Indonesian Journal of Cardiology
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Sadapan Lewis: Mengungkap Gelombang P yang Tersembunyi
No full textBackground. The Lewis lead configuration can help to detect atrial activity and its relationship to ventricular activity, so diagnosis can be achieved more accurately. With Lewis lead ECG, it will make easier to make a diagnosis, especially in identifying electrical activity in the atrium.
Case Illustration. Case 1. A 61-year-old male with decreased consciousness et causa metabolic. From a standard 12-lead ECG, the P waves are difficult to identify, and at first glance it looks like atrial fibrillation. From the Lewis ECG in lead I, it appears that the QRS wave is always preceded by a P wave, with different morphologies (more than 3 forms), that showed as multifocal atrial tachycardia (MAT) with a heart rate of 120 beats / minute. Case 2. The 58-year-old male patient complained of typical ischemic chest pain and palpitations. A standard 12 lead ECG examination revealed a rhythmic tachycardia with a wide QRS wave at a rate of 210 beats / minute. From the Lewis ECG in lead I, we can see that the P waves that appear are not always followed by QRS. Thus, it can be seen that the AV dissociation is a VT so that VT management can be done immediately. Case 3. A 65-year-old male patient diagnosed with grade 5 CKD on dialysis. From a standard 12 lead ECG examination, a wide QRS wave with a P wave is obtained which is sometimes seen behind the QRS wave, making the diagnosis difficult to establish. From the Lewis ECG in lead I, it appears that the P wave always appears at the end of the QRS wave, so it can be seen that the rhythm from the ECG is derived from accelerated idioventricular rhythm with ventriculoatrial conduction.
Conclusion. The accuracy of ECG interpretation is needed to determine the next treatment for the patient. Through the ECG examination with the Lewis lead method, the cardiac electrical activity will be more visible, so it will be very helpful in the interpretation of the ECG in cases that are not clear on the standard 12 lead ECG examination
Original Research Abstracts
Get PDFIndonesian Society of Interventional Cardiology Annual Meeting 2021
Abstracts: Original Research Abstract
Research Articles
Get PDFThe 5th Indonesian Intensive and Acute Cardiovascular Care Meeting
Abstracts: Original Research Abstrac
Case Reports
Get PDF9th Annual Scientific Meeting of the Indonesian Heart Rhythm Society 2022
Abstracts: Case Report
Reviews
No full text9th Annual Scientific Meeting of the Indonesian Heart Rhythm Society 2022
Abstracts: Reviews
 
Reviews
Get PDFAbstracts of the 31st Annual Scientific Meeting of the Indonesian Heart Association (ASMIHA) 202
Hemodynamic and Clinical Outcomes of Milrinone Compared to Dobutamine in Cardiogenic Shock: A-Systematic Review and Meta-Analysis
Get PDFBackground
Despite years of clinical experience with the two most commonly used inotropes i.e dobutamine and milrinone, in the cardiogenic shock setting, there is a lack of head-to-head comparison between inotropes in cardiogenic shock. We conducted a systematic review and meta-analysis on the comparison of hemodynamic and clinical effects of dobutamine and milrinone in cardiogenic shock.
Methods
A comprehensive literature search using PubMed and Scopus was performed. Among 40 studies retrieved from the database, 3 studies were included for hemodynamic comparison outcome and 2 studies for clinical outcomes.
Results
Three studies with 101 patients were included for hemodynamic analysis and two studies with 146 patients for clinical analysis. We observed no significant difference between cardiac index, pulmonary capillary wedge pressure, and mean arterial pressure at 1 hour after milrinone and dobutamine administration. However, there is significantly lower mPAP after milrinone infusion compared to dobutamine (mean difference -8,7 (-9,97 to -7,43) mmHg, p<0,01). We also observed no significant difference in in-hospital mortality but significantly shorter ICU length of stay in the milrinone group (mean difference -1 (-1,92 to -0,08) days).
