Background : The Corona virus Disease COVID-19 have been independently associated with the cause of pneumonia and acute respiratory distress syndrome with high risk of mortality. Mounting evidence substantiates the presence of cardiac injury in patients with COVID-19. Although a recent study reported that 12% of patients had COVID-19 associated acute cardiac injury. Case presentation : A 38 year old male was admitted with pneumonia and cardiac symptoms. He was genetically confirmed as COVID-19 by swab PCR testing, 1 week after admission. He also had elevated CKMB and Hs troponin T level, high Ferritin level, CRP, lymphopenia, and a slight increase in N/L ratio. Chest radiography showed bilateral pneumonia. The patient was confirmed to the diagnosis of Myocardial injury. After receiving tocilizumab and immunoglobulin, his condition improved gradually with the declining laboratory inflammation marker, but there was a secondary infection with an increased of leucocyte and worsen chest radiography, escalating antibiotic and metilprednisolon was given, the patient gradually improving. Conclusion : COVID-19 patients may develop cardiac complication such as cardiac injury or myocarditis, and this is our first case of COVID-19 infection complicated with cardiac injury.
{"title":"COVID 19 with Cardiac Injury Complication, A case Report","authors":"Puti Sarah Saus, D. Hanafy, Rossana Barack","doi":"10.30701/ijc.v1i1.1011","DOIUrl":"https://doi.org/10.30701/ijc.v1i1.1011","url":null,"abstract":"\u0000Background : The Corona virus Disease COVID-19 have been independently associated with the cause of pneumonia and acute respiratory distress syndrome with high risk of mortality. Mounting evidence substantiates the presence of cardiac injury in patients with COVID-19. Although a recent study reported that 12% of patients had COVID-19 associated acute cardiac injury. \u0000Case presentation : A 38 year old male was admitted with pneumonia and cardiac symptoms. He was genetically confirmed as COVID-19 by swab PCR testing, 1 week after admission. He also had elevated CKMB and Hs troponin T level, high Ferritin level, CRP, lymphopenia, and a slight increase in N/L ratio. Chest radiography showed bilateral pneumonia. The patient was confirmed to the diagnosis of Myocardial injury. After receiving tocilizumab and immunoglobulin, his condition improved gradually with the declining laboratory inflammation marker, but there was a secondary infection with an increased of leucocyte and worsen chest radiography, escalating antibiotic and metilprednisolon was given, the patient gradually improving. \u0000Conclusion : COVID-19 patients may develop cardiac complication such as cardiac injury or myocarditis, and this is our first case of COVID-19 infection complicated with cardiac injury. \u0000","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43139226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dunia saat ini menghadapi situasi yang tidak pernah terjadi sebelumnya dalam sejarah manusia: pandemi Covid-19 (Gambar). Pengetahuan manusia mengenai penyakit Covid-19 secara pesat berkembang sejak laporan kasus awal dari Wuhan.1 Secara pesat, banyak laporan kasus, seri kasus, kohor dan belakangan studi mengenai Covid-19 dan tatalaksananya dilaporkan di berbagai jurnal. Beberapa jurnal esensial, seperti NEJM dan Lancet, bahkan menerbitkan isu khusus mengenai Covid-19. Pengetahuan tentang Covid-19 secara mayor boleh dikatakan berasal dari tiga klaster kohor epidemi; yaitu di China (terutama Wuhan), Italia, dan Amerika Serikat. Beberapa klaster lainnya, seperti dari Korea Selatan dan Jerman, melaporkan keberhasilan meredam perluasan epidemi.
