Indonesia is currently suffering through a pandemic outbreak of severe respiratory syndrome Coronavirus 2 (SARS-CoV-2) known as Coronavirus Disease 2019 (COVID-19). Every day this infection raises double health community is fighting COVID-19 with their armamentarium and policy. Indonesian Heart Association (IHA) has already issued the statement about cardiovascular services during the outbreak of COVID-19. The policy is rescheduling non urgent outpatient visits as necessary social distancing strategy in outpatient clinic and using personal protective equipment (PPE) in outpatient clinic or during the cardiac examination (echocardiography cardiac CT electrophysiology and invasive cardiology). Most of international recommendations have recommended social distancing and reschedule non urgent visits. This document gives a general information about the prevention of COVID-19 in cardiology department.
{"title":"Break the chain of COVID-19 transmission: Perspective from a cardiologist-in-practice","authors":"S. Purwowiyoto, B. Purwowiyoto","doi":"10.30701/IJC.1000","DOIUrl":"https://doi.org/10.30701/IJC.1000","url":null,"abstract":"Indonesia is currently suffering through a pandemic outbreak of severe respiratory syndrome Coronavirus 2 (SARS-CoV-2) known as Coronavirus Disease 2019 (COVID-19). Every day this infection raises double health community is fighting COVID-19 with their armamentarium and policy. Indonesian Heart Association (IHA) has already issued the statement about cardiovascular services during the outbreak of COVID-19. The policy is rescheduling non urgent outpatient visits as necessary social distancing strategy in outpatient clinic and using personal protective equipment (PPE) in outpatient clinic or during the cardiac examination (echocardiography cardiac CT electrophysiology and invasive cardiology). Most of international recommendations have recommended social distancing and reschedule non urgent visits. This document gives a general information about the prevention of COVID-19 in cardiology department.","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":"48994767","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}
J. Henrina, I. C. S. Putra, H. Gunawan, I. Cahyadi, L. Suciadi
With a rapidly growing pandemic of coronavirus disease of 2019 (COVID-19), a public health emergency of international concern, the medical communities and national health systems are being tested for their preparedness. The culprit that is responsible for this viral respiratory disease, is a novel type of coronavirus, now identified as severe acute respiratory syndrome coronavirus - 2 (SARS-CoV2). At the present time, there are gaps in the knowledge regarding the safety of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for COVID-19 patients due to concern of ACE2, which is critical for viral entry and their levels are upregulated when using these (Renin Angiotensin Aldosterone System) RAAS blockers. ACE2 is a glycoprotein metalloprotease that plays an essential role in physiologic and pathological states and it is ubiquitously found in human organs. Despite sharing homology, ACE is different from ACE2, and while the former cleaves angiotensin 1 to angiotensin 2, the latter cleaves angiotensin two to angiotensin 1-7. Extrapolated from experimental animal studies, ACE2 and angiotensin 1-7 are important and protective for the lung physiology based on mice model of acute lung injury by various causes. Other evidence also demonstrates harm over benefits when stopping RAAS blockers, particularly in patients with cardiovascular disease, in which using these drugs are proven to be life-saving. In the light of the paucity of evidence derived from well-designed study, societies and colleges recommend continuing RAAS blockers until new evidence says otherwise.
