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"The textbook will describe the relationship between human cardiopulmonary system and exercise in a format that is related to the mode of exercise, health status and aging. It will include data regarding exercise training principles and the adaptations of the cardiopulmonary following, anaerobic, resistance and aerobic training. A more in-depth presentation of the cardiopulmonary system adaptations in pressing environments such as: warm, cold and altitude. Therefore, students will experience a depth and extent of content balanced with unique and effective learning features: It will help students find the way by both the text and subject matter. Knowing cardiopulmonary exercise function in health and disease will allow understand new research and findings relevant to cardiovascular status as assessed by cardiopulmonary exercise indices. It will bring together investigational exercise physiologists, cardiologists and scientists who share a wealth of experience needed to judge the cardiovascular status and function, and the impairments of patients with a variety of cardiac dysfunction. This book will provide a comprehensive, updated presentation of the information of the cardiovascular system as a whole, and its individual components."

"Pendahuluan: Coronary Artery Disease (CAD) merupakan salah satu penyakit kardiovaskular yang menjadi penyebab utama kematian di dunia. Tindakan kateterisasi dengan menggunakan teknik transradial arteri (TRA) telah mampu menurunkan angka morbiditas dan angka mortalitas dari CAD, tetapi prosedur ini juga berkontribusi untuk terjadinya komplikasi yang cukup besar. Tujuan: dari penelitian ini untuk mengidentifikasi pengaruh handgrip exercise dynamometer terhadap nyeri, edema dan hematoma pada pasien CAD post transradial cardiac catheterization. Metode: Desain penelitian ini menggunakan quasi experiment design dengan bentuk pre test and post test nonequivalent control group. Teknik sampling yang digunakan dalam penelitian ini adalah non probability sampling yaitu Convinience sampling. Nyeri dan edema merupakan hasil utama dari penelitian ini yang dipantau dan diukur 2 jam setelah intervensi sedangkan hematoma dipantau dan diukur 24 jam setelah intervensi. Hasil: Terdapat penurunan skala nyeri dan edema yang signifikan sesudah dilakukan handgrip exercise pada kelompok intervensi dengan p value = 0,000. Tidak ada penurunan skala nyeri dan edema sesudah pada tindakan yang diberikan sesuai SOP Rumah sakit secara signifikan dengan p value > 0,05. Terdapat perbedaan yang signifikan median penurunan skala nyeri dan edema sesudah dilakukan handgrip exercise pada kelompok intervensi dibandingkan dengan kelompok kontrol (p value < 0,05). Terdapat perbedaan yang signifikan pada kejadian hematoma sesudah dilakukan handgrip exercise pada kelompok intervensi yaitu 5,8% dibandingkan dengan kelompok kontrol 80,8% (p value < 0,05). Kesimpulan: handgrip exercise dynamometer dapat menurunkan nyeri, edema dan hematoma pada pasien CAD posttransradial cardiac catetherization.

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Introduction: Coronary Artery Disease (CAD) is leading cause of mortality worldwide. Catheterization using the transradial arterial (TRA) technique has been able to reduce morbidity and mortality rates from CAD, but this procedure also contributes to the occurrence of complications. Aim: this study to identify the effect of the handgrip exercise dynamometer on pain, edema and hematoma in CAD patients post transradial cardiac catheterization. Method: This research design uses a quasi experimental design with the form of a pre test and post test nonequivalent control group. The sampling technique used in this research is non-probability sampling, namely convenience sampling. Pain and edema were the main outcomes of this study which were monitored and measured 2 hours after the intervention while hematoma was monitored and measured 24 hours after the intervention. Results: There was a significant reduction in pain and edema before and after handgrip exercise in the intervention group with p value = 0.000. There was no significant reduction in the pain and edema scale before and after the intervention given according to the hospital SOP with a p value < 0.05. There was a significant difference in the median reduction in pain and edema after handgrip exercise in the intervention group compared to the control group (p value < 0.05). There was a significant difference in the incidence of hematoma after handgrip exercise in the intervention group, namely 5.8% compared to the control group, 80.8% (p value < 0.05). Conclusion: handgrip exercise dynamometer can reduce pain, edema and hematoma in CAD posttransradial cardiac catetherization patients."

