Pedoman Tatalaksana Dislipidemia PERKI 2013

Pedoman tatalaksana ini merupakan pedomantatalaksana dislipidemia pertama yang dibuat oleh PERKI. Tujuan pembuatan pedoman tatalaksana ini adalah untuk membantu dokter membuat keputusan dalam praktek sehari-hari. Pedoman inimenyarikan dan mengevaluasi bukti-bukti yang ada ketika pedoman tatalaksana ini dibuat. Isi dari pedoman tatalaksana ini mengacu terutama pada pedoman tatalaksana dislipidemia ESC/EAS tahun 2011 serta berbagai hasil penelitian lainnya. Keputusan akhir tentang terapi individual merupakan tanggung jawab dari dokter yang menangani pasien

To reperfuse or not to reperfuse: a case report of Wellens’ syndrome with suspected COVID-19 infection

Background Wellens’ syndrome is known to be associated with left anterior descending artery occlusion that could lead to an extensive anterior wall myocardial infarction. Thus, emergency cardiac catheterization is needed. However, during coronavirus disease 2019 (COVID-19) pandemic, it is recommended for hemodynamically stable acute coronary syndrome patients with COVID-19 infection to be treated conservatively in an isolated hospital ward. Case presentation We report an 85-year-old patient with chief complaints of typical, squeezing chest pain in the past 4 h. The patient had a high fever, dyspnea, sore throat, and fatigue for 3 days. He had previously come into contact with COVID-19 positive relatives. The patient was hemodynamically stable and pulmonary auscultation revealed coarse rales in the entire lung. Electrocardiography (ECG) evaluation during the pain episode showed non-specific ST-T changes in lead V2-V5. After sublingual nitrate was administered, ECG evaluation during the pain-free period revealed a biphasic T wave inversion in lead V2 and V3. Laboratory workup showed elevated cardiac marker and leucopenia with neutrophilia and lymphopenia. Rapid immunochromatographic test and initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) evaluation from nasopharyngeal swab showed negative results. However, radiographic evaluations suggest the diagnosis of COVID-19 infection. While waiting for the second RT-PCR evaluation, the patient was diagnosed with Wellens’ syndrome with suspected COVID-19 infection. The patient was treated conservatively according to national guidelines and scheduled for elective cardiac catheterization. On the third day, the patient felt better and insisted on being discharged home. Ten days after discharged, the patient died of myocardial infarction. Conclusion Emergency cardiac catheterization should be done for patient with Wellens’ syndrome, regardless of the COVID-19 infection status

Purulent pericarditis in advanced thymoma: A case report

Thymoma is the most common primary anterior mediastinum mass with various clinical manifestations, and one of the manifestations is pericardial effusion. While pericardial ef- fusion in thymoma is usually serous, it can become purulent when an infection occurs in a nearby organ, albeit rare. In this report, we present a rare case of a 27-year-old woman who had purulent pericarditis secondary to an advanced thymoma. The patient came to the emergency department with the chief complaints of worsening chest discomfort, non- productive cough, and fever in the past 2 weeks. The patient was diagnosed with thymoma 5 months prior. Based on the examinations, it was discovered that the patient had pericardi- tis. After the pericardiocentesis was performed and the fluid was examined, the patient was diagnosed with purulent pericarditis secondary to thymoma. The patient was then treated with intravenous antibiotic and pericardial drain. Unfortunately, the patient’s condition de- teriorated, and the patient died on the fifth day of hospitalization. This case highlights an infrequent but potentially life-threatening complication of thymoma. In addition, thymi

Maternal cardiovascular risk in early and late onset of preeclampsia patients five years after labor : A comparative study

