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"Telah dilakukan penelitian retrospektif terhadap pasien infark miokard akut (IMA) yang dirawat di ICCU RSUPN Dr Cipto Mangunkusumo, Jakarta antara Januari 1994 sampai Desember 1999. Dari 513 pasien yang dirawat dengan IMA, 227 pasien adalah usia lanjut, di mana 35,2 % dari mereka adalah wanita. Sebagian besar IMA usia lanjut mengeluh nyeri dada yang khas seperti pada pada kelompok usia muda. Pasien IMA usia lanjut cenderung terlambat datang ke rumah sakit dan lebih banyak menderita IMA gelombang Q. Faktor risiko diabetes melitus dan hipertensi lebih sering dijumpai pada usia lanjut. Prevalensi fibrilasi atrial dan mortalitas lebih tinggi pada usia lanjut. (Med J Indones 2003; 12: 229-35)

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A retrospective study were performed in patients with acute myocardial infarction (AMI) that hospitalized in ICCU Cipto Mangunkusumo hospital, Jakarta during the period of January 1994 until Decmber 1999. There were 513 patients hospitalized with MCI, 227 patients (44.2%) were classified as elderly, and 35.2% of them were female. Most of the elderly AMI patients reported typical chest pain just like their younger counterparts. Elderly AMI patients tend to come later to the hospital, and more Q-wave myocardial infarction were identified compared to non-Q-wave myocardial infarction. Risk factors of diabetes mellitus and hypertension were more common among the elderly. The prevalence of atrial fibrillation and the mortality rate were higher among elderly AMI patients. (Med J Indones 2003; 12: 229-35)"

"Infark miokard akut (IMA) telah menjadi sebab utama kematian di negara Barat maupun di Indonesia. Keterlambatan diagonis dan tatalaksana dini yang salah seringkali mengakibatkan kegagalan reperfusi dengan trombolitik. Dokter umum sebagai lini kesehatan pertama harus dibekali dengan ketrampilan mendiagnosis dan juga menangani IMA. Dalam tulisan ini dilaporkan kasus gagal terapi trombolitik pada pria usia 47 tahun setelah tujuh jam mengalami nyeri dada angina, yang telah sebelumnya ditangani oleh dokter umum. (Med J Indones 2005; 14:249-52)

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Acute myocardial infarction (AMI) has been the leading cause of death in Western countries, as well as in Indonesia. Delay in diagnosis and incorrect early management often result in failure of thrombolytic reperfusion. General practitioner (GP) as the primary care, needs to be equipped with the ability to diagnose and moreover to manage AMI. A case of fail thrombolytic management in a 47 years old man after seven hours of angina typical chest pain, after previously managed by GP, is being reported. (Med J Indones 2005; 14:249-52)"

"Beberapa penelitian terdahulu menunjukkan kontradiksi hubungan antara dispersi QT dengan kejadian takiaritmia ventrikel dan atau kematian jantung mendadak. Penelitian-penelitian itu tidak mengeluarkan pengguna obat penghambat reseptor beta, bahkan pengguna obat tersebut merupakan mayoritas pada sampel mereka. Karena penggunaan penghambat reseptor beta sebagai pencegahan sekunder yang masih rendah di Pusat Jantung Nasional Harapan Kita, maka penelitian ini dilakukan untuk mengetahui hubungan antara dispersi QT dengan kejadian takiaritmia ventrikel dan atau kematian jantung mendadak pada pasien pascainfark. Interval QT, dispersi QT dan variabel klinis dibandingkan antara 36 orang pasien pascainfark yang mengalami takiaritmia ventrikel dan atau kematian jantung mendadak (kelompok kasus), dengan 75 pasien pascainfark yang tidak mengalami kedua kejadian tersebut (kelompok kelola). Dispersi QT yang lebih panjang (115 + 41 msec vs 81 + 25 msec, p < 0.001). Interval QT maksimal terkoreksi juga lebih panjang pada kelompok kasus (534 + 56 vs 501 + 35 msec, p < 0.001). Analisa regresi logistik menunjukkan adanya hubungan antara pemanjangan dispersi QT dengan kejadian takiaritmia ventrikel dan atau kematian jantung mendadak dengan RO 3,2, 4, dan 5,8 masing-masing untuk nilai potong 80, 90, dan 100 mdet. Dispersi QT dapat memprediksi kejadian takiaritmia ventrikel dan atau kematian jantung mendadak pada pasien infark miokard akut. Hasil ini menunjukkan bahwa dispersi QT tetap bermanfaat pada kondisi bebas pengaruh obat penghambat reseptor beta. (Med J Indones 2005; 14: 230-6)

