ACI (Acta Cardiologia Indonesiana)
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Pericardial and Pleural Effusion in Patient with Relapse Stage IV Breast Cancer: Same Pathology, Different Etiology?
No full textPericardial effusion associated with malignacy has poor prognosis. The prompt identification of etiology is mandatory, such that timely management can be performed and survival can be increased. However, difficulty in etiology determination is commonly encountered. In this case, we report female patient with relapse stage IV breast cancer who develop massive pericardial and bilateral pleural effusion. The similar characteristics were found in both effusion fluids, however the identification of etiology was not similar. Metastatic cells were found in pleural effusion, whereas they were absent in pericardial effusion
Atrial Arrhythmia in Atrial Septal Defect Patient: A Case Report and Review of Literature
No full textAtrial fibrillation (AF) and atrial flutter are the most common cardiac arrhythmias associated with atrial septal defects (ASD) in adult patients. The incidence could be as high as 52% in patients ages 60 years or more.Patient with congenital heart disease who developed atrial arrhythmias had a >50% increased stroke risk. Nevertheless, studies regarding the pathophysiological mechanism underlying the high incidence of atrial fibrillation in adult patients with ASD remain relatively few. We reported a female 46 years referred to Sardjito hospital with chest discomfort and palpitation. ECG showed atrial flutter, 90 beat per minute, incomplete RBBB, RAD and RVH. Transthoracal echocardiography shown ASD left to right shunt with diameter 1.2 -1.8 cm, LA, RA and RV dilatation, with normal systolic function. From right heart catetherization, the result is ASD High Flow Low Resistance, with pulmonary hypertension (mPAP 44 mmHg).The consequences of left to right shunt across an ASD is RV volume overload and pulmonary overcirculation. Atrial arrhytmia are a common result of long standing right side heart volume and pressure overload. The idea of combining ASD closure and arrhythmia intervention is another approach to consider
The Characteristics and Distribution of Congenital Heart Disease in Outpatient Clinic and Inpatient Ward of RSUD Dr. Soedono Madiun East Java in Year 2015
No full textBackground: Congenital heart disease is a heart abnormality that presents at birth and fatal in the majority of the case. Congenital heart disease affecting up to 8-10 in every 1,000 newborn. Methods: This study was a descriptive research about the characteristics and distribution of congenital heart disease at ward and clinic of a government hospital in East Java for a year, by investigating medical record from 1 January 2015 – 31 December 2015. We classified and analyzed the patients based on the different groups of age, gender, type of congenital heart disease, the age of first diagnosed, nutritional status, co-morbidities of the disease, medical intervention, and the funding. Result: Total sample from this research was 49 subjects, consist of 53% male and 46% female. CHD was mostly diagnosed in the first year of life (75%), with acyanotic CHD as the most common type. Malnutrition was found in 51% of the subjects. Nonsurgical medical intervention was the most common management performed to treat the condition (97%). The funding with National Health Insurance (PBI or non-PBI) was used in more than half of the subjects (51%). Conclusion: As the conclusion, CHD was commonly found in the first year of life with noncyanotic type dominated the CHD patients. As the highly cost of this disease, it was surprising that only half of the subjects were covered by National Health Insurance. A good funding resource was really needed to make sure the treatment plan of the diseases was well executed
The Shared Pathogenesis of Pulmonary Artery Hypertension
No full textPulmonary artery hypertension is defined as an increased in pulmonary artery pressureexceeding 25 mmHg with normal pulmonary wedge pressure. The pathogenesis of pulmonaryartery hypertension involves interaction among vascular, cellular and biomarker componentsin the pulmonary tissue; with eventual result is elevated pulmonary artery pressure. Vascularcomponents are remodeling of intimal, medial and adventitial layers. Cellular components areplayed by apoptosis-resistant endothelial cells, proliferative-prone pulmonary artery smoothmuscle cells, fibroblasts and inflammatory cells. The functional biomarkers are produced andmediated by these cellular changes, mainly endothelin-1, thromboxane, serotonin, nitric oxide,and prostacyclin. The pulmonary vascular remodeling in pulmonary artery hypertension arediverse and may present in various severity based on underlying etiology. Understanding theshared pathogenesis in pulmonary artery hypertension is of paramount importance in order toimprove the disease management and treatment approach