{"title":"Menulis Pandemi","authors":"Sunanto Ng","doi":"10.30701/ijc.v1i1.1026","DOIUrl":"https://doi.org/10.30701/ijc.v1i1.1026","url":null,"abstract":"Dunia saat ini menghadapi situasi yang tidak pernah terjadi sebelumnya dalam sejarah manusia: pandemi Covid-19 (Gambar). Pengetahuan manusia mengenai penyakit Covid-19 secara pesat berkembang sejak laporan kasus awal dari Wuhan.1 Secara pesat, banyak laporan kasus, seri kasus, kohor dan belakangan studi mengenai Covid-19 dan tatalaksananya dilaporkan di berbagai jurnal. Beberapa jurnal esensial, seperti NEJM dan Lancet, bahkan menerbitkan isu khusus mengenai Covid-19. Pengetahuan tentang Covid-19 secara mayor boleh dikatakan berasal dari tiga klaster kohor epidemi; yaitu di China (terutama Wuhan), Italia, dan Amerika Serikat. Beberapa klaster lainnya, seperti dari Korea Selatan dan Jerman, melaporkan keberhasilan meredam perluasan epidemi.","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46554027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. Hasanah, S. Nauli, Vebiona Kartini Prima Putri, Habibie Arifianto, N. Suryana, Lita Dwi Suryani, W. Aditya, Paskariatne Probodewi
Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) yang dikenal dengan COVID-19 adalah penyakit yang baru dan telah menyebar dengan cepat dari Wuhan (provinsi Hubei) ke provinsi lain di Cina dan seluruh dunia termasuk Indonesia. Secara umum COVID-19 adalah penyakit akut yang bisa sembuh tetapi juga mematikan dengan case fatality rate (CFR) sebesar 4%. Spektrum klinis pneumonia COVID-19 berkisar dari kondisi ringan sampai dengan berat. COVID-19 diduga memiliki risiko potensiasi proses patofisiologi terhadap timbulnya komplikasi kardiak dan telah diketahui bahwa mekanisme penyakit kardiovaskular serupa dengan mekanisme jalur imunologi. Penyakit kardiovaskular adalah komorbid terbanyak pada pasien COVID-19 SARS dan MERS. Prevalensi diabetes mellitus (DM) dan penyakit kardiovaskular pada SARS adalah 11% dan 8% dan membawa angka kematian meningkat 2 kali lipat. Pada kasus COVID-19 komorbid penyakit kardiovaskular lebih banyak menunjukkan kasus yang berat. Bagaimana mekanisme komorbid ini memperburuk keluaran pasien masih tidak jelas namun beberapa hipotesisnya antara lain usia lanjut gangguan sistem imun peningkatan kadar ACE2 atau mungkin ada hubungan antara COVID-19 dengan penyakit kardiovaskular. Tinjauan pustaka ini akan menjelaskan berbagai gangguan kardiovaskular yang mungkin terjadi pada infeksi COVID-19 secara lebih mendalam.
{"title":"Cardiovascular Complications In COVID 19 Infection","authors":"D. Hasanah, S. Nauli, Vebiona Kartini Prima Putri, Habibie Arifianto, N. Suryana, Lita Dwi Suryani, W. Aditya, Paskariatne Probodewi","doi":"10.30701/IJC.994","DOIUrl":"https://doi.org/10.30701/IJC.994","url":null,"abstract":"Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) yang dikenal dengan COVID-19 adalah penyakit yang baru dan telah menyebar dengan cepat dari Wuhan (provinsi Hubei) ke provinsi lain di Cina dan seluruh dunia termasuk Indonesia. Secara umum COVID-19 adalah penyakit akut yang bisa sembuh tetapi juga mematikan dengan case fatality rate (CFR) sebesar 4%. Spektrum klinis pneumonia COVID-19 berkisar dari kondisi ringan sampai dengan berat. COVID-19 diduga memiliki risiko potensiasi proses patofisiologi terhadap timbulnya komplikasi kardiak dan telah diketahui bahwa mekanisme penyakit kardiovaskular serupa dengan mekanisme jalur imunologi. Penyakit kardiovaskular adalah komorbid terbanyak pada pasien COVID-19 SARS dan MERS. Prevalensi diabetes mellitus (DM) dan penyakit kardiovaskular pada SARS adalah 11% dan 8% dan membawa angka kematian meningkat 2 kali lipat. Pada kasus COVID-19 komorbid penyakit kardiovaskular lebih banyak menunjukkan kasus yang berat. Bagaimana mekanisme komorbid ini memperburuk keluaran pasien masih tidak jelas namun beberapa hipotesisnya antara lain usia lanjut gangguan sistem imun peningkatan kadar ACE2 atau mungkin ada hubungan antara COVID-19 dengan penyakit kardiovaskular. Tinjauan pustaka ini akan menjelaskan berbagai gangguan kardiovaskular yang mungkin terjadi pada infeksi COVID-19 secara lebih mendalam.","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44878995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Age-related change in autonomic nerves covers parasympathetic function decrease that hampers heart rate (HR) control. The effective attempt to improve autonomic nervous function for elderly is routine exercise, however exercise duration among elderly is not always standardized. This study is aimed to compare the effect of different exercise duration to post-exercise Heart Rate Recovery (HRR) between two elderly groups with the same frequency, intensity, type