"Latar belakang : Berbagai penelitian menunjukkan bahwa setelah pengobatan tuberkulosis (TB) selesai dan dinyatakan sembuh, sebagian besar penyintas TB masih mengalami gejala sisa. Saat ini program penanggulangan TB sudah berjalan dengan baik, tetapi tindakan rehabilitasi pada pasien yang masih mengalami keterbatasan kapasitas fungsional dan faal paru pasca tuberkulosis masih belum menjadi prioritas program nasional. Penelitian ini bertujuan untuk mencari apakah terdapat hubungan antara luas lesi pada foto toraks yang sudah menjadi standar pemeriksaan pada pasien dengan pengobatan TB dengan kapasitas fungsional lewat pemeriksaan uji latih jantung paru (ULJP) dan faal paru lewat pemeriksaan spirometri, sehingga bisa menjadi alat skrining pasien yang memerlukan pemeriksaan lebih lanjut. Metode : Desain penelitian ini adalah deskriptif observasional dengan metode potong lintang untuk mengetahui luas lesi foto toraks, uji latih jantung paru dan spirometri pada pasien bekas TB paru sensitif obat di RSUP Persahabatan. Hasil : Didapatkan 45 subjek penelitian yang memenuhi kriteria dan bersedia ikut penelitian. Terdapat korelasi negatif bermakna antara luas lesi foto toraks dengan parameter ULJP yaitu VO2 Max (r = −0,389) dan Minute Ventilation (r = −0,435), dengan nilai p masing-masing 0,008 dan 0,003. Terdapat korelasi negatif bermakna antara luas lesi foto toraks dengan parameter spirometri yaitu VEP1 (r = −0,489) dan KVP (r = −0,578), dengan nilai p masing-masing 0,001 dan <0,001, Variabel perancu yang berpengaruh adalah diabetes mellitus dengan koefisien regresi -9,756 terhadap peak minute ventilation dengan nilai p = 0,023. Kesimpulan : Terdapat hubungan antara luas lesi foto toraks dengan ULJP dan spirometri.

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Background : Multiple studies show that following the completion of tuberculosis (TB) treatment and successful recovery, the majority of TB survivors still experience residual symptoms. While the TB control program is currently well established, the rehabilitation of individuals with diminished functional capacities post-tuberculosis remains a secondary concern within the national program. This study aims to determine whether there were correlation between chest x-ray lesion area which has become a standard examination in patients undergoing TB treatment, with functional capacity as measured by cardiopulmonary exercise testing (CPET) and lung function assessed through spirometry, so it can be a screening tool for patients who require further examination. Methods : The design of this study was descriptive observational with a cross-sectional method to determine chest x-ray lesion area, cardiopulmonary exercise testing and spirometry in post drug susceptible pulmonary TB patients at Persahabatan Hospital. Results : There were 45 subjects who met the criteria and were agree to take part in the research. There was a significant negative correlation between chest x-ray lesion area and CPET parameters VO2 Max (r = −0.389) and Minute Ventilation (r = −0.435), with p values of 0.008 and 0.003, respectively. There was a significant negative correlation between chest x-ray lesion area and spirometry parameters, FEV1 (r = −0.489) and FVC (r = −0.578), with p values of 0.001 and <0.001, respectively. The significant confounding variable is diabetes mellitus with a regression coefficient -9.756 to peak minute ventilation with p value = 0.023. Conclusions : There were negative correlation of chest x-ray lesion area with CPET and spirometry in post drug susceptible pulmonary TB patients."

"Penelitian ini bertujuan untuk mengetahui efektivitas latihan aerobik rehabilitasi jantung fase dua berbasis rumah dibandingkan berbasis rumah sakit pada pasien penyakit jantung koroner pascaintervensi koroner perkutan. Jumlah subjek penelitian sebesar 32 subjek, dengan masing-masing 15 subjek pada tiap kelompok yang dapat dianalisis. Subjek rata-rata berusia 57,97±11,59 tahun dan didominasi oleh laki-laki (80%). Kedua kelompok menunjukkan peningkatan bermakna uji jalan enam menit setelah 6 minggu intervensi dibandingkan sebelum (berbasis rumah sakit 397±78-450±73 m; berbasis rumah 350±106-454±67 m) nilai p<0,05. Peningkatan uji jalan enam menit tidak berbeda bermakna secara statistik pada kelompok berbasis rumah sakit (62 m) dibandingkan kelompok berbasis rumah (61 m) nilai p>0,05. Kesimpulan penelitian ini adalah latihan aerobik rehabilitasi jantung fase dua selama 6 minggu secara signifikan meningkatkan jarak tempuh uji jalan enam menit dan peningkatan tidak berbeda bermakna berbasis rumah sakit dibandingkan berbasis rumah pada pasien pasien penyakit jantung koroner pascaintervensi koroner perkutan.

