ACI (Acta Cardiologia Indonesiana)
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The Incidence of Mitral Valve Prolapse and Mitral Valve Regurgitation in Patient with Secundum Atrial Septal Defect
No full textBackground: Association between secundum atrial septal defect (ASD) and mitral valve disease has been recognized for many years. Noninvasive studies indicate a high incidence of mitral valve prolapse (37-70 percent) in these patients. Change of left ventricular geometry in atrial septal defect had been showed were associated with degree of mitral valve prolapse. This study delineates the incidence of mitral valve prolaps and mitral regurgitation in adult patients with secundum atrial septal defect and association with age at onset and size defect. Method: This study was a substudy from ASD registry in Dr. Sardjito General Hospital. The records of 103 adult patients ranged in age from 17 to 76 years old, with an average of 36 years old, and consisted of 16 men and 87 women who had secundum atrial septal defects demonstrated by crosssectional echocardiography between july 2012 until july 2013. Echocardiographic examinations were performed with the patient in the supine position. The echocardiograph was a Vivid 7. The mitral valve apparatus and mitral regurgitation was examined with long axis images, short axis image and apical four chamber view. Result: Mitral valve prolapse was observed in 76% patients with secundum atrial septal defect. Prolaps of anterior mitral leafl et (AML) in age group younger than 35 years and older than 36 years are 38,6% and 61,4% respectively. The incidence of mitral regurgitation was 43%. Severity varianceof mitral regurgitation were 31,7% mild, 7,7% moderate and 2,9% severe. Mitral regurgitation in patient with prolapse AML was 56.4%. None of the patients without mitral valve prolapse had mitral regurgitation.In patient with size defect more than 2 cm, the proportion of prolapse of AML and mitral regurgitation was higher as compared with patient with size defect less than 2 cm. Conclusion: Incidence of mitral valve prolaps and mitral regurgitation are high in patient with atrial septal defect and increase with onset of age. Patients with larger size defect had a greater likelihood of mitral prolapse and mitral regurgitation. Onset of age and size defect might be associated with magnitude of the shunt and abnormal ventricular geometry.Keywords: secundum atrial septal defect, mitral valve prolaps, mitral regurgitatio
Diagnostic Performance Addition of Abnormal P Wave Dispersion on Moderate Risk Duke Treadmill Score Criteria in Detecting Severe Stenosis of Coronary Arteries in Stable Angina Pectoris Patients
No full textBackground: Moderate risk Duke treadmill score (DTS) in threadmill test (TMT), needs additional diagnostic tool to increase its sensitivity of detecting severe coronary artery stenosis in patients with stable angina pectoris. A P wave dispersion (PWD) during TMT currently has a significant relationship with DTS value and can increase the sensitivity in identifying an ischemia. This studyaimed to investigate whether the addition of PWD in moderate risk DTS can improve the prediction of the severity of coronary artery stenosis in patients with stable angina pectoris. Methods: This study is a diagnostic test with cross-sectional design. The subjects were patients who had undergone TMT and coronary angiography at the Dr. Sardjito General Hospital Yogyakarta. The outcomes were sensitivity and specifi city of abnormal PWD in moderate risk DTS patients for predicting the severe stenosis in those with stable angina pectoris as compared with moderate risk DTS and normal PWD.Results: The additional of PWD at moderate risk DTS on 64 subjects had a sensitivity of 86.7%, a specifi city of 44.1%, a positive predictive value of 57.8%, a negative predictive value of 79.0%, a positive likelihood ratio of 1.6, a negative likelihood ratio of 0.3 and a prevalence of 46.9%, witha prediction accuracy of 64.1%. Conclusion: The additional of abnormal PWD in moderate risk DTS had a sensitivity of 86.7% and a specificity of 44.1% for severe coronary artery stenosis in patients with angina pectoris.Keywords: P wave dispersion, moderate risk Duke treadmill score, severe coronary stenosis
Chronic Venous Insuffi ciency in a Woman with Standing Profession
No full textThe prevalence of Chronic Venous Insufficiency (CVI) give a high social impact. InEurope, approximately 40% of the adult population affected by venous disorders. In general, the prevalence of CVI is about 5% - 15%. The prevalence is increasing by age
Isolated Persistent Left Superior Vena Cava, Role of Echocardiography Screening and CT angiography
No full textBackground: An isolated persistent left SVC with concomittant agenesis of right SVC in adult patients is a very rare abnormality. Physician should consider it particularly in patients, in which venous acces will be performed. Our rare case deals with the importance of detailed echocardiographic examination with screening of coronary sinus dilatation before the electrophysiology study.Case: A 65-year-old woman came to outpatient clinic for a chief complaint of palpitations. Her ECG showed paroxysmal SVT with WPW syndrome. She underwent echocardiography examination before electrophysiology study and it was found that she had a dilated coronary sinus. Therefore we performed cardiac CT. It was found that she had a persistent left superior vena cava (SVC) and an absence of a right SVC with no other congenital anomaly.Conclusion: A comprehensive echocardiography examination to look for a dilation of coronary sinus is a first suggestion to screen this anomaly, eventually followed by echocardiography with agitated saline injection and/or computed tomography can help physician to anticipate the anomaly before the invasive procedure involving the thoracic vein.Keywords: echocardiography, cardiac CT angiography, vascular malformation, superiorvena cav
Cardiovascular Prevention: The Present And The Future
No full textCardiovascular disease (CVD) prevention is defined as a coordinated set of actions, at the.....
