Rehabilitasi Kardiovaskular Di Indonesia

A process by which a person is restored to an optimal physical, medical, psychological, social, emotional, sexual, vocational and economic status. Itulah definisi Cardiac Rehabilitation dari WHO tahun 1969, yang kemudian disempurnakan pada saat ini dengan memperhatikan dasar penyakit, proses dan kondisi pasca sakit. Definisi tersebut dijabarkan dalam definisi terkini yaitu: The rehabilitation of cardiac patients is the sum of activities required to influence favourably the underlying cause of the disease, as well as the best possible physical, mental and social conditions, so that they may by their own efforts, preserve or resume when lost, as normal a place as possible in the society

Hubungan Morfologi Ventrikel Kiri Orang Terlatih dengan Respons Hipoksia di Ruang Udara Bertekanan Rendah

Background. The higher the altitude, the higher the risk to hypoxia exposure. Good fitness status of airplane pilot has been thought of great importance to encounter hypoxic risk. Meanwhile, intensive endurance training results in increase of left ventricular mass and change of cardiac function due to down regulation of beta adrenergic receptor. It is not clear whether the difference in myocardial morphology due to endurance training will cause difference tolerance in hypoxia responses.Objectives. To compare hypoxia response of trained and untrained men and to investigate association of left ventricle morphology and hypoxia responses.Methods. This is a cross-sectional study involving 128 trained and 25 untrained men. They underwent medical examination in Saryanto Institute of Aerospace Medicine, Jakarta. Echocardiography and treadmill test ex-amination were performed. The time of useful consciousness (TUC) was measured using 25,000 feet hypobaric stimulation chamber.Results. Six subjects were excluded due to incomplete data. The mean age of trained men was 22 ± 1.0 years. TUC of trained (n=122) and untrained (n=25) men were 232 ± 64 sec and 260 ± 51 sec, respectively (p=0.01). To evaluate for association between echocardiographic parametric of ventricle morphology and TUC, all subjects were divided into TUC < 4 min and TUC = 4 min. Parameters related to TUC are LVEDD and LVMI. TUC < 4 min related to larger LVEDD and LVMI. Conclusion. Trained men had shorter TUC compared to untrained men. Shorter TUC related to larger LVEDD and LVMI.Latar Belakang.Risiko hipoksia meningkat dengan makin tingginya ketinggian di atas permukaan laut. Tingkat kebugaran fisik yang baik dianggap penting bagi para penerbang untuk menghadapi risiko hipoksia. Sementara itu, latihan endurance yang intensif dapat menyebabkan peningkatan massa ventrikel dan perubahan fungsi jantung yang berhubungan dengan down-regulasi reseptor beta adrenergik. Belum jelas apakah perbedaan morfologi jantung, sebagai dampak latihan, menyebabkan perbedaan kemampuan toleransi hipoksia?Tujuan. Untuk mengetahui respons hipoksia orang terlatih dibandingkan dengan orang tak terlatih dan mencari hubungan morfologi ventrikel kiri dengan respons hipoksia. Metode. Disain penelitian ini adalah studi potong lintang. Subyek adalah calon siswa penerbang TNI. Subyek terlatih adalah 128 perwira remaja lulusan Akademi TNI Angkatan Udara, sedangkan 25 orang subyek tidak terlatih adalah siswa lulusan SMU. Kedua subyek tersebut menjalani seleksi calon penerbang militer di Lembaga Kesehatan Penerbangan dan Antariksa, Jakarta. Kedua subyek menjalani pemeriksaan ekokardiografi, treadmill test, dan pemeriksaan aerofisiologi di Ruang Udara Bertekanan Rendah untuk menilai waktu sadar efektif (WSE).Hasil. Dari 128 subyek terlatih, 6 orang tidak diikutsertakan karena data yang tidak lengkap. Umur rerata subyek terlatih 22 ± 1,0 tahun. WSE subyek terlatih dan tidak terlatih adalah masing-masing 232 ± 64 detik dan 260 ± 51 detik (p=0,01). Pada analisa regresi multivariat, LVEDD (Left Ventricular End Diastolic Diameter) mempunyai hubungan yang bermakna dengan WSE, [OR 0,156 (KI 95% 0,046 – 0,527)]. Kelompok dengan LVEDD =4,85 cm mempunyai risiko 3,0 kali mengalami hipoksia (WSE < 4 menit) dibandingkan kelompok dengan LVEDD < 4,85 cm , [OR 3,0 (KI 95% 1,52 – 5,99)]. Kesimpulan. LVEDD berhubungan terbalik dengan WSE, dimana nilai LVEDD > 4,85 cm berisiko mengalami hipoksia 3x lipat

Pengaruh Latihan Fisik Dan Respon Molekuler Pembuluh Darah Arteri

Regular physical activity (exercise training, ET) has a strong positive link with cardiovascular health. The beneficial effects of ET on the endothelium arteries are believed to result from increased vascular shear stress during ET bouts. A number of mechanosensory mechanisms have been elucidated that may contribute to the effects of ET on vascular function. Exercise training also consistently improves the nitric oxide bioavailability, and the number of endothelial progenitor cells, and diminishes the level of inflammatory markers, namely pro inflammatory cytokines and C-reactive protein. This review summarizes current understanding of control of vascular adaptation by exercise and how these processes lead to improved cardiovascular health.Aktivitas fisik yang dilakukan secara teratur mempunyai hubungan yang positif dengan kesehatan kardiovaskular. Efek latihan fisik yang menguntungkan pada endotel pembuluh darah arteri dipercaya akibat dari peningkatan shear stresspembuluh darah selama melakukan latihan fisik. Beberapa mekanisme mekanosensori yang terjadi karena efek latihan fisik ikut berperan pada fungsi pembuluh darah. Latihan fisik yang dilakukan secara terus menerus juga memperbaiki bioavailibilitas nitrik oksida, jumlah sel­sel progenitor endotel, dan menurunkan kadar petanda inflamasi, yaitu sitokin proinflamasi dan C­reactive protein. Tinjauan pustaka ini merangkum pengertian terkini tentang adaptasi pembuluh darah terhadap latihan fisik dan bagaimana hal tersebut dapat memperbaiki kesehatan kardiovaskular