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This study aims to determine the effectiveness of home-based phase II cardiac rehabilitation aerobic exercise compared to hospital-based in patients with coronary heart disease after percutaneous coronary intervention. Total subjects were 32 subjects, with 15 subjects in each group that could be analyzed. The average subject’s age was 57.97±11.59 years old and dominated by men (80%). Both groups showed a significant increase in the six-minute walk test after 6 weeks of intervention compared to baseline (hospital-based 397±78-450±73 m; home-based 350±106-454±67 m) with p value<0.05. The increase in the six-minute walk test was not statistically significantly different in the hospital-based group (62 m) compared to the home-based group (61 m) with p value>0.05. The conclusion of this study is Cardiac rehabilitation aerobic exercise in phase two for 6 weeks significantly increased the distance traveled on the six-minute walk test and the increase was not significantly different from hospital-based compared to home-based in patients with coronary heart disease after percutaneous coronary intervention."

"Latar BelakangPenggunaan cardiopulmonary bypass (CPB) dalam bedah jantung bidirectional cavopulmonary shunt (BCPS) pada anak dapat memicu low cardiac output syndrome (LCOS). Pasien dengan LCOS berhubungan dengan lama rawat intensive care unit (ICU) yang berkepanjangan, sehingga berisiko tinggi mengalami komplikasi penyerta. Meskipun faktor CPB dan LCOS berpotensi memengaruhi lama rawat ICU, belum ada penelitian serupa di Indonesia yang mengevaluasi hubungan ini pada pasien BCPS. MetodePenelitian ini menggunakan desain kohort retrospektif dengan sampel 109 pasien (63 laki-laki, 44 perempuan) yang menjalani operasi BCPS di Rumah Sakit Cipto Mangunkusumo dari Januari 2019 hingga Juni 2024. Analisis bivariat dan multivariat digunakan untuk mengevaluasi hubungan antara penggunaan CPB dan faktor lainnya terhadap kejadian LCOS serta lama rawat ICU.HasilPasien yang menjalani BCPS tanpa CPB memiliki penurunan risiko mengalami LCOS (aOR = 0,29, CI 95% 0,11 – 0,77, p < 0,05). Namun, CPB bukan faktor prediktor independen yang signifikan terhadap lama rawat ICU (p > 0,05). Lama rawat ICU lebih dipengaruhi oleh adanya LCOS (p < 0,001), terlepas dari penggunaan CPB. Faktor usia dan berat badan tidak berhubungan signifikan dengan kejadian LCOS maupun lama rawat ICU (semua p > 0,05).KesimpulanPenggunaan CPB dalam operasi BCPS berhubungan dengan peningkatan risiko LCOS, yang kemudian memperpanjang lama rawat ICU. Namun, lama rawat ICU pada pasien BCPS lebih ditentukan oleh adanya LCOS, bukan oleh penggunaan CPB itu sendiri.

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Introduction

The use of cardiopulmonary bypass (CPB) in bidirectional cavopulmonary shunt (BCPS) surgery in children can trigger low cardiac output syndrome (LCOS). Patients with LCOS are associated with prolonged intensive care unit (ICU) stays, placing them at higher risk of associated complications. Although CPB and LCOS factors have the potential to affect ICU stays, there has been no similar study in Indonesia evaluating this relationship in BCPS patients.

Method

This study utilized a retrospective cohort design with a sample of 109 patients (63 males, 44 females) who underwent BCPS surgery at Cipto Mangunkusumo Hospital from January 2019 to June 2024. Bivariate and multivariate analyses were used to evaluate the relationship between CPB use and other factors on the incidence of LCOS and ICU length of stay.