The Role of Smoking Cessation in Cardiovascular Disease
No full textIndonesia is in the world 1st rank for the number of male smokers over the age of 15 years. It.....
Using Short Message Service as An Interactive Health Education to Prevent Cardiovascular Disease
No full textBackground: Puskesmas (Primary health care /PHC) in Indonesia is the one of the primary ...
Efficacy of Lumbrokinase and Warfarin Compared to Single Warfarin on Thrombus Resolution in Deep Vein Thrombosis
No full textBackground: Deep vein thrombosis (DVT) is a challenging condition for clinician in all specialities. Prognosis after vein thromboembolism is worse and much worse after pulmonary embolism. Anticoagulant is the mainstay therapy for deep vein thrombosis, but there is still slow thrombus resolution even with the use of optimal anticoagulant. The use of intravenous thrombolytic agentsis one of the methods to signifi cantly lyse thrombus. Since there is increasing risk of bleeding with the use of the agents, indication is limited. Lumbrokinase is oral thrombolytic that may give significant thrombus lyses without increasing the risk of bleeding for deep vein thrombosis. This study was conducted to compare single warfarin therapy with combination of lumbrokinase andwarfarin for thrombus resolution in deep vein thrombosis patients. Methods: This study was a randomized open labeled trial comparing deep vein thrombosis patients using single warfarin therapy group to group using combination lumbrokinase and warfarin. 22 patients meet the inclusion and exclusion criteria. Patients were followed for 30 days and in the end of the trial, evaluation using vascular Doppler ultrasonography was done. Chi-square analysis was used to compare the outcome between two therapy groups. Results: In this trial, group therapy with added lumbrokinase to warfarin yielded a tendency toward better thrombus resolution compared to group with single warfarin therapy (58.3% vs.30%, p=0.231). Conclusion : Added therapy with lumbrokinase to warfarin may give better thrombus resolution as compared to single warfarin therapy, although there is no signifi cant difference between groups.Keywords: deep vein thrombosis, lumbrokinase, warfari
Association Between Mean Platelet Volume (MPV) with Major Adverse Cardiovascular Events in Acute Coronary Syndrome during Hospitalization
No full textBackground: Platelets play a central role in the pathogenesis of acute coronary syndrome with various clinical manifestations of unstable angina pectoris, myocardial infarction with ST segment elevation, and myocardial infarction without ST segment elevation. Mean platelet volume (MPV), the average size of platelets in blood obtained from routine blood tests, reflects the activation of platelets. Previous study revealed that higher MPV showed a higher thrombotic potential, by increasing the platelet activation, secretion of tromboxan A2 and the expression of glycoprotein Ib and IIb/IIIa receptors. This study aims to determine whether the MPV may predict the major cardiovascular events in patients with acute coronary syndrome.Metode: We perform a retrospective cohort study involving 372 patients with acute coroanry syndrome who admitted to Intensive Cardiac Care Unit Dr. Sardjito Hospital Yogyakarta. The research is conducted between January 2009 to January 2011, comprising 180 (48.3%) STEMI patients, 87 (23.3%)NSTEMI patients and 105 (28.4%) unastable angina patients. Subjects are further grouped as those with high MPV and low MPV. MPV measurement is obtained on routine blood tests of those patients.The major adverse cardiovascular events are cardiovascular death, non fatal reinfarction, stroke, acute heart failure and cardiogenic shock.Result: Cut-off value of MPV in this study is 8.85 fL determined with ROC curve analysis. The major adverse cardiovascular events is significantly higher in those with MPV >8.85 fL compared with those with the MPV ≤8.85 fL (incidence: 28.4% vs. 18.9%, p = 0.034), with the relative risk (RR) 1.65, 95% CI 1.037-2.783. The mean MPV in patients with major adverse cardiovascular events was significantly higher as compared to those without major adverse cardiovascular events (9.506 ± 1.76 fl vs.8.96 ± 1.45 fl, p = 0.001).Conclusion: Mean platelet volume (MPV) are associated with major adverse cardiovascular events in acute coronary syndrome. The high MPV may be considered as a predictor of major cardiovascular events in patients with acute coronary syndrome.Keywords: acute coronary syndrome, mean platelet volume, major adverse cardiovascular events