension after mitral valve surgery in patients with chronic organic mitral regurgitation
Authors: Ariani Rina , Sakidjan Indriwanto , Setianto Budhi
Published: September 2018

Objectives. This study sought to evaluate the prevalence of pulmonary hypertension after mitral valve surgery ini patients with chronic organic mitral regurgitation and to determine preoperative and predischarge predictors for persistent pulmonary hypertension after surgeryMethods. This is a cohort retrospective study involving subjects with chronic organic mitral regurgitation with preoperative systolic PA pressure > 50 mmHg undergoing surgery. Demographic and echocardiography datas were collected prior to surgery, predischarge, and follow up datas were evaluated after minimal 6 months duration. Subjects were then devided into groups based on existence of persistent pulmonary hypertension after follow up. Bivariate and multivariate analysis was done to determine contributing factors.Results.There were 92 subjects with dominant mitral regurgitation included in this study with median age 40 (range 17-68) years with slight female predominance (55%). Persistent pulmonary hypertension was observed in 23 subjects (25%) predischarge and in 20 subjects (20.7%) after mean follow up of 11 + 5.5 months. Bivariate analysis revealed preoperative TAPSE, underlying etiology, severity of pulmonary hypertension preoperatively, postoperative atrial fibrilation, mean mitral valve gradient predischarge, and the presence of residual pulmonary hypertension predischarge were related with persistent pulmonary hypertension. From multivariate analysis, post operative atrial fibrillation [OR 7.3 (CI 95% 1.64-33.33, p=0.09)], mean mitral valve gradient predischarge [OR 1.67 (CI 95% 1,3-2.7, p=0.038)], and preoperative TAPSE [OR 0.143 (CI 95% 0.03-0.70, p=0.017)] were independent predictors for persistent pulmonary hypertension after mitral valve surgery.Conclusion. Persistent pulmonary hypertension was observed in 20.7% subjects after mitral valve surgery. Preoperative TAPSE, post operative atrial fibrillation, and predischarge mean mitral valve gradient were independent predictors.
Diagnosis Sindrom Brugada
Authors: Faisal Edward
Published: September 2018

Brugada syndrome is an inherited autosomal dominant disease that cause sudden death, which related with mutation of SCN5A gene, ? subunit of sodium channel. The risk Brugada syndrome in male is 8 times more than females. The average age is 40 years old, which can happen between age 1 to 77 years old. The Incidence is 5 to 66 per 10.000 people. The golden diagnostic tools is ECG, an abnormality QRS-T found in lead V1-V3. I report a case of Brugada syndrome with neither sign nor symptoms. The disease coincidental in routine medical examination.
2014 Indonesian Heart Association Guidelines of Management of Atrial Fibrillation
Authors: Yuniadi Yoga , Hanafy Dicky A , Rahardjo Sunu B , Tondas Alexander E , Maharani Erika , Hermanto Dony Y , Munawar Muhammad
Published: September 2018

Atrial fibrillation is the most frequent arrhythmia in clinical practice and causing huge health problem. Therefore, a national guidelines in management of AF that comprise of pathomechanism, clasifications, anticoagulants management for stroke prevention, rate and rhythm control is developed to ensure patients get best therapeutic option. The guidelines is developed in line with variable health care level in Indonesia from primary up to tertiary care.
An effort to find biomarker for micro-vascular obstruction in patient with myocardial infarction undergoing primary revascularization: is fibrinogen the answer?
Authors: Widyantoro Bambang
Published: September 2018

Meski revaskularisasi telah menunjukkan manfaat besar dalam menurunkan morbiditas dan mortalitas pada pasien infark miokard akut dengan elevasi segmen ST (IMA-EST), manfaat dari intervensi koroner perkutan primer (IKPP) yang berhasil mengembalikan aliran koroner epikardial seringkali tidak optimal di tingkat mikro sirkulasi karena adanya obstruksi mikrovaskular.Obstruksi mikrovaskular (OMV) berperan penting dalam menentukan prognosis pasien paska tindakan,1, 2 dan telah dilaporkan bahwa keberadaan obstruksi mikro-vaskular berkorelasi dengan penurunan survival pasien paska IMA-EST, melalui pengaruhnya pada proses remodeling ventrikel.3, 4
Correlation between P-Selectin Level and Left Atrial Function in Rheumatic Mitral Stenosis
Authors: Shanti Prafithrie Avialita , Yuniadi Yoga , Haryono Nur
Published: September 2018

Background. Mitral stenosis (MS) prevalence remains significant in developing countries because of the prevalence of Rheumatic Heart Disease (RHD). In moderate-severe MS patients, enormous increase in turbulent region and shear stress cause vascular endothelial dysfunction, and as the consequence, it increases the risk of thromboembolic complications. P-selectin is an adhesion molecule that play a role in the inflammation process, where it is expressed rapidly in mere minutes. Left Atrial Volume Index (LAVI) is a superior parameter compared with other two-dimensional echocardiography method to assess left atrial function.Methods. This was a cross-sectional study involving 20 MS moderate-severe patients with mitral valve area (MVA) < 1.5 cm2, to whom successful Percutaneous transvenous Balloon Mitral Valvulotomy (PBMV) was performed. Samples were taken consecutively from May-October 2013 at the National Cardiovascular Center Harapan Kita, Jakarta. Blood samples of P-selectin were collected pre and post-PBMV. The result was statistically analyzed with echocardiography data of LAVI prior PBMV to describe any association between expression of P-selectin and atrial function.Result.We found no association between LAVI and P-selectin level pre and post-PBMV in MS patients. That is described in the value of pre PBMV ?=-0.103 (95% CI -0.251-0.045) with p=0.16 and post-PBMV ?= 0.009 (95% CI -0.155-0.172) with p=0.91 We then performed linear regression test with adjusted confounding variable including sex, age, and atrial fibrillation, still we found no association between LAVI and P-selectin level, with the value of pre PBMV ?= -0.154 (95% CI -0.340-0.032) p=0.09 and post PBMV ?= -0.049 (95% CI -0.250-0.152) p=0.61.Conclusion. There is no difference in P-selectin level pre and post PBMV. There is no association between poor LAVI value and expression of P-selectin pre and post PBMV in MS.
Pedoman Terapi Memakai Alat Elektronik Kardiovaskular Implan (Aleka) Perhimpunan Dokter Spesialis Kardiovaskular Indonesia 2014
Authors: Hanafy Dicky A , Yuniadi Yoga , Raharjo Sunu B , Tondas Alexander E , Rahadian Adhantoro , Yamin Muhammad , Tanubudi Daniel , Hartono Beny , Munawar Muhammad
Published: September 2018

