Indonesian Journal of Cardiology
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Calcium Serum Levels and Blood Pressure Response in trained subjects who consumed goat milk
Get PDFBackground: Calcium plays a role in regulating blood pressure and one exogenous sources of calcium are goat milk. Indonesian society is generally believed that goat milk can lower blood pressure and useful as antihypertensive, but so far have not found scientific evidence of how the mechanism of goat milk for controlling blood pressure. This study aimed to analyze the effect of the consumption of goat milk for lowering blood pressure and its relation to calcium serum levels in people trained.
Method: Subjects, 19 gymnasts (the treatment group) and 10 runners (the control group), male and female, aged 17-28 years. Treatment: goat’s milk 250 mg / day, adÂministered after dinner (at 19:00 to 20:00 pm), for 90 days. Design research is quasy experimental pretest-posttest design. Analysis of data using normality test Kolmogorof Smirnof-Z (p>0.05), Levene homogeneity test (p>0.05), t test (p<0.05) and Pearson correlation test (p <0.05).
Results: The results showed systolic blood pressure after consume goat milk decreased significantly in the treatment group compared to the control group (122 ± 7:33 and 10:54 ± 115 vs 119 ± 7.61 ± 4.83 mmHg and 118 mmHg; p <0.05), whereas diastolic blood pressure in the treatment group and the control group (80.42 ± 5:53 and 7:08 ± 78.42 mmHg vs; 78.50 ± 3:37 and 3:16 ± 79 mmHg; p> 0.05) did not show differÂences after administration of goat’s milk. Serum calcium levels after administration of dairy goats in the treatment group increased significantly compared with the control group (9:47 ± 0:25 and 0:32 ± 9.87 mg / dl vs 9.74 ± 0:42 and 9:37 ± 0:38 mg / dl; p <0.05). The results of Pearson correlation test (r) showed r=-0.45; p=0.05, meanÂing there were nonsignificant correlation between systolic blood pressure with serum calcium levels.
Conclusion: Delivery of goat’s milk can decrease systolic blood pressure and stimulates the secretion of calcium, but a decrease in systolic blood pressure was not associated with increased serum calcium levels in people trained.
Abstrak
Latar Belakang: Kalsium berperan dalam mengatur tekanan darah dan salah satu sumber kalsium eksogen adalah susu kambing. Masyarakat Indonesia umumnya percaya bahwa susu kambing dapat menurunkan tekanan darah dan bermanfaat sebagai antihipertensi, namun sejauh ini belum ditemukan bukti ilmiah bagaimana kerja susu kambing dalam mengontrol tekanan darah. Penelitian ini bertujuan menganalisis pengaruh konsumsi susu kambing dalam menurunkan tekanan darah dan hubungannya dengan kadar kalsium serum pada orang terlatih.
Metode: Subjek, 19 pesenam (kelompok perlakuan) dan 10 atlet lari (kelompok kontrol), laki-laki dan perempuan, usia 17-28 tahun. Perlakuan: pemberian susu kambing 250 mg/hari, diberikan setelah makan malam (pukul 19.00-20.00 wib), selama 90 hari. Design penelitian adalah quasy experimental pretest-posttest design. Analisis data menggunakan uji normalitas Kolmogorof Smirnof-Z (p>0,05), uji homogenitas Levene (p>0,05), uji t (p<0,05) dan uji korelasi pearson (p<0,05).
Hasil: hasil penelitian menunjukkan tekanan darah sistolik setelah pemberian susu kambing pada kelompok perlakuan menurun signifikan dibandingkan kelompok kontrol (122±7.33 dan 115±10.54 vs 119±7.61 dan 118±4.83 mmHg mmHg; p<0,05), sedangkan tekanan darah diastolic pada kelompok perlakuan dan kelompok kontrol (80.42±5.53 dan 78.42±7.08 mmHg vs; 78.50±3.37 dan 79±3.16 mmHg; p>0,05) tidak menunjukkan perbedaan setelah pemberian susu kambing. Kadar kalsium serum setelah pemberian susu kambing pada kelompok perÂlakuan meningkat signifikan dibandingkan dengan kelompok kontrol (9.47±0.25 dan 9.87±0.32 mg/dl vs 9.74±0.42 dan 9.37±0.38 mg/dl; p<0,05). Hasil uji korelasi pearson (r) menunjukkan r=-0,45; p=0,05, artinya terdapat korelasi sedang yang tidak bermakna antara tekanan darah sistolik dengan kadar kalsium serum.
