Pulmonary Artery Hypertension Associated with HIV Infection in Nine Year-Old Child

Pulmonary arterial hypertension (PAH) is a serious life threatening and severe complication ofHIV infection. A PAH presentation in patient with HIV tends to non specific, result in recognizeddiagnosis at a later stage. A 9 year-old HIV patient came to Pediatric Clinic with a chief complaint of worsening dyspneu for 1 month, leg edema and difficulty lying on a flat bed. Patient showed signs and symptoms that lead to pulmonary hypertension. An ECG findings were sinus rhythm, right axis deviation, and right ventricular hypertrophy. Echocardiography findings showed rightventricular and atrial enlargement, and high probability of pulmonary hypertension. Blood examination showed CD 4 was 84 cells/μL. The patient was managed as pulmonary arteryhypertension associated with HIV (HIV-PAH) infection.The patient was admitted for 3 weeksand eventually discharged with relieve condition

Correlation between Carotid Intimal-Media Thickness and Coronary Artery Disease Severity in Stable Coronary Artery Disease Patients

Background: Atherosclerosis is a fundamental process in the natural course of coronary heart disease (CHD), carotid artery disease and peripheral artery disease. Atherosclerosis is caused by an imbalance of homeostasis in the level of the endothelial layer and the presence of risk factors. The manifestations of coronary atherosclerosis have a wide spectrum of diseases, ranging from subclinical to clinical phases. In patients without CHD symptoms, changes incarotid artery morphology include carotid intimal-media thickness (CIMT) and carotid plaques which correlated with CHD. This study aims to see the relationship between CIMT with the severity of coronary lesions in stable coronary artery disease.Methods: The study was an analytical observational research using cross sectional design. Data was taken by consecutive sampling from outpatient hospital clinic. The CIMT score was obtained from the examination of a communis carotid artery using a B-mode ultrasound device. The value ofCIMT is divided into 2 groups based on the value of the sensitivity curve and the specifcity curve. The value of Syntax was obtained from the catheterization laboratory and the factors that influenced it were recorded. Pearson correlation test is used to analyze the relationship of CIMT and Syntax value. The logistic regression test used for multivariate test.Results: Of the 58 patients, there were 33 subjects who had a CIMT score of > 0.71 mm and 25 subjects who had a CIMT score of ≤0.71 mm. There is a positive correlation (r = 0.403; p 0.71 mm compared to CIMT values ≤0.71 mm were 29 versus 4 (RR: 1.831; CI 95%:1.194-2.807; p = 0.01). A multivariate test showed CIMT consistently as a independent risk factor of Syntax value in stable coronary artery disease with RP 5.27 (CI 95%: 1.306-25.047; p = 0.021).Conclusion: The increase in CIMT value has a signifcant positive correlation with the Syntax value. A CIMT > 0.71 mm is a independent risk factor of high Syntax value in stable coronary artery disease with prevalence ratio 5.2

Study of NT-pro-BNP and Hs-Troponin I biomarkers for early detection of children’s heart function of protein-energy malnutrition

The Protein Energy Malnutrition (PEM) is the condition of a lack of carbohydrate and protein stores in the body that trigger chronic failure nutrient intake and body maintenance function caused to impact the heart functions. The NT-pro-BNP and Hs- Troponin I proteins were found as the indicator of cardiac dysfunction. The sixty subjects of PEM, analyzed by standard of Indonesia Healt Ministry as well as nutritional status. The blood electrolytes examined by laboratory assay and the levels of Hs-Troponin 1 and NT-Pro-BNP were analyzed by Immune-Chromatography method. Assessing of the ventricular mass with the seeing the peak of the diastolic flow rate of left ventricular that estimated by the curve of the receiver operating characteristic and the area under the curve (P<0.05). The result has shown that the PEM decreased in the left ventricular mass for impaired heart function and systolic disorder. The Hs- Troponin I (90.9%) has better sensitivity than NT-pro-BNP (85.5%) if the merger of those markers possesses the lowest sensitivity (81.8%). These proteins have good biomarkers in heart function, mainly in cases where PEM is present