{"title":"Recommendations of RAAS Blocker Use Amidst The Coronavirus Pandemic","authors":"J. Henrina, I. C. S. Putra, H. Gunawan, I. Cahyadi, L. Suciadi","doi":"10.30701/ijc.v1i1.1007","DOIUrl":"https://doi.org/10.30701/ijc.v1i1.1007","url":null,"abstract":"With a rapidly growing pandemic of coronavirus disease of 2019 (COVID-19), a public health emergency of international concern, the medical communities and national health systems are being tested for their preparedness. The culprit that is responsible for this viral respiratory disease, is a novel type of coronavirus, now identified as severe acute respiratory syndrome coronavirus - 2 (SARS-CoV2). At the present time, there are gaps in the knowledge regarding the safety of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for COVID-19 patients due to concern of ACE2, which is critical for viral entry and their levels are upregulated when using these (Renin Angiotensin Aldosterone System) RAAS blockers. ACE2 is a glycoprotein metalloprotease that plays an essential role in physiologic and pathological states and it is ubiquitously found in human organs. Despite sharing homology, ACE is different from ACE2, and while the former cleaves angiotensin 1 to angiotensin 2, the latter cleaves angiotensin two to angiotensin 1-7. Extrapolated from experimental animal studies, ACE2 and angiotensin 1-7 are important and protective for the lung physiology based on mice model of acute lung injury by various causes. Other evidence also demonstrates harm over benefits when stopping RAAS blockers, particularly in patients with cardiovascular disease, in which using these drugs are proven to be life-saving. In the light of the paucity of evidence derived from well-designed study, societies and colleges recommend continuing RAAS blockers until new evidence says otherwise.","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":"43981331","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}
Indonesia is currently suffering through a pandemic outbreak of severe respiratory syndrome coronavirus 2 (SARS-CoV-2) known as Coronavirus Disease 2019 (COVID-19). Every day this infection raises double, health community is fighting COVID-19 with their armamentarium and policy. Indonesian Heart Association (IHA) has already issued the statement about cardiovascular services during the outbreak of COVID-19. The policy is rescheduling non urgent outpatient visits as necessary, social distancing strategy in outpatient clinic and using personal protective equipment (PPE) in outpatient clinic or during the cardiac examination (echocardiography, cardiac CT, electrophysiology and invasive cardiology). Most of international recommendations have recommended social distancing and reschedule non urgent visits. This document gives a general information about the prevention of COVID-19 in cardiology department.
{"title":"Break the chain of COVID-19 transmission: Cardiologist Perspective","authors":"S. Purwowiyoto, B. Purwowiyoto","doi":"10.30701/ijc.v1i1.1000","DOIUrl":"https://doi.org/10.30701/ijc.v1i1.1000","url":null,"abstract":"Indonesia is currently suffering through a pandemic outbreak of severe respiratory syndrome coronavirus 2 (SARS-CoV-2) known as Coronavirus Disease 2019 (COVID-19). Every day this infection raises double, health community is fighting COVID-19 with their armamentarium and policy. Indonesian Heart Association (IHA) has already issued the statement about cardiovascular services during the outbreak of COVID-19. The policy is rescheduling non urgent outpatient visits as necessary, social distancing strategy in outpatient clinic and using personal protective equipment (PPE) in outpatient clinic or during the cardiac examination (echocardiography, cardiac CT, electrophysiology and invasive cardiology). Most of international recommendations have recommended social distancing and reschedule non urgent visits. This document gives a general information about the prevention of COVID-19 in cardiology department.","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":"44694120","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}
Indonesia has declared a COVID-19 outbreaks because of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in March 2020. COVID-19 has significantly increased morbidity and mortality worldwide. Some studies have shown good clinical outcomes with the use of combination of chloroquine or hydroxychloroquine and azithromycin. That drugs can prolong the QT interval and increase the risk of Torsade de Pointes (TdP). The risk is increasing in several conditions such as in critical patients, metabolic disorders, sepsis, multiorgan dysfunction and with drug-drug interactions. Cardiologists need to know how to manage this condition to reduce the risk of TdP.
{"title":"Managing QT prolongation in the Era of Coronavirus Disease 2019 (COVID-19)","authors":"S. Purwowiyoto, D. Hermanto, M. Iqbal","doi":"10.30701/ijc.v1i1.1002","DOIUrl":"https://doi.org/10.30701/ijc.v1i1.1002","url":null,"abstract":"Indonesia has declared a COVID-19 outbreaks because of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in March 2020. COVID-19 has significantly increased morbidity and mortality worldwide. Some studies have shown good clinical outcomes with the use of combination of chloroquine or hydroxychloroquine and azithromycin. That drugs can prolong the QT interval and increase the risk of Torsade de Pointes (TdP). The risk is increasing in several conditions such as in critical patients, metabolic disorders, sepsis, multiorgan dysfunction and with drug-drug interactions. Cardiologists need to know how to manage this condition to reduce the risk of TdP.","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":"41373526","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}
Indonesia has declared a COVID-19 outbreaks because of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) in March 2020. COVID-19 has significantly increased morbidity and mortality worldwide. Some studies have shown good clinical outcomes with the use of combination of chloroquine or hydroxychloroquine and azithromycin. That drugs can prolong the QT interval and increase the risk of Torsade de Pointes (TdP). The risk is increasing in several conditions such as in critical patients’ metabolic disorders sepsis multiorgan dysfunction and with drug-drug interactions. Cardiologists need to know how to manage this condition to reduce the risk of TdP.
