ACI (Acta Cardiologia Indonesiana)
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Diagnostic Values of P-Wave Dispersion to Detect Diastolic Function in Patient with Hypertension
No full textBackground: Hypertension is one of the main causes of cardiovascular disease. Patients with hypertension have increase risk of heart failure compared to populations with normal blood pressure. Clinical evidence shows diastolic dysfunction (DD) can lead to heart failure. Diagnostic of DD with echocardiography is important but access to echocardiography machines is limited compared to electrocardiography (ECG). ECG research correlates P-wave dispersion (PWD) with DD. The aim of this study is to determine the value of PWD to diagnose DD in patients with hypertension.Methods: A cross sectional study was conducted in patients with hypertension at Dr. Sardjito Hospital. Patients received echocardiography, ECG, blood pressure measurement and data recording. The diastolic dysfunction was determined based on 2016 ASE/EACVI criteria. We conducted ROC analysis to determine the cut-off point of P-wave dispersion and the area under the curve (AUC) value, and bivariate analysis on demographic and clinical factors related to PWD. Multivariate analysis was performed to determine the independent factors affecting PWD.Results: 113 patients met the criteria of the study subjects, with 47 men (37.2%), mean age 58.32±11.17 years. Thirteen (11.5%) subjects had DD and 37 subjects (32.7%) with increased PWD. Results showed increased PWD above 71.4 m.s with AUC 76.2%, sensitivity 75%, specifcity 72.2%, positive predictive value 33.3%, negative predictive value 96%, and accuracy of 72.5% in diagnosing DD.Conclusion: This is the frst study to examine the diagnostic value of PWD to detect diastolic function based on 2016 ASE/EACVI criteria. We found PWD above cut-off point 71.4 m.s has a moderate diagnostic value for detecting DD in patients with hypertension
Atrio-Ventricular Septal Defect in Pregnant Women, How to Deal with It : A Case Study
No full textPregnancy is not always well tolerated in women with congenital heart disease (CHD) such as atrio-ventricular septal defect (AVSD), predominantly due to heart failure deterioration and increasing pulmonary hypertension (PH). Managements of those patients are challenging, especially during third trimester and after delivery care. Decision about time of termination, mode of delivery and anesthetic management are also debatable. In this article we report two similarcases of pregnant women with AVSD and severe PH. The frst patient was 27 years old, 28-29 weeks pregnant came with shortness of breath. She had history of miscarriage once. Based on her transthoracal echocardiography, she was diagnosed with AVSD partial type (primum ASD) with severe PH and then treated with intravenous furosemide, oral beraprost and oral sildenafl. The second patient was 27 years old 30-31 weeks pregnant with shortness of breathand appeared cyanotic. She delivered her frst child spontaneously without any symptoms. Based on her transthoracal echocardiography she was diagnosed with AVSD transitional type (large primum ASD with small inlet VSD) and Eisenmenger syndrome. She was treated with intravenous furosemide and oral beraprost. Those two patients underwent planned C-section under general anesthesia, both babies were survived but the patient did not survived severaldays after the procedure due to PH crisis. Until now, management PH associated with CHD in pregnant women is complex. Fluid management and pulmonary artery hypertension (PAH)- targeted therapies are important. Mode of delivery on this cases is also remain debated. Some studies stated planned C-section might be a better choice and combination epidural and lowdose spinal anesthesia might be better than general anesthesia. At the end, when a woman with CHD and PH chooses to continue pregnancy, multidisciplinary team approach is crucial to achieve good outcomes
Association Between Coronary Artery Lesion Severity and Erectile Dysfunction in Stable Coronary Heart Disease Patients
No full textBackground: Atherosclerosis is the underlying process of coronary heart disease. Atherosclerosis is preceded by endothelial dysfunction caused by systemic mechanical and chemical stressors that may occur throughout the blood vessels. Recent studies have found the link incidence of atherosclerosis in the coronary arteries and other arteries as well. Erectile dysfunction (ED) is a clinical manifestation might be caused by atherosclerosis in iliac or pudendal artery. Previous studies have established the relationship between coronary artery involvement and the incidence of ED, but the odds of risk has not been well established. Methods: This was an age matched-paired case-control study. Erectile dysfunction in CHD patients who had undergone coronary angiography was checked by IIEF - 5 questionnaire. The severity of coronary artery lesion was assessed with a Syntax score from coronary angiography results. Moreover these results were assessed by a single experienced observer, blind method and were shown consistency test. Then, the risk of coronary artery lesion severity of the ED was analyzed by chi square test using SPSS version 20. Result: There were 86 subjects consist of 57 subjects in the case group and 29 subjects in thecontrol group. Stable CHD patients with high Syntax scores had 2.75 times risk for development of ED compare with low Syntax scores patients (OR : 2.75, 95 % CI : 1.08 to 6.95, p = 0.03). The severity of coronary artery lesions assessed with Syntax scores were not statistically signifi cant as an independent factor as the incidence of ED. Conclusion: Stable CHD patients with higher severity of lesions in coronary artery have a higher risk of erectile dysfunction than patients with lower severity of the lesion but was not statistically significant as an independent factor on the incidence of ED.Keywords: Severity of coronary artery lesions, erectile dysfunction, stable coronary heart diseas
Current Diagnosis and Management of Myocarditis
No full textMyocarditis is an inflammation of the myocardium. The clinical presentations of myocarditis range from nonspecific systemic symptom such as fever, myalgias, palpitations, or exertional dyspnea, to severe hemodynamic derangement and sudden death. The wide variation of clinical manifestations has made the exact incidence of myocarditis difficult to determine. The prevalence of myocarditis based on autopsy data is ranging from 2 to 42%. Myocarditis has heterogeneous clinical presentation, ranging from mild chest pain or palpitations to cardiogenic shock and life-threatening ventricular arrhythmias. The diagnosis of myocarditis requires a high initial suspicion. Non-invasive techniques, such as cardiac magnetic resonance imaging, can be useful to diagnose and monitor of disease. The endomyocardial biopsy is the gold standard for definitive diagnosis of myocarditis and can identify the etiology of myocarditis. By endomyocardial biopsy, it can direct patients who can be managed by conventional therapy or who require specific treatment based on underlying etiology, such as antiviral or intravenous immunoglobulin infusion.Keywords: myocarditis; diagnosis; managemen
