Indonesian Journal of Cardiology
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No full textIntroduction: A surgical incision infection known as sternal wound infection (SWI) usually occurs in one month after cardiac surgery. Many different pathogens can cause SWI. Additional risk factors that contribute to the formation of these infections include obesity, chronic obstructive pulmonary disease (COPD), and the long-term use of ventilation devices, poor nutrition, diabetes mellitus, re-exploration of bleeding event, age, duration of the surgery, duration of hospital stay, type of surgery, and postoperative blood transfusion. The mortality rates of sternal wound infections following heart surgery can vary from 10% to 47% which presents a serious and potentially fatal consequence. This review aims to recognize the microbes involved in infection in order to properly manage SWI patients and reduce mortality and morbidity associated with post-cardiac surgery SWI.
Methods: A systematic review was conducted according to PRISMA criteria, with a literature search across multiple databases such as PubMed, Science Direct, and Google Scholar until September 6th, 2024. Eligibility criteria included retrospective case-control studies or randomized controlled trials (RCTs) in English on adults diagnosed with SWI after open heart surgery, as well as studies that studying microbes causing SWI and presenting raw data. Data from studies that met the criteria were evaluated to assess the microbes involved in post-cardiac surgery sternal wound infection.
Results: A total of 10,596 references were discovered and 8 articles were chosen for the integrative review based on duplication, relevance and inclusion/exclusion criteria.
Conclusion: The most common microbes found in cases of sternal wound infection after cardiac surgery were coagulase negative Staphylococcus (CoNS) followed by Staphylococcus epidermidis, which is the normal flora of human skin. In addition, the presence of obesity, diabetes, and critical preoperative status were associated with an increased risk of SWI, explaining that there is a complex interaction between patient factors and microbial involvement.
Keywords: sternal wound infection, cardiac surgery, microb
Predictors of prolonged use of mechanical ventilation in patients with acute respiratory failure and acute heart failure in the CVCU RSUD Dr. Saiful Anwar Malang
Get PDFBackground
Acute respiratory failure (ARF) is a critical condition that often complicates hospitalization and commonly arises from cardiopulmonary dysfunctions such as acute heart failure. Prolonged mechanical ventilation (PMV) in these patients is associated with increased morbidity, mortality of about 30%, and greater healthcare resource utilization. Identifying predictors of PMV is essential to improve outcomes and optimize management strategies.
Methods
A retrospective cohort study was conducted on all patients who underwent endotracheal intubation in the Cardiovascular Care Unit (CVCU) of RSUD Dr. Saiful Anwar Malang from 2015 to 2021. Patients with incomplete medical records or who died within 14 days of mechanical ventilation were excluded. Univariate and multivariate logistic regression analyses identified independent predictors of PMV. Receiver operating characteristic (ROC) curves were generated to assess model discrimination using the area under the curve (AUC), with corresponding sensitivity and specificity. Data were analyzed using SPSS 22.0.
Results
Five independent predictors of PMV were identified: tachycardia (p = 0.013), metabolic acidosis (p = 0.002), impaired renal function (p = 0.009), shock (p = 0.006), and major bleeding (p = 0.002). Multivariate analysis showed the following odds ratios(OR, 95% CI): tachycardia 2.06 (1.09–5.99), metabolic acidosis 2.03 (1.09–6.33), impaired renal function 2.87 (1.28–6.46), shock 2.83 (1.13–7.06), and major bleeding 1.36 (1.18–2.15). The model demonstrated good discrimination with an AUC of 0.83 (95% CI 0.77–0.88), sensitivity 0.87, and specificity 0.73.
Conclusion
In patients with respiratory failure due to acute heart failure, tachycardia, metabolic acidosis, impaired renal function, shock, and major bleeding were independent predictors of prolonged mechanical ventilation. The predictive model showed high sensitivity and acceptable specificity, supporting its clinical usefulness for early identification of high-risk patients and targeted intervention
Inverted U wave & de Winter pattern: under-recognized sign of acute coronary occlusion
Get PDFBackground: Interpreting ECGs for evidence of ischemia in patients with noticeable changes, such as ST-segment elevation and ST-segment depression, can be easily identified. However, identifying & recognizing atypical ECG patterns of acute coronary syndrome is essential in preventing significant mortality and morbidity. In thefollowing case report, we describe inverted U wave & de Winter pattern.
Case Illustration: A 58-year-old male presented to the emergency department with pressure-like chest pain. His initial evaluation revealed normal blood pressure and elevated blood glucose levels, and an initial ECG was incorrectly interpreted as normal. Eight hours later, he returned with worsened chest pain. The new ECG revealed the de Winter ECG pattern, which indicates acute occlusion of the left anterior descending artery. Additionally, previously overlooked inverted U waves in the initial ECG suggested myocardial ischemia.Eventually, the angiography revealed a complete occlusion of the proximal left anterior descending coronary artery. The patient underwent stent placement and have a good outcome
Conclusions: Inverted U wave and the de Winter pattern described in this case indicates an acute LAD occlusion. It’s a rare finding, but it is critical for emergency physicians to recognize it for urgent reperfusion therapy. Unfamiliarity with these high-risk ECG pattern may lead to delays in appropriate treatment, causing negative effects on morbidity and mortality
Management of Acute Coronary Syndrome Indonesia: Insight from One ACS Multicenter Registry
Get PDFIn “Management of Acute Coronary Syndrome in Indonesia: Insight from One ACS Multicenter Registry”
(Indonesian Journal of Cardiology, 43(2), 45-55. https://doi.org/10.30701/ijc.1406), there is an error
noted.