{"title":"How to manage QT prolongation in COVID-19 patients","authors":"S. Purwowiyoto, D. Hermanto, M. Iqbal","doi":"10.30701/IJC.1002","DOIUrl":"https://doi.org/10.30701/IJC.1002","url":null,"abstract":"Indonesia has declared a COVID-19 outbreaks because of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) in March 2020. COVID-19 has significantly increased morbidity and mortality worldwide. Some studies have shown good clinical outcomes with the use of combination of chloroquine or hydroxychloroquine and azithromycin. That drugs can prolong the QT interval and increase the risk of Torsade de Pointes (TdP). The risk is increasing in several conditions such as in critical patients’ metabolic disorders sepsis multiorgan dysfunction and with drug-drug interactions. Cardiologists need to know how to manage this condition to reduce the risk of TdP.","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":"46755221","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}
S. Salim, S. Raharjo, D. Hermanto, D. Hanafy, Y. Yuniadi
Background: Atrioventricular (AV) block is a threatening condition that caused sudden loss of consciousness and death, notably if happened to aircraft pilot will compromise the reliability of flight operations and safety. Cardiac arrhythmia is well known as one of the main disqualifier for loss of flying license, and discriminating between benign and potentially significant rhythm abnormalities remains a challenge. The present case describes the electrophysiological feature of a high-grade AV block in an aircraft pilot. Case illustration: A 60-year-old male worked as commercial aircraft pilot presented with asymptomatic high-grade AV block during inflight Holter monitoring. He had never experienced any remarkable symptoms nor history of near syncope, but had a history of percutaneous coronary intervention (PCI) with one stent at left circumflex (LCx) coronary artery. Electrophysiology (EP) study revealed AH interval of 105 ms, HV interval of 50 ms, AV node effective refractory period of 280 ms and Weckenbach point of 330 ms, suggesting a normal EP study. Stimulation with atrial pacing and ATP showed prolongation of AH interval without changes in HV interval, showing the presence of a supra-Hisian AV node dysfunction. The highly demanding physiological environment in aircraft elucidate the likelihood of vagotonic cause of his condition and pacemaker implantation was not warranted. Conclusion: Atrioventricular (AV) block is an AV conduction disorder that can manifests in various symptoms and severity. Electrophysiology study is considered as a modality to locate the site of block that allows the avoidance of unnecessary permanent pacing and the appropriate prophylactic pacing.