Kesimpulan: Pemberian susu kambing dapat menurun tekanan darah sistolik dan merangsang sekresi kalsium namun penurunan tekanan darah sistolik tidak berhubungan dengan peningkatan kadar kalsium serum pada orang terlatih
Perioperative Antithrombotic Management
No full textThe management of antithrombotic therapy in the perioperative setting is a common problem, balancing haemorrhagic risk with thrombotic risk. High-quality evidence is lacking regarding the optimal approach for patients on oral anticoagulants or antiplatelet agents. The two main issues that need to be considered in perioperative antithrombotic management is the patient’s risk of a thromboembolic event when therapy is interrupted and the risk of bleeding associated with the surgery or procedure. An assessment of these factors will determine the optimal perioperative anticoagulant management apÂproach. The overall objective of this review is to provide a practical approach relating to perioperative management which can be used in everyday clinical practice.
Abstrak
Masalah tatalaksana terapi antitrombotik perioperatif yaitu menyeimbangkan risiko perdarahan dan risiko trombosis masih sering dijumpai sehari-hari. Bukti klinis yang kuat mengenai tatalaksana yang optimal dari terapi antikoagulan atau antiplatelet masih sangat sedikit. Dua hal yang perlu dipikirkan dalam tatalaksana terapi antitrombotik perioperatif adalah risiko kejadian tromboemboli ketika terapi antitrombotik dihentikan dan risiko perdarahan akibat tindakan pembedahan yang dilakukan. Penilaian faktor-faktor tersebut akan menentukan pendekatan yang optimal dari tatalaksana antikoagulan perioperatif. Tinjauan pustaka ini bertujuan memberikan pendekatan praktis tentang tatalaksana antitrombotik perioperatif yang dapat dipakai dalam praktik klinis sehari-hari
Pulmonary Atresia with Intact Ventricular Septum in a Neonate
Get PDFIntroduction: Pulmonary atresia with an intact ventricular septum is a condition that is characterized by a complete obstruction to right ventricular outflow with varying degrees of right ventricular and tricuspid valve hypoplasia. This condition is uniformly fatal if untreated. In this case report, we present a case of a neonate with a pulmonary atresia with intact ventricular septum
Case Presentation: A 2 days-old female Indonesian newborn was referred to our facility. The newborn was delivered from a G4P3A0 mother with a gestational age of 39 weeks (term delivery). Chest x-ray done at the referring facility is significant for a seemingly right heart hypertrophy, casting a “boot-shaped†appearance of the right heart border. Laboratory results done at the referring facility is significant for a neutrophilia of 82% and lymphocytopenia of 13% An episode of hypoglycemia was reported on referring facility with a blood sugar level of 50 mg/dl. Multiple episodes of cyanosis were reported at referring facility, CPAP was administered but the improvement was limited. Pulse oximetry averaged between 72-80% at the referring facility. Physical examinaÂtion shows an actively moving neonate, with a strong cry. Perioral cyanosis was seen. Vital signs were as follows; heart rate 128 x / minute, temperature 37oC, respiratory rate 54 x / minute, pulse oximetry 74%, capillary refill time < 3 seconds. The rest of the physical examination was within normal limits. Laboratory result on admission at our facility is significant for low hematocrit, low erythrocyte count, leukopenia with neutrophilia and thrombocytopenia. Patient was admitted to NICU and given CPAP. Echocardiography 2 days upon arrival at our facility reveals a patent ductus arteriosus with the pressure of 4-5 mmHg and diameter of 0.3 cm, no forward flow from the right ventricle to the pulmonary artery, doppler mode demonstrated pulmonary artery filling from ductus arteriosus. The rest of the findings were within normal limits.