Results

Patients who underwent BCPS without CPB had a reduced risk of developing LCOS (aOR = 0.29, 95% CI 0.11–0.77, p < 0.05). However, CPB was not a significant independent predictor of ICU length of stay (p > 0.05). ICU length of stay was more affected by the presence of LCOS (p < 0.001), regardless of CPB use. Age and weight factors were not significantly associated with either LCOS incidence or ICU length of stay (all p > 0.05).

Conclusion

The use of CPB in BCPS surgery is associated with an increased risk of LCOS, which subsequently prolongs ICU stay. However, the length of ICU stay in BCPS patients is more determined by the presence of LCOS, rather than CPB use itself."

"Latar Belakang: Transfusi darah dan kelasi besi merupakan terapi utama thalasemia khususnya pada thalassemia beta mayor yang bergantung transfusi. Harapan hidup dan prognosis pada pasien pasien tersebut telah bertambah baik dalam beberapa dekade terakhir. Namun demikian gangguan pada jantung masih merupakan penyebab mortalitas utama pada pasien thalassemia beta mayor bergantung transfusi. Toksisitas besi pada jantung merupakan penyebab utama kelainan jantung pada pasien-pasien tersebut. Modalitas utama untuk deteksi toksisitas besi pada jantung adalah dengan MRIT2 yang kesediaannya terbatas.Tujuan: Penelitian ini bertujuan mendapatkan profil toksisitas besi pada jantung penderita thalassemia beta bergantung transfusi. Penelitian ini juga bertujuan melihat korelasi antara toksisitas besi dengan fungsi sistolik jantung, fungsi diastolik jantung dan kadar NTproBNP. Selain itu penelitian ini bertujuan untuk melihat korelasi muatan besi dengan toksisitas besi pada jantung, fungsi sistolik jantung, fungsi diastolik jantung dan kadar NTproBNP.Metode: Penelitian potong lintang pada penderita dewasa dengan thalassemia beta mayor yang bergantung transfusi di Poliklinik Thalasemia Dewasa RSCM Jakarta pada bulan Desember 2017. Data sekunder diperoleh dari rekam medik pasien berupa riwayat medis, hasil lab, hasil pemerikssan MRI T2 dan ekokardiografi. Dilakukan pemeriksaan fisik dan pengambilan darah untuk pemeriksaan NTproBNP. Analisis data berupa data deskriptif dan uji korelasi dengan uji Pearson dan Spearman.Hasil: Sebanyak 62 orang pasien dilibatkan dalam studi. Median untuk T2 jantung adalah 24,96 ms. Terdapat 27,4 pasien dengan hemosiderosis jantung yang ringan-sedang dan 11,3 dengan hemosiderosis jantung yang berat. Tidak terdapat korelasi antara toksisitas besi pada jantung dengan fraksi ejeksi, ratio E/A maupun kadar NTproBNP. Terdapat korelasi lemah antara ferritin serum dan toksisitas besi pada jantung r=-0,312, p=0,007. Terdapat korelasi lemah antara ferritin serum dan fraksi ejeksi r=-0,281, p=0,013.Simpulan: Toksisitas besi pada jantung ditemukan pada 38,7 penderita dewasa dengan thalassemia beta bergantung transfusi. Tidak terdapat korelasi antara toksisitas besi pada jantung dengan fungsi sistolik, fungsi diastolik mauapun kadar NTproBNP pada penderita dewasa dengan thalssemia beta bergantung transfusi. Terdapat korelasi lemah antara ferritin serum dengan toksisitas besi pada jantung dan fungsi sitolik jantung. Tidak terdapat korelasi antara muatan besi dengan NTproBNP.