criteria of routine exercise. Method: Method was cross-sectional study which compared exercise duration of standardized group (3x90 minutes/week) and unstandardized group (3x30 minutes/week). Group 1 was elders with standardized duration from Healthy Heart Club and Group 2 was elders who take unstandardized duration from Elderly Home in Bandung city. Each group consisted of 43 elders and data were collected in July-August 2019. After one hour of medium intensity exercise, all respondents were examined for resting HR (HRrest), maximum HR (HRmax), one minute post-exercise HR, and four minutes post-exercise HR. HRR was obtained by subtracting HRmax by one minute post-exercise HR and normal if > 12 bpm. Analysis data was done by SPSS with Mann-Whitney U Test, Fisher Chi Square and Logistic regression. Result: Most of respondents were 60-69 years old and female. Respondents in unstandardized group were more low education, hypertension and smoking. The HRrest of both groups was categorized as normal but increased greater (30x/min) in standardized group. The result showed a significant difference in comparation of median HRR (p=0.001) and number of normal and abnormal HRR (p=0.001) between both groups. Gender, smoking and standardized duration of exercise associated with abnormality of HRR, elders who take unstandardized duration have 12.7 times risk to get abnormal HRR. Conclusion: Routine exercise for elderly is recommended in standardized duration with minimal 150 minutes per week in order to increase post-exercise HRR.
{"title":"The Effect of Routine Gymnastics toward Post-Exercise Heart Rate Recovery in Elderly","authors":"Arie Ramdhiani Mahassa, M. R. Akbar, S. Y. Sari","doi":"10.30701/ijc.v1i1.1025","DOIUrl":"https://doi.org/10.30701/ijc.v1i1.1025","url":null,"abstract":"Background: Age-related change in autonomic nerves covers parasympathetic function decrease that hampers heart rate (HR) control. The effective attempt to improve autonomic nervous function for elderly is routine exercise, however exercise duration among elderly is not always standardized. This study is aimed to compare the effect of different exercise duration to post-exercise Heart Rate Recovery (HRR) between two elderly groups with the same frequency, intensity, type criteria of routine exercise. \u0000Method: Method was cross-sectional study which compared exercise duration of standardized group (3x90 minutes/week) and unstandardized group (3x30 minutes/week). Group 1 was elders with standardized duration from Healthy Heart Club and Group 2 was elders who take unstandardized duration from Elderly Home in Bandung city. Each group consisted of 43 elders and data were collected in July-August 2019. After one hour of medium intensity exercise, all respondents were examined for resting HR (HRrest), maximum HR (HRmax), one minute post-exercise HR, and four minutes post-exercise HR. HRR was obtained by subtracting HRmax by one minute post-exercise HR and normal if > 12 bpm. Analysis data was done by SPSS with Mann-Whitney U Test, Fisher Chi Square and Logistic regression. \u0000Result: Most of respondents were 60-69 years old and female. Respondents in unstandardized group were more low education, hypertension and smoking. The HRrest of both groups was categorized as normal but increased greater (30x/min) in standardized group. The result showed a significant difference in comparation of median HRR (p=0.001) and number of normal and abnormal HRR (p=0.001) between both groups. Gender, smoking and standardized duration of exercise associated with abnormality of HRR, elders who take unstandardized duration have 12.7 times risk to get abnormal HRR. \u0000Conclusion: Routine exercise for elderly is recommended in standardized duration with minimal 150 minutes per week in order to increase post-exercise HRR.","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43752344","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Primary Percutaneous Coronary Intervention Procedure (PPCI) results in reperfusion injury which will result in more extensive infarction. Remote Ischemic Postconditioning (RIPC) is a protective strategy to reduce the increase in the area of infarction. miRNA-145 also plays a role in the protective effect of IPC and RIPC. Research Methods: This study uses a pre and post test approach only with control group design with experimental research designs. Data is taken at the Integrated Heart Services Installation RSUP Dr. M. Djamil Padang from July to November 2019, 40 patients with ST-segment elevation myocardial infarction (STEMI) performed RIPC. Bivariate analysis was performed to determine differences in levels of miRNA-145 and troponin I in STEMI patients