Pharmacoinvasive Strategy in Acute STEMI

Recently, primary percutaneous coronary intervention (PCI) is the best option for reperfusion in STEMI patients, in clinical trials has lower rates of reinfarction, stroke and mortality than fibrinolytic therapy. Because of system delays in routine practice, prehospital administration of fibrinolytic therapy may lead to similar clinical outcomes, especially in those patients who present in early onset after symptom. Assessment of failed reperfu-sion for rescue PCI and invasive strategy after fibrinolitic therapy leading similar outcome with primary PCI. This review focuses on the timing of, and indications for, an invasive strategy after fibrinolytic therapy, including that for failed pharmacological reperfusion

Fibrilasi Atrium Pada Penyakit Hipertiroidisme Patogenesis dan Tatalaksana

Fibrilasi atrium (atrial fibrilation, AF) merupakan aritmia jantung yang paling sering terjadi pada pasen usia diatas 65 tahun. Prevalensi semakin tinggi dengan bertambahnya usia, dan merupakan penyebab utama terjadinya stroke. AF sering timbul sebagai manifestasi hipertiroidisme, dan menjadi predisposisi terbentuknya trombus dan emboli. AF dan disritmia supraventrikular lainnya yang disebabkan oleh hipertiroidisme, menambah angka kematian penyakit vaskular. Pada sepuluh hingga limabelas persen pasen dengan hipertiroidisme akan berlanjut menjadi AF, dan insiden ini semakin tinggi bila disertai penyakit jantung

Ablasi Takikardia Ventrikular dengan Pemetaan Elektro-Anatomikal 3 Dimensi

Tingginya keberhasilan serta rendahnya morbiditas, telah menjadikan ablasi frekuensi radio transkateter sebagai terapi lini pertama pada beberapa jenis aritmia. Angka kesuksesan pada aritmia stabil dengan lokasi anatomis yang dapat diprediksi atau gambaran elektrogram intrakardiak yang khas seperti takikardia ventrikular idiopatik, atau atrial flutter yang bergantung pada ismus telah mencapai 90%.Namun, ablasi dari beberapa aritmia yang lebih kompleks seperti beberapa takikardi atrial, atrial fibrilasi, serta kebanyakan takikardia ventrikular masih merupakan tantangan besar. Hal ini disebabkan antara lain oleh keterbatasan teknik pemetaan kateter konvensional secara fluoroskopi dalam melokalisasi substrat aritmogenik. Ketidak-mampuan untuk menghubungkan secara akurat EKG intrakardiak dengan lokasi endokardium yang spesifik karena gerakan ujung kateter, juga membatasi reliabilitas pemetaan

PERFORMA SIMPLIFIED ACUTE PHYSIOLOGY SCORE 3 SEBAGAI PREDIKTOR MORTALITAS PADA UNIT RAWAT INTENSIF KARDIOVASKULAR

Background: Severity of illness scoring systems has gained increasing popularity in Intensive Care Units (ICUs) since 1980s. Physicians used them for predicting mortality and assessing illness severity in clinical trials. The Simplified Acute Physiology Score 3 (SAPS 3) is the only score that can predict hospital mortality within an hour of admission to ICU. Although this scoring systems has been widely used in ICUs, they have not been commonly applied in Intensive Cardiovascular Care Units (ICVCUs) since the population is quite different especially in disease subset. Therefore, the objective of this study was to evaluate the parameters in the SAPS 3 scoring system performance for predicting mortality in ICVCU population.Methods: This was an observational study with cross-sectional approach using secondary data from RAICOM (Registry of Acute and Intensive Cardiovascular Care on Outcome) taken from September 2013 – September 2014 in the ICVCU National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia. The secondary data were collected, analysed, and matched with SAPS 3 variables. All missing and invalid data were excluded. All data was processed and the SAPS 3 score was calculated in each patient. Multivariate analysis with logistic regression was conducted to evaluate the significance of the parameters in predicting mortality. Discrimination was assessed by area under the receiver operator characteristic curve (AUROC). Calibration was assessed by Hosmer-Lemeshow goodness-of-fit test through calculating the ratio of observed?to?expected numbers of deaths.Results: A total of 233 patients were included in this study and the observed hospital mortality was 16.7% (39/233). The patients enrolled were divided into survivors and nonsurvivors. Bivariate analyses of SAPS 3 variables showed intra-hospital location before ICVCU admission, use of vasoactive agents, reasons for ICVCU admission, infection, Glasgow Coma Score (GCS), creatinine level, and platelet count were significantly different between nonsurvivors than survivors (P<0.05). The SAPS 3 score was significantly higher in nonsurvivors than survivors. The AUC (95% confidence intervals [CIs]) for SAPS 3 score was 0.752 (0.669–0.835). The Hosmer?Lemeshow goodness?of?fit test for SAPS 3 demonstrated a Chi?square test score of 1.729, P = 0.943. Multivariate logistic regression was conducted for all variables that were probably correlated to prognosis. Eventually, intermediate ward as intra-hospital location before ICVCU admission was selected as an independent risk factors for predicting mortality (OR 4.165; 95% CI 1.462-11.864; P=0.008), whereas surprisingly the presence of community-acquired pneumonia (CAP) before ICVCU admission was a protective factor from hospital mortality (OR 0.224; 95% CI 0.068-0.730; P=0.013).Conclusion: Parameters in the SAPS 3 score system exhibited satisfactory performance in discrimination. In predicting hospital mortality, these parameters also showed good calibration for estimating hospital mortality. Intermediate ward as intra-hospital location before ICVCU admission appeared to be independently associated with mortality whereas patients with CAP comorbid as a protective factor against mortality. Despite the good result of this study, there are still plenty room of improvement for developing similar score in the future specifically for ICVCU population