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Background Regular blood transfusions and chelation are the mainstay of treatment in TDT patients. This has improved the survival and prognosis of the patients. Cardiac complications still remain to be the main cause of mortality. Cardiac iron toxicity is the main cause of complications leading to cardiac failure. MRI T2 is the gold standard for diagnosing cardiac iron toxicity, however this facility is limited in Indonesia.Objective.This study aimed to get a profile of the cardiac iron toxicity in adult TDT beta major patients to obtain a correlation of cardiac iron toxicity with cardiac function and NTproBNP levels and to evaluate if there is any correlation between iron overload with cardiac iron toxicity, cardiac function and NTproBNP levels.Methods Cross sectional study was done which included thalassemia beta major transfusion dependent patients from the adult thalassemia policlinic of RSCM hospital during desember 2017. Data was obtained from the medical records including history, laboratory results and results of MRIT2 and echocardiography. Physical examination was done and blood drawn for NTproBNP estimation. Data was analysed for descriptive data and correlation tests using pearsons or spearman rsquo s test.Results 62 patients were included in the study. Median cardiac T2 was 24.96 ms. 27.4 patients had mild moderate cardiac hemosiderosis and 11.3 had severe cardiac siderosis. There was no correlation between cardiac iron toxicity and ejection fraction, E A ratio and NTproBNP levels. There was a weak correlation between ferritin levels and cardiac toxicity r 0,312, p 0,007 as well as with ejection fraction r 0,281, p 0,013. There was no correlation between ferritin levels and E A or NTproBNP. There was no correlation between transferrin saturation levels with cardiac iron toxicity, ejection fraction, E A ratio as well as NTproBNPConclusion Cardiac iron toxicity was seen in 38,7 of TDT patients in this study. There was no correlation between cardiac toxicity and cardiac functions as well as NTproBNP levels. There was a weak correaltion between ferritin levels with cardiac toxicity and systolic function but no correlation with diastolic function. There was no correlation between transferrin saturation levels with cardiac toxicity, systolic function, diatolic function as well NtproBNP levels."

"Background:Cardiac rehabilitation in patients with Coronary Artery Bypass Surgery (CABG) is an effective way in reducing mortality in patients with coronary heart disease (CHD). The presence of impaired cardiac autonomic function is increase the risk of arrhythmias and sudden death. Exercise training as one component of cardiac rehabilitation can improve autonomic function that can be measured indirectly with Heart Rate Recovery (HRR). The aim of this study is to assess the effect of the frequency of physical exercise on improved of HRR.Metod:The data used for this analysis include 100 patients who underwent second phase of cardiac rehabilitation after CABG at Pusat Jantung Nasional Harapan Kita, Jakarta between July and October 2013. Patients were categorized into group I (exercise 3 times a week) : 40 people and group II (5 times a week exercise) : 60 people. Heart rate recovery was measured with a 6 minute walk test (6MWT). Measurements were performed 2 times, in the early phase and the evaluation phase after 12 times. Increased HRR from both groups were analyzed by linear regression analysis.Result :In our study, age, gender, diabetes mellitus, psychological, smoking, coronary artery bypass surgery and the duration of aortic cross clamp did not affect the increase of HRR. Five times a week exercise training gives significant increase of HRR compare to 3 times a week exercise training after analyzed multivariate linear regression ( RR 2.9, 95% KI 1.53 to 4.40, p <0.001 ).Conclusion:Frequency of physical exercise 5 times a week give a better response to the increase in HRR than exercise 3 times a week.

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Latar Belakang:Rehabilitasi jantung pada pasien Bedah Pintas Arteri Koroner (BPAK) merupakan tindakan efektif dalam menurunkan mortalitas pada pasien dengan Penyakit Jantung Koroner (PJK). Adanya gangguan fungsi otonom jantung dikatakan meningkatkan risiko aritmia dan kematian mendadak. Latihan fisik sebagai salah satu komponen rehabilitasi jantung dapat meningkatkan fungsi otonom yang dapat diukur secara tidak langsung dengan Heart Rate Recovery (HRR). Penelitian ini bertujuan untuk menilai pengaruh frekuensi latihan fisik terhadap peningkatan HRR.Metode:Sebanyak 100 pasien pasca BPAK yang melakukan rehabilitasi jantung fase II dipilih secara konsekutif sejak 1 Juli ? 15 Oktober 2013 di Pusat Jantung nasional Harapan Kita, Jakarta. Pasien dikelompokkan menjadi kelompok I (3 kali latihan seminggu) sebanyak 40 orang dan kelompok II (5 kali latihan seminggu) sebanyak 60 orang. Heart rate recovery satu menit diukur dengan uji jalan 6 menit/6 minute walk test (6MWT). Pengukuran dilakukan 2 kali, pada fase awal dan fase evaluasi setelah 12 kali. Peningkatan HRR dari kedua kelompok dianalisa dengan analisa regresi linier.Hasil:Pada studi kami, usia, gender, diabetes melitus, psikologis, merokok, bedah pintas arteri koroner dan lamanya aortic cross clamp setelah dianalisa tidak mempengaruhi peningkatan HRR secara bermakna. Frekuensi latihan 5 kali seminggu memberikan peningkatan HRR yang bermakna secara statistik dibandingkan 3 kali seminggu setelah dianalisa dengan regresi linier multivariate (RR 2,9; 95 % IK 1,53-4,40, p<0,001)Kesimpulan: Frekuensi latihan fisik 5 kali seminggu memberikan respon yang lebih baik terhadap peningkatan HRR dibandingkan latihan 5 kali seminggu."