underwent PPCI with and without RIPC using the Wilcoxon test and the Mann Whitney test. Results:A total of 40 patients who underwent the PPCI procedure were divided into two groups PPCI + RIPC (n = 20) and PPCI without RIPC (n = 20). There were no significant differences in the basic characteristics between the two groups. There were no significant difference in escalation of median expression of miRNA-145 in PPCI+ RIPC [pre test 36.33 (27.44-52.39), post test 34.83 (27.65-65.26), p = 0.765] compared to PPCI without RIPC [pre test 31.66 (26.31-43.28), post test 33.43 (26.83-64.97), p = 0.765]. There were an increase in median troponin I levels in both groups, PPCI+ RIPC [pretest 4,104.70 (67.30-40,000.00), post test 30,448.50 (120.00-16.3192.20), p = 0.001] and PPCI without RIPC [pretest 826.50 (17.00-48.259.00), post test 42.784.50 (2,119.00-162.897.00), p = <0.001]. Conclusion:There were no significant difference in median expression of miRNA-145 in STEMI patients before and after (48 hours) underwent PPCI+RIPC and PPCI without RIPC. There were a significant difference in median levels of troponin I in STEMI patients before and after (48 hours) underwent PPCI+RIPC and PPCI without RIPC. Keywords: Remote Ischemic Postconditioning, miRNA-145, troponin I
{"title":"Effect of Remote Ischemic Postconditioning on miRNA-145 and Troponin I levels in STEMI patients undergoing primary percutaneous coronary intervention","authors":"Pradita Diah Permatasari, M. Fadil, M. Syafri","doi":"10.30701/ijc.989","DOIUrl":"https://doi.org/10.30701/ijc.989","url":null,"abstract":"Background: Primary Percutaneous Coronary Intervention Procedure (PPCI) results in reperfusion injury which will result in more extensive infarction. Remote Ischemic Postconditioning (RIPC) is a protective strategy to reduce the increase in the area of infarction. miRNA-145 also plays a role in the protective effect of IPC and RIPC. Research Methods: This study uses a pre and post test approach only with control group design with experimental research designs. Data is taken at the Integrated Heart Services Installation RSUP Dr. M. Djamil Padang from July to November 2019, 40 patients with ST-segment elevation myocardial infarction (STEMI) performed RIPC. Bivariate analysis was performed to determine differences in levels of miRNA-145 and troponin I in STEMI patients underwent PPCI with and without RIPC using the Wilcoxon test and the Mann Whitney test. Results:A total of 40 patients who underwent the PPCI procedure were divided into two groups PPCI + RIPC (n = 20) and PPCI without RIPC (n = 20). There were no significant differences in the basic characteristics between the two groups. There were no significant difference in escalation of median expression of miRNA-145 in PPCI+ RIPC [pre test 36.33 (27.44-52.39), post test 34.83 (27.65-65.26), p = 0.765] compared to PPCI without RIPC [pre test 31.66 (26.31-43.28), post test 33.43 (26.83-64.97), p = 0.765]. There were an increase in median troponin I levels in both groups, PPCI+ RIPC [pretest 4,104.70 (67.30-40,000.00), post test 30,448.50 (120.00-16.3192.20), p = 0.001] and PPCI without RIPC [pretest 826.50 (17.00-48.259.00), post test 42.784.50 (2,119.00-162.897.00), p = <0.001]. Conclusion:There were no significant difference in median expression of miRNA-145 in STEMI patients before and after (48 hours) underwent PPCI+RIPC and PPCI without RIPC. There were a significant difference in median levels of troponin I in STEMI patients before and after (48 hours) underwent PPCI+RIPC and PPCI without RIPC. Keywords: Remote Ischemic Postconditioning, miRNA-145, troponin I","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49656728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The necessity of timely management of ST-elevation myocardial infarction (STEMI) is now disrupted by the Covid-19 pandemic. This paper discussed the challenge to manage STEMI in Indonesia due to Covid-19. It also discussed the alternative strategies for solution. Challenge can occur in term of the healthcare safety as well as STEMI patient safety. Healthcare safety potentially impaired by the problem of STEMI mimicry due to cardiovascular complication of Covid-10, inaccuracy of Covid-19 screening, lack of effective personal protection equipment for the healthcare and appropriate catheterisation laboratory to anticipate virus contamination. The safety of STEMI patient is potentially impaired due to prolonged ischemia time, and the risk of cross-infection. Solution for this challenge should include mass screening, rapid and accurate test to rule-out Covid-19, dual system of hospital units - Covid and non-Covid, and algorithm for triage patients with STEMI and Covid-19.