An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The
correct DOI is https://doi.org/10.30701/ijc.1406. The error occurs only in the PDF; the DOI listed in the
article metadata is already correct.
The publisher apologizes for any inconvenience caused by this error.DOI of original article: https://doi.org/10.30701/ijc.140
Modified STEMI protocol for PPCI during COVID-19 Pandemic: Does it prolong Door-To-Balloon performance?
Get PDFIn “Modified STEMI protocol for PPCI during COVID-19 Pandemic: Does it prolong Door-To-Balloon performance?” (Indonesian Journal of Cardiology, 44(3), 103-10. https://doi.org/10.30701/ijc.1325), there is an error noted.
An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1325. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.The publisher apologizes for any inconvenience caused by this error.DOI of original article: https://doi.org/10.30701/ijc.132
Management of Decongestion in Acute Heart Failure: Time for a New Approach?
Get PDFIn “Management of Decongestion in Acute Heart Failure: Time for a New Approach?” (Indonesian Journal of Cardiology, 43(2), 77-89. https://doi.org/10.30701/ijc.1381), there is an error noted.
An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1381. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.
The publisher apologizes for any inconvenience caused by this error.DOI of original article: https://doi.org/10.30701/ijc.138
Reviews
No full textAbstracts of the 11th Annual Scientific Meeting of the Indonesian Heart Rhythm Society (InaHRS) 2024: Review
Case Reports
Get PDFAbstracts of the 11th Annual Scientific Meeting of the Indonesian Heart Rhythm Society (InaHRS) 2024: Case Report
Utility of Ischemic Signs from Initial ECG in Detecting Culprit Vessels in NSTE-ACS Patients
Get PDFBackground: Non-ST-Elevation ACS (NSTE-ACS) is a part of ACS which require some special attentions. Multivessel coronary disease (MVD) is common in patients with NSTE-ACS and associated with difficulties in determining the main target of revascularization. ECG is the first-line diagnostic tool in the assessment of patients with suspected ACS. However, the utility of the ECG in localizing coronary culprit lesions in NSTE-ACS is not well established. This study was conducted to evaluate whether the pattern of the ischemic signs in ECG can be used to identify the coronary culprit vessel in patients with NSTE-ACS.
Methods: This is a single-centered cross-sectional study using secondary data. The data of all 101 patients with NSTE-ACS who were planned for revascularization procedure between January 2021 and December 2021 were collected from medical record. ECG with ischemic signs were classified to three locations of suspected coronary vessel with culprit lesions and it will be compared to its corresponding angiographic data. The accuracy data will be presented including both sensitivity and specificity.
Results: This study involved 75 men (74.3%) and 26 women (25.7%) with mean age 61.2±9.1 years old. There were 72 patients presented with ischemic signs form ECG with identifiable culprit vessel to be suspected. The sensitivity and specificity of ischemic signs ECG in localizing culprit vessels from angiography were 37.0% and 85.5% in LAD distribution, 38.1% and 81.3% in LCX distribution, and 41.1% and 85.1% in RCA distribution, respectively.
Conclusion: Overall ischemic signs in ECG gave impression of modest accuracy with conspicuous key points that ECG distribution have high specificity in detecting culprit vessels but with low sensitivity. Thus, ischemic signs from initial ECG can be used to detect culprit vessels in NSTE-ACS patients.This article has a related Erratum
Exploring Clinical and Echocardiographic Factors in EHRA Type 2 Atrial Fibrillation for Predicting Ischaemic Stroke: A Search for Unrevealed Insights
Get PDFBackground: Atrial fibrillation (AF) is the most common cardiac arrhythmia in adults. Valvular heart diseases (VHD), regardless of the arrhythmic problems, increase the risk of thromboembolism, which are even higher in those with associated atrial fibrillation. The EHRA (Evaluated Heartvalves, Rheumatic or Artificial) classification categorised AF patients with significant VHD into type 1 and type 2. Unfortunately, there are currently very limited data on risk prediction in stroke-related valvular AF, particularly in the Asian population.
Aims: To investigate the clinical and echocardiographic risk factors for ischaemic stroke prediction in patients with EHRA type 2 VHD.
Methods: This retrospective study enrolled 695 AF patients with EHRA type 2 VHD. The data were collected from patients' medical records who met the inclusion and exclusion criteria from 2015 until 2020. The primary outcome was ischaemic strokes within observation period.
Results: There were 67 ischaemic stroke events (9,6%) of the total sample. Our analysis found that none of the analysed variables proved to be statistically significant risk factors in predicting the occurrence of ischaemic stroke. The median CHA2DS2-VASc risk prediction in the sample was 3, with an accuracy of AUC 0.502 (CI 95%; 0.429 – 0.576), sensitivity 56.7% and specificity 44.7%.
Conclusion: Based on the parameters analysed in this study, no factor was statistically well-predictive to predict the ischaemic stroke incidence in EHRA type 2 VHD AF. In addition, the CHA2DS2-VAS accuracy was low in this population. Further exploration is needed to build an accurate ischaemic stroke risk prediction for EHRA type 2 VHD.This article has a related Erratum