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Recent studies showed contradictive results of the relation between QT dispersion and the occurrence of ventricular tachyarrhythmias and/or sudden cardiac death. In addition, beta adrenoreceptors blocking agents, which are known to decrease the incidence of lethal arrhythmias after myocardial infarction, administered to the majority of patients in those studies population. Since b-blocker as secondary prevention drug was underutilized at National Cardiovascular Center Harapan Kita, this study was performed to find out the relation between QT dispersion and ventricular tachyarrhythmias and/or sudden cardiac death after previous myocardial infarction. The QT interval duration, QT dispersion and clinical variables of 36 postinfarction patients with history of sustained ventricular tachyarrhythmias and/or sudden cardiac death (event group) were compared with 75 postinfarction patients without such events (control group). QT dispersion differed significantly between study groups and was increased in the event group (115 ± 41 msec vs 81 ± 25 msec, p < 0.001). Corrected maximal QT interval duration was also prolonged in the event group (534±56 vs 501±35 msec, p < 0.001). Regression analysis showed that increasing QT dispersion was related to the occurrence of ventricular tachyarrhythmias and/or sudden cardiac death with OR of 3.2, 4, and 5.8 for cut-off point of 80, 90, and 100 msec respectively. The QT dispersion could predict the occurrence of ventricle tachyarrhythmias and/or sudden cardiac death in patient with AMI. This study confirmed that the QTd remain useful in free of beta blocking agents state. (Med J Indones 2005; 14: 230-6)"

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Aktivitas seksual adalah kebutuhan vital bagi manusia yang dapat terganggu setelah Infark Miokard Akut (IMA) sehingga kapan kembali melakukan aktivitas seksual merupakan hal yang harus menjadi perhatian. Namun saat ini, kembali beraktivitas seksual belum menjadi prioritas dalam pelayanan keperawatan. Penelitian ini bertujuan mengidentifikasi pengaruh dari karakteristik responden, farmakologi, komorbiditas, masalah seksual, dukungan pasangan, dukungan tenaga kesehatan, pengetahuan, fungsi fisik dan faktor psikologis (ansietas-depresi) terhadap kembali beraktivitas seksual. Penelitian menggunakan desain survey analitik cross sectional pada 107 responden rawat jalan yang diambil dengan teknik consecutive sampling. Penelitian menggunakan instrumen Short-Form 12 (SF-12) untuk menilai fungsi fisik, Sex after MI Knowledge Test (SMIKT) untuk mengukur pengetahuan seksual paska IMA dan The Hospital Anxiety and Depression Scale (HADS) untuk mengukur ansietas dan depresi. Hasil penelitian yang dianalisa dengan uji chi-square dan fishers exact menunjukkan bahwa variabel yang berhubungan signifikan adalah farmakologi (beta-blocker) (p=0,020), masalah seksual (p=0,017) dan pengetahuan (p=0,038). Responden dengan beta-bloker, mempunyai masalah seksual dan pengetahuan seksual yang kurang cenderung terlambat kembali beraktivitas seksual. Program edukasi seksual dan peningkatan kolaborasi interprofesional diharapkan dapat membantu pasien lebih cepat kembali beraktivitas seksual paska IMA.