{"title":"Tantangan Penatalaksanaan STEMI di Pandemi Covid-19","authors":"Su-Ping Ng, Dafsah Arifa Juzar","doi":"10.30701/ijc.v1i1.1023","DOIUrl":"https://doi.org/10.30701/ijc.v1i1.1023","url":null,"abstract":"The necessity of timely management of ST-elevation myocardial infarction (STEMI) is now disrupted by the Covid-19 pandemic. This paper discussed the challenge to manage STEMI in Indonesia due to Covid-19. It also discussed the alternative strategies for solution. Challenge can occur in term of the healthcare safety as well as STEMI patient safety. Healthcare safety potentially impaired by the problem of STEMI mimicry due to cardiovascular complication of Covid-10, inaccuracy of Covid-19 screening, lack of effective personal protection equipment for the healthcare and appropriate catheterisation laboratory to anticipate virus contamination. The safety of STEMI patient is potentially impaired due to prolonged ischemia time, and the risk of cross-infection. Solution for this challenge should include mass screening, rapid and accurate test to rule-out Covid-19, dual system of hospital units - Covid and non-Covid, and algorithm for triage patients with STEMI and Covid-19.","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46567150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Miokarditis umumnya terjadi akibat infeksi sistemik dari virus yang bersifat kardiotropik. Pada kondisi miokarditis akut ini dapat menyebabkan gangguan hemodinamik atau aritmia letal. Studi terbaru menunjukkan tatalaksana miokarditis terkait penyebab ditambah dengan “guideline directed medical care” akan memberi keluaran yang baik. Presentasi klinis miokarditis beragam dari yang tidak terlalu berat sampai dengan syok kardiogenik. Dengan perkembangan terapi saat ini, bantuan sirkulasi extracorporeal membrane oxygenation (ECMO) dan deteksi dini miokarditis fulminan, maka miokarditis dapat tertangani dengan baik. Dugaan miokarditis fulminan pada COVID-19 telah dilaporkan pada beberapa laporan kasus namun belum ada bukti patologi yang telah terkonfirmasi dari spesimen miokard adanya keterlibatan virus pada miokarditis COVID-19. Pada kasus dengan gambaran critical ill didapatkan tanda dan bukti peningkatan biomarker kerusakan miokard (cTn) dan peningkatan biomarker akibat stress dinding ventrikel kiri (BNP atau NTproBNP). Pada beberapa kasus, pemberian imunosupresan dan monitoring yang baik dapat meningkatkan peluang remisi. Kata kunci : Miokarditis, fulminan, COVID 19
{"title":"Deteksi dan Penanganan Awal Miokarditis dan Miokarditis Fulminan","authors":"Siti Elkana Nauli, Hawani Sasmaya Prameswari","doi":"10.30701/ijc.v1i1.995","DOIUrl":"https://doi.org/10.30701/ijc.v1i1.995","url":null,"abstract":"Miokarditis umumnya terjadi akibat infeksi sistemik dari virus yang bersifat kardiotropik. Pada kondisi miokarditis akut ini dapat menyebabkan gangguan hemodinamik atau aritmia letal. Studi terbaru menunjukkan tatalaksana miokarditis terkait penyebab ditambah dengan “guideline directed medical care” akan memberi keluaran yang baik. Presentasi klinis miokarditis beragam dari yang tidak terlalu berat sampai dengan syok kardiogenik. Dengan perkembangan terapi saat ini, bantuan sirkulasi extracorporeal membrane oxygenation (ECMO) dan deteksi dini miokarditis fulminan, maka miokarditis dapat tertangani dengan baik. Dugaan miokarditis fulminan pada COVID-19 telah dilaporkan pada beberapa laporan kasus namun belum ada bukti patologi yang telah terkonfirmasi dari spesimen miokard adanya keterlibatan virus pada miokarditis COVID-19. Pada kasus dengan gambaran critical ill didapatkan tanda dan bukti peningkatan biomarker kerusakan miokard (cTn) dan peningkatan biomarker akibat stress dinding ventrikel kiri (BNP atau NTproBNP). Pada beberapa kasus, pemberian imunosupresan dan monitoring yang baik dapat meningkatkan peluang remisi. \u0000Kata kunci : Miokarditis, fulminan, COVID 19","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45153068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Myocarditis is commonly caused due to systemic viral infection with cardiotropic nature. In the acute phase this disorder could cause lethal hemodynamic or arrhythmic disorders. Newest studies showed that the use of guideline-directed medical care in the care of myocarditis will lead to better outcomes. This condition varies in presentation ranging from mild to life-threatening such as cardiogenic shock. With the current advances in early detection and circulatory support using extracorporeal membrane oxygenation (ECMO) myocarditis could be managed very well. Cases of myocarditis related to COVID-19 has been reported however as per this time there has no confirmed pathological evidence regarding direct causation between COVID-19 and myocarditis however in these severely ill patients’ elevations in cardiac biomarkers (cTn BNP and NTproBNP) occurs and the administration of immunosuppressant could increase the chance of remission. Keyword: Myocarditis fulminant COVID-19.