Conclusion: Pulmonary atresia with an intact ventricular septum is a condition that relies on the patent ductus arteriosus for pulmonary blood supply, the patency of it is of paramount importance.
Abstrak
PENDAHULUAN: Atresia arteri pulmonalis dengan septum ventrikel yang utuh merupakan kondisi yang dikarakterisasikan dengan sumbatan total pada right ventricular outflow dengan berat hipoplasia ventrikel kanan dan trikuspid kanan yang beratnya bervariasi. Pada umumnya kondisi tersebut fatal apabila tidak ditangani. Pada laporan kasus ini, kami melaporkan suatu kasus neonates dengan atresia arteri pulmonalis dengan septum ventrikel yang utuh.
PRESENTASI KASUS: Neonatus perempuan berumur 2 hari dirujuk ke rumah sakit kami. Bayi dilahirkan dari G4P3A0 usia kehamilan 39 minggu. Ronsen thoraks yang dilakukan oleh fasilitas kesehatan yang merujuk memperlihatkan hipertrofi jantung kanan serta bentuk “boot-shaped†pada batas jantung kanan. Hasil laboratorium pada fasilitas kesehatan tersebut menunjukan neutrofilia dan limfositopenia. Terdapat juga riwayat hipoglikemi. Episode sianosis berulang terjadi pada fasilitas kesehatan yang merujuk. Pemasangan CPAP kurang membuahkan hasil dengan saturasi O2 72-80% ketika tiba pada rumah sakit kami. Pemeriksaan fisik menunjukan tangis kuat dan gerak aktif dengan sianosis perioral. Detak jantung 128 kali/menit, suhu 37oC, laju naas 54 kali/menit, oksimetri nadi 74% dan waktu isi kapiler <3 detik. Pemeriksaan laboratorium saat pasien dating menunjukan hematocrit, hitung eritrosit, leukosit dan thrombosit yang rendah. Pasien dirawat di NICU dan diberikan CPAP. Ekokardiografi 2 hari kemudian menunjukan duktus arteriosus patent dengan tekanan 4-5 mmHg dan diameter 0.3 cm, tidak ada aliran maju dari ventrikel kanan kepada arteri pulmonalis, mode Doppler menunjukan pengisian arteri pulmonalis dari duktus arteriosus. Pemeriksaan lainnya dalam batas normal.
KESIMPULAN: Atresia arteri pulmonalis dengan septum ventrikel yang utuh merupakan suatu kondisi dimana aliran darah menuju paru bergantung pada duktus arteriosus yang paten sehingga patensi daripada duktus tersebut sangatlah pentin
Systematic Reviews and Meta-Analyses
No full textAbstracts of the 6th Annual Scientific Meeting of the Indonesian Heart Rhythm Society
Jakarta, 21-22 September 2018
Systematic Reviews and Meta-Analyses
 
Effect of Myocardial Fibrosis on Left Ventricular Function in Rheumatic Mitral Stenosis: A Preliminary Study with Cardiac Magnetic Resonance
Get PDFBackground: Left ventricular (LV) dysfunction was frequently found in rheumatic mitral stenosis. Myocardial fibrosis had been revealed in rheumatic heart disease and could be associated with LV dysfunction. We evaluate myocardial fibrosis profile related to LV function in rheumatic mitral stenosis with cardiac magnetic resonance (CMR).
Methods: Eighteen patients with severe rheumatic mitral stenosis without history of coronary artery disease or its risk factors underwent 1.5T CMR examination. LV ejection fraction (LVEF), right ventricular ejection fraction (RVEF), myocardial fibrotic tissue were evaluated with CMR. Other hemodynamic data was derived from echocarÂdiography results.