Clinical Characteristics of Adult Uncorrected Secundum Atrial Septal Defect, A Pilot Study

ABSTRACTAtrial septal defect (ASD) is the most frequent congenital heart disease in adulthood. Pulmonary hypertension (PH) complicating ASD compels patients seeking medical assistance because of its disabling symptom. Most adult ASD develop PH which render significant morbidity and mortality. The aim of the study is to characterize the clinical profiles of adult patients with ASD. The study design was cross sectional. The subjects were enrolled consecutively from outpatient clinics and inpatient wards. The demography, medical and imaging data were collected and recorded in case report form. Descriptive statistics was applied to characterize the subjects. Seventy-six subjects were enrolled. The majority were women (77.6 %) in the productive and child-bearing ages (63.2%). The most common symptoms were dyspneu on effort, fatigue, and palpitation. Most subjects had functional capacity of WHO class functional II (70.2 %). The mean oxygen saturation was 96.4 %. Based on the echocardiography examination, 77.6% of subjects had suffered from PH. The mean longest diameter of defects were 2.7 cm. The direction of blood flow was mostly left to right (77.6 %). Left and right ventricle function were within normal limit. Right heart catheterization showed mean left atrial pressure 11.5 mmHg, which confirmed the precapillary or arterial PH. Mean pulmonary artery pressure was 42.0 mmHg. The pulmonary artery resistance index mostly less than 4 Wood Unit/ m2 (63.7 %), indicating the feasibility to close the defect. Whereas 24.6 % of subjects were contraindicated for closing. Pulmonary artery hypertension (PAH) was diagnosed in 77.6 % subjects, meanwhile 13.2 % had borderline PAH. In conclusion, most adult ASD patients had developed PAH, mostly young women in productive ages, mainly visited hospital due to symptom of PH, the direction of flow predominantly left to right side and mostly had reduced functional capacity

Clinical characteristics of adult uncorrected secundum atrial septal defect: a pilot study