PEDOMAN TERAPI MEMAKAI ALAT ELEKTRONIK KARDIOVASKULAR IMPLAN (ALEKA)Perkembangan dan kemajuan pada diagnostik dan terapi dalam tata laksana pasien dengan kelainan irama jantung merupakan dasar disusunnya pedoman terapi memakai alat elektronik kardiovaskular implan (Aleka) ini. Pedoman ini disusun oleh Perhimpunan Aritmia Indonesia - Indonesian Heart Rhythm Society (lnaHRS), sebuah kelompok kerja dari Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI), berdasarkan pedoman terbaru yang dipublikasi oleh perhimpunan Eropa maupun Amerika Utara dan disesuaikan dengan keadaan lokal di Indonesia.Pedoman Aleka ini terdiri dari alat pacu jantung permanen (APJP), defibrilator kardiak implan (DKI) dan terapi resinkronisasi jantung (TRJ). Kumpulan rekomendasi ini memberi pedoman untuk penggunaan Aleka dengan tepat tetapi bukan sebagai pedoman untuk tata laksana aritmia secara umum.Bradikardia simtomatik menjadi indikasi implantasi APJP. Sebelum keputusan diambil untuk implantasi APJP, pertanyaan utama yang muncul adalah apakah simtom yang dialami pasien berhubungan dengan bradikardia, baik yang dicurigai maupun terdokumentasi. Ada kemungkinan bahwa kondisi yang terjadi bersifat sementara (akibat iskemia, efek samping obat, gangguan elektrolit, inflamasi, sepsis) dan dapat ditangani dengan pemacuan temporer serta dapat disembuhkan dengan mengobati penyebab yang mendasari. lndikasi implantasi APJP haruslah dievaluasi secara teliti dan dicari penyebab yang mendasari. lndikasi kelas I untuk implantasi APJP tidak dapat menyingkirkan pilihan tata laksana alternatif yang mungkin ada. Diagnosis banding termasuk penyebab kardiak maupun non-kardiak harus disingkirkan terlebih dahulu.Untuk terapi memakai Aleka, tidak hanya dibutuhkan pengetahuan gangguan irama jantung yang dalam namun juga pengetahuan teknik dasar. Pendekatan transvena telah mempermudah teknik bedah dan memudahkan tindakan implantasi sehingga dapat dilakukan oleh kardiolog. Hanya dengan memiliki pengertian yang mendalam mengenai keterkaitan antara fungsi dari pemacuan yang
Aplikasi Panduan ESC tentang Penyakit Arteri Koroner Stabil 2013 dan Revaskularisasi Miokard 2014: MRI Kardiak dengan Stres Adenosin dalam Diagnosis, Stratifikasi Risiko dan Strategi Penatalaksanaan
Authors: Wicaksono Sony Hilal
Published: September 2018

Ilustrasi KasusSeorang pasien perempuan usia 55 tahun memiliki keluhan angina tipikal/khas dan didiagnosis sebagai Angina PektorisStabil (APS), dengan factor risiko diabetes mellitus tipe 2, dislipidemia, hipertensi dan perokok aktif. Hasil elektrokardiogram (EKG) pasien ini menunjukkan irama sinus dengan laju QRS 71x/menit, gambaran gelombang qR di sadapan III, selain itu dalam batas normal.Pasien kemudian menjalani uji latih Jantung dengan treadmill. Uji treadmill dihentikan pada durasi 5 menit dan 46 detik karena kejadian penurunan tekanan darah yang drastis, dari 187/103 mmHg menjadi 117/97 mmHg. Tidak tampak perubahan gambaran elektrokardiogram.Karena hasil uji latih jantung dengan treadmill yang tidak konklusif, pada pasien direncanakan dilakukan pemeriksaan MRI kardiak dengan stress adenosine untuk mendeteksi iskemia pada kunjungan selanjutnya. Sementara pasien diberikan terapi medikamentosa yang optimal untuk penyakit arteri koroner stabil.
Intermittent Wide Qrs Complex During Sinus Rhythm
Authors: Yuniadi Yoga
Published: September 2018

Seorang pria 40 tahun datang ke poli Aritmia dengan keluhan palpitasi berulang. Pemeriksaan fisik dalam batas normal. Ekokardiografi didapatkan EF 56% dan angiografi menunjukkan arteri koroner normal. Rekaman EKG terlihat seperti gambar di bawah ini,Rekaman EKG menunjukkan gambaran bigemini yaitu selang-seling antara kompleks QRS sempit dan lebar. Perhatikan bahwa baik kompleks QRS sempit maupun lebar keduanya didahului oleh gelombang P. Yang menarik adalah (1) interval PR sangat pendek pada saat kompleks QRS lebar dan (2) interval PP kompleks QRS sempit ke QRS sempit(A) tidak merupakan dua
Stratifikasi Risiko, Cost-Analysis dan Jaminan Kesehatan Nasional di Bidang Kardiovaskular
Authors: Adiarto Suko
Published: September 2018