Results: These patients (40.4±10.5 years old, 72.2% female, 66.7% atrial fibrillation) had LVEF of 50.9±15.9% and RVEF of 37.7±13.9%. Volume of fibrotic tissue in these patients were 16.6 (5.5-55.8)%. In multivariate analysis, volume of fibrotic tissue was a significant predictor of LVEF that myocardial fibrotic tissue of 1% was associated with LVEF reduction of 0.87% (95% CI 0.51%-1.24%).
Conclusion: LV function was determined by the extent of myocardial fibrosis in rheuÂmatic mitral stenosis.
Abstrak
Latar Belakang: Disfungsi ventrikel kiri (LV) sering ditemukan pada mitral stenosis rematik. Fibrosis miokardium ditemukan pada penyakit jantung rematik. Fibrosis miokardium pada penyakit jantung rematik juga dihubungkan dengan disfungsi LV. Kami mengevaluasi profil fibrosis miokardium yang berhubungan dengan fungsi LV pada mitral stenosis rematik dengan cardiac magnetic resonance (CMR).
Metode: Dilakukan pemeriksaan 1.5T CMR pada delapanbelas pasien dengan mitral stenosis rematik berat tanpa riwayat penyakit jantung koroner atau faktor resikonya. Fraksi ejeksi LV (LVEF), fraksi ejeksi RV (RVEF), dan jaringan fibrotik miokardium dievaluasi menggunakan CMR. Data hemodinamik lainnya didapatkan dari pemeriksaan ekokardiografi.
Hasil: Pasien tersebut (40.4±10.5 tahun, 72.2% perempuan, 66.7% fibrilasi atrium) memiliki LVEF 50.9±15.9% dan RVEF 37.7±13.9%. VolÂume jaringan fibrotic pada pasien tersebut adalah 16.6 (5.5-55.8)%. Dalam analisis multivariat, volume jaringan fibrotic adalah prediktor LVEF yang signifikan yaitu 1% jaringan fibrotic miokardium dihubungkan dengan menurunan LVEF sebesar 0.87% (95% CI 0.51%-1.24%).
Kesimpulan: Fungsi LV dipengaruhi seberapa besar fibrosis miokardium pada mitral stenosis remati
Original Articles
Get PDFOriginal Articles; Abstracts of the 10th Indonesian Society of Interventional Cardiology Annual Meeting Jakarta, 23-25 November 201
Efek Pemberian Statin terhadap Proliferasi Endothelial Progenitor Cell pada Darah Tepi Penderita Penyakit Jantung Koroner Stabil
Get PDFBackground: Atherosclerotic lesions develop as the result of an inflammatory process initiated by endothelial damage. Endothelial progrenitor cells (EPCs), which is derived from bone marrow, participate in endothelial repair and new vessel growth. Cardiovascular pharmacotherapies have been shown to improve overall numbers and function of EPCs in patients with cardiovascular risk and cardiovascular disease. Studies have reported that statins exert beneficial effects on EPCs by enhancing EPC proliferation and differentiation. Thus, we require a research to analyze the effects of three different statins on EPC proliferation. The objective of this study is to analyze the effect of statins on EPC proliferation from peripheral blood of stable coronary artery disease patient.Methods: This is an in vitro true experimental post-test only control group design. The mononuclear cells (MNCs) were isolated from peripheral blood of stable coronary artery disease patient and were cultured in CFU-Hill medium for three days. Then samples were put into four groups, simvastatin experiment group, atorvastatin experiment group, rosuvastatin experiment group and control group. Each experiment group was divided into three subgroups with different doses, 0.1 ?mol/L, 0.5 ?mol/L, and 2.5 ?mol/L then incubated for 48 hours. EPC proliferation was evaluated afterwards with MTT cell proliferation assay. Immunocytochemistry method was performed for EPC identification to evaluate expression of CD34+. CFU-Hills were observed to confirm functional characteristics of EPC. Data were analyzed by independent T-test and ANOVA.Results: MTT cell proliferation assay showed a significant increase of EPC proliferation in simvastatin, atorvastatin, and