{"title":"High-grade Atrioventricular Block in Pilot","authors":"S. Salim, S. Raharjo, D. Hermanto, D. Hanafy, Y. Yuniadi","doi":"10.30701/ijc.v1i1.950","DOIUrl":"https://doi.org/10.30701/ijc.v1i1.950","url":null,"abstract":"Background: Atrioventricular (AV) block is a threatening condition that caused sudden loss of consciousness and death, notably if happened to aircraft pilot will compromise the reliability of flight operations and safety. Cardiac arrhythmia is well known as one of the main disqualifier for loss of flying license, and discriminating between benign and potentially significant rhythm abnormalities remains a challenge. The present case describes the electrophysiological feature of a high-grade AV block in an aircraft pilot. \u0000Case illustration: A 60-year-old male worked as commercial aircraft pilot presented with asymptomatic high-grade AV block during inflight Holter monitoring. He had never experienced any remarkable symptoms nor history of near syncope, but had a history of percutaneous coronary intervention (PCI) with one stent at left circumflex (LCx) coronary artery. Electrophysiology (EP) study revealed AH interval of 105 ms, HV interval of 50 ms, AV node effective refractory period of 280 ms and Weckenbach point of 330 ms, suggesting a normal EP study. Stimulation with atrial pacing and ATP showed prolongation of AH interval without changes in HV interval, showing the presence of a supra-Hisian AV node dysfunction. The highly demanding physiological environment in aircraft elucidate the likelihood of vagotonic cause of his condition and pacemaker implantation was not warranted. \u0000Conclusion: Atrioventricular (AV) block is an AV conduction disorder that can manifests in various symptoms and severity. Electrophysiology study is considered as a modality to locate the site of block that allows the avoidance of unnecessary permanent pacing and the appropriate prophylactic pacing.","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":"44302848","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}
N. Namiranian, M. Emami, A. Naghedi, S. Razavi-Ratki
Abstract Background: Transient ischemic dilation (TID) measures left ventricle (LV) volume changes which can be associated with combination of myocardial and endocardial ischemia. Various stress methods, single photon emission computerized tomography (SPECT) imaging protocol, camera and software incite controversy on TID cut off. The purpose of this study was to evaluate the TID ratio in detection of coronary artery disease (CAD) categories in a systematic review and meta-analysis. Method: We conducted a systematic search of electronic databases (PubMed, Scopus, Embase and Web of Science) up to 1 January 2017. The reference lists of all included studies were searched for a higher accuracy. The search strategy was according a defined PICO as P: none, I: Transient ischemic dilation, O: Coronary Artery Diseases, C: Angiographies. Statistical analysis was done by Comprehensive meta-analysis software version 2 (CMA-2). Result: After study selection process, 7 studies were selected for data extraction. TID was studied from 1987. The sample size of included studies ranged between 86 and 545. The mean age of included patients varied between 58 and 69 years old. Ranges of TID in CAD categories were excluded. The pooled estimates of TID in single and dual pharmacological stress test in three CAD categories were calculated. Conclusion: Our findings show that more studies are needed to compare the TID variability. Although in this study meta-analysis was done and TID was summarized from studies but the software differences were ignored.
背景:短暂性脑缺血扩张(TID)测量左心室(LV)容量的变化，这可能与心肌和心内膜缺血合并有关。各种应力方法、单光子发射计算机断层扫描(SPECT)成像方案、相机和软件引发了对TID切断的争论。本研究的目的是通过系统回顾和荟萃分析来评估TID在检测冠状动脉疾病(CAD)类别中的比例。方法:系统检索截至2017年1月1日的电子数据库(PubMed、Scopus、Embase和Web of Science)。检索所有纳入研究的参考文献列表以获得更高的准确性。搜索策略是根据定义的PICO为P:无，I:短暂性缺血扩张，O:冠状动脉疾病，C:血管造影。采用综合meta分析软件version 2 (CMA-2)进行统计分析。结果:经过研究选择过程，筛选出7项研究进行数据提取。从1987年开始研究TID。纳入研究的样本量在86到545之间。纳入患者的平均年龄在58至69岁之间。排除CAD分类中TID的范围。计算三种CAD类别单次和双次药物应激试验TID的汇总估计值。结论:我们的研究结果表明，需要更多的研究来比较TID的变异性。虽然本研究进行了meta分析，并从研究中总结了TID，但忽略了软件差异。
