Indonesian Journal of Cardiology
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Break the chain of COVID-19 transmission: Perspective from a cardiologist-in-practice
Get PDFIndonesia is currently suffering through a pandemic outbreak of severe respiratory syndrome coronavirus 2 (SARS-CoV-2) known as Coronavirus Disease 2019 (COVID-19). Every day this infection raises double, health community is fighting COVID-19 with their armamentarium and policy. Indonesian Heart Association (IHA) has already issued the statement about cardiovascular services during the outbreak of COVID-19. The policy is rescheduling non urgent outpatient visits as necessary, social distancing strategy in outpatient clinic and using personal protective equipment (PPE) in outpatient clinic or during the cardiac examination (echocardiography, cardiac CT, electrophysiology and invasive cardiology). Most of international recommendations have recommended social distancing and reschedule non urgent visits. This document gives a general information about the prevention of COVID-19 in cardiology department
Pengaruh Gender Dan Manifestasi Kardiovaskular Pada COVID-19
Get PDFCardiovascular manifestations, in the form of myocardial injury, can occur in patients infected with COVID-19. Data collected from various COVID-19 pandemic case reports indicated that male patients experience myocardial injury more frequently than females. However, not any definitive mechanism has been found yet that underlies susceptibility to myocardial injury due to infection with SARS-CoV-2 attributable to gender differences. Some theories propose are differences in the number of X chromosomes, the influence of sex hormones, and differences in immune reactions between males and females. A further comprehensive research needs to be done on the mechanism of cardiovascular manifestations and the effect of gender on COVID-19 disease.
Keywords: Gender, cardiovascular manifestation, myocardial injury, COVID-19.Manifestasi kardiovaskular berupa injuri miokard, dapat timbul pada pasien yang terinfeksi COVID-19. Data yang dikumpulkan dari berbagai laporan kasus pandemi COVID-19 menunjukkan bahwa laki-laki lebih sering mengalami injuri miokard dibandingkan perempuan. Hingga saat ini belum ditemukan mekanisme pasti yang mendasari kerentanan untuk mengalami injuri miokard akibat terinfeksi SARS-CoV-2 karena perbedaan gender. Beberapa teori yang diajukan adalah perbedaan jumlah kromosom X, pengaruh hormon seks dan perbedaan reaksi imun antara laki-laki dan perempuan. Perlu dilakukan penelitian lanjutan yang lebih mendalam tentang mekanisme manifestasi kardiovaskular dan pengaruh gender pada penyakit COVID-19.
Kata kunci: Gender, manifestasi kardiovaskular, injuri miokard, COVID-19
Tantangan Penatalaksanaan STEMI di Pandemi Covid-19
Get PDFThe necessity of timely management of ST-elevation myocardial infarction (STEMI) is now disrupted by the Covid-19 pandemic. This paper discussed the challenge to manage STEMI in Indonesia due to Covid-19. It also discussed the alternative strategies for solution. Challenge can occur in term of the healthcare safety as well as STEMI patient safety. Healthcare safety potentially impaired by the problem of STEMI mimicry due to cardiovascular complication of Covid-10, inaccuracy of Covid-19 screening, lack of effective personal protection equipment for the healthcare and appropriate catheterisation laboratory to anticipate virus contamination. The safety of STEMI patient is potentially impaired due to prolonged ischemia time, and the risk of cross-infection. Solution for this challenge should include mass screening, rapid and accurate test to rule-out Covid-19, dual system of hospital units - Covid and non-Covid, and algorithm for triage patients with STEMI and Covid-19
Young Investigators Award Session
Get PDFAbstracts of the 29th Annual Scientific Meeting of the Indonesian Heart Association (ASMIHA)
1st ASMIHA Digital Conference, 23-25 October 202
Nilai Diagnostik Tebal Lemak Epikardial dalam Mendeteksi Lesi Koroner pada Pasien Angina Pektoris Stabil
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Background: Abdominal visceral adiposity is a risk factor of cardiovascular diseases. It correlates with increasing level of pro-inflammatory adipokines and cytokines which can induce endothelial dysfunction. Epicardial adipose tissue is considered as true visceral adiposity of the heart. Epicardial adipose tissue have pivotal role than other visceral adiposity because of adjacency to the heart and coronary vessels. This study was aimed to measure the cut off point of epicardial fat thickness as a diagnostic marker for the presence of coronary lesion.
Methods: This was an observational analytic study with crossectional comparative design. Data was retrieved prospectively at the Heart Center Dr. M. Djamil Padang from August 2019 to February 2020 in stable angina pectoris patients who underwent coronary angiography. The Epicardial Fat Thickness (EFT) was measured at end-diastole from the Parasternal long axis (PLAX) views of three cardiac cycles on the free wall of the right ventricle on echocardiography examination. Bivariate analysis was used to assess epicardial fat thickness and presence of the coronary lesions using Independent Sample T test. A diagnostic test was performed based on receiver operating curve (ROC) analysis.