Mulai berlakunya sistem kesehatan nasional di Indonesia menandai era baru di bidang pembiayaan kesehatan nasional, dimana pembiayaan kesehatan yang sebelumnya didominasi oleh pembayaran tunai secara pribadi kini secara perlahan tapi pasti telah bergeser pada sistem asuransi, dimana keikutsertaan seluruh warga negara merupakan salah kunci sukses terselenggaranya sistem pembiayaan ini dengan baik. Berkaca pada pendapat para ahli di bidang pembiayaan kesehatan dan pengalaman negara-negara maju, tidak disangsikan lagi, ketika telah berjalan dengan sempurna sistem ini merupakan sistem pembiayaan terbaik. Tentu saja pada tahap awal pelaksanaan sistem jaminan ini masih terdapat beberapa kekurangan mendasar yang perlu mendapat perhatian serius untuk dapat segera diperbaiki.Seperti mengkonfirmasi data statistik yang telah ada tentang mortalitas dan morbiditas, BPJS kesehatan baru-baru ini me release data penyakit dengan pembiayaan kesehatan tertinggi dimana penyakit jantung dan pembuluh darah, keganasan (kanker) dan penyakit ginjal kronik merupakan 3 penyakit yang memuncaki tabel pengeluaran keuangan BPJS kesehatan.1 Penyakit jantung dan pembuluh darah berada di urutan pertama dengan jumlah pengeluaran
A Registry to regionalized treatment of Unstable Angina/Non-ST Elevation Myocardial Infarction
Authors: J Rachman Otte
Published: September 2018

multicentre Registry to access the current usage of antiplatelet therapy was conducted recently in Indonesia, that can be found in the current edition of this journal. 1 This was the only registry conducted in Indonesia and this was the only one that try to see the current compliance of the anti-platelet therapy in patients with Unstable Angina / Non-ST Elevation Myocardial Infarction not undergoing PCI procedure in Indonesia. This was very relevant since there is a surge of this diseases in the last decade and more cardiologist worked in the area and also there is more cath lab available to do invasive therapy. Such a facility should be used appropriately and efficiently as not to overburden the available resources both in time and economic aspect, especially in the era of BPJS (universal Health Coverage) which already use up much of these resources.The BPJS program is an ideal program which give treatment to the majority of people but since the resources is limited it is the duty of the government not to use it indiscriminately and as efficient as possible so it can be delivered to the right people according to its priority. As Indonesia is comprised of large area with thousands of Islands and many population that are devided of many subethnics that are different in many
Right Anomalous Coronary Artery Origin: The Role of Multislice CT Angiography
Authors: M Kurniawan Isyana , Elen Elen , A Atmadikoesoemah Celly , Kasim Manoefris
Published: September 2018

Introduction: The anomalous origin of the right coronary artery (RCA) from the left coronary sinus coursing between the aorta and the pulmonary trunk is rare, but may cause myocardial ischemia and sudden death. Multislice CT coronaryangiography offers the possibility to visualize anomalous coronary artery origin non-invasively in details.Case Illustration: A 54-year-old man with a history of arterial hypertension, and hypercholesterolemia began to present with typical chest pain. After some non-invasive examination, he had coronary angiographythat revealed 70% stenosis at mid intermediate artery, normalLMCA, LAD and LCX. Ostium of RCA was found near the left valsava sinus afterrepeated cannulation attempts, no stenosis was found at RCA. After successful revascularization at intermediate artery, patient still had typical chest pain with positive ischemic response in treadmill test. Multislice CT coronary angiography was performedto evaluate the etiology of chest pain. The scan showed patent stent at intermediate artery and anomalous RCA origin from the left coronary sinus withacute angle take-off, luminal narrowing of the osteal-proximal part, as well as luminal compression between the ascending aorta and the pulmonary trunk (an interarterial course) while RCA appeared as dominant vessel. These features were considered as malignant coronary anomaly that could lead to the recommendation of surgical correction.Discussion: Accurate recognition and documentation of coronary artery anomalies are essential to determine the significance of such findings and to avoid furtherclinical complications. Multislice CT coronary angiography is a non-invasive imaging modality that can easily and precisely depict the origin and course of coronary artery anomalies as well as its relationship with adjacent structures.
Role of Echocardiography as Supporting Diagnostic Modality in Localized Stanford Type A Aortic Dissection
Authors: Munirwan Haris , Soesanto Amiliana Mardiani , Ariani Rina , Taofan Taofan , Adiarto Suko , Sunu Ismoyo , Herlambang Bagus , Aligheri Dicky , Astuti Retno Dwi
Published: September 2018

Ascending Stanford type A aortic dissection carries a high morbidity and mortality. Proper identification of the proximal origin of the dissection and determination of concomitant aortic valve involvement significantly facilitate surgical repair which may improve survival.2Rapid imaging is necessary for the timely diagnosis of a potentially life-threatening condition. Transthoracic Echocardiography is highly accurate for the detection of acute aortic syndromes especially identify ascending aortic pathology such as type A aortic dissection.3 We report the unusual case of 52-years old male who present atypical presentation of aortic dissection with unclear view of dissection by CT Angiography aorta, and diagnosed as Localized Stanford A Aortic dissection with supported data by echocardiography modality.
Penyakit Arteri Koroner: Pilih CABG atau PCI?
Authors: Yuniadi Yoga
Published: September 2018