{"title":"Transient ischemic dilation as a diagnostic marker in myocardial perfusion SPECT protocols: a systematic review and meta-analysis","authors":"N. Namiranian, M. Emami, A. Naghedi, S. Razavi-Ratki","doi":"10.30701/ijc.v0i0.981","DOIUrl":"https://doi.org/10.30701/ijc.v0i0.981","url":null,"abstract":"Abstract \u0000Background: Transient ischemic dilation (TID) measures left ventricle (LV) volume changes which can be associated with combination of myocardial and endocardial ischemia. Various stress methods, single photon emission computerized tomography (SPECT) imaging protocol, camera and software incite controversy on TID cut off. The purpose of this study was to evaluate the TID ratio in detection of coronary artery disease (CAD) categories in a systematic review and meta-analysis. Method: We conducted a systematic search of electronic databases (PubMed, Scopus, Embase and Web of Science) up to 1 January 2017. The reference lists of all included studies were searched for a higher accuracy. The search strategy was according a defined PICO as P: none, I: Transient ischemic dilation, O: Coronary Artery Diseases, C: Angiographies. Statistical analysis was done by Comprehensive meta-analysis software version 2 (CMA-2). \u0000Result: After study selection process, 7 studies were selected for data extraction. TID was studied from 1987. The sample size of included studies ranged between 86 and 545. The mean age of included patients varied between 58 and 69 years old. Ranges of TID in CAD categories were excluded. The pooled estimates of TID in single and dual pharmacological stress test in three CAD categories were calculated. \u0000Conclusion: Our findings show that more studies are needed to compare the TID variability. Although in this study meta-analysis was done and TID was summarized from studies but the software differences were ignored.","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46152011","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}
{"title":"Perlukah kriteria hipertensi baru dan target pengendalian tekanan darah yang lebih agresif? Telaah paska studi SPRINT serta panduan ACC/AHA 2017 dan ESH/ESC 2018","authors":"Bambang Widyantoro","doi":"10.30701/ijc.v39i2.765","DOIUrl":"https://doi.org/10.30701/ijc.v39i2.765","url":null,"abstract":"","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48556400","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}
EFFECTS OF N-ACETYLCYSTEIN ON HSCRP LEVEL IN ACUTE MYOCARDIAL INFARCTION PATIENTS RECEIVING FIBRINOLYTIC THERAPY Savithri Indriani1, Ahmad Yasa1, Trisulo Wasyanto1 1Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Sebelas Maret, RS Dr. Moewardi, Surakarta, Indonesia Background: Worldwide, coronary heart disease (CHD) is a leading cause of death. Inflammation in CHD and acute myocardial infarction (AMI) is a trigger due to the formation of atheroma plaques in the coronary arteries. N-Acetylcysteine (NAC) can prevent inflammation, remodeling and left ventricular dysfunction, interstitial fibrosis, and improve survival. Objective: To determine the effect of NAC on hsCRP levels in patients with acute myocardial infarction who received fibrinolytic therapy. Methods: This study was an experimental study with pre and post, single blind and randomization methods on the effect of NAC on hsCRP levels compared to controls carried out in July - August 2018 on the incidence of ST Elevation Myocardial Infarction (STEMI) came to Dr Moewardi Hospital and get fibrinolytic therapy. Results: A total of 33 patients were included in this study, there were 15 patients (mean age 58.80 ± 8.54 years) of the control group and 18 patients (mean age 55.45 ± 9.92 years) the treatment group receiving additional therapy of NAC evervescent 600 mg three times a day for three days . This study showed that hsCRP levels after intervention in the control and treatment groups were significantly different with p = 0.001. The level of hsCRP in the control group after administration of NAC had a median of 114.50 mg / L (18.60 - 300.00) while in the treatment group had a median of 18.75 mg / L (5.50 - 102.90). Conclusion: The addition of NAC 600 mg of therapy three times daily for 3 days can reduce hsCRP