Indonesian Journal of Cardiology
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Hubungan Fungsi Seksual dengan Kecemasan Pasien Pasca-Infark Miokard Akut
Get PDFBackground: Sexual dysfunction and anxiety frequently happens on patients after acute myocardial infarction (AMI) and can affect patients’ quality of life. The purpose of this study was to examine the assosiation of sexual function post-AMI patients with anxiety.
Methods: It was a cross-sectional study. Respondents are patients in Integrated Cardiac Clinic of Cipto Mangunkusumo Hospital that meet inclusion and exclusion criteria. They signed informed consent. Sexual function was assessed using International Index of Erectyle Function (IIEF) and anxiety was assessed using Hamilton Anxiety Rating Scale (HAM-A).
Results: Post-AMI patients had erectile dysfunction (82.5%), orgasm dysfunction (72.5%) and libido dysfunction (93.8%). Respondents expressed sexual intercourse dissatisfaction (97.5%) and overall dissatisfaction (90%). The proportion of post-AMI anxiety was 52.5%. There was no assosiation between sexual function post-AMI with anxiety.
Conclusion: Anxiety and sexual dysfunction post-AMI is a considerable problem. Factors that affect anxiety and sexual dysfunction post-AMI needs to be explored further so that an integrated management guidelines could be proposed.Latar Belakang: Disfungsi seksual dan kecemasan sering dialami oleh pasien pasca-infark miokard akut (acute myocardial infarct, AMI) dan dapat memengaruhi kualitas hidup. Tujuan penelitian ini adalah untuk menguji hubungan fungsi seksual dengan kecemasan pasien pasca-AMI.
Metode: Penelitian ini menggunakan desain potong lintang. Responden adalah pasien rawat jalan Poliklinik Jantung Terpadu RS Cipto Mangunkusumo yang memenuhi kriteria inklusi dan eksklusi serta menandatangani informed consent. Fungsi seksual dinilai dengan International Index of Erectyle Function (IIEF) sedangan kecemasan dinilai dengan Hamilton Anxiety Rating Scale (HAM-A).
Hasil: Pasien pasca-AMI mengalami disfungsi ereksi (82,5%), disfungsi orgasme (72,5%), dan disfungsi libido (93,8%). Responden pada umumnya menyatakan ketidakpuasan dalam hubungan seksual (97,5%) dan terhadap kehidupan seksual secara keseluruhan (90%). Proporsi kecemasan pasca-AMI adalah 52,5%. Tidak terdapat hubungan antara fungsi seksual dengan kecemasan pasca-AMI.
Kesimpulan: Kecemasan dan disfungsi seksual merupakan masalah yang perlu diperhatikan pada pasien pasca-AMI. Faktor-faktor yang memengaruhi kecemasan dan disfungsi seksual pasca-AMI perlu dieksplorasi lebih lanjut sehingga panduan tatalaksana yang terintegrasi dapat disusun dengan baik
Kompleks QRS Terfragmentasi sebagai Prediktor Multivessel Disease pada Sindrom Koroner Akut
Get PDFBackground: The incidence of multivessel disease in acute coronary syndrome (ACS) is expected to be identified as early as possible in order to perform optimal management. The presence of multivessel disease can lead to ischemia or myocardial infarction. Fragmented QRS complex (fQRS) is a new electrocardiography (ECG) parameter that has been proven to be caused by ischemia or myocardial infarction.Methods: A cross-sectional study. Patients with ACS that admitted at Dr. Wahidin Sudirohusodo Makassar since December 2014 - March 2015 who are eligible were enrolled in this study.Presence of fQRS evaluated on first 12-lead ECG at hospital admission. Presence of multivessel disease based on coronary angiography. Data were analyzed by logistic regression. Data was significant if the p-value<0.05.Results: There are 63 subjects (56 men and 7 women) included in this study. Older age, history of ACS before, presence of dyslipidemia, and presence of fQRS were significantly more often in group with multivessel disease. After analyzed with logistic regression, the fQRS was the only significant predictor of multivessel disease with p value 0.003 and odds ratio 13.28.Conclusion: Presence of fQRS in the first 12-lead ECG when admitted to the hospital was an independent predictor of multivessel disease in patients with ACS.Latar Belakang: Kejadian multivessel disease pada sindrom koroner akut (SKA) diharapkan dapat diketahui secepat mungkin supaya dapat dilakukan penanganan yang optimal. Adanya multivessel disease dapat menyebabkan iskemia maupun infark miokard yang lebih luas. Kompleks QRS terfragmentasi (fQRS) merupakan parameter elektrokardiografi (EKG) baru yang telah terbukti disebabkan oleh