Strategi revaskularisasi pada penyakit arteri koroner (PAK) terus menjadi bahan debat di kalangan kardiologi. Berbagai uji klinis yang telah dilakukan menunjukkan hasil yang bervariasi dan harus ditelaah secara detil karena persoalan strategi revaskularisasi menjadi masalah yang tidak sederhana tetapi harus memperhatikan subset pasien yang befvariasi untuk mendapatkan hasil yang terbaik. Prinsip dasar yang harus tetap dijaga oleh para kardiolog adalah keputusan medis harus berorientasi pada pasien. Patient first!Perbandingan secara tidak langsung antara bedah pintas arteri koroner (BPAK/CABG) dengan intervensi koroner perkutan (IKP/PCI) menunjukkan dengan CABG keperluan pengulangan revaskularisasi lebih sedikit. Masalah yang selalu dipertanyakan dalam membandingkan kedua teknik revaskularisasi itu adalah pengaruh perkembangan teknologi stent terhadap luaran pasien. Berbeda dengan teknik CABG relatif tidak banyak berubah yaitu terdiri dari teknik on- atau off-pump, sedangkan teknologi stent berkembang cepat dan mungkin akan memberikan luaran yang berbeda karena stent generasi terakhir dipercaya memiliki patency rate yang lebih baik. Teknologi stent berkembang dari bare-metal stent ke drug-eluting stent, kemudian drug eluting stent juga berevolusi mulai dari generasi pertama yang memakai obat sirolimus atau paclitaxel ke generasi kedua yang memakai obat everolimus atau zotarolimus. Demikian juga farmako-teknologi polymer yang berkembang ke arah polymer-free stent. Dalam hal platform stent dimulai dari stainless steel, cobalt chromium, platinum dan terakhir memakai polylactyic acid yang dapat diserap.
Left Atrial Myxoma with Tricuspid Regurgitation: Pathophysiology, Diagnostic Approach, and Management
Authors: Almazini Prima , Siswanto Bambang Budi , Hersunarti Nani , Soerarso Rarsari , Soesanto Amiliana M
Published: September 2018

Cardiac myxomas are the most common primary cardiac tumors. Myxoma are more common in women. Clinical manifestations can mimic many cardiac and noncardiac conditions. Transthoracic echocardiography (TTE) is the gold standard method in the diagnosis of cardiac myxoma. The management of cardiac myxoma are medical therapy for the treatment of associated conditions and surgical removal as the definitive treatment.
Interferensi Listrik terhadap ECG
Authors: Yuniadi Yoga
Published: September 2018

Seorang laki-laki, 71 tahun dengan riwayat PPOK, dirujuk ke poli Aritmia dengan dugaan fibrilasi atrial. Keluhan pasien lebih menggambarkan gejala PPOK tanpa keluhan tambahan. Gambar EKG yang menjadi alasan dirujuk disertakan di bawah ini:
Benarkah Obat Penghambat Pompa Proton Meningkatkan Risiko Infark Miokard?
Authors: Yuniadi Yoga
Published: September 2018

Isu tentang pengaruh obat Penghambat Pompa Proton (P3) terhadap kejadian kardiovaskular mayor sudah cukup lama menjadi debat di kalangan kardiologi. Berbagai studi terkait masalah ini telah dilakukan tetapi memberikan hasil yang kontradiktif. Ching dkk1 meneliti hampir 3300 pasien pasca intervensi koroner perkutan yang dibagi jadi dua kelompok yaitu dengan dan tanpa P3. P3 yang dikonsumsi meliputi lansoprazole, pantoprazole, omeprazole dan esomeprazole. Pada pengamatan selama 9 bulan didapatkan insiden mortalitas, revaskularisasi dan kejadian kardiovaskular mayor yang lebih tinggi pada kelompok P3 dengan rasio hazard 1.7. Sebaliknya metanalisis dari 23 studi oleh Kwok dkk memperlihatkan tidak terdapat perbedaan kejadian kardiovaskular mayor pada pasien yang mengkonsumsi klopidogrel dan P3.2Sebuah studi yang dimuat di jurnal terbuka Plos One pertengahan tahun ini cukup mengejutkan kalangan kardiologi. Shah dkk3 melakukan studi observasional dari sekitar 16 juta data rekam medis dan menyimpulkan bahwa obat P3 berhubungan dengan peningkatan risiko infark miokard pada populasi umum. Enam belas persen penderita penyakit refluks gastroesofageal (GERD) yang diberi P3 menunjukkan peningkatan risiko infark miokard (95%IK 1.09 hingga 1.24) dan peningkatan risiko mortalitas kardiovaskular (HR 2.0, 95%IK 1.07 hingga 3.78, p = 0.031).Jadi ada dua isu besar terkait P3, yaitu diduga meningkatkan kejadian kardiovaskular mayor pada pasien penyakit jantung koroner (PJK) dan peningkatan kejadian infark miokard pada populasi umum. Bagaimanakah sikap yang harus diambil oleh para klinisi terkait hal di atas? Tulisan ini merupakan suatu stimulus agar para klinisi melihat lebih seksama pengaruh interaksi P3 pada pasien maupun populasi umum.
Atrial Fibrillation in Chronic Obtruktive Pulmonary Disease
Authors: Kaffah Silmi , Yuniadi Yoga , Samoedro Erlang
Published: September 2018

Chronic Obstructive Pulmonary Disease (COPD) often coexists with cardiovasculae disease (comorbidities) that may have a significant impact in prognosis. Atrial fibrillation (AF) is the most common comorbid, which is supraventricular tachyarrhythmias uncoordinated and ineffective atrial activation. Emergence of atrial fibrillation if not handled properly associated with morbidity and mortality are high . Exact pathogenesis of AF in COPD but may associated with atrial factors , inflammation ,activation of the renin - angiotensin - aldosterone system (RAAS), coronary heart disease , disorders of the autonomic tone and pharmacological. Complications of AF consisted of thromboembolic events including stroke. The management of AF with COPD should be adjusted to optimize therapeutic result
Chronic Mitral Regurgitation : Optimal time to Intervention
Authors: Rudiktyo Estu , Soesanto Amiliana M.
Published: September 2018

Chronic mitral regurgitation is commonly encountered valve disease. In this disease, there is volume overload on the left ventricle leading to left ventricle dilatation and dysfuction. Surgical or percutaneous intervention can improve prognosis, however optimal timing of intervention still controversial. In the past, timing of intervention was based solely on symptoms and left ventricle function. There have been recent advances in our knowledge, diagnosis, and treatment of mitral regurgitation. All of these advances have provided an incentive to change the indication for timing of operations in patients with mitral regurgitation, setting a new paradigm of an early operation before the onset of ventricular dysfunction. In this article we will outline these newer advances and provide recommendations regarding optimal timing of intervention for mitral regurgitation.
Myocardial Bridging: Peran ct dan mri dalam Diagnosis dan Stratifikasi Risiko
Authors: Wicaksono Sony Hilal
Published: September 2018