{"title":"Detection and Management of Myocarditis and Fulminant Myocarditis","authors":"S. Nauli, H. S. Prameswari","doi":"10.30701/IJC.995","DOIUrl":"https://doi.org/10.30701/IJC.995","url":null,"abstract":"Myocarditis is commonly caused due to systemic viral infection with cardiotropic nature. In the acute phase this disorder could cause lethal hemodynamic or arrhythmic disorders. Newest studies showed that the use of guideline-directed medical care in the care of myocarditis will lead to better outcomes. This condition varies in presentation ranging from mild to life-threatening such as cardiogenic shock. With the current advances in early detection and circulatory support using extracorporeal membrane oxygenation (ECMO) myocarditis could be managed very well. Cases of myocarditis related to COVID-19 has been reported however as per this time there has no confirmed pathological evidence regarding direct causation between COVID-19 and myocarditis however in these severely ill patients’ elevations in cardiac biomarkers (cTn BNP and NTproBNP) occurs and the administration of immunosuppressant could increase the chance of remission. Keyword: Myocarditis fulminant COVID-19.","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45652367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Parama, D. Rifanda, W. A. Widodo, Daniel Ruslim
Background: Acute ST-segment–elevation myocardial infarction (STEMI) is a disease of high mortality and morbidity, and primary percutaneous coronary intervention (PPCI) is the preferred therapy for patient in golden period or with hemodynamic instability.1,2 Currently the world has been declared under COVID-19 (coronavirus disease 2019) pandemic by the World Health Organization (WHO).3 Signs and symptoms of COVID-19 patients can mimic acute decompensated heart failure, or induce acute cardiovascular problem.3 Screening is key, but there are conditions where physicians might miss positive COVID-19 cases, especially in critical cardiovascular emergency. Case Illustration: A 60-year old male came to emergency room with breathlessness and chest pain 8 hours prior. He was diagnosed as acute inferior STEMI with acute lung edema and cardiogenic shock (KILLIP IV, acute heart failure wet and cold). COVID-19 screening was negative. Patient underwent PPCI, found to have total occlusion of right coronary artery (RCA) with thrombus and tight stenosis in left coronary artery (LAD). Successful PPCI to RCA was performed with TIMI 3 flow result, and hemodynamic improved. Ten hours after PPCI, hemodynamic deteriorated and peripheral oxygen saturation dropped. Patient was intubated and put on ventilator. Repeated chest X-Ray and thoracic CT showed lung condition has abruptly worsened – with ground glass opacity (GGO) found. His condition worsened quickly, and family agreed to a do not resuscitate (DNR) consent. Conclusion: Acute cardiovascular condition in COVID-19 Pandemics represent big challenges, especially in early diagnostic and cardiovascular intervention decision. We were presenting a case where signs and symptoms of COVID-19 might appear later. Therefore, in this pandemic era every emergency cardiovascular intervention with signs of respiratory problem should be performed as if patient was a positive COVID-19 case.