"Tesis ini disusun untuk mengetahui pengaruh pemberian edukasi terhadap kepatuhan pasien penyakit jantung koroner dalam menjalani rehabilitasi jantung fase II di rumah. Penelitian ini menggunakan desain kuasi-eksperimental. Sebanyak 46 subjek penelitian pasien penyakit jantung koroner (pasca infark miokard atau pasien yang telah menjalani PCI maupun CABG) yang mampu berjalan mandiri dan dinyatakan mampu menjalani latihan di rumah, dibagi menjadi dua kelompok, yaitu kelompok perlakuan dan kelompok kontrol dengan masing-masing berjumlah 23 orang. Pada kelompok perlakuan diberikan edukasi mengenai rehabilitasi jantung fase II melalui penayangan video edukasi di rawat inap, pemberian pesan pengingat selama melakukan latihan di rumah, dan leaflet. Kelompok perlakuan melakukan latihan di rumah dengan frekuensi 3 kali/minggu selama 8 minggu. Kelompok kontrol hanya mendapatkan edukasi melalui leaflet saat di rawat inap, dan tetap disarankan untuk melakukan latihan di rumah dengan frekuensi yang sama dengan kelompok perlakuan. Pemantauan latihan dan kepatuhan dilakukan dengan logbook. Penelitian ini menunjukkan bahwa pemberian intervensi berupa edukasi memiliki pengaruh pada tingkat kepatuhan pasien penyakit jantung koroner dalam menjalani rehabilitasi jantung fase II di rumah, yang tergambar dari sesi latihan yang lebih tinggi pada kelompok intervensi (p=0.001). Angka kepatuhan (menjalani minimal 20 dari 24 sesi latihan) pada kelompok intervensi adalah sebesar 91%, sedangkan pada kelompok kontrol hanya 30%, dengan proporsi kepatuhan berbeda bermakna (p=0.001, RR 3,000 (1,597 – 5,636)).

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This thesis was aimed to know the impact of educational intervention to compliance of coronary artery disease patients in doing home-based cardiac rehabilitation phase II. The study design was quasi-experimental. A total of 46 coronary artery disease patients who were able to walk independently and suitable in doing home-based exercise were divided into 2 groups, each consisted of 23 subjects. Subjects in intervention group were given educational intervention through video, short-text reminder messaging while doing home exercise, and leaflet. They were stated to do home exercise for 3 times/week for 8 weeks.

Subjects in control group only get educational leaflet, and stated to do the same home exercise regimen. Monitoring of exercise and adherence was done through logbook. This study showed that educational intervention could improve compliance in home-based exercise. The intervention group showed higher number 24(5-24) of exercise sessions (p=0.001). The compliance rate (defined as attending minimum 20 out of 24 sessions) in intervention group was 91%, while in control group 30%, with statistically significant difference."

"Stress proof the heart presents a general picture of behavioral cardiology while focusing in depth on critical specifics. Leading experts in the field explore the psychological aspects of living with arrhythmia, intracardiac device, heart failure, and heart transplant, relating them to psychological characteristics such as pessimism and the feeling of overcommitment. Mainstream treatments, such as stress management and smoking cessation, and emerging interventions, such as computer-based therapies and personality-based techniques."