PendahuluanMyocardial bridging (MB) adalah anomali kongenital arteri koroner yang paling umum ditemukan. MB adalah bila terdapat sebagian segmen dari arteri koroner yang berjalan epikardial mengambil jalur menukik ke dalam miokard sehingga menciptakan jembatan di atas segmen arteri koroner tersebut. Insidens MB berdasarkan temuan studi-studi otopsi, didapatkan angka terendah adalah 15% dan angka tertinggi 85%.1 Arteri koroner yang paling sering mengalami myocardial bridging adalah Left Anterior Descending (LAD), yang berdasarkan studi-studi didapatkan angka terendah 67% dan angka tertinggi 98% pasien.2,3 MB dikategorikan termasuk varian normal arteri koroner, dan sebagian besar kasus tidak menampilkan gejala, namun terdapat kasus yang menjadi masalah. Gejala dan gambaran elektrokardiografi yang ditimbulkan oleh iskemia pada MB tidak spesifik sehingga sulit dibedakan dengan iskemia akibat aterosklerosis arteri koroner.4 MB menyebabkan kompresi segmen arteri sehingga terjadi perubahan hemodinamika yang mengakibatkan iskemia, sehingga dapat tampil dengan gejala dan tanda khas iskemia seperti angina, atau temuan iskemia miokard berdasarkan uji stres, datang dengan sindrom koroner akut, temuan disfungsi ventrikel kiri, aritmia bahkan hingga kematian jantung mendadak.5Kemaknaan klinis MB yang tidak spesifik dan rentangnya luas mulai dari dianggap varian normal hingga dapat fatal menjadikan MB perlu mendapatkan perhatian di awal untuk mendapatkan data diagnosis anatomi MB kemudian stratifikasi risiko sesuai kemaknaan fisiologis.
Evaluasi Alat Pacu Jantung Permanen Dari Elektrokardiogram
Authors: Yuniadi Yoga
Published: September 2018

KasusSeorang pria, 67 tahun datang ke poli jantung di RSU Jambi dengan riwayat pemasangan alat pacu jantung di RSU Bengkulu 6 bulan yang lalu. Tidak terdapat keluhan dan pasien dapat melakukan aktivitas sehari-hari sebagai seorang pensiunan pegawai negri sipil.Rekaman EKG diperlihatkan pada gambar di bawah ini,
Dyslipidemia Aterogenic, antara fakta dan harapan yang akan datang
Authors: Sargowo Djanggan
Published: September 2018

Disregulasi dari metabolisme lipoprotein merupakan inti dari perkembangan aterosklerosis. Suatu studi epidemi prospektif secara konsisten menunjukkan bahwa kenaikan dari Low Density Lipoprotein Cholesterol (LDL-C) dihubungkan dengan peningkatan risiko dari penyakit kardiovaskular, namun hal tersebut mungkin secara terpisah menyebabkan dislipidemia aterogenik, jika bergabung dengan hipertensi, obesitas sentral dan resistensi insulin, yang secara bersamaan dikenal sebagai sindroma metabolik. Dislipidemia aterogenik ditandai dengan tingginya trigliserid (TG) plasma, rendahnya High Density Lipoprotein Cholesterol (HDL-C) dan tingginya konsentrasi apolipoprotein (apo)-B yang berisi lipoprotein, khususnya peningkatan small dense LDL.Hipertrigliserid (HTG) adalah peningkatan kadar trigliserid (TG) puasa di atas normal (> 150 mg/dl). Pada 2010 di Amerika Serikat ada 74,6 juta penduduk mempunyai peningkatan kadar trigliserid, 36,4 juta diantara mereka memiliki kadar triglsierid yang tinggi (200-499 mg/dl), dengan meningkatnya prevalensi ini secara paralel juga terjadi peningkatan yang tajam terhadap kejadian obesitas.1
Metabolic Syndrome : an Emerging Risk Factor for Congestive Heart Failure
Authors: Hoetama Erick , Hermawan Bambang
Published: September 2018

Background : Congestive heart failure (CHF) and metabolic syndrome (MetS) are both current major cardiovascular problems. Until recently, the connection between them has not been well understood yet. Mets is composed by several facets which is closely related with the pathophysiology of CHF. This study will try to discuss the relationship between Mets and CHF.Methods: We conducted an observational analytic study using cross sectional design. Subjects were gathered from January until March 2015. All data are descriptively presented, and analyzed using bivariate and multivariate method.Results: MetS itself does not account as risk factor for CHF (OR 1,49; CI95% 0,67-3,32; p=0,328). Component of Mets which shows significant relationship with CHF are raised blood pressure (OR 6,82; CI95% 1,47-31,53; p=0,014) and impaired glucose tolerance (OR 5,95; CI95% 3,26-10,85; p=0,000)Conclusion: Some elements of Mets, not Mets per se, are strong independent predictor for congestive heart failure.
Extraction of the left ventricular lead crt fracture
Authors: Miranti Isyana , Dewangga Made Satria Yudha , Mahargo Widyo , Utami Sulistiyati Bayu , Yuniadi Yoga
Published: September 2018

In recent years, implantation of cardiac resynchronization therapy (CRT) devices has significantly increased. Left ventricular (LV) pacing through the Coronary Sinus (CS) is the standard approach for CRT. Many LV lead placement techniques to get lead stability and optimal threshold, one with wire PCI. We presented a case with LV lead CRT extraction were broken after being fitted with wire PCI with stabilization purpose and to obtain an appropriate threshold, the extraction was done by snaring techniques.
Double Inlet Left Ventricle (DILV), Double Outlet Left Ventricle (DOLV), Malposition of Great Arteries, Inlet Ventricle Septal Defect (VSD) and Patent Ductus Arteriosus
Authors: Sakasasmita Sylvie , Harimurti Ganesja M , Fakhri Dicky , Venty Venty
Published: September 2018