iskemia maupun infark miokard.Metode: Studi potong lintang. Penderita SKA yang dirawat di RSUP Dr. Wahidin Sudirohusodo Makassar sejak bulan Desember 2014 – Maret 2015 yang memenuhi kriteria inklusi dan eksklusi menjadi subjek pada penelitian ini.Adanya fQRS dinilai pada EKG 12-lead saat awal masuk rumah sakit. Kejadian multivessel disease berdasarkan hasil kateterisasi jantung. Data variabel yang bermakna dianalisis dengan regresi logistik. Data dinyatakan signifikan jika nilai p<0,05.Hasil: Didapatkan 63 subjek (56 pria dan 7 wanita). Usia tua, riwayat SKA sebelumnya, adanya dislipidemia, dan adanya fQRS secara bermakna lebih sering ditemukan pada grup dengan multivessel disease. Setelah diuji dengan regresi logistik, adanya fQRS merupakan satu-satunya prediktor bermakna kejadian multivessel disease dengan nilai p=0,003 dan odds ratio 13,28.Kesimpulan: Adanya fQRS pada EKG 12-lead saat awal masuk rumah sakit merupakan prediktor independen kejadian multivessel disease pada SKA
Uji Diagnostik Squatting Stress Echocardiography dengan Angiografi Koroner dalam Mendiagnosis Penyakit Jantung Koroner
Get PDFBackground: In patients with significant coronary heart disease (CHD), increased preload and afterload during a squat can cause wall motion abnormalities (WMA) which can be detected on echocardiography. This study was conducted to determine the diagnostic value of stress echocardiography squatting as a non-invasive examination of a relatively simple, inexpensive, and safe in the detection of coronary artery stenosis in stable CHD and unstable angina patients.Methods: This study was a cross-sectional design. The subjects were all patients with stable CHD and unstable angina whom were treated in Instalasi Pusat Jantung Rumah Sakit Dr. M. Djamil Padang from May to July 2016. Subjects underwent squatting stress echocardiography procedures followed by coronary angiography. Diagnostic test was used to determine the sensitivity, specificity, positive predictive value, negative predictive value and accuracy of squatting stress echocardiography.Results: The sensitivity, specificity, and accuracy of squatting echocardiography for diagnosis of CAD were 90.3%, 88.9% and 89.7%, respectively.Conclusion: Squatting stress echocardiography can be proposed as a non-invasive examination which is relatively simple, inexpensive and safe to detect coronary artery stenosis on patients with stable CHD and unstable CHD.Latar Belakang: Pada pasien dengan penyakit jantung koroner (PJK) yang signifikan, peningkatan preload dan afterload selama berjongkok dapat menyebabkan wall motion abnormalities (WMA) yang dapat terdeteksi pada pemeriksaan ekokardiografi. Penelitian ini dilakukan untuk mengetahui nilai diagnostik squatting stress echocardiography sebagai pemeriksaan non-invasif yang relatif sederhana, murah, dan aman dalam mendeteksi stenosis arteri koroner pada pasien dengan PJK stabil dan PJK tidak stabil.Metode Penelitian: Penelitian ini berupa potong lintang. Subjek adalah semua pasien PJK stabil dan tidak stabil yang dirawat di Instalasi Pusat Jantung RS. Dr. M. Djamil Padang dari bulan Mei sampai Juli 2016. Prosedur yang dilakukan adalah squatting stress echocardiography kemudian angiografi koroner. Uji diagnostik digunakan untuk mengetahui sensitivitas dan spesifisitas dari squatting stress echocardiography.Hasil: Nilai diagnostik squatting stress echocardiography pada penderita PJK stabil dan PJK tidak stabil dalam mendeteksi iskemia adalah: sensitivitas 90,3%, spesifisitas 88,9%, nilai duga positif 93,3%, nilai duga negatif 84,2%, dan akurasi 89,7%.Kesimpulan: Squatting stress echocardiography dapat diusulkan sebagai pemeriksaan non-invasif yang relatif sederhana, murah, dan aman dalam mendeteksi stenosis arteri koroner pada pasien dengan PJK stabil dan PJK tidak stabil
Alat Pacu Jantung Tanpa Kabel
Get PDFThe 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.Perkembangan teknologi kesehatan memberikan kemajuan dalam tatalaksana kelainan irama jantung. Alat pacu jantung memegang peranan penting dalam tatalaksana pasien dengan kelainan irama jantung dengan metode nonbedah. Penemuan alat pacu jantung tanpa kabel memberikan banyak manfaat dibanding alat pacu jantung konvensional dimana alat tersebut ditanam melalu kateter. Berbagai studi telah dlakukan dan masih berlangsung untuk memantau manfaat dan keamanan alat tersebut. Pada prinsipnya Indonesia siap berpartisipasi dalam teknologi terbaru alat pacu jantung tanpa kabel, kebijakan jaminan kesehatan nasional memegang peranan penting dalam penggunaan terbaru ini di masa yang akan datang
