Indonesian Journal of Cardiology
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Modifiable Survival Factors of Out-of-Hospital Cardiac Arrest among Global Population: Systematic Review and Meta-Analysis
Get PDFOut-of-hospital cardiac arrest (OHCA) is the most common type of cardiac arrest and causing much mortality and burden even preventive measure has been made. Therefore, we conducted study to reduce OHCA morbidity and mortality by finding modifiable survival factors in-order to interfere them. We did systematic review of large cohort studies (n>100,000) on general population from four databases, then filtered 3,560 studies into 9 studies and appraised them using Newcastle-Ottawa scale for quality and Cochrane risk-of-bias before being synthesized. Among 486,012 subjects, we found out that age and shockable rhythm is unmodifiable but could be helped with lifestyle. Modifiable factors are grouped into two: bystander response including public location (OR=1.24; CI 95%=1.16–1.32), bystander witness (OR=1.45; CI 95%=1.36–1.56), bystander CPR (OR=1.45; CI 95%=1.36–1.56); and emergency service delivery including paramedic response <10 minutes (OR=1.55; CI 95%=1.41–1.70), ambulance physician (OR=1.52; CI 95%=1.37–1.68). Having OHCA in public means bigger chance of being resuscitated. However, resuscitation by uneducated bystander shown harmful thus public education was needed. Emergency services were considered important to arrive with competent workers, especially physicians who was trained on defibrillator usage and management regiment. Therefore, increasing public awareness, provide more ambulance and district health center facility, and training of health care workers are essential. In conclusion, management of OHCA involved multidisciplinary action throughout the nation to increase outcome of OHCA and lessen the burden. More area-specified and factor-specified studies should be conducted to improve applicability
Recent Echocardiography Parameters for Predicting Better Functional Result after Mitral Valve Correction Surgery in Patients with Primary Mitral Regurgitation
Get PDFAbstract
Objectives We analyzed whether some echocardiographic parameters are good predictors of functional result after mitral valve correction surgery.
Background Ejection fraction was not the only parameter to decide optimal time for surgery, nor an indicator for a better functional result after surgery. Severity measurement being a main consideration in surgery decision. Reduced left ventricle dimension after surgery reflect a better functional result.
Methods In 2019, 67 patients was included in this analysis. Age 53 (17-67) years, male 52,2%. All patients are with severe primary mitral regurgitation and treated by mitral valve surgery (mitral valve repair or replacement). Retrospective echocardiographic analysis was performed, to find the best parameter for predicting better functional outcome after surgery.
Results Data was collected from January to December 2019. From 262 primary mitral valve surgery underwent in National Heart Center Harapan Kita, there was 67 patients included, the other was excluded due to probability of secondary mitral regurgitation mechanism, concomitant congenital heart disease and or other significant valves disease, missing post-surgery data due to referral flow to the prior hospital and less complete echocardiographic views for further analysis. In bivariate analysis, end-diastolic volume (EDV) and regurgitant volume (RV) were strong predictor of decreasing left ventricle diameter after surgery (p 0.0001 and p 0.05). End-diastolic volume 133,5 ml or more is predictive for decreasing left ventricle diameter if surgery was conducted (sensitivity 87.3%, sensitivity 66.7%).
Conclusions EDV and RV found to be good predictors for functional outcome of primary mitral valve surgery than other echocardiographic parameters. Measuring EDV before deciding timing of surgery will be helpful in targeting better functional result after surgery.
 
Original Articles
Get PDFAbstracts of the 12th Indonesian Society of Interventional Cardiology Annual Meeting (ISICAM) 2020
27-29 November 202
Cardiac Patients for Non-Cardiac Surgery: Anesthetic Management in Patients with Permanent Pacemaker
Get PDFPermanent pacemaker (PPM) are being used in greater frequency in managing patients with electrophysiology disorders. These patients can be presented for either cardiac or non-cardiac surgery after their device implantation. They also will undergo either general or regional anesthesia to facilitate the surgical procedure. As an anesthesiologist, understanding patients’ condition, pacemaker care and safe anesthetic technique of choice are very important to provide safe patient management. Therefore, this literature reviewed and summarized a systematic approach which can be followed in managing these patients.