Correlation of Brachial Flow Mediated Dilation with Severity of Coronary Artery Disease

Background. Endothelial dysfunction precedes the development of morphological changes and contributes to atherosclerotic lesion development and progression. Evaluation using non invasive method such as brachial FMD (flow mediated dilation) has given inconsistent information for extension and coronary atherosclerotic severity regarding endothelial dysfunction. This research will evaluate the correlation between brachial FMD and severity of coronary artery disease (CAD) stenosis. Methods. It was a cross sectional study. Evaluations were performed in 85 patients who had followed elective coronary angiography and fulfilled inclusion criteria in National Cardiovascular Center Harapan Kita since January until October of 2012. Correlation between brachial FMD and severity of CAD stenosis (Gensini score) was evaluated using linear regression analysis. Results. Brachial FMD had negative correlation with Gensini score (R= -0,227; P= 0,037). Hypertension had negative correlation with brachial FMD (R= -0,235; P= 0,032). Male gender had positive correlation with brachial FMD (R= 0,220; P= 0,040). Conclusion. There was weak negative correlation between brachial FMD and Gensini score

Bleeding Predictor in ST-Elevation Myocardial Infarction Underwent Primary Percutaneous Coronary Infarction: The Indonesian (INA) Bleeding Risk Score

Background Acute myocardial infarction still become one of the leading mortality cause in the world. Among these patients, ST elevation myocardial infartion (STEMI) has the greatest mortality rate among other type of Myocardial Infarction. When a myocard infarct patient have bleeding events, mortality rate greatly increased. Up until now, there is no specific bleeding risk assessment tool to predict bleeding events in STEMI patient. Methods A retrospective cohort study, done in National Cardiovascular Center Harapan Kita, Jakarta in STEMI patients underwent Primary Percutaneous Coronary Intervention (PPCI). Bleeding event was defined according to definition by Bleeding Academic Research Consortium (BARC) European Society of Cardiology, 2011. Categories for data obtained was basic characteristics, clinical examinations, initial therapies, lab results, x-ray, PPCI procedures, and in hospital treatments. Statistical analysis was done using multivariat analysis using logistic regression method and then converted to a scoring system. Results 579 sampels fit the inclusion and exclusion criteria. Bleeding event occured in 42 patients (7.3%). Indonesia bleeding score (Range 1-100) was created by assignment of variables that included in the final model according to their Odds Ratio (OR) values. Those variables are: female gender (OR 2.91, CI 1.23-6.91), Killip class 3 / 4 (OR 5.64, CI 2.27-14.03), Age ? 62 y.o (OR 2.19, CI 1.00-4.83), White blood cell >12.000 (OR 2.12, CI 0.95-4.73), Creatinine >1.5 (OR 2.17, CI 0.95-4.96), Body Mass Index ? 25 (OR 1.71, CI 0.83-3.51), Multiple coronary lesion (OR 1.95, CI 0.83- 4.54), Femoral access (OR 2.33, CI 0.77-7.01), and TPM implantation (OR 3.21, CI 1.28-8.07). These variabels was converted into two type of scoring system. The INA-1 contains all of the variables, and INA-2 minus variables related to interventional result and procedures. Conclusion Indonesia bleeding score quantifies risk for in-hospital bleeding event in STEMI patients underwent PPCI, which enhances baseline risk assessment for STEMI care

Correlation Between Circulating Leptin Level with Left Ventricle Mass in Normotensive Men

Background.Obesity is one of Cardiovascular risk factor. Obesity caused increase in heart mass due to cellular hypertrophic and metaplastic proses, independently of hemodynamic factors such as blood pressure. There were hyperleptinemia in obesity due to the selective Leptin resistency in central nervous system and peripheral organs. Study with cultured rat cardiomyocyte have shown hypertrophy and hyperplastic effect of Leptin to cardiomyocyte. Some clinical studies have shown correlation between circulating Leptin level with Left Ventricle Mass in hypertensive and insulin resistance men. Objective. This study aimed to elaborate the correlation between circu-lating Leptin level with Left Ventricle Mass in normotensive men. Methods. A cross sectional study was performed with normotensive men, which included 40 obese normotensive and 40 normoweight men. All patients underwent physical and laboratory assessment and examination of Left Ventricle with echocardiography. The circulating Leptin level were determined by ELISA method. The Leptin level were expressed as median (25th percentile; 75th percentile) Results. The circulating Leptin level were significantly different between the obese normotensive and the lean group. The Left Ventricle Mass in Obese increased, although have not fulfilled the criteria for Left Ventricle Hypertrophy. There were significant correlation between Left Ventricle Mass with BMI (r = 0,711; p<0,001) and waist circumference (r = 0,732; p<0,001). Respectively, there were significant correlation between Left Ventricle Mass Index with BMI (r = 0.541; p<0.001) and waist circumfer-ence (r = 0,558; p<0.001. There were significant correlation between circulating Leptin level with Left Ventricle Mass (r = 0,510; <0,001) and Left Ventricle Mass Index (r = 0,414; p<0,001) in obese men. Conclusion.Circulating Leptin level is correlated with Left Ventricle Mass in normotensive men