Prinsip 3Rs dan Pedoman ARRIVE pada Studi Hewan Coba
Get PDFThe use of animals in research has concerned the general public and thoughtful researchers for a long time. For improved animal welfare and increased research quality, researchers have moral obligations to include the 3Rs. The Three Rs are basic principles of humane experimental technique that were first set out by Russell and Burch in 1959. They are now widely accepted within the international scientific community and in associated legislation and guidelines, as a means of avoiding or reducing animal use and suffering and helping to improve the quality of science. When reporting animal studies, it is recommended that manuscripts conform to the principals of the Animals in Research: Reporting In Vivo Experiments (ARRIVE) guidelines, incorporated the 3Rs principal.Penggunaan hewan coba dalam riset telah menjadi perhatian publik dan peneliti sejak lama. Untuk meningkatkan kesejahteraan hewan coba dan kualitas riset, peneliti memiliki tanggung jawab moral untuk memperhatikan aspek 3R. 3R adalah prinsip-prinsip dasar dalam teknik eksperimental manusiawi yang pertama kali diperkenalkan oleh Russell dan Burch pada tahun 1959. Prinsip ini kini sudah diterima secara luas di kalangan ilmuwan internasional dan dalam kaitannya dengan legislasi dan pedoman, sebagai upaya menghindari atau mengurangi penggunaan dan penderitaan hewan coba serta membantu meningkatkan kualitas sains. Ketika melaporkan hasil studi yang melibatkan hewan coba, naskah laporan seyogyanya mengikuti prinsip Animals in Research: Reporting In Vivo Experiments (ARRIVE), yang mengikutsetakan prinsip 3R
Pemberian Agen Vasoaktif Berdasarkan Hemodinamik pada Syok Kardiogenik
No full textCardiogenic shock is a life-threatening emergency that occurs frequently with acutemyocardial infarction (AMI) and the mortality remains over 50% in most studies. Despitesuccessful revascularization, cardiovascular failure leading to multiple organ failure mayoccur. Therapy with vasoactive agents should be initiated to restore adequate arterialpressure and organ perfusion in patients with shock. Recent analysis suggests that systemicinflammatory response syndrome (SIRS) is an important component of the hemodynamicinstability in cardiogenic shock. Inflammation through the nitric oxide (NO) pathway leadingto decrease in vascular resistance and these patients may necessitate supplementalvasopressor therapy. A subanalysis of a prospective randomized trial suggested that norepinephrine(NE) may be preferred over dopamine in patients with cardiogenic shock,while dobutamine is the inotrope of choice. We present a case of a shock cardiogenicand a review of a therapeutic scheme for the pharmacological treatment of patients incardiogenic shock
A Case Report of Elderly Woman with Supraventricular Tachycardia associated with Intracranial Bleeding
Get PDFBackground The neurogenic cardiac injury is related to brain injury-induced catÂecholamine and neuro-inflammatory responses and is more likely in those with the most severe neurological insult.
Case Report A 78 years-old female presented to the emergency department after being found lying on the floor with a laceration on the head. On physical examination GCS 3, BP 140/90 mmHg, HR 190 bpm, respiratory rate 25x/minute. PMH of hypertension and diabetes were denied. ECG showed supraventricular tachycardia of 186 bpm. LaboraÂtory exams showed hyponatremia, hypokalemia, and leukocytosis. CT scan revealed subarachnoid hemorrhage, intracerebral hematomas, chronic subdural hematoma, midline shift and subfalcine herniation. The systemic catecholamine ‘storm’ driven by the central neuroendocrine axis massively increases sympathetic outflow, activates the adrenal gland and may lead to arrhythmia. Increased ICP, Midline shift, and subsequent physical compression of the brainstem and hypothalamic autonomic centers can trigger catecholamine responses that could instigate an arrhythmia. Suboptimal cardiac output and cerebral perfusion worsen secondary brain injury leading to a worse prognosis. Since cardioversion failed, amiodarone was administered. Cardioversions failed to convert to sinus rhythm and amiodarone was administered. Therapy to reduce intracranial pressure was also administered. The patient passed away 4 hours after admission.