Congenital heart disease is an interesting area which present a great various arrangement of the cardiac stucture. We present a rare case of 11 months old male with complex congenital heart disease consisted of Double Inlet Left Ventricle (DILV), Double Outlet Left Ventricle (DOLV) with Malposition of Great Arteries, Inlet Ventricle Septal Defect (VSD) and Patent Ductus Arteriosus (PDA).Patient was an eleven months old male who was admitted in our institution for cardiac operation. He was diagnosed with congenital heart disease since three days old with initial presentation of cyanosis when he was crying. His physical growth was retarded but his developmental Milestones was considered normal. On admission, his oxygen saturation was 88% with ambient air. The diagnosis was confirmed by echocardiography. He was planned to undergo staging surgery which would end to Fontan Procedure. Pulmonary Artery (PA) banding was performed to reduce blood flow to pulmonary circulation, distribute more blood from the left ventricle to aorta and systemic circulation and prepare for bidirectional Glenn Shunt procedure one year later and Fontan procedure a year after that.
Metabolism changes and the role of the free radicals on myocardial ischemia
Authors: Sarvasti Dyana
Published: September 2018

Myocardial ischemic results from severe impairment of coronary blood supply and produces a spectrum of clinical syndromes. It results in a characteristic pattern of metabolic and structural changes that leads to extremely complex situations, which have been extensively studied in recent years. A detailed understanding is now available of the complexity of the response of the myocardium to an ischemic insult. Reperfusion is the most effective way to treat the ischaemic myocardial. But, restoration of flow, however, might result in numerous other negative consequences, thus directly influencing the degree of recovery. Much evidence shows that during the period of myocardial ischemia and reperfusion can occur various changes both in terms of metabolic, electrical, histology, structural, and physiological. Pathological changes in the form of metabolic changes and the role of free radicals on the condition of ischemia and reperfusion injury will be discussed. There are several potential manifestations and outcomes associated with myocardial ischemia and reperfusion.
Conotruncal Heart Defects
Authors: Dimiati Herlina , Lubis Silfia Yasmine
Published: September 2018

Conotruncal anomalies comprise a diverse group of congenital heart defects involving the outflow tracts of the heart and the great .They are a leading cause symptomatic cyanotic cardiac disease diagnosed in utero. Conotruncal anomalies can be diagnosed by prenatal echocardiography with a high degree of accuracy. The overall prognosis for fetuses with a conotruncal anomaly is poor
LONG RP TACHYCARDIA: What is the mechanism?
Authors: Yuniadi Yoga
Published: September 2018

Seorang anak perempuan, 11 tahun dikonsulkan ke poli Aritmia dengan keluhan sesak dan berdebar. Rasa berdebar sudah dirasakan sejak lebih dari satu tahun yang lalu. Akhir-akhir ini pasien juga mengeluh sesak dan mudah capek. Pada pemeriksaan fisik didapatkan batas jantung kiri yang membesar dengan fixed wide split bunyi jantung kedua. Tidak terlihat sianosis. Ekokardiografi menunjukkan sebuah atrial septal defek sekundum yang besar dengan diameter 2.5 cm. Pasien mengalami takikardia incessant yang tidak respon dengan beberapa anti-aritmia dengan rekaman EKG 12 sadapan diperlihatkan di bawah ini.Tampak suatu takikardia regular dengan laju 115 kpm. Durasi QRS sempit (110 mdet) dengan morfologi gelombang P di belakang setiap kompleks QRS. Jarak awitan kompleks QRS ke awitan gelombang P
Kontroversi peran studi elektrofisiologi pada sindrom brugada
Authors: Yuniadi Yoga
Published: September 2018

Sindrom Brugada adalah suatu abnormalitas sistem listrik jantung yang merupakan predisposisi terjadinya takikardia ventrikel dan hilang kesadaran. Takikardia ventrikel dapat berhenti spontan dan pasien pulih dari sinkop lalu berobat dengan keluhan sinkop, atau takikardia berdegenerasi menjadi fibrilasi ventrikel (FV)dan menyebabkan kematian jantung mendadak. Oleh karena itu sangat penting mengenal gambaran EKG sindrom Brugada lalu melakukan stratifikasi risiko yang cermat.Salah satu yang menjadi perdebatan hangat adalah stratifikasi risiko sindrom Brugada melalui tindakan studi elektrofisiologi (SEF). Nilai prediktif induksi aritmia ventrikel saat SEF masih kontroversial. Studi yang melibatkan 408 pasien sindrom Brugada tanpa riwayat henti jantung menunjukkan bahwa pasien dengan indusibilitas FV memiliki risiko kematian jantung mendadak karena FV enam kali lipat dalam pengamatan 2 tahun.1 Akan tetapi studi multisenter dari Eropa,2, 3 Jepang4, 5 dan beberapa metaanalisis6, 7 tidak menunjukkan hasil yang positif sehingga indikasi SEF untuk stratifikasi risiko sindrom Brugada hanya IIb pada tahun 2013 (Gambar 1). Metaanalisis8 yang lain memperlihatkan hasil yang positif yaitu ketika presentasi klinis pasien sindrome Brugada dipisahkan antara sinkop dan asimtomatik dalam analisanya.
Role of Mitral Leaflet Separation Index (MLSI) in Determining Mitral Stenosis Severity
Authors: Rina Artha I Made Junior , M Soesanto Amiliana , Sakidjan Indriwanto , M Harimurti Ganesja
Published: September 2018