 

 

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Sexual activity is a vital need for humans which can be distrupted due to Acute Myocardial Infarction (AMI) therefore when to resumption of sexual activity is an important matter must be concern. However, return to sexual activity have not been a priority in nursing care nowadays. The study aimed to identify influence of characteristics respondent, pharmacology, comorbidity, sexual problem, partners support, health professional support, sexual knowledge, physical function and psychology factors (anxiety-depression) on returning to sexual activity. The study used analytic survey with cross sectional approach and consecutive sampling involving 107  outpatient. The instruments used were Short Form 12 (SF-12) to assess physical function, Sex after MI Knowledge Test (SMIKT) to measure the post-IMA sexual knowledge and The Hospital Anxiety and Depression Scale (HADS) to measure anxiety and depression level. The results were analyzed by fishers exact and chi square test showed a significant relationship between  pharmacological factor (beta-blocker) (p=0,02), sexual problems (p=0,017) and sexual knowledge (0,038) with returning to sexual activity after IMA. Respondents were receiving beta-blocker, having sexual problems and lacking of sexual knowledge tend to be late resuming sexual activity. Sexual education programe and increased interprofessional collaboration are expected to help post-IMA patients regain their sexual activity  faster.

 

 

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"Angka kematian pada pasien dengan infark miokardium akut (IMA) telah menurun secara signifikan oleh karena strategi terapi reperfusi saat ini. Terapi reperfusi dapat berakibat pada cedera reperfusi. Oleh karena itu, tatalaksana pada pasien ini menghadapi tantangan baru dalam hal diagnosis dan tatalaksana gagal jantung, identifikasi kondisi iskemia, estimasi keperluan antikoagulan, dan penilaian risiko kardiovaskular secara menyeluruh. Ilustrasi kasus ini akan menunjukkan pengaruh magnetic resonance imaging (MRI) kardiak dalam penilaian patofisiologi IMA pada era terapi reperfusi. MRI kardiak akan memberikan informasi berguna yang akan membantu para klinisi dalam tatalaksana dan pemilihan strategi terapi spesifik pada pasien IMA.

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AbstractMortality in patients with acute myocardial infarction (AMI) has decreased significantly and appears to be the result of current reperfusion therapeutic strategies. Reperfusion itself may develop into reperfusion injury. Therefore, management of these patients poses several challenges, such as diagnosing and managing heart failure, identifying persistent or inducible ischaemia, estimating the need for anticoagulation, and assessing overall cardiovascular risk. This case presentation will demonstrate the impact of cardiac magnetic resonance imaging (MRI) in the assessment of the pathophysiology of AMI inthe current reperfusion era. Cardiac MRI can provide a wide range of clinically useful information which will help clinicians to manage and choose specific therapeutic strategies for AMI patients."

"Evidence from epidemiologic studies suggests that periodontal diseases may exert a weak to moderate influence on the severity and course of coronary heart disease. The aim of this study was to investigate whether an association between chronic oral infections and the presence of an acute myocardial infarction (AMI) exists. A total of 248 patients after AMI and 249 healthy controls were recruited for this study. The oral assessment included caries frequency (DMFT indices), number of teeth, probing pocket depths, bleeding on probing, clinical attachment level, as well as radiographs to diagnose apical lesions. The medical examination included a blood analysis, e.g. the determination of the serum concentration of C-reactive protein (CRP). The data analysis showed statistically significant differences between AMI patients and the controls with regard to number of missing teeth (p = 0.001), DMFT index (p = 0.001) and presence of apical lesions of endodontic origin (p = 0.001). Logistic regression showed that the probability of having lesions of endodontic origin was with an odds ratio of 1.54 (95 % CI 1.10-2.16; p = 0.012) considerably higher in the AMI patient group. Likewise, the AMI patients had with an odds ratio of 1.21 (95 % CI 1.14-1.28; p < 0.001) a higher number of missing teeth. The data from the blood analysis, in particular the CRP values, showed no significant correlation with the number of apical lesions. The results of the present study underline that patients, who have experienced a myocardial infarction, had more missing teeth and a higher number of inflammatory processes, especially of endodontic origin, than healthy patients."