Conclusion Arrhythmia related to brain injury may lead to suboptimal cerebral perfuÂsion and leads to further autonomic derangements leading to a vicious cycle of cerebral and cardiovascular injuries. This condition should be accounted for swiftly to prevent secondary brain injuries and myocardial ischemia.
Abstrak
Latar Belakang Respons katekolamin dan radang terhadap cedera otak menyebabkan cedera jantung neurogenik yang lebih sering terjadi pada kerusakan neurologis yang berat.
Laporan Kasus Seorang perempuan 78 tahun datang ke IGD setelah ditemukan tergeletak di lantai dengan robek pada kulit kepala. Pada pemeriksaan fisik ditemukan GCS 3, TD 140/90 mmHg, detak jantung 190 kali/menit, laju pernafasan 25 kali/menit. Riwayat hipertensi dan diabetes disangkal. EKG menunjukan takikardia supraventrikular takikardi 186 kali/menit. Pemeriksaan laboratorium menunjukan hiponaÂtremia, hipokalemia dan leukositosis. CT scan menunjukan perdarahan subaraknoid, perdarahan intraserebral, perdarahan subdural kronis, midline shift dan herniasi subfalcine. Badai katekolamin sistemik yang dicetuskan oleh aksis neuroendokrin pusat meningkatkan outflow simpatetik yang mengaktifkan kelenjar adrenal dan menyebabkan aritmia. Peningkatan tekanan intrakranial, midline shift, dan penekanan batang otak serta pusat autonomik hipotalamus dapat mencetuskan respon katekolamin yang dapat menyebabkan aritmia. Curah jantung yang tidak optimal dan perfusi otak yang buruk menyebabkan cedera otak sekunder yang mengarah pada prognosis yang buruk. Karena kardioversi gagal merubah irama menjadi sinus maka amiodaron diberikan. Pengobatan untuk menurunkan tekanan intrakranial juga diberikan. Pasien meninggal 4 jam setelah masuk rumah sakit.
Kesimpulan Aritmia yang berhubungan dengan cedera otak dapat menyebabkan perfusi otak yang suboptimal serta menyebabkan ketidakteraÂturan otonom dan menyebabkan lingkaran setan kerusakan otak dan jantung-pembuluh darah. Hal ini harus segera ditangani untuk mencegah cedera otak sekunder dan iskemi miokardial
Perbandingan Kejadian Klinis Kardiovaskular Mayor Selama Perawatan di Rumah Sakit pada Penderita Infark Miokard Akut Elevasi Segmen ST Inferior Dengan dan Tanpa Depresi Segmen ST Prekordial
Get PDFBackground: The clinical implications of precordial ST segment depression (PSTD) during acute inferior myocardial infarction has been an area of debate, and still under investigation with conflicting results. Based on previous studies, the presence of PSTD defines a high risk subset of patients with acute inferior myocardial infarction due to a more extensive myocardial ischemia that lead to a higher incidence of major adverse cardiovascular events (MACE). Despite of these results, others still considered this ECG finding as a benign electrical phenomenon. The aim of this study is to compare the incidence of in-hospital MACE in patients of acute inferior myocardial infarction with or without PSTD and to know whether PSTD can be used as a predictor of in-hospital MACE in acute inferior myocardial infarction.Methods: A total of 96 acute inferior myocardial infarction patients admitted from December 2013-2015 at Cardiology Department of Haji Adam Malik General Hospital were retrospectively analyzed. Patients were divided into two groups based on the presence of PSTD on admission ECG. Bivariate and multivariate analyses were performed to study the association between PSTD and in-hospital MACE, p value<0.05 was considered statistically significant.Results: The bivariate analysis showed that in-hospital MACE was significantly higher in patients of acute inferior myocardial infarction with PSTD than without PSTD (92% vs 8%, p<0.001). On multiple logistic regression analysis, patients of acute inferior myocardial infarction with PSTD have a 5.4 fold increased risk of in-hospital MACE than patients without PSTD (OR 5.480; 95% CI 1.759-17.067, p=0.003).Conclusion: The presence of precordial ST segment depression on admission ECG in acute inferior myocardial infarction patients was associated with a higher in-hospital MACE and was an independent predictor of