The Past, Present, and Future of Myocardial Revascularization
No full textOne of the important diagnostic modalities in cardiology is cardiac catheterization, which is onetool for myocardial revascularization. This examination is particularly useful in the aspect ofcardiac hemodynamic evaluation, among other utilities. This review describes the advance ofcardiac catheterization from the beginning of its discovery to future development
Abstracts of Symposium II: Acute Coronary Syndrome: The Obstructive Plug
No full textAbstracts of Symposium II: Acute Coronary Syndrome: The Obstructive Plu
Correlation between Tp-Te Interval and Myocardial Blush Grade Value in Anterior ST Elevation Myocardial Infarction Patient
No full textBackground: Clinical manifestations of coronary herat disease (CHD) may be an ST-Elevation Myocardial Infarction (STEMI). In STEMI condition, there is a metabolic disorder and ion exchange disturbance which causes dispersion of transmural repolarization, as well as micro coronary circulation disturbance involving mechanism of microvascular dysfunction. The Tp-Te interval is an electrocardiogram paramener that could be described as the transmural dispersion of repolarization. Assessment of Myocardial Blush Grade (MBG) is a coronary angiography densitometry method that can be used to assess microvascular dysfunction. This study aims to examine the correlation between Tp-Te interval and MBG in anterior STEMI.Methods: The research desgin is cross sectional. Data were taken consecutive from August to November 2017. The Tp-Te interval assessment was performed on the basis of an electrocardiogram record from the subjects. The MBG value assessment was performed using a Quantitative Blush Evaluator (QuBE) computer program based on coronary angiography. The Tp-Te interval is divided into 2 groups: Tp-Te interval > 94 ms and Tp-Te interval ≤ 94 ms. The MBG values are divided into 3 groups: MBG QuBE 1, MBG QuBE 2 and MBG QuBE 3. The assessment of Tp-Te interval and MBG value was performed by observer in intra-observer which were acknowledged based on Kappa and blindness conformity test results against patient clinical data. Pearson correlation test was used to analyze the correlation between Tp-Te interval and MBG value, while logistic regression test was used for multivariate test.Results: Of the total 32 study subjects, there were 23 subjects with Tp-Te interval >94 ms and 9 subjects with Tp-Te interval ≤94 ms. There was a negative correlationwith moderate strength between the Tp-Te interval and the MBG value in the anterior STEMI patients (r =-0.501, p =0.004). There was a prevalence ratio of 4.304 between Tp-Te interval >94 milliseconds against MBG QuBE 1 (95%CI: 1.264-14.658, p <0.001). Multivariate tests showed Tp-Te intervals consistently as independent risk factors for MBG values in subjects with anterior STEMI.Conclusion: There is a negative correlation with moderate strength between the Tp-Te interval and the MBG value in the anterior STEMI patients
Association Between Neutrophil to Lymphocyte Ratio and Left Ventricle Global Longitudinal Strain in Acute Myocardial Infarction
No full textBackground: High neutrophil to lymphocyte ratio (NLR) is independently associated with lower EF, in hospital complications, and higher mortality rates in acute myocardial infarction (AMI). Global longitudinal strain (GLS) measurement after AMI demonstrated specific benefit compared with LVEF in evaluation of the extent of post MI left ventricular myocardial injury. The aim of this study was to determine the association between NLR and left ventricular GLS in AMI patients.Methods: An analytic observational study was conducted on August-December 2017 to patients who admited to Dr. Moewardi General Hospital which diagnosed STEMI or NSTEMI. Blood examination and transthoracic echocardiography were performed. They were divided into two groups according to GLS measurement result, GLS>-13.8% and GLS≤-13.8%. The cut-off value of NLR to predict GLS>-13.8%was determined by ROC curve analysis. Bivariate and multivariate analysis to assess whether high NLR was associated with GLS>-13.8% were performed.Results: As many as 57 patients were included in this study, 24 patients (mean age 56,21±9,43) in GLS ≤-13.8% group and 33 patients (mean age 56.67±8.24) in GLS >-13.8%. NLR was significantly higher in GLS>-13.8% group 6.06 (5.36-6.86) compare 4.20 (3.49-5.04),in GLS≤-13.8%, p=0.001. The cut-off value of NLR was 4.69. The bivariate analysis showed that NLR>4.69 associated with GLS>-13.8%, OR 2.70 (CI 95% 1.41-5.17, p=0.001). Multivariate analysis shown that higher NLR have more probability to develop GLS>-13.8%, OR 8.53 (CI 95% 2.38-30.60, p<0.001).Conclusion: There is an association between NLR and left ventricular GLS in AMI patients. AMI patients with high NLR are more likely to have worse GLS