Conclusion
Administration of milrinone resulted in lower PA pressure and shorter ICU LOS compared to dobutamine in patients with cardiogenic shock.
This article has a related Erratum
inggris
Get PDFBackground
Zwolle, TIMI, and GRACE risk scores have been proven to predict mayor adverse cardiovascular events (MACE) in STEMI patients undergoing primary percutaneous coronary intervention (PCI). However, they were developed over a long time ago which many advances have been made in the cardiovascular field today. The scores were also developed in the non-Asian majority population and their accuracy for Indonesian population remains unknown. We aimed to validate and compare these scores for Indonesian population.
Methods
An analytical observational study was conducted on 193 patients undergoing primary PCI. The Zwolle, GRACE, and TIMI risk scores were calculated for each patient. Then, the risk score validation was carried out with the calibration test using Hosmer Lemeshow test and discrimination test using the AUC ROC. Furthermore, the comparisons between the risk scores were carried out using the DeLong test.
Results
The three scores have good results in the Hosmer Lemeshow calibration test (p > 0.05). The discrimination test also indicated good results with AUC ROC Zwolle, TIMI and GRACE risk scores respectively 0.776; 0.782; 0.831 (p<0.05). There was no significant difference in the prediction accuracy of the three risk scores in the DeLong test.
Conclusions
The Zwolle, TIMI, and GRACE risk scores had good validity for predicting major adverse cardiovascular events in STEMI patients undergoing primary PCI. There was no significant difference in the prediction accuracy of the three risk scores.
This article has a related Erratum
Management of Decongestion in Acute Heart Failure: Time for a New Approach?
Get PDFAs the primary cause of hospitalization in acute heart failure (AHF) patients, congestion was responsible for a higher risk of mortality, rehospitalization, and renal dysfunction in AHF patients. Although loop diuretic was routinely used as the mainstay of AHF therapy, it is still ineffective to obtain the euvolemic state in most hospitalized AHF patients. Therefore, a higher loop diuretic dose was often required to increase the decongestion effect. However, consequently, it can cause several detrimental complications, including renal dysfunction, neurohormonal activation, hyponatremia, hypokalaemia, and reduced blood pressure, which eventually result in poor prognosis. Hence, the new approach may be proposed to optimize decongestion in acute phase, including the use of arginine vasopressin V2 receptor antagonist – Tolvaptan. As an additive therapy to loop diuretic in AHF patients, it can be considered due to its several beneficial effects, including greater decongestion effect, lowered worsening renal function incidence, counteract neurohormonal activation, neutralized hyponatraemic state, no alteration of potassium metabolism, stabilize the blood pressure, and reduced requirement of a higher dose of loop diuretic to achieve an equal or even greater decongestion effect compared to a high dose of loop diuretic alone. Tolvaptan provided favourable outcomes in several specific populations and was considered safe with several mild adverse effects. Several guidelines across countries have approved the use of Tolvaptan in AHF patients with or without hyponatremia. The initial dose of Tolvaptan was 7.5 to 15 mg and can be titrated up to 30 mg. However, further studies were still required to determine the timing dose and optimal dose of Tolvaptan in general and elderly populations with AHF, respectively.This article has a related Erratum
Management of Acute Coronary Syndrome Indonesia : Insight from One ACS Multicenter Registry
Get PDFBackground
Acute coronary syndrome (ACS) is a life-threatening disorder which contributes to high morbidity and mortality in the world. Registry of ACS offers a great guidance for improvement and research. We collated a multicentre registry to gain information about demographic, management, and outcomes of ACS in Indonesia.
Methods
IndONEsia Acute Coronary Syndrome Registry (One ACS Registry) was a prospective nationwide multicenter registry with 14 hospitals participating in submitting data of ACS via standardized electronic case report form (eCRF). Between July 2018 and June 2019, 7634 patients with ACS were registered. This registry recorded baseline characteristics; onset, awareness, and transfer time; physical examination and additional test; diagnosis; in-hospital medications and intervention; complications; and in-hospital outcomes.