levels in patients with STEMI receiving fibrinolytic therapy compared to patients with acute myocardial infarction with ST segment elevation who did not receive additional NAC therapy. Keywords: hsCRP, N-Acetylcysteine, acute myocardial infarction . PENGARUH N-ACETYLCYSTEIN TERHADAP HSCRP PADA PASIEN INFARK MIOKARD AKUT DENGAN ELEVASI SEGMEN ST YANG MENDAPAT TERAPI FIBRINOLITIK Savithri Indriani1, Ahmad Yasa1, Trisulo Wasyanto1 Departemen Ilmu Penyakit Jantung dan Pembuluh Darah, Fakultas Kedokteran Universitas Sebelas Maret, RS Dr. Moewardi, Surakarta, Indonesia Latar Belakang: Di seluruh dunia, penyakit jantung koroner (PJK) merupakan penyebab utama kematian. Inflamasi pada PJK dan infark miokard akut (IMA) merupakan pemicu akibat terbentuknya plak ateroma pada arteri koroner. N-Acetylcysteine (NAC) dapat mencegah inflamasi, remodeling dan disfungsi ventrikel kiri, fibrosis interstisial, dan meningkatkan survival. Tujuan: Untuk mengetahui pengaruh NAC terhadap kadar hsCRP pada pasien infark miokard akut yang mendapatkan terapi fibrinolitik. Metode: Penelitian ini merupakan penelitian eksperimental dengan metode pre d
{"title":"EFFECTS OF N-ACETYLCYSTEIN ON HSCRP LEVEL IN ACUTE MYOCARDIAL INFARCTION PATIENTS RECEIVING FIBRINOLYTIC THERAPY","authors":"S. Indriani, A. Yasa', T. Wasyanto","doi":"10.30701/ijc.v39i4.798","DOIUrl":"https://doi.org/10.30701/ijc.v39i4.798","url":null,"abstract":"EFFECTS OF N-ACETYLCYSTEIN ON HSCRP LEVEL IN ACUTE MYOCARDIAL INFARCTION PATIENTS RECEIVING FIBRINOLYTIC THERAPY \u0000 \u0000Savithri Indriani1, Ahmad Yasa1, Trisulo Wasyanto1 \u00001Department of Cardiology and Vascular Medicine, Faculty of Medicine, \u0000Universitas Sebelas Maret, RS Dr. Moewardi, Surakarta, Indonesia \u0000 \u0000Background: Worldwide, coronary heart disease (CHD) is a leading cause of death. Inflammation in CHD and acute myocardial infarction (AMI) is a trigger due to the formation of atheroma plaques in the coronary arteries. N-Acetylcysteine (NAC) can prevent inflammation, remodeling and left ventricular dysfunction, interstitial fibrosis, and improve survival. \u0000Objective: To determine the effect of NAC on hsCRP levels in patients with acute myocardial infarction who received fibrinolytic therapy. \u0000Methods: This study was an experimental study with pre and post, single blind and randomization methods on the effect of NAC on hsCRP levels compared to controls carried out in July - August 2018 on the incidence of ST Elevation Myocardial Infarction (STEMI) came to Dr Moewardi Hospital and get fibrinolytic therapy. \u0000Results: A total of 33 patients were included in this study, there were 15 patients (mean age 58.80 ± 8.54 years) of the control group and 18 patients (mean age 55.45 ± 9.92 years) the treatment group receiving additional therapy of NAC evervescent 600 mg three times a day for three days . This study showed that hsCRP levels after intervention in the control and treatment groups were significantly different with p = 0.001. The level of hsCRP in the control group after administration of NAC had a median of 114.50 mg / L (18.60 - 300.00) while in the treatment group had a median of 18.75 mg / L (5.50 - 102.90). \u0000Conclusion: The addition of NAC 600 mg of therapy three times daily for 3 days can reduce hsCRP levels in patients with STEMI receiving fibrinolytic therapy compared to patients with acute myocardial infarction with ST segment elevation who did not receive additional NAC therapy. \u0000Keywords: hsCRP, N-Acetylcysteine, acute myocardial infarction \u0000. \u0000 \u0000PENGARUH N-ACETYLCYSTEIN TERHADAP HSCRP PADA PASIEN INFARK MIOKARD AKUT DENGAN ELEVASI SEGMEN ST YANG MENDAPAT TERAPI FIBRINOLITIK \u0000 \u0000Savithri Indriani1, Ahmad Yasa1, Trisulo Wasyanto1 \u0000Departemen Ilmu Penyakit Jantung dan Pembuluh Darah, Fakultas Kedokteran \u0000Universitas Sebelas Maret, RS Dr. Moewardi, Surakarta, Indonesia \u0000 \u0000Latar Belakang: Di seluruh dunia, penyakit jantung koroner (PJK) merupakan penyebab utama kematian. Inflamasi pada PJK dan infark miokard akut (IMA) merupakan pemicu akibat terbentuknya plak ateroma pada arteri koroner. N-Acetylcysteine (NAC) dapat mencegah inflamasi, remodeling dan disfungsi ventrikel kiri, fibrosis interstisial, dan meningkatkan survival. \u0000Tujuan: Untuk mengetahui pengaruh NAC terhadap kadar hsCRP pada pasien infark miokard akut yang mendapatkan terapi fibrinolitik. \u0000Metode: Penelitian ini merupakan penelitian eksperimental dengan metode pre d","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47686046","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}