Results: Patients were diagnosed as CAD group group (n =150; 58,11 ± 8,24 years) and non-CAD group (n = 50; 53,16 ± 9,78 years) based on coronary angiogram result. Epicardial fat thickness was higher in subjects with coronary lesions (3,62 ± 1,03 mm) compared with subjects without coronary lesions (1,55 ± 1,10 mm) with p <0.001. Epicardial fat thickness ≥ 2.835 mm predict the presence of coronary lesion by 82% sensitivity, 86% specificity and 88.9% accuracy based on the AUC value.
Conclusions: Abnormal epicardial fat thickness ≥ 2.835 mm can be a good diagnostic marker to detect the presence of coronary lesion. Latar Belakang: Penumpukan lemak viseral merupakan faktor resiko terjadinya penyakit kardiovaskular. Deposit berlebih ini menyebabkan peningkatan produksi sitokin pro-inflamasi oleh sel lemak viseral, yang akan menginduksi terjadinya disfungsi endotel. Jaringan lemak epikardial saat ini dianggap sebagai depot jaringan lemak viseral jantung. Penelitian ini bertujuan untuk mengetahui nilai titik potong lemak epikardial abnormal yang dapat digunakan untuk menilai ada atau tidaknya lesi koroner.
Metode Penelitian: Penelitian ini adalah penelitian observasional analitik dengan menggunakan desain crossectional comparative. Data diambil secara prospektif pada Instalasi Pelayanan Jantung RSUP. Dr. M. Djamil Padang dari bulan Agustus 2019 sampai Februari 2020 dengan inklusi pasien angina pektoris stabil yang menjalani angiografi koroner. Tebal lemak epikardial (TLE) diukur sebanyak tiga siklus jantung saat fase akhir diastolik pada potongan parasternal long axis (PLAX) di dinding luar ventikel kanan. Dilakukan analisis bivariat pada variabel tebal lemak epikardial terhadap lesi koroner dengan Independent Sample T test, setelah itu dilakukan uji diagnostik berdasarkan analisis receiver operating curve (ROC).
Hasil Penelitian: Pasien didiagnosis sebagai subyek dengan lesi koroner (n =150; 58,11 ± 8,24 years) dan tanpa lesi koroner (n = 50; 53,16 ± 9,78 tahun) bedasarkan hasil angiografi koroner. Tebal lemak epikardial lebih tinggi pada subjek dengan lesi koroner (3,62 ± 1,03 mm) dibandingkan dengan subjek tanpa lesi koroner (1,55 ± 1,10 mm) dengan p<0,001. Nilai potong lintang tebal lemak epikardial pada penelitian ini adalah 2.835 mm dalam mendeteksi lesi koroner, dengan kemampuan prediksi dalam kategori baik (sensitivitas 82%, spesifisitas 86%, dan akurasi 88.9%) berdasarkan nilai AUC.
Kesimpulan: Tebal lemak epikardial lebih dari 2.835 mm memiliki kekuatan diagnostik yang baik dalam menentukan ada atau tidak lesi koroner
Olahraga Rutin Untuk Meningkatkan Imunitas Pasien Hipertensi Selama Masa Pandemi COVID-19
Get PDFHipertensi merupakan salah satu komorbid yang paling banyak ditemukan pada Coronavirus disease-19 (COVID-19) dan berasosiasi dengan prognostik buruk dari infeksi tersebut. Olahraga rutin ternyata dapat meningkatkan imunitas tubuh, sehingga dapat berperan dalam pencegahan infeksi COVID-19 selain efeknya terhadap penurunan tekanan darah. Olahraga tipe aerobik dengan intensitas sedang 30-60 menit, dengan cara tetap melakukan pembatasan jarak, ataupun dengan teknik home exercise dan virtual dengan daring, dapat dilakukan oleh penderita hipertensi dalam meningkatkan imunitas selama masa pandemi COVID-19
Menulis Pandemi
Get PDFDunia saat ini menghadapi situasi yang tidak pernah terjadi sebelumnya dalam sejarah manusia: pandemi Covid-19 (Gambar). Pengetahuan manusia mengenai penyakit Covid-19 secara pesat berkembang sejak laporan kasus awal dari Wuhan.1 Secara pesat, banyak laporan kasus, seri kasus, kohor dan belakangan studi mengenai Covid-19 dan tatalaksananya dilaporkan di berbagai jurnal. Beberapa jurnal esensial, seperti NEJM dan Lancet, bahkan menerbitkan isu khusus mengenai Covid-19. Pengetahuan tentang Covid-19 secara mayor boleh dikatakan berasal dari tiga klaster kohor epidemi; yaitu di China (terutama Wuhan), Italia, dan Amerika Serikat. Beberapa klaster lainnya, seperti dari Korea Selatan dan Jerman, melaporkan keberhasilan meredam perluasan epidemi
Review Articles
Get PDFAbstracts of the 12th Indonesian Society of Interventional Cardiology Annual Meeting (ISICAM) 2020
27-29 November 202
COVID 19 with Cardiac Injury Complication, A case Report
Get PDFBackground : The Corona virus Disease COVID-19 have been independently associated with the cause of pneumonia and acute respiratory distress syndrome with high risk of mortality. Mounting evidence substantiates the presence of cardiac injury in patients with COVID-19. Although a recent study reported that 12% of patients had COVID-19 associated acute cardiac injury.