ABSTRACT : Preeclampsia still remains an important topic in relation to the cardiovascular system in more than 300 million women worldwide, with both short and longterm mobidities. The purpose of this study was to compare maternal cardiovascular risk of early and lateonsets of preeclampsia 5 years after labor. It was a retrospective cohort study of preeclampsia patients within the period of January 2013 to January 2014, who delivered at Dr. Soetomo General Hospital. The maternal cardiovascular risk assessment include; body mass index (kg/m2), waist circumference (cm), blood pressure (mmHg), fasting blood sugar levels (mg/dL), HDL cholesterol levels (mg/dL), LDL cholesterol levels (mg/dL), blood triglyceride levels (mg/dL), total cholesterol levels (mg/dL) and ATP-III Framingham scores. There was a higher and significant cardiovascular risk factors in relations to hypertension and/or metabolic syndrome (p 0.031) in the early-onset of severe preeclampsia group, which also supported an increase of 1.47 folds of cardiovascular risks (RR 1..471; CI 95 [1.071-2.019]) compared with the late-onset group. The incidence of metabolic syndrome 5 years after preeclampsia was higher in the early-onset of preeclampsia group compared with the late-onset. Also, the cardiovascular risk factors related to hypertension and / or metabolic syndrome were higher in the early-onset group and supported an increase in cardiovascular risk factors of 1.47 times compared with the late-onset group

Peranan Angiotensin Receptor Blockers Pada Hipertensi

Hipertensi didefinisikan sebagai suatu keadaan dimana tekanan darah sistolik ≥ 140 mm Hg dan atau tekanan darah diastolik ≥ 90 mm Hg. Saat ini prevalensi hipertensi semakin meningkat dan menjadi masalah kesehatan yang signifikan di seluruh dunia. Diperkirakan terdapat penambahan sebanyak 27 juta orang yang menderita hipertensi pada akhir 2030. Di Indonesia prevalensi hipertensi pada orang dewasa (>18 tahun) masih cukup tinggi (31,7%), bahkan lebih tinggi daripada Singapura (27,3%), Thailand (22,7%) dan Malaysia (20%). hanya 7,2% yang sadar telah menderita hipertensi dan 0,4% yang mendapatkan terapi hipertensi

MEKANISME SURVIVAL HUMAN ADIPOCYTE MESENCHYMAL STEM CELL (H-AMSC) PADA KULTUR DENGAN PRAKONDISI HIPOKSIA MELALUI EKSPRESI CD44, VEGF, SCF, OCT-4, HSP27, BCL2, DAN HAMBATAN APOPTOSIS

The efficacy of stem cell therapy using of Adipocyte- Mesenchymal Stem Cell (h-AMSC) in post-acute myocardial infarction has been limited because of AMSC is not compatible to the new microenvironment that may leads to cell death. Hypoxic preconditioning of sub lethal low oxygen (O2 1%) during culture has been reported as an effective strategy to overwhelmed this condition. This study was conducted to evaluate the expression of CD 44, VEGF, SCF, OCT-4, BCL2, HSP27, and apoptosis on culture under hypoxic preconditioning. The main objective of this study is to explain the mechanism of survival enhancement of h-AMSC during culture with hypoxia. The other objective of this study is also looking for the role of hypoxic preconditioning on specific marker expression such as CD44, VEGF, SCF, OCT-4, BCL2, HSP27, and inhibition of apoptosis. This trial also aimed to study the optimal time duration of hypoxic preconditioning exposure to improve survival of h-AMSC so that could be used as a reference for h- AMSCs culture strategy before transplantation. This research is an experimental laboratory explorative study (in vitro study). Samples were derived from abdominal human adipocyte with minor surgery and afterward the tissue divided into 24 culture units, randomly allocated into two groups; 12 unit as treatment group and 12 unit as control group. Hypoxic group were cultured under hypoxic condition (O2: 1 %) and control group were cultured under normoxia condition (O2 : 21%) for 24, 48, 72 hours. The two groups above were observed for the expression of CD44, VEGF, SCF, OCT4, BCL2, HSP27, and apoptotic inhibition. The marker of CD44 was evaluated with flowcytometry method, the expression of VEGF, SCF, OCT-4, BCL2, HSP27 were evaluated with immunocytochemistry method, and the apoptosis was counted by Tunnel Assay method. Data were analyzed using Multivariate Analysis of Variance (MANOVA), and path of mechanism analysis with Multiple Linear Regression. This study results showed that the expression of CD44 was not significantly different between hypoxia versus normoxia (p=0.066). Hypoxic preconditioning significantly increased the expression of VEGF (p=0.000; b=0.774) as compare to normoxia, but time difference of hypoxia exposure resulted significant VEGF expression where the highest expression VEGF has been observed in 24 hours (p=0.000). All other markers such as SCF, OCT-4, BCL2 and HSP27 revealed significant increased of expression under hypoxia versus normoxia, but the time difference of hypoxic preconditioning exposure to SCF, OCT-4, BCL2, and HSP 27 showed that exposure at 24-hour culture under hypoxic preconditioning is the most optimal time for culture to enhance all markers expression as well as the occurrence of apoptosis. On multiple linier analysis, the expression of VEGF positively affected SCF expression (b=0.889), SCF expression positively affected OCT4 expression (b=0.985). OCT-4 expression positively affected BCL2 expression (b=0.878). Hypoxic preconditioning also significantly increased HSP27 expression versus normoxia (p=0.000). BCL2 expression inhibited the number of apoptosis (b=