"[, Penelitian ini bertujuan untuk mencari korelasi antarapola perubahan kadar Mg plasma dan K serum terhadaptimbulnya GIJ pada IMA. Jumlah sampel yang memenuhi kreteria penelitian sebanyak 28 orang yang terdiri dari 24 orang pria dan 4 orang wanita. Penderita IMA yang mengalami GIJ selama perawatan di ICCU RSCM sebesar 70%. GIJ yang terjadi dapat berupa gangguan konduktifitas (kelompok I) dan gangguan iritabilitas (kelompok II), sedang 30% irama sinus (kelompok III).

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This study aims to find a correlation between

pattern of changes in plasma Mg and K levels of serum to

the emergence of GIJ at IMA. The number of samples that met the research criteria was 28 people consisting of 24 men and 4 women. IMA patients who experience GIJ during treatment at ICCU RSCM is 70%. GIJ that occurs can be in the form of conductivity disorders (group I) and irritability disorders (group II), while 30% of sinus rhythms (group III).]"

"Latar Belakang : Deteksi infark pada populasi sindroma koroner akut non elevasi segmen ST (SKA-NEST) pada praktik klinis sulit dan menyebabkan kegagalan stratifikasi risiko yang tepat. Pemeriksaan enzim jantung tidak tersedia secara luas, memiliki waktu tunggu yang lama, dan membutuhkan biaya yang tidak sedikit.Tujuan : Mengetahui akurasi dasar dan akurasi paska training kecerdasan buatan Learning Intelligent for Effective Sonography (LIFES) dalam mendeteksi infark miokard pada populasi SKA-NEST berdasarkan gambaran ekokardiografiMetode : Penelitian ini merupakan studi diagnostik yang mengevaluasi kemampuan kecerdasan buatan berbasis deep learning LIFES dalam mendeteksi infark miokard pada pasien SKA-NEST di RSJPDHK pada tahun 2019-2023 berdasarkan gambaran ekokardiografi. Dilakukan transfer learning menggunakan dataset penelitian dan cross validation untuk mengetahui tingkat akurasi model baru paska transfer learning.Hasil : Sebanyak 721 subjek memenuhi kriteria inklusi dan eksklusi dari tahun 2019-2023. 310 diantaranya adalah pasien infark miokard non elevasi segmen ST (IMA-NEST). Sebanyak 67,8 % subjek adalah laki-laki dengan median usia 61 tahun. Median waktu dilakukan ekokardiografi dari admisi adalah tiga hari. Terdapat perbedaan signifikan pada beberapa parameter ekokardiografi pada kelompok infark vs non infark berupa median FEVKi 53% vs 63 % (p < 0,001), median LVEDD 48,8 mm vs 44,6 mm (p < 0,001), median rerata E/E’ 12,0 vs 9,8 (p < 0,001) dan median LAVI 30 ml/m2 vs 26 ml/m2 (p < 0,001). Performa diagnostik LIFES terhadap infark didapatkan paling baik pada tampilan PLAX dengan sensitivitas 88,7 % dan spesifisitas 20,4 % AUC 0,55 pada LIFES fase 2 model 1. Paska transfer learning, model LIFES-MI menghasilkan akurasi terbaik pada tampilan A4C dengan sensitivitas 41,3 % dan spesifisitas 83,7% AUC 0,61.Kesimpulan Model kecerdasan buatan LIFES fase 2 model 1 memiliki sensitivitas yang baik untuk deteksi infark miokard, sedangkan model LIFES-MI memiliki spesifisitas yang baik dalam mendeteksi infark miokard berdasarkan gambaran ekokardiografi pada populasi SKA-NEST.

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Background: Detecting myocardial infarction in the non-ST segment elevation acute coronary syndrome (NSTEACS) population in clinical practice is challenging and leads to failure in appropriate risk stratification. Cardiac enzyme assays are not widely available, have long waiting times, and incur significant costs.

Objective: To determine the baseline accuracy and post-training accuracy of the Learning Intelligent for Effective Sonography (LIFES) artificial intelligence in detecting myocardial infarction in the NSTEACS population based on echocardiographic findings.

Method: This study is a diagnostic study that evaluates the ability of deep learning-based artificial intelligence LIFES in detecting myocardial infarction in NSTEACS patients at RSJPDHK from 2019 to 2023 based on echocardiographic videos.. Transfer learning was performed using the research dataset and cross-validation to determine the accuracy level of the new model post-transfer learning.