Hemodynamic Profiles as a Predictor of Mortality and Length Of Stay in ICCU: Insight from Registry of Acute and Intensive Cardiovascular Care Outcome

Aims: The ability to differentiate high risk and low risk patients in ICCU is beneficial. Hemodynamic profiles can be used to describe patient’s condition immediately. Based on the presence of congestion and poor perfusion, patients can be divided into four hemodynamic profiles. We aim to evaluate the prognostic value of hemodynamic profiles for patient’s mortality and length of stay (LOS) in intensive cardiac care unit (ICCU). Methods: In this retrospective cohort study, patients who admitted to ICCU of National Cardiovascular Center Harapan Kita Jakarta, Indonesia, were classified into four hemodynamic profiles: dry-warm, dry-cold, wet-warm, and wet-cold. Bivariate analysis was performed to see the significance between hemodinamic profiles with mortality and LOS, continued with multvariate analysis to evaluate the contribution of other significant factors. Results: Of 742 patients included, the mortality rate was 7.8%. With dry-warm profile as reference, relative risk for mortality was 2.3 (95% CI 1.303-4.076), 5.8 (95% CI 1.992-16.906), and 8.7 (95% CI 3.513-21.567) for wet-warm, dry-cold and wet cold, consecutively. Mean differences of LOS (days) as follows: wet-warm (1.719; 95% CI 1.21-2.23), dry-cold (3.418; 95% CI 1.52-5.32), and wet-cold (4.654; 95% CI 2.64-6.67) compared to dry-warm. Hemodynamic profiles, especially wet-cold profile, consistently predicted mortality and longer LOS in ICCU by multivariable analysis. Conclusion: The presence of “wet” profile double the risk of death, “cold” profile has five fold risk of death, while the presence of both has the highest risk for mortality and longer LOS. Hemodynamic profiles assessme   Abstrak Latar Belakang: Kemampuan untuk membedakan pasien resiko tinggi dan resiko rendah di ICCU sangat penting. Profil hemodinamik dapat digunakan untuk mengenali kondisi pasien secara cepat. Berdasarkan adanya tanda kongesti dan perfusi yang buruk pasien dapat dikelompok­kan ke dalam empat profil hemodinamik. Studi ini bertujuan untuk mengevaluasi nilai prognostik profil hemodinamik terhadap mortalitas dan lama rawat pasien di Intensive Cardiac Care Unit (ICCU). Metode : Studi kohort retrospektif ini dilakukan di Rumah Sakit Pusat Jantung dan Pembuluh Darah Nasional Harapan Kita, Jakarta, Indo­nesia. Pasien yang dirawat di ICCU dikelompokkan ke dalam empat profil hemodinamik: kering-hangat, kering-dingin, basah-hangat dan basah-dingin. Analisis bivariate dilakukan untuk menilai hubungan antara profil hemodinamik dengan mortalitas dan lama rawat di ICCU, dilanjutkan dengan analisis multivariate untuk mengevaluasi kontribusi faktor-faktor lain yang signifikan Hasil : Total pasien yang ikut dalam studi sebanyak 742 pasien dan tingkat mortalitas sebesar 7,8%. Resiko relatif (RR) mortalitas untuk profil basah-hangat, kering-dingin dan basah-dingin berturut-turut sebesar 2.3 (95% CI 1.303-4.076), 5.8 (95% CI 1.992-16.906), dan 8.7 (95% CI 3.513-21.567) bila dibandingkan terhadap profil kering-hangat sebagai referensi. Rerata perbedaan lama rawat sebesar 1.719 (95% CI 1.21-2.23), 3.418 ( 95% CI 1.52-5.32), (4.654 (95% CI 2.64-6.67) untuk profil basah-hangat, kering-dingin, dan basah dingin berturut-turut bila dibandingkan dengan profil kering-hangat. Profil hemodinamik, terutama profil basah-dingin secara konsisten memprediksi mortalitas dan lama rawat yang lebih panjang setelah analisis multivariat. Kesimpulan: Profil “basah” memiliki resiko mortalitas dua kali lipat, profil “dingin” memiliki resiko mortalitas lima kali lipat, sedangkan ked­uanya secara bersamaan memiliki resiko mortalitas dan lama rawat lebih panjang paling tinggi. Profil hemodinamik dapat digunakan sebagai prediktor mortalitas dan lama rawat pasien di ICCU secara efektif.