Various approach and guidelines have been discussed in the literature on how to manage patients with PPM who will undergo anesthesia. In this literature, the American Society of Anesthesiology (ASA) standard was used as a framework for managing patients with PPM. Meanwhile, the decision of anesthesia technique that being chosen should be based on patients’ clinical condition, the surgical procedure itself, the duration of surgery, and the convenience of the surgeon.
Overall, patients with PPM require special attention in perioperative management. Both anticipations of the patient’s condition and the performance of PPM must always be considered to provide safe anesthesia practice
Mobitz Type II Second-Degree Atrioventricular Block in a Pilot : To Pace or Not to Pace?
Get PDFBackground: Atrioventricular (AV) block is a threatening condition that caused sudden loss of consciousness and death, notably if happened to aircraft pilot will compromise the reliability of flight operations and safety. Cardiac arrhythmia is well known as one of the main disqualifier for loss of flying license, and discriminating between benign and potentially significant rhythm abnormalities remains a challenge. The present case describes the electrophysiological feature of a high-grade AV block in an aircraft pilot.
Case illustration: A 60-year-old male worked as commercial aircraft pilot presented with asymptomatic high-grade AV block during inflight Holter monitoring. He had never experienced any remarkable symptoms nor history of near syncope, but had a history of percutaneous coronary intervention (PCI) with one stent at left circumflex (LCx) coronary artery. Electrophysiology (EP) study revealed AH interval of 105 ms, HV interval of 50 ms, AV node effective refractory period of 280 ms and Weckenbach point of 330 ms, suggesting a normal EP study. Stimulation with atrial pacing and ATP showed prolongation of AH interval without changes in HV interval, showing the presence of a supra-Hisian AV node dysfunction. The highly demanding physiological environment in aircraft elucidate the likelihood of vagotonic cause of his condition and pacemaker implantation was not warranted.
Conclusion: Atrioventricular (AV) block is an AV conduction disorder that can manifests in various symptoms and severity. Electrophysiology study is considered as a modality to locate the site of block that allows the avoidance of unnecessary permanent pacing and the appropriate prophylactic pacing
Transient ischemic dilation as a diagnostic marker in myocardial perfusion SPECT protocols: a systematic review and meta-analysis
No full textAbstract
Background: Transient ischemic dilation (TID) measures left ventricle (LV) volume changes which can be associated with combination of myocardial and endocardial ischemia. Various stress methods, single photon emission computerized tomography (SPECT) imaging protocol, camera and software incite controversy on TID cut off. The purpose of this study was to evaluate the TID ratio in detection of coronary artery disease (CAD) categories in a systematic review and meta-analysis. Method: We conducted a systematic search of electronic databases (PubMed, Scopus, Embase and Web of Science) up to 1 January 2017. The reference lists of all included studies were searched for a higher accuracy. The search strategy was according a defined PICO as P: none, I: Transient ischemic dilation, O: Coronary Artery Diseases, C: Angiographies. Statistical analysis was done by Comprehensive meta-analysis software version 2 (CMA-2).
Result: After study selection process, 7 studies were selected for data extraction. TID was studied from 1987. The sample size of included studies ranged between 86 and 545. The mean age of included patients varied between 58 and 69 years old. Ranges of TID in CAD categories were excluded. The pooled estimates of TID in single and dual pharmacological stress test in three CAD categories were calculated.