Results: A total of 721 subjects met the inclusion and exclusion criteria from 2019 to 2023. Among them, 310 were non-ST segment elevation myocardial infarction (NSTEMI) patients. 67.8% of the subjects were male with a median age of 61 years. The median time from admission to echocardiography was three days. There were significant differences in several echocardiographic parameters between the infarct and non-infarct groups, including median EF% 53% vs 63% (p < 0.001), median LVEDD 48.8 mm vs 44.6 mm (p < 0.001), median mean E/E' 12.0 vs 9.8 (p < 0.001), and median LAVI 30 ml/m2 vs 26 ml/m2 (p < 0.001). LIFES diagnostic performance for infarction was best achieved in the PLAX view with sensitivity of 88.7% and specificity of 20.4%, AUC 0.55 in LIFES phase 2 model 1. Post-transfer learning, the LIFES-MI model produced the best accuracy in the A4C view with sensitivity of 41.3% and specificity of 83.7%, AUC 0.61.

Conclusion: The Learning Intelligent for Effective Sonography (LIFES) phase 2 model 1 has good sensitivity for detecting myocardial infarction, while the LIFES-MI model has good specificity in detecting myocardial infarction based on echocardiographic findings in the NSTEACS population."

"Intervensi koroner perkutan primer (IKPP) merupakan pilihan utama terapi repefusi pada infark miokard akut dengan elevasi segmen ST (IMAEST) dan obstruksi mikrovaskular (OMV) merupakan salah satu komplikasi yang sering terjadi pada IKPP. Osteoprotegerin (OPG) merupakan tumor necrosis factor receptor yang konsentrasinya meningkat pada pasien IMA-EST. Studi yang menganalisis hubungan konsentrasi serum OPG dengan luasnya infark masih sangat terbatas. Metode. Tiga puluh enam pasien yang menjalani intervensi koroner perkutan primer (IKPP) pada bulan September hingga November 2013, direkrut secara konsekutif pada studi potong lintang ini. Dilakukan analisis hubungan antara konsentrasi serum OPG sebelum IKPP dengan hs-trop T 24 jam pasca IKPP. Hasil. Analisis bivariat menunjukkan hubungan antara konsentrasi serum OPG dengan hs-trop T (r = 0.41, p =0.015). Analisis multivariat konsentrasi serum OPG dan onset nyeri mempengaruhi luas infark (indeks kepercayaan 5.15 – 49.19, p =0.017 dan indeks kepercayaan 2.56 - 15.28, p = 0.005). Kesimpulan. Hasil penelitian ini menunjukkan hubungan antara konsentrasi serum osteoprotegerin saat masuk dengan luas infark miokard yang diukur dengan hs-trop T pada pasien IMA-EST yang menjalani IKPP.

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Primary percutaneous coronary intervention (PPCI ) is the preferred option for reperfusion therapy in acute ST-elevation myocardial infarction (STEMI) patients and microvascular obstruction (MVO) is one of the complication that might occurred during PPCI. Osteoprotegerin (OPG) is a tumor necrosis factor receptors that may increased in STEMI patients. Studies that analyze the relationship between serum concentrations of OPG with the extent of infarction are still very limited.

Method. Thirty six patients underwent PPCI were enrolled in this cross sectional study during September to November 2013. We analyzed the relationship between serum concentrations of OPG before PPCI with the level of hs-trop T measured 24 hours after PPCI.

Results. Bivariate analysis showed a significant correlation between serum osteoprotegerin concentration and hs-trop T (r=0.41, p=0.015). Multivariate analysis showed significant correlation between the extent of infarction with both onset of pain (confidence interval 2.56-15.28, p=0.005) and serum osteoprotegerin concentrations (confidence interval 5.15-49.19, p= 0.017).

Conclusion. This study showed that serum osteoprotegerin concentration have a significant relationship to the extent of infarction measured with hs-trop T in acute STEMI patients underwent PPCI."