{"title":"Primary PCI in COVID-19 Pandemic: Be Cautious, It Might Reveal Itself Later","authors":"A. Parama, D. Rifanda, W. A. Widodo, Daniel Ruslim","doi":"10.30701/ijc.v1i1.1009","DOIUrl":"https://doi.org/10.30701/ijc.v1i1.1009","url":null,"abstract":"Background: Acute ST-segment–elevation myocardial infarction (STEMI) is a disease of high mortality and morbidity, and primary percutaneous coronary intervention (PPCI) is the preferred therapy for patient in golden period or with hemodynamic instability.1,2 Currently the world has been declared under COVID-19 (coronavirus disease 2019) pandemic by the World Health Organization (WHO).3 Signs and symptoms of COVID-19 patients can mimic acute decompensated heart failure, or induce acute cardiovascular problem.3 Screening is key, but there are conditions where physicians might miss positive COVID-19 cases, especially in critical cardiovascular emergency. \u0000Case Illustration: A 60-year old male came to emergency room with breathlessness and chest pain 8 hours prior. He was diagnosed as acute inferior STEMI with acute lung edema and cardiogenic shock (KILLIP IV, acute heart failure wet and cold). COVID-19 screening was negative. Patient underwent PPCI, found to have total occlusion of right coronary artery (RCA) with thrombus and tight stenosis in left coronary artery (LAD). Successful PPCI to RCA was performed with TIMI 3 flow result, and hemodynamic improved. Ten hours after PPCI, hemodynamic deteriorated and peripheral oxygen saturation dropped. Patient was intubated and put on ventilator. Repeated chest X-Ray and thoracic CT showed lung condition has abruptly worsened – with ground glass opacity (GGO) found. His condition worsened quickly, and family agreed to a do not resuscitate (DNR) consent. \u0000Conclusion: Acute cardiovascular condition in COVID-19 Pandemics represent big challenges, especially in early diagnostic and cardiovascular intervention decision. We were presenting a case where signs and symptoms of COVID-19 might appear later. Therefore, in this pandemic era every emergency cardiovascular intervention with signs of respiratory problem should be performed as if patient was a positive COVID-19 case.","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45250015","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Permanent pacemaker (PPM) are being used in greater frequency in managing patients with electrophysiology disorders. These patients can be presented for either cardiac or non-cardiac surgery after their device implantation. They also will undergo either general or regional anesthesia to facilitate the surgical procedure. As an anesthesiologist, understanding patients’ condition, pacemaker care and safe anesthetic technique of choice are very important to provide safe patient management. Therefore, this literature reviewed and summarized a systematic approach which can be followed in managing these patients. Various approach and guidelines have been discussed in the literature on how to manage patients with PPM who will undergo anesthesia. In this literature, the American Society of Anesthesiology (ASA) standard was used as a framework for managing patients with PPM. Meanwhile, the decision of anesthesia technique that being chosen should be based on patients’ clinical condition, the surgical procedure itself, the duration of surgery, and the convenience of the surgeon. Overall, patients with PPM require special attention in perioperative management. Both anticipations of the patient’s condition and the performance of PPM must always be considered to provide safe anesthesia practice.
{"title":"Cardiac Patients for Non-Cardiac Surgery: Anesthetic Considerations in Patients with Permanent Pacemaker","authors":"Eva Oktavia","doi":"10.30701/ijc.v1i1.946","DOIUrl":"https://doi.org/10.30701/ijc.v1i1.946","url":null,"abstract":"Permanent pacemaker (PPM) are being used in greater frequency in managing patients with electrophysiology disorders. These patients can be presented for either cardiac or non-cardiac surgery after their device implantation. They also will undergo either general or regional anesthesia to facilitate the surgical procedure. As an anesthesiologist, understanding patients’ condition, pacemaker care and safe anesthetic technique of choice are very important to provide safe patient management. Therefore, this literature reviewed and summarized a systematic approach which can be followed in managing these patients. \u0000Various approach and guidelines have been discussed in the literature on how to manage patients with PPM who will undergo anesthesia. In this literature, the American Society of Anesthesiology (ASA) standard was used as a framework for managing patients with PPM. Meanwhile, the decision of anesthesia technique that being chosen should be based on patients’ clinical condition, the surgical procedure itself, the duration of surgery, and the convenience of the surgeon. \u0000Overall, patients with PPM require special attention in perioperative management. Both anticipations of the patient’s condition and the performance of PPM must always be considered to provide safe anesthesia practice.","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45943143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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