Objective. To Correlate MLSI with 3-D mitral valve area (MVA) planimetry in determining mitral stenosis (MS) severity.Background. Mitral Stenosis (MS) is still a major problem in cardiology, and causes of morbidity dan mortality worldwide. Echocardiogrphy plays an important role in assessing mitral stenosis severity. Mitral leaflet separation index (MLSI) is one of simple method that can be used in peripheral by using common ultrasound to assess the severity mitral stenosis.Methods. We employed a cross sectional study. Mitral stenosis patients who referred for evaluation echocardiography in National Cardiac Center Harapan Kita from April to September 2011. MLSI was obtained by averaging the maximal leaflet separation distance at the tips in diastole in parasternal long-axis and apical four- chamber views. 3-Dimensional (3-D) mitral valve area (MVA) planimetry as a reference. The only exclusion criteria was severe calcification and poor echo window. Echocardiography examination using Philips E33i.Results. Seventy six consecutive patients were enrolled, 5 subjects were excluded from study because of severe calcification and poor echo window. Proportion of woman is 73.2 % and mostly in age group < 40 years old (43.7 %). Severe mitral stenosis was dominate the subject, 47 subject (66.2 %), moderate was 19 subject (26.8 %), and mild only 5 subjects (7.0 %). Analysis with Spearman correlations obtained a good correlation with r = 0.70, p < 0.001, good correlation was found in sinus rhythm with r = 0.78, p < 0.001 and atrial fibrillation with r = 0.79, p < 0.001. MLSI less than 0.69 cm predicted severe MS with 85 % sensitivity and 82.4 % specificity.Conclusions. Mitral leaflet separation index (MLSI) has a good correlation with 3-D MVA planimetry. MLSI less than 0.69 cm can estimate severe SM.
Coronary Artery Fistula, an Unusual Cause of Chest Pain in Adult : Role of Computed Tomography Angiography
Authors: Almazini Prima , Rahman Andy , Yaniarti Dian , Sahara Elen , Anantaria Celly , Kasim Manoefris
Published: September 2018

Coronary artery fistula, usually congenital in origin, is an abnormal communication between a coronary artery and a cardiac chamber or great vessel. A coronary artery fistula can produce myocardial ischemia from coronary steal phenomenon. First case, a 54-year-old man was found to have a fistula from the left anterior descending coronary artery and right coronary artery to the main pulmonary artery, a rare anomaly. This patient developed chest pain due to myocardial ischemia in the left anterior descending coronary artery distribution for several months before evaluation. The patient was suggested to close the fistula but rejected. Second case, a-57 year-old woman was found to have fistula from left anterior descending coronary artery to main pulmonary artery. Patient presented with chest pain since 6 years ago. The patient was planned to close the fistula transcutaneously. Coronary artery fistulas, though rare, should be considered in the differential diagnosis when an adult patient presents with chest pain. Although coronary angiography is the gold standar diagnostic test for detection of coronary artery fistula, computed tomography angiography may be an alternative test through its good spatial resolution.
Parameter Pengukuran Ventrikel Kiri menggunakan Ekokardiografi Bagian 2
Authors: Suryo Ario
Published: September 2018

1. Fungsi regional ventrikel kiriModel pembagian segmen Vki digunakan dalam praktek klinis sehari-hari. Model pembagian menjadi 17 segmen direkomendasikan untuk menilai perfuso miokardial dengan menggunakan ekokardiografi dan teknik atau modalitas pencitraan lainnya . ( PET Scan atau Cardiac MRI). Model ini dapat dilihat pada gambar 4Model 16 segmen direkomendasikan dipakai secara rutin untuk menilai gerakan dinding Vki karena gerakan endokardial dan penebalan pada bagian apeks Vki sulit untuk bisa dideteksi. Untuk menilai gerakan dinding ini , setiap segmen sebaiknya di dievaluasi menggunakan berbagai pandangan dan 4 tingkatan penilaian digunakan yaitu (1) normal atau hiperkinetik, (2) hipokinetik, (3) akinetik (tidak adanya penebalan miokard atau penebalan minimal), dan diskinetik (penipisan saat sistolik atau penipisan).
Apolipoproten B, LDL Cholesterol and apoB/apoA-I Ratio in Patients With Stable Angina
Authors: Handayani Olivia , Sargowo Djanggan
Published: September 2018

Aim: To acknowledge the nature of correlation between apolipoprotein B concentrations and LDL cholesterol levels in patients with stable angina pectoris and also to show that the ratio of apoB/apoA-I may be a promising predictor for the risk of cardiovascular disease.Methods: This is an observational study with cross-sectional approach of 34 patients with stable angina pectoris. Prior to the study, patients were advised to fast for 10-12 hours and must complete the informed consent. Patients underwent physical examination and anthropometric measurements (height, body weight, waist circumference), blood test, and ECG check.Results: From 34 patients, the prevalence of high levels of total cholesterol (>200 mg/dl) in men and women are 45.5% and 47.8%, respectively; and 90.9% men and 87% women with increased LDL-C (?100 mg/dl). Low value of apoA-I was determined in 5 men (45.5%) and 4 women (17.4%); and high value of apoB was found in 7 men (63.6%) and 11 women (47.8%), whereas 13 subjects with unfavorable apoB/apoA-I ratio. Six subjects had low levels of apoA-I along with high levels of apoB. ApoB/apoA-I ratio above 0.9 was found in 6 or 11 men (54.5%) and 7 of 23 women (30.4%).Conclusion: We found that in 34 patients with stable angina, 18 of them (52.9%) showed high plasma apoB concentration. This is parallel to 30 subjects (88.2%) with high LDL cholesterol levels, and also 13 subjects (38.2%) with high apoB/apoA-I ratio. It can be concluded the higher the ratio of apoB to apoA-I, the greater the risk of cardiovascular disease. Lifestyle management and pharmacological intervention in dyslipidemia is important in reduction of cardiovascular events.
Higher Plasma Glucose Level In Hypertensive Patient With Angiotensin Converting Enzyme Gene Deletion Of Intron 16
Authors: Yunita Lowry , Rohman Mohammad Saifur , Kuncahyo Bagus H , Lukitasari Mifetika , Madjidi Arina , Faizah Maulidiyatun Nuril , Widodo Nashi
Published: September 2018