2020 Asian Pacific Society of Cardiology Consensus Recommendations on Antithrombotic Management for High-risk Chronic Coronary Syndrome

The unique characteristics of patients with chronic coronary syndrome (CCS) in the Asia-Pacific region, heterogeneous approaches because of differences in accesses and resources and low number of patients from the Asia-Pacific region in pivotal studies, mean that international guidelines cannot be routinely applied to these populations. The Asian Pacific Society of Cardiology developed these consensus recommendations to summarise current evidence on the management of CCS and provide recommendations to assist clinicians treat patients from the region. The consensus recommendations were developed by an expert consensus panel who reviewed and appraised the available literature, with focus on data from patients in Asia-Pacific. Consensus statements were developed then put to an online vote. The resulting recommendations provide guidance on the assessment and management of bleeding and ischaemic risks in Asian CCS patients. Furthermore, the selection of long-term antithrombotic therapy is discussed, including the role of single antiplatelet therapy, dual antiplatelet therapy and dual pathway inhibition therapy

Skin Mottling as Clinical Manifestation of Cardiogenic Shock

A 59 years old male came to the emergency department with chief complain of dyspnea.  Dyspnea has worsened since 3 days before admission accompanied with dyspnea on effort, orthopnea and paroxysmal nocturnal dyspnea. In the emergency department, patient experienced cardiac arrest after defecating, leading to cardiopulmonary resuscitation for 45 minutes. Administration of vasoactive drugs were done and the patient was intubated.Post resucitaiton physical examination showed that the patient was sedated, with blood pressure of 72/40 (on dobutamine support). Peripheral circulation examination showed cold and clammy extremities, skin mottling of the lower extremity with mottling score of 2. CRT is more than 2 seconds. Blood gas analysis showed severe metabolic acidosis with blood lactate of 8.1.Angiographic examination were previously done on the patient during the previous admission with the results of three vessels disease with a chronic total occlusion in the left anterior descending artery. However, patient had refused further intervention regarding the coronary problems. Patient also has longtsanding atrial fibrillation.Patient was admitted into the intensive care unit for further management. Patient was stabilized during admisison in the intensive care with inotropes, however despite the hemodynamic stablilization the skin remain mottled-regardless. Patient had complicating factors in the form of pneumonia and sepsis. Patient had difficulty in weaning the ventilator and died because of arrythmia complication

Buku Saku Jantung Dasar

DAFTAR ISI : Penyakit jantung bawaan Krisis hipertensi di pelayanan primer Diabetes dan penyakit jantung Penyakit katup jantung Aritmia Gagal jantung akut Gagal jantung kronis Penyakit jantung dan manifestasi sistem saraf pusat Penyakit jantung dan kehamilan Obat jantung dalam kehamila

Konsep Kebebasan di Mata Generasi Muda Muslim di Daerah Bandung dan Jakarta: Sebuah Studi Fenomenologi

This phenomenological study investigated the way three authentic Indonesian Muslims who live in Bandung and Jakarta gave meaning to the word freedom. Three informants were purposively selected to participate in the study: a 34-year-old Muslim businesswoman; married; and lives in Jakarta; a Muslim man, 36 years old, single, a lawyer who lives in Bandung; and a 21-year-old single man who is a sophomore at a private university in Bandung. In-depth interview was administered to obtain detailed and more comprehensive information about the participants’ thoughts and experiences.  IPA (Interpretative Phenomenological Analysis) and Domain Analyses were utilized to analyze the data gathered. The study found that birth order, parenting styles, exposure to collectivist or individualistic value systems as well as Western concept of freedom, repentance or “Tawbah”, and increased knowledge about Islam were strongly related to their meaning construction of the word freedom