Z. Zainuddin, Endang Ratnaningsiah, Andika Rizki Lubis, Sebastian Andi Manurung, T. Pratikto, A. Soesanto
Abstract Background: Though the use of Low Molecular Weight Heparin (LMWH) in general is preferred due to its convenient and eliminates the need for activated Partial Thromboplastin Time ( aPTT) monitoring but Unfractionated Heparin (UFH) is still widely used in clinical setting due to its availability and low price. Besides UFH, the use of oral anticoagulant therapy with warfarin, has been the standard therapy for the prevention of thromboembolism in patients with AF. Our aim is to report a case of the resolution of left atrial thrombus in a patient with mitral stenosis. Case Illustration: A Case report of a female patient aged 54 years who admitted with a sudden neurological deficits and mitral stenosis with atrial fibrillation. Transthoracal Echocardiography (TTE) showed mobile thrombus which moved and obstructed the mitral valve during diastolic phase. Unfractionated heparin (UFH) was administered 3000 unit bolus intravenously and maintained with 600 unit per hour with the combination of warfarin 2 mg for five days. TTE evaluation showed the resolution of LA thrombus. Conclusion : The administration of the combination of UFH and warfarin had successfully caused resolution of the LA thrombus and prevented the patient from surgical intervention. This case report indicated that Unfractionated Heparin and Warfarin were still the treatments option in LA thrombus patients with mitral stenosis and atrial fibrillation. Key words :Left atrial thrombus, unfractionated heparin, thrombus resolution
{"title":"Left Atrial Thrombus Resolution Using Unfractionated Heparin and Warfarin in a Patient with Mitral Stenosis","authors":"Z. Zainuddin, Endang Ratnaningsiah, Andika Rizki Lubis, Sebastian Andi Manurung, T. Pratikto, A. Soesanto","doi":"10.30701/ijc.v40i3.870","DOIUrl":"https://doi.org/10.30701/ijc.v40i3.870","url":null,"abstract":"Abstract \u0000Background: Though the use of Low Molecular Weight Heparin (LMWH) in general is preferred due to its convenient and eliminates the need for activated Partial Thromboplastin Time ( aPTT) monitoring but Unfractionated Heparin (UFH) is still widely used in clinical setting due to its availability and low price. Besides UFH, the use of oral anticoagulant therapy with warfarin, has been the standard therapy for the prevention of thromboembolism in patients with AF. Our aim is to report a case of the resolution of left atrial thrombus in a patient with mitral stenosis. \u0000Case Illustration: A Case report of a female patient aged 54 years who admitted with a sudden neurological deficits and mitral stenosis with atrial fibrillation. Transthoracal Echocardiography (TTE) showed mobile thrombus which moved and obstructed the mitral valve during diastolic phase. Unfractionated heparin (UFH) was administered 3000 unit bolus intravenously and maintained with 600 unit per hour with the combination of warfarin 2 mg for five days. TTE evaluation showed the resolution of LA thrombus. \u0000Conclusion : The administration of the combination of UFH and warfarin had successfully caused resolution of the LA thrombus and prevented the patient from surgical intervention. This case report indicated that Unfractionated Heparin and Warfarin were still the treatments option in LA thrombus patients with mitral stenosis and atrial fibrillation. \u0000 \u0000Key words :Left atrial thrombus, unfractionated heparin, thrombus resolution \u0000 \u0000 ","PeriodicalId":32916,"journal":{"name":"Majalah Kardiologi Indonesia","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44401576","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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