rosuvastatin groups compared with control group (0.237±0.007, 0.248±0.01, 0.231±0.008 vs 0.17±0.008, p<0.05). It also revealed significant difference in EPC proliferation between each experiment groups, which atorvastatin showed the highest effect. EPC proliferation in atorvastatin is higher than simvastatin group (0.248±0.01 vs. 0.237±0.007, p<0.05), and simvastatin is also higher than rosuvastatin group (0.237±0.007 vs. 0.231±0.008, p<0.05). CFU-Hill counts demonstrated highest number in rosuvastatin group, followed by atorvastatin, and simvastatin. Immunocytochemistry showed positive expression of CD34.Conclusion: Statins increase EPC proliferation from peripheral blood of stable coronary artery disease patient. Atorvastatin showed the highest EPC proliferation, followed by simvastatin, and rosuvastatin. Each statins increased EPC proliferation dose-dependently.Latar Belakang: Lesi atherosklerotik merupakan akibat dari proses inflamasi yang diawali oleh kerusakan endotel. Endothelial progenitor cell (EPC), yang berasal dari sumsum tulang, berpartisipasi dalam perbaikan endotel dan pertumbuhan pembuluh darah baru. Farmakoterapi kardiovaskular telah dibuktikan dapat memperbaiki jumlah dan fungsi EPC pada penderita dengan risiko kardiovaskular dan penyakit kardiovaskular. Banyak studi melaporkan bahwa statin memiliki efek yang menguntungkan terhadap EPC yaitu dengan meningkatkan proliferasi dan diferensiasi. Oleh karena itu, kami melakukan penelitian untuk menganalisis efek tiga statin yang berbeda terhadap proliferasi EPC. Tujuan penelitian ini adalah untuk menganalisis efek pemberian statin terhadap proliferasi EPC pada darah tepi penderita penyakit jantung koroner stabil.Metode: Penelitian ini kami lakukan secara in vitro true experimental post-test only control group design. Sel mononuklear diisolasi dari darah tepi penderita penyakit jantung koroner stabil dan kultur dilakukan dalam medium CFU-Hill selama tiga hari. Sampel kemudian dibagi menjadi empat kelompok, yaitu kelompok simvastatin, atorvastatin, rosuvastatin dan kelompok kontrol. Tiap kelompok yang diberi perlakuan tersebut dibagi lagi menjadi tiga subkelompok dengan dosis yang berbeda, yaitu 0,1 ?mol/L, 0,5 ?mol/L, dan 2,5 ?mol/L kemudian diinkubasi selama 48 jam. Proliferasi EPC dievaluasi setelahnya dengan MTT cell proliferation assay. Metode imunositokimia dilakukan untuk identifikasi EPC dengan mengevaluasi ekspresi CD34+. Pemeriksaan dan penghitungan CFU-Hill dilakukan untuk mengonfirmasi karakteristik fungsional EPC. Data dianalisis dengan uji T independen dan ANOVA.Hasil: MTT cell proliferation assay menunjukkan peningkatan bermakna terhadap proliferasi EPC pada kelompok simvastatin, atorvastatin, dan rosuvastatin dibandingkan dengn kelompok kontrol (0,237±0,007, 0,248±0,01, 0,231±0,008 vs. 0,17±0,008, p<0,05). Proliferasi EPC juga berbeda antar-kelompok statin, dengan efek tertinggi didapatkan pada kelompok atorvastatin. Proliferasi EPC pada kelompok atorvastatin lebih tinggi daripada kelompok simvastatin (0,248±0,01 vs. 0,237±0,007, p<0,05), dan simvastatin lebih tinggi daripada kelompok rosuvastatin (0,237±0,007 vs. 0,231±0,008, p<0,05). Penghitungan CFU-Hill memperlihatkan jumlah tertinggi pada kelompok rosuvastatin, diikuti atorvastatin, dan simvastatin. Pemeriksaan imunositokimia menunjukkan ekspresi positif terhadap CD34.Kesimpulan: Statin meningkatkan proliferasi EPC pada darah tepi penderita penyakit jantung koroner stabil. Efek tertinggi tampak pada kelompok atorvastatin, diikuti kelompok simvastatin, dan rosuvastatin. Tiap statin meningkatkan proliferasi dengan bergantung dosis (dose-dependent)
Hypolipidemic Effect and Antioxidant Activity of Tamarind Leaves Extract in Hypercholesterol-Fed Rats