Conclusion: Our findings show that more studies are needed to compare the TID variability. Although in this study meta-analysis was done and TID was summarized from studies but the software differences were ignored
Rekomendasi Penyekat RAAS Di Tengah - Tengah Pandemi Coronavirus
No full textWith a rapidly growing pandemic of coronavirus disease of 2019 (COVID-19), a public health emergency of international concern, the medical communities and national health systems are being tested for their preparedness. The culprit that is responsible for this viral respiratory disease, is a novel type of coronavirus, now identified as severe acute respiratory syndrome coronavirus - 2 (SARS-CoV2). At the present time, there are gaps in the knowledge regarding the safety of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for COVID-19 patients due to concern of ACE2, which is critical for viral entry and their levels are upregulated when using these (Renin Angiotensin Aldosterone System) RAAS blockers. ACE2 is a glycoprotein metalloprotease that plays an essential role in physiologic and pathological states and it is ubiquitously found in human organs. Despite sharing homology, ACE is different from ACE2, and while the former cleaves angiotensin 1 to angiotensin 2, the latter cleaves angiotensin two to angiotensin 1-7. Extrapolated from experimental animal studies, ACE2 and angiotensin 1-7 are important and protective for the lung physiology based on mice model of acute lung injury by various causes. Other evidence also demonstrates harm over benefits when stopping RAAS blockers, particularly in patients with cardiovascular disease, in which using these drugs are proven to be life-saving. In the light of the paucity of evidence derived from well-designed study, societies and colleges recommend continuing RAAS blockers until new evidence says otherwise
Cardiovascular Implications of Coronavirus Disease 2019: Review of Current Literatures
Get PDFThe coronavirus disease-2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) that first appeared in Wuhan, China. COVID-19 was found to have significant connection with the cardiovascular system by causing complications such as myocarditis and arrhythmias. Furthermore, medications for COVID-19 have been shown to induce cardiovascular side effects. The emergence of COVID-19 spreading also raised questions on the need for modification of life support algorithms to protect vulnerable healthcare workers.
 
English
No full textAt the end of year 2019, the world faced an outbreak of a highly virulent novel Coronavirus disease (COVID-19), which changed the way physicians, including cardiologists, do their routine clinical practice. As distance limitation and efficient use of personal protective devices must be employed to prevent the pandemic spreading, even simple electrocardiogram (ECG) taking that involves directly placing electrode leads on a patient’s body may become riskier. This review will discuss the possibility of minimal or no touch EKG using the latest wireless technologies, beneficial in monitoring COVID-19 patients for cardiovascular problems or patients who seek cardiac care, but with posing risk of concomitant COVID-19
Cardiomyopathy in COVID-19 Survivors: Mechanism, Management, and Prevention
Get PDFCoronavirus disease (COVID-19) caused by infection of SARS-CoV-2 as of April 2020 has been confirmed in more than 2.3 million people, with more than 150 thousands deaths across the globe. It has been known that COVID-19 patients with underlying cardiovascular diseases and its risks including: hypertension, diabetes, coronary artery disease, and cerebrovascular diseases may develop more severe respiratory track symptoms requiring intensive care. Some patients may presenting with myocarditis or acute cardiomyopathy, which has high mortality and morbidity. There was also evidence of myocardial Injury with an increase of troponin in one-third of those infected by covid-19. It is conceivable that among those who recover from COVID-19 infection, there is a risk of developing further cardiomypathy once the pandemic receding in the future. It is important to pay attention to this survivor group since the pandemic may be lasting for longer period. Optimal medical treatment and comprehensive prevention should be taken to manage those high risk patients of developing cardiomyopathy during hospital care as well post discharge. These includes provide best available COVID-19 drugs, cardiovascular medications, and social preventive measures.Coronavirus disease (COVID-19) caused by infection of SARS-CoV-2 as of April 2020 has been confirmed in more than 2.3 million people, with more than 150 thousands deaths across the globe. It has been known that COVID-19 patients with underlying cardiovascular diseases and its risks including: hypertension, diabetes, coronary artery disease, and cerebrovascular diseases may develop more severe respiratory track symptoms requiring intensive care. Some patients may presenting with myocarditis or acute cardiomyopathy, which has high mortality and morbidity. There was also evidence of myocardial Injury with an increase of troponin in one-third of those infected by covid-19. It is conceivable that among those who recover from COVID-19 infection, there is a risk of developing further cardiomypathy once the pandemic receding in the future. It is important to pay attention to this survivor group since the pandemic may be lasting for longer period. Optimal medical treatment and comprehensive prevention should be taken to manage those high risk patients of developing cardiomyopathy during hospital care as well post discharge. These includes provide best available COVID-19 drugs, cardiovascular medications, and social preventive measures