Case presentation : A 38 year old male was admitted with pneumonia and cardiac symptoms. He was genetically confirmed as COVID-19 by swab PCR testing, 1 week after admission. He also had elevated CKMB and Hs troponin T level, high Ferritin level, CRP, lymphopenia, and a slight increase in N/L ratio. Chest radiography showed bilateral pneumonia. The patient was confirmed to the diagnosis of Myocardial injury. After receiving tocilizumab and immunoglobulin, his condition improved gradually with the declining laboratory inflammation marker, but there was a secondary infection with an increased of leucocyte and worsen chest radiography, escalating antibiotic and metilprednisolon was given, the patient gradually improving.
Conclusion : COVID-19 patients may develop cardiac complication such as cardiac injury or myocarditis, and this is our first case of COVID-19 infection complicated with cardiac injury.Background : The Corona virus Disease COVID-19 have been independently associated with the cause of pneumonia and acute respiratory distress syndrome with high risk of mortality. Mounting evidence substantiates the presence of cardiac injury in patients with COVID-19. Although a recent study reported that 12% of patients had COVID-19 associated acute cardiac injury.
Case presentation : A 38 year old male was admitted with pneumonia and cardiac symptoms. He was genetically confirmed as COVID-19 by swab PCR testing, 1 week after admission. He also had elevated CKMB and Hs troponin T level, high Ferritin level, CRP, lymphopenia, and a slight increase in N/L ratio. Chest radiography showed bilateral pneumonia. The patient was confirmed to the diagnosis of Myocardial injury. After receiving tocilizumab and immunoglobulin, his condition improved gradually with the declining laboratory inflammation marker, but there was a secondary infection with an increased of leucocyte and worsen chest radiography, escalating antibiotic and metilprednisolon was given, the patient gradually improving.
Conclusion : COVID-19 patients may develop cardiac complication such as cardiac injury or myocarditis, and this is our first case of COVID-19 infection complicated with cardiac injury
Colchicine as an Adjuvant Therapy for Coronary Artery Disease: A Systematic Review
Get PDFBackground:Inflammation plays a significant role in atherosclerosis at all phases. Colchicine is a pleiotropic anti-inflammatory agent that may be beneficial in various stages of coronary artery disease (CAD).
Methods:We searched for literatures in PubMed, Cochrane Library, ScienceDirect, and Proquest regarding the use of colchicine on top of current optimal medical therapy for CAD.
Results: Twelve studies were identified: three studies in stable CAD patients and the remaining nine assessed in acute coronary syndrome (ACS) and post-ACS patients. The majority of studies used a colchicine dose of 0.5 mg/day. Adjuvant colchicine of 0.5 mg daily reduced the risk of developing ACS, cardiac arrest, or ischemic stroke in stable CAD: HR (hazard risk) 0.33 (95% CI 0.18-0.59), p<0.001. Patients admitted with ACS who received a 2 mg loading dose of colchicine pre-percutaneous coronary intervention (PCI) showed smaller infarct size than control: 18.3 (IQR 7.6-29.9) ml/1.73 m2vs 23.2 (18.5-33.4) ml/1.73 m2(p=0.019).In post-ACS patients, adjuvant colchicine of 0.5 mg daily significantly reduced the rate of ischemic cardiovascular events: HR 0.77 (95% CI 0.61-0.96), p=0.02.
Conclusion: Stable CAD patients benefit from 0.5 mg daily dose of adjuvant colchicine to reduce the incidence of future cardiovascular events. For patients presenting with ACS, a loading dose of 2 mg of colchicine pre-PCI followed by a week of 0.5 mg colchicine twice daily on top of optimal medical care can reduce infarct size. This should be followed by consumption of 0.5 mg daily dose of adjuvant colchicine post-ACS for at least 20 months to prevent future reinfarctions