Effect of Captopril Rapid Uptitration to Plasma Aldosterone Level in Patients with Acute Myocardial Infarction

Background: Acute myocardial infarction is a myocardial necrosis associated with acute myocardial ischemia of which the incidence keeps increasing over time. Appropriate management of acute myocardial infarction is very important in order to determine the efficacy of the therapy and also to prevent further complications due to acute myocardial infarction. Captopril is essential in the management of acute myocardial infarction to inhibit the renin-angiotensin-aldosterone system whereby aldosterone may increase the probability of heart failure and increase mortality up to approximately 10 times compared to patients with acute myocardial infarction without heart failure. The administration of captopril should be uptitrated the doses in order to obtain optimal results, however there is no such fixed standard on how fast the doses of captopril should be uptitrated in order to obtain a more optimal effect, especially in order to suppress the plasma aldosterone level. This study examined the effect of rapid uptitration of captopril in the first 3 days of treatment of patients with acute myocardial infarction on plasma aldosterone levels compared to the increase in the captopril standard uptitration.Subjects and Method: This is an experimental research with Randomized Controlled Trial (RCT). 28 patients with Acute Myocardial Infarction on Cardiovascular Intensive Care Unit (ICVCU) and Cardiovascular wards of RSUD Dr. Moewardi hospital Surakarta were sequentially involved as research subjects and then randomly divided into a control group who received standard captopril uptitration and treatment group who received captopril rapid uptitration. The blood plasma was taken on the first day before the administration of captopril and on the last day of treatment. The plasma aldosterone level was tested by ELISA. Independent t-tests were carried out for data that qualified the normality test and mann whitney test if not qualified in the normality test with kolmogorov smirnov. It was considered statistically significant if the value of p < 0.05.Results: Plasma Aldosterone levels in treatment group was lower than control group and statistically significant (1133.54 ± 748.81 pg/dl vs 512.16 ± 444.81 pg/dl; p = 0.013 )Conclusion: Treatment with captopril rapid uptitration can decrease aldosterone plasma levels lower than captopril with standard uptitration in patient with acute myocardial infarction.Keywords: Acute myocardial infarction, plasma aldosterone, captopril, captopril rapid uptitation.Correspondence: Verry Gunawan Sohan. Master Program of Family Medicine, Sebelas Maret University, Surakarta.Indonesian Journal of Medicine (2016), 1(3): 160-168https://doi.org/10.26911/theijmed.2016.01.03.0

Association Between Left Ventricular Global Longitudinal Strain and Functional Capacity Measured with Six-Minutes Walk Test in Patients After Acute Myocardial Infarction.

Background: The ischemia resulting from critical coronary narrowing or total occlusion first affects the subendocardialmyofibers. Thus, abnormalities in longitudinal function can be detected before reductions in LVEF and reflects infarct size. The 6MWT provides information that may be a better index of the patients ability to perform daily activities. This study was to assess the relationship between left ventricular (LV) global longitudinal strain (GLS) and functional capacity measured with 6 minute walk test (6MWT) after AMI.Subjects and Method: This is a cross sectional study of patients with STEMI and NSTEMI, at Moewardi Hospital, Surakarta. Eligible patients underwent echocardiography global longitudinal 2D-STE that performed within 48 hour of admission and 6MWT pre- discharge or at the first follow-up visits (day 4-9). Patients were divided into 2 groups according to the LV GLS value, patients with substantial infarction (LV GLS > -13.8%) and non-substantial infarction (LV GLS -13.8% (n=32) were more likely to be older (57.6 y.ovs 55 y.o), less in functional capacity (10.17 1.3 ml/kg/min vs 11.04 0.98 ml/kg/min; p= 0.018) and less in 6 MWT distance (347.97 65.49 m vs392.39 49.44 m; p=0.016). Using ROC curves, the 6 MWT distance cutoff value of 375 m identified patients with LV GLS >-13.8%, sensitivity of 72.2% and specificity 65.6%, respectively with AUC= 0.70 (CI 95%; 0.559-0.852; p= 0.017). However, LV GLS >-13.8% and age >60 y.o remained the independent predictor in a multivariate logistic regression analysis to identify 6 MWT distance -13.8%, (OR =7.967; CI 95%= 1.669-38.030; p=0.009) and age >60 y.o, (OR=10.898; CI95%= 2.201-53.971; p=0.003).Conclusions: In patients after AMI with substantial infarction (LV GLS >-13.8%) had less in functional capacity. The 6 MWT distance cutoff value of 375 m identified patients with LV GLS >-13.8% and could be used in rehabilitation program after AMI.Keywords: Acute Myocardial Infarction, LV Global longitudinal strain, functional capacity, 6 MWT.Correspondence:Trisulo Wasyanto. Department of Cardiology and Vascular Medicine, Faculty of Medicine, Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami No. 36 A, 57126, Surakarta, Central Java.Indonesian Journal of Medicine (2017), 2(3): 192-206https://doi.org/10.26911/theijmed.2017.02.03.0

Pemberdayaan Yayasan Sebagai Pelopor Gerakan Masyarakat Hidup Sehat Dalam Upaya Pencegahan Penyakit Hipertensi

Penyakit Tidak Menular (PTM) merupakan penyebab kematian tertinggi di dunia, termasuk di Indonesia. Salah satu PTM yang cukup tinggi prevalensinya adalah hipertensi. Kabupaten Karanganyar merupakan salah satu kabupaten di provinsi Jawa Tengah dengan jumlah kasus hipertensi yang cukup tinggi dan prevalensinya terus meningkat dari tahun ke tahun. Pemerintah Indonesia dan pemerintah kabupaten setempat telah mencanangkan Gerakan Masyarakat Hidup Sehat (Germas) sebagai upaya pengendalian PTM. Yayasan Usaha Umat Karanganyar (YUUK), sebuah organisasi masyarakat yang berlokasi di Tasikmadu, Karanganyar, telah memiliki program kegiatan pendidikan dan pelatihan yang diperlukan oleh masyarakat setempat, namun program pendidikan dan pelatihan tersebut belum menjamah aspek kesehatan masyarakat. Untuk mengoptimalkan kesehatan masyarakat setempat melalui pemberdayaan organisasi kemasyarakatan, tim pengabdian masyarakat yang tergabung dalam grup riset Human Proteomics Fakultas Kedokteran Universitas Sebelas Maret (FK UNS) melakukan kegiatan penyuluhan dan konsultasi tentang hipertensi dan serta pelatihan penggunaan tensimeter digital dan oximeter. Kegiatan tersebut bertujuan untuk meningkatkan peran serta YUUK dalam pencegahan dan deteksi dini penyakit hipertensi. Sasaran kegiatan ini adalah para remaja di sekitar masjid Al Walidah Tasikmadu Karanganyar. Hasil dari kegiatan tersebut adalah meningkatnya pemahaman peserta mengenai hipertensi dan keterampilan memantau kesehatan kardiovaskuler melalui penggunaan tensimeter digital. Evaluasi kegiatan ini dilakukan dengan cara menghubungi pengurus YUUK untuk mendapatkan laporan tentang implementasi pemanfaatan 2 unit tensimeter digital dan 1 unit oximeter yang diberikan oleh tim pengabdi kepada pengelola Yayasan untuk dimanfaatkan sebaik-baiknya bagi masyarakat sekitar. Tim pengabdi juga terus memonitor prevalensi hipertensi dari tahun ke tahun di Kabupaten Karanganyar