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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)"

"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."

"Despite improvements