Results
Nearly half of patients (48.8%) were diagnosed with STE-ACS. Most prevalent risk factors were male gender, smoking, hypertension. Patients with NSTE-ACS tended to have more concomitant diseases including diabetes mellitus, dyslipidemia, prior AMI, HF, PCI, and CABG. Majority of ACS patients in our registry (89.4%) were funded by national health coverage. Antiplatelet, anticoagulant, antihypertensive, and statins were prescribed as 24-hours therapy and discharge therapy; however presription of potent P2Y12 inhibitor was low. More STE-ACS patients underwent reperfusion therapy than non-reperfusion (65.2% vs. 34.8%), and primary PCI was the most common method (45.7%). Only 21.8% STE-ACS patients underwent reperfusion strategy within 0-3 hours of onset. Invasive strategy performed in 17.6% of NSTE-ACS patients, and only 6.7% performed early (within <24 hours). Patients underwent early invasive strategy had a shorter median LoS than late invasive strategy (P<0.001). A shorter median LoS also found in intermediate and low risk patients. Mortality rate in our ACS patients was 8.9%; STE-ACS patients showed higher mortality than NSTE-ACS (11.7 vs. 6.2%).
Conclusion
Our registry showed a comparable proportion between STE- and NSTE-ACS patients, with male gender predominant in middle age. Both STE- and NSTE-ACS sharing the same risk factors. We need an improvement in referral time, especially in patients with STE-ACS. Evidence from our registry showed that there are two issues that need to be addressed in order to improve ACS outcomes: optimal and adequate medical treatment and invasive strategy.
This article has a related Erratum.Background
Acute coronary syndrome (ACS) is a life-threatening disorder which contributes to high morbidity and mortality in the world. Registry of ACS offers a great guidance for improvement and research. We collated a multicentre registry to gain information about demographic, management, and outcomes of ACS in Indonesia.
Methods
IndONEsia Acute Coronary Syndrome Registry (One ACS Registry) was a prospective nationwide multicenter registry with 14 hospitals participating in submitting data of ACS via standardized electronic case report form (eCRF). Between July 2018 and June 2019, 7634 patients with ACS were registered. This registry recorded baseline characteristics; onset, awareness, and transfer time; physical examination and additional test; diagnosis; in-hospital medications and intervention; complications; and in-hospital outcomes.
Results
Nearly half of patients (48.8%) were diagnosed with STE-ACS. Most prevalent risk factors were male gender, smoking, hypertension. Patients with NSTE-ACS tended to have more concomitant diseases including diabetes mellitus, dyslipidemia, prior AMI, HF, PCI, and CABG. Majority of ACS patients in our registry (89.4%) were funded by national health coverage. Antiplatelet, anticoagulant, antihypertensive, and statins were prescribed as 24-hours therapy and discharge therapy; however presription of potent P2Y12 inhibitor was low. More STE-ACS patients underwent reperfusion therapy than non-reperfusion (65.2% vs. 34.8%), and primary PCI was the most common method (45.7%). Only 21.8% STE-ACS patients underwent reperfusion strategy within 0-3 hours of onset. Invasive strategy performed in 17.6% of NSTE-ACS patients, and only 6.7% performed early (within <24 hours). Patients underwent early invasive strategy had a shorter median LoS than late invasive strategy (P<0.001). A shorter median LoS also found in intermediate and low risk patients. Mortality rate in our ACS patients was 8.9%; STE-ACS patients showed higher mortality than NSTE-ACS (11.7 vs. 6.2%).
Conclusion
Our registry showed a comparable proportion between STE- and NSTE-ACS patients, with male gender predominant in middle age. Both STE- and NSTE-ACS sharing the same risk factors. We need an improvement in referral time, especially in patients with STE-ACS. Evidence from our registry showed that there are two issues that need to be addressed in order to improve ACS outcomes: optimal and adequate medical treatment and invasive strategy