Abstract Atrial septal defect (ASD) is the most frequent congenital heart disease in adulthood. Pulmonary hypertension (PH) complicating ASD compels patients seeking medical assistance because of its disabling symptom. Most adult ASD develop PH which render significant morbidity and mortality. The aim of the research is to characterize the clinical profiles of adult patients with ASD. The research design was cross sectional. The subjects were enrolled consecutively from outpatient clinics and inpatient wards. The demography, medical and imaging data were collected and recorded in case report form. Descriptive statistics was applied to characterize the subjects. Seventy-six subjects were enrolled. The majority were women (77.6 %) in the productive and child-bearing ages (63.2%). The most common symptoms were dyspneu on effort, fatigue, and palpitation. Most subjects had functional capacity of WHO class functional II (70.2 %). The mean oxygen saturation was 96.4 %. Based on the echocardiography examination, 77.6% of subjects had suffered from PH. The mean longest diameter of defects were 2.7 centimeter. The direction of blood flow was mostly left to right (77.6 %). Left and right ventricle function were within normal limit. Right heart catheterization showed mean left atrial pressure 11.5 mmHg, which confirmed the precapillary or arterial PH. Mean pulmonary artery pressure was 42.0 mmHg. The pulmonary artery resistance index mostly less than 4 Wood Unit/m2 (63.7 %), indicating the feasibility to close the defect. Whereas 24.6 % of subjects were contraindicated for closing. Pulmonary artery hypertension (PAH) was diagnosed in 77.6 % subjects, meanwhile 13.2 % had borderline PAH. In conclusion, most adult ASD patients had developed PAH, mostly young women in productive ages, mainly visited hospital due to symptom of PH, the direction of flow predominantly left to right side and mostly had reduced functional capacity. Keywords : atrial septal defect, pulmonal hypertension, pulmonary artery hypertension   Abstrak Defek septum atrium (DSA) merupakan penyakit jantung bawaan yang paling sering dijumpai pada usia dewasa karena tanda dan gejalanya yang samar. Hipertensi paru (HP) merupakan komplikasi DSA yang mendorong pasien mendatangi rumah sakit karena munculnya gejala yang berat. Hampir semua pasien DSA dewasa mengalami HP yang menyebabkan angka kesakitan dan kematian yang bermakna. Tujuan penelitian ini adalah untuk mengetahui karakteristik klinis pasien dengan DSA dan HP. Disain penelitian adalah potong lintang. Subjek dicuplik secara berurutan dari klinik rawat jalan dan rawat inap. Data demografi, medis dan pencitraan dikumpulkan dan dicatat dalam suatu case report form. Penelitian deskriptif dilakukan untuk menilai karakteristik subjek. Sebanyak tujuh puluh enam subjek dicuplik. Mayoritas subjek adalah wanita (77,6 %) dalam usia muda, produktif dan subur (63,2 %). Gejala paling sering adalah sesak saat aktivitas, mudah lelah, dan berdebar. Sebagian besar pasien masuk dalam kelas fungsional WHO II (70,2 %). Rerata saturasi oksigen 96,4 %. Berdasar hasil ekhokardiografi, sebanyak 77,6 subjek telah mengalami HP. Rerata diameter terpanjang defek adalah 2,7 centimeter. Arah aliran darah melewati defek sebagian besar kiri ke kanan (77,6 %). Fungsi ventrikel kanan dan kiri dalam batas normal. Kateterisasi jantung kanan menunjukkan rerata tekanan atrium kiri sebesar 11,5 mmHg yang menandakan HP prekapiler/arteri. Rerata tekanan arteri pulmonalis sebesar 42.0 mmHg. Nilai indeks tahanan arteri pulmonalis sebagian besar kurang dari 4 Wood unit/m2 (63,7 %) yang menunjukkan kemungkinan bisa dilakukan penutupan defek. Sedangkan 24,6 % subjek kontraindikasi untuk penutupan. Hipertensi arteri pulmonalis (HAP) didiagnosis pada 77,6 % subjek, sedangkan 13,2 % subjek mengalami HAP borderline. Sebagai kesimpulan, sebagian besar DSA dewasa telah mengalami HAP, sebagian besar wanita muda yang berusia produktif, sebagian besar mengunjungi rumah sakit karena gejala HP, arah aliran sebagian besar dari kiri ke kanan dan sebagian besar telah mengalami penurunan kapasitas fungsional

Profile of Endothelin-1, Nitric Oxide, and Prostacyclin Levels in Pulmonary Arterial Hypertension Related to Uncorrected Atrial Septal Defect: Results from a Single Center Study in Indonesia

Background and Objectives. Pulmonary arterial hypertension (PAH) pathomechanism involves an increased plasma level of endothelin-1 and a reduced plasma level of prostacyclin and nitric oxide. Whether similar mechanisms prevail in PAH associated with atrial septal defect (ASD) is unclear. This study aimed to investigate the relationship of endothelin-1, prostacyclin, and nitric oxide with PAH in uncorrected ASD in Indonesian population. Methods. The study design was cross-sectional. The subjects were adult uncorrected secundum ASD with PAH. Pulmonary artery pressure was measured with right heart catheterization. Pulmonary venous blood was obtained during catheterization for measuring endothelin-1, prostacyclin, and nitric oxide. Correlation tests were performed to determine any association between biomarkers and mean pulmonary artery pressure (mPAP). The levels of biomarkers were compared based on the severity of PAH. Statistical significance was determined at p<0.05. Results. Forty-four subjects were enrolled in this study. Endothelin-1 level and mPAP had significant moderate positive correlation (r = 0.423 and p value = 0.004). However, no significant correlation was observed between prostacyclin, nitric oxide levels, and mPAP. The pattern of endothelin-1, prostacyclin, and nitric oxide was distinctive. Levels of endothelin-1 were incrementally increased from mild, moderate, to severe PAH. The levels of prostacyclin and nitric oxide had similar pattern in association with the severity of PAH, which was increased in mild-to-moderate PAH but decreased in severe PAH. Conclusions. There was a distinctive pattern of endothelin-1, prostacyclin, and nitric oxide based on severity of PAH in adult uncorrected ASD. Significant correlations existed between endothelin-1 and the severity of PAH and mPAP