Background Renin Angiotensin Aldosteron System plays major role in hypertension pathophysiology. Has been proposed that half of individuals with essential hypertension are considered insulin resistant. Angiotensin Converting Enzyme gene polymorphism taking the control of ACE level in human plasma. There might be a correlation between ACE gene polymorphism and plasma glucose level.Objective This study sought to investigate ACE gene polymorphism insertion/deletion in hypertensive patients and its correlation with plasma glucose level.Method A total of 100 hypertensive patients at Saiful Anwar cardiovascular outpatients clinic who received ACEi at least 8 weeks were included. ACE genotype were determined by polymerase chain reaction method, and plasma glucose level was measured by enzymatic colorimetric assay method.Result The II, ID, and DD genotype were observed in 48%, 29% and 23% of participant, respectively. The fasting and 2 hours post prandial plasma glucose were significantly higher in DD genotype patients. The insertion/deletion polymorphisms were not related significantly to age, sex, cough, and controlled blood pressure of those patients.Conclusion This study showed that 23% of hypertensive patients had DD genotype with higher plasma glucose level as compare to those of II and ID genotype.
Ruptured Aneurysm of Sinus of Valsalva Into the Right Ventricle: The Role of Echocardiography
Authors: A Primawati , L Krisdinarti , H Mumpuni
Published: September 2018

1% of the incidence of congenital cardiac anomalies. The most frequent complication is rupture into the right ventricle, causing a shunt from left to right or aortic valve insufficiency with congestive heart failure requiring immediate surgical management. Echocardiography is a diagnostic modality that can be used to help diagnose the presence of sinus Valsalva aneurysm and complications.Clinical case: A 35 years old man with complaints dating dyspnoea on exertion and swelling in both legs. Cardiac auscultation obtained their continuous noisy grade III / VI in the lower left sternal border. Electrocardiography showed sinus tachycardia tachycardia with right axis deviation, right ventricular hypertrophy, and ventricular extrasystoles. Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) shows an overview of the sinus of Valsalva aneurysm rupture to the right of the right ventricle.Discussion: When on the clinical findings led to the suspicion rupur sinus of Valsalva aneurysm, the evaluation can be performed using TTE, TEE, Magnetic Resonance Imaging (MRI), maupunkateterisasi heart. Gold standard diagnosis of ruptured sinus Valsalva aneurysm is a cardiac catheterization, but with the advancement of a new generation of engines echocardiography, TTE and TEE has played an important role in the diagnostic confirmation of sinus of Valsalva aneurysm rupture.Conclusion: Echocardiography is the diagnostic modality that is quite helpful in making the diagnosis, complications and surgical therapeutic options in cases of ruptured sinus of Valsalva aneurysm.
Leadless Cardiac Pacemakers: Where are we?
Authors: Sudharsono Albert , Hanafy Dicky A. , Yuniadi Yoga
Published: September 2018

The development of health technology benefits in the treatment of heart rhythm abnormalities. Cardiac pacemakers with nonsurgical methods plays a critical role in the management of patients with heart rhythms disorders. The discovery of a leadless pacemaker provides many benefits compared to conventional pacemaker where the device can be implanted by transcatheter delivery. Various studies have been done and still continued to monitor the efficacy and safety of this device. In principle, Indonesia is ready to participate in the advance technology of leadless pacemaker. National Health Covarage policy will play an important role in this new technology in the future.
Pemeriksaan Ekokardiografi Fungsi Diastolik Ventrikel Kiri: Apa yang baru dari Rekomendasi ASE dan EACVI 2016? (Bagian 1)
Authors: Rukdityo Estu , Soesanto Amiliana M
Published: September 2018

Pemeriksaan fungsi diastolik ventrikel kiri merupakan bagian tidak terpisahkan pada setiap pemeriksaan ekokardiografi rutin. Gangguan fungsi diastolik yang dinilai melalui pemeriksaan ekokardiografi merupakan salah satu kriteria diagnosis gagal jantung dengan fraksi ejeksi normal (heart failure with preserved ejection fraction, HFpEF).1 ASE (American Society of Echocardiography) dan EACVI [European Association of Cardiovascular Imaging]) telah mengeluarkan panduan pemeriksaan ekokardiografi fungsi diastolik ventrikel kiri pada tahun 2009.2 Sayangnya panduan tersebut terlalu banyak menggunakan parameter fungsi diastolik sehingga agak sulit diaplikasikan pada pemeriksaan rutin ekokardiografi sehari-hari. Panduan tersebut juga tidak memuat konsensus yang jelas untuk menentukan derajat disfungsi diastolik bila terdapat ketidaksesuaian hasil antara berbagai parameter yang ada.
Jurnal Kardiologi Indonesia: Kini dan Yang Akan Datang
Authors: Raharjo Sunu Budhi
Published: September 2018

Pada suatu hari, sehabis visit pasien ruangan, saya dipanggil Ketua Pengurus Pusat PERKI (Dr. Ismoyo Sunu) ke ruangan beliau. Seperti biasa, ketika seorang junior dipanggil oleh seorang senior, biasanya akan ada tugas baru yang menanti. Benar saja, beliau meminta saya untuk mengelola Jurnal Kardiologi Indonesia (JKI). Saat itu saya berpikir bahwa beliau hanya bercanda karena Editor-in-Chief JKI yang sebelumnya adalah orang-orang hebat yang sungguh saya hormati (Dr. Faisal Baraas, Dr. M. Munawar, Dr. Anna Ulfah R., dan Dr. Yoga Yuniadi). Saya sampaikan bahwa saya berkeberatan. Namun pada beberapa kesempatan berikutnya, beliau tetap meminta saya untuk mengelola JKI sehingga saya goyah. Dialog pun mulai kami lakukan.