Evolving Antiplatelet Treatment, Will the New Agent Change Clinical Practice for All Acute Coronary Syndrome?

Despite improvements in the treatment of acute coronary syndromes (ACS), cardiovascular disease remains the leading cause of death in the United States. Antiplatelet agents, such as aspirin and clopidogrel, play an important role in the treatment of patients with ACS, particularly those at high risk for whom treatment may yield the greatest benefits. The main challenge in preventing and managing ACS is to tailor treatment for each patient by taking into consideration patient characteristics, co-morbidities, underlying short- and long-term risk factors, ischemic and bleeding risks, and expected individual responses to different medications. Several new alternatives providing more rapid and consistent platelet inhibition than aspirin and clopidogrel have been introduced for routine treatment of patients with ACS. These new treatments seem to provide additional benefits without a significant increase in the risk of bleeding, if used for the appropriate patients

Peranan Penggunaan Terapi Antiplatelet Pada Sindroma Koroner Akut

Sindroma Koroner Akut (SKA) merupakan gambaran spektrum presentasi klinis yang terdiri dari STEMI (ST elevation Myocard Infarction), NSTEMI (non ST elevation Myocard Infarction dan angina tidak stabil (unstable Angina/UA). Hal ini selalu dikaitkan dengan pecahnya plak aterosklerosis dan trombosis parsial atau total dari arteri yang terkait. (Fuster, 2011) Presentasi dari ST elevasi segmen miokard infark (STEMI) sekitar 29%-47% dari semua kejadian dengan presentasi klinis nyeri dada. Tingkat mortalitas atau kematian dini yang tinggi pada pasien dengan STEMI sebagian besar disebabkan oleh keparahan iskemik dari arteri yang terkait (West, 2013). Namun adanya manajemen reperfusi segera yang dilakukan baik secara farmakologi dengan fibrinolisis ataupun secara mekanis dengan intervensi coroner perkutan primer (Primary Percutaneous Coronary Intervention/PCI) dapat membatasi ukuran infark dan mengurangi mortalitas

E4der0 Evolving Antiplatelet Treatment Will The New Agent Change Clinical Practice for All Acute Coronary Syndrome ?

Despite improvements in the treatment of acute coronary syndromes (ACS), cardiovascular disease remains the leading cause of death in the United States. Antiplatelet agents, such as aspirin and clopidogrel, play an important role in the treatment of patients with ACS, particularly those at high risk for whom treatment may yield the greatest benefits. The main challenge in preventing and managing ACS is to tailor treatment for each patient by taking into consideration patients characteristics, comorbidities, underlying short- and long-term risk factors, ischemic and bleeding risks, and expected individual responses to different medications. Several new alternatives providing more rapid and consistent platelet inhibition than aspirin and clopidogrel have been introduced for routine treatment of patients with ACS. These new treatments seem to provide additional benefits without a significant increase in the risk of bleeding, if used for the appropriate patients

Current Management OFST-Elevation Myocardial Infarction (STEMI)

Infark miokard dengan ST elevasi (STEMI) didefinisikan sebagai suatu sindroma klinis berupa gejala iskemia miokard yang berkaitan dengan gambaran ST elevasi yang persisten pada sadapan elektrokardiografi (EKG) dan diikuti oleh pelepasan biomarker akibat nekrosis miokard. STEMI merupakan salah satu bagian dari spektrum Sindroma Koroner Akut (SKA). SKA menyebabkan lebih dari satu juta hospitalisasi setiap tahunnya di Amerika Serikat, dimana proporsi STEMI berkisar antara 29-47%. Angka kematian akibat STEMI terus mengalami penurunan dalam empat dekade terakhir, salah satu faktor utama yang mempengaruhinya adalah perkembangan strategi reperflusi koroner