Get PDFBackground: Higher cost and side effects made of some anticholesterol drugs usedin long time are the reasons why some people change to herbal therapies. Tamarind(Tamarindus indica) leaves is one of the herbal therapies. This research aims to determinehypolipidemic effect and antioxidant activity of extract of tamarind leaves (ETL).Methods: We used 25 rats as samples, divided into five groups of negative control(CMC 0.5%), positive control (Ezetimibe 1.26 g/kgBW)), first, second and third doseof ETL consequently are 0.93, 1.86 and 3.73 g/kgBW.Results: Paired-samples T-test showed ETL significantly decreased total cholesterol(TC), triglyceride (TG) level, and high-density lipoprotein cholesterol (HDL-C) levelsignificantly increased compared with negative control groups (p≤0.05). Low-densitylipoprotein cholesterol (LDL-C) level had significant difference only at second dose ofETL (p<0.05). Furthermore, the data’s difference between pre- and post-interventionwere analyzed with one-way ANOVA test in TC, TG, and HDL-C level, ETL had asignificant difference (p≤0.05), while there was no significant difference in LDL -Cbetween groups (p>0.05). Data were also analyzed by Post Hoc test. TC, TG, andHDL-C level had a significant difference between all variance ETL’s doses and positivecontrol compared with negative control group (p≤0.05). For antioxidant activity, ETLexhibited the significant reduction in the levels of malondialdehyde (MDA) by pairedsamplesT-test (p≤0.05) but there was no significant difference in both of MDA andsuperoxide dismutase (SOD) level (p>0.05) analyzed by One-way ANO VA test.Conclusion: All variant of ETL’s doses have hypolipidemic effect and antioxidant activity.ETL also has similar effect with Ezetimibe. Saponin, flavonoid, epicatechin, tanin, andpolyphenol that is contained likely contribute to these pharmacologic effects
Jurnal Kardiologi Indonesia: Kini dan Yang Akan Datang
Get PDFPada 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
Repolarisasi Dini Tidak Selalu Jinak
Get PDFEarly repolarization (ER) pattern is marked with J-point elevation, slurring or notching the terminal portion of the QRS and ST segment elevation has been considered benign over the last few decades. However, some reports now suggest a link between early repolarization and increased risk of death due to arrhythmias and idiopathic ventricular fibrillation (VF), known as ER syndrome. Implantable cardioverter-defibrillators implantation and drug isoproterenol are the suggested therapy in patients with ER syndrome. In contrast, patients without symptoms of the syndrome ER are common and have a better prognosis. Risk stratification in asymptomatic patients in the ER remains a gray area. There are still many unanswered questions, so studies exploring the underlying mechanisms of ER continues to be developed.Pola repolarisasi dini (early repolarization/ER) ditandai dengan elevasi J-point, slurring atau notching bagian terminal dari QRS, dan elevasi segmen ST telah dianggap jinak selama beberapa dekade terakhir. Namun, beberapa laporan saat ini menunjukkan adanya hubungan antara repolarisasi dini dan meningkatnya risiko kematian karena aritmia dan fibrilasi ventrikel (ventricular fibrillation/VF) yang idiopatik, dikenal sebagai sindrom ER. Pemakaian implantable cardioverter-defibrillator (ICD) dan obat isoproterenol merupakan terapi yang disarankan pada pasien dengan sindrom ER. Sebaliknya, pasien tanpa gejala sindrom ER cukup banyak populasinya dan memiliki prognosis yang lebih baik. Stratifikasi risiko pada pasien asimptomatik ER masih tetap menjadi wilayah abu-abu. Masih banyak pertanyaan yang belum terjawab, sehingga studi yang mengeksplorasi mekanisme yang mendasari ER terus dikembangkan