in-hospital MACE.Latar Belakang: Implikasi klinis depresi segmen ST (DSST) prekordial pada infark miokard akut elevasi segmen ST (IMAEST) inferior hingga saat ini masih menjadi perdebatan dengan hasil yang kontradiktif. Berdasarkan penelitian-penelitian sebelumnya, adanya DSST prekordial menyatakan kelompok penderita IMAEST inferior risiko tinggi oleh karena iskemia miokardium luas sehingga menyebabkan insiden kejadian klinis kardiovaskular mayor (KKvM) yang lebih tinggi. Meskipun dengan hasil ini, DSST prekordial masih dianggap sebagai benign electrical phenomenon. Penelitian ini bertujuan untuk mengetahui perbedaan KKvM selama perawatan di rumah sakit pada penderita IMAEST inferior dengan dan tanpa DSST prekordial, serta mengetahui bahwa DSST prekordial dapat digunakan sebagai prediktor KKvM selama perawatan di rumah sakit pada IMAEST inferior.Metode: Sebanyak 96 penderita IMAEST inferior yang dirawat di Departemen Kardiologi Rumah Sakit Umum Haji Adam Malik mulai Desember 2013-2015 dianalisis secara retrospektif. Pasien dibagi menjadi dua kelompok berdasarkan adanya DSST prekordial pada EKG awal. Analisis bivariat dan multivariat dilakukan untuk mengetahui hubungan antara DSST prekordial dan KKvM selama perawatan di rumah sakit, nilai p<0,05 dianggap bermakna secara statistik.Hasil: Analisis bivariat menunjukkan KKvM selama perawatan di rumah sakit lebih tinggi pada penderita IMAEST inferior dengan DSST prekordial berbanding tanpa DSST prekordial (92% vs 8%, p<0,001). Pada analisis regresi logistik, penderita IMAEST inferior dengan DSST prekordial memiliki peningkatan risiko 5,4 kali untuk mengalami KKvM selama perawatan di rumah sakit dibandingkan penderita tanpa DSST prekordial (OR 5,480; 95% IK 1,759-17,067; p=0,003).Kesimpulan: Penderita IMAEST inferior dengan DSST prekordial memiliki insiden KKvM selama perawatan di rumah sakit yang lebih tinggi. DSST prekordial pada IMAEST inferior merupakan prediktor independen terhadap KKvM selama perawatan di rumah sakit
Diagnostic Value of Left Ventricular Early Inflow-Outflow Index in Determining Severity of Mitral Regurgitation
Get PDFBackground: Determining severity of mitral regurgitation (MR) is very important, asit is related with prognosis and management of the disease. Currently, there is no goldstandard exists for quantification of MR severity using echocardiography. AmericanSociety of Echocardiography (ASE) guidelines recommend several parameters basedon integrative criteria using color and spectral Doppler and anatomic measurement.Left Ventricular Early Inflow Outflow Index (LVEIO Index) was proposed as one parameterto assess the severity of MR by omitting geometric error from regurgitantvolume method. Thus, LVEIO index offers a simple, easy and accurate measurementin determining severity of MR.Methods: This study was a diagnostic test research with cross-sectional design. Thesubjects were all patients with organic mitral regurgitation who underwent echocardiographyexamination to measure severity of MR using the LVEIO index as well asother parameters measurements based on parameters of ASE guidelines. Diagnostictest was used to determine the sensitivity, specificity, positive predictive value, negativepredictive value and accuracy of LVEIO index.Results: Of 49 patients in this study, 23 of them have severe MR and 26 are non-severeMR patients. The proportion of gender between two groups almost similar with an agerange from 56 to 61 years and the most common etiology finding was degenerative MR.Echocardiography examination showed the ejection fraction in severe MR was 63±4.2%and 64±3.9% in non-severe MR. The value of LAVI, MPAP, E-wave, VC, EROA andLVEIO index increased parallel with severity of MR (LAVI; 67±18.2 vs. 40±14.2 ml/m2,MPAP; 28±12.8 vs. 20±12.6 mmHg, E-wave 1.5±0.3 vs. 1±0.2 m/s, VC 0.8±0.3 vs.0.5±0.1 cm, EROA 0.4±0.1 vs 0,2±0,1cm2, LVEIO 9±2,4 vs. 5±1,8). The sensitivity,specificity, and accuracy of LVEIO index for diagnosis of severe MR were 86%, 84%,and 89%, respectively.Conclusion: LVEIO can be proposed as a relatively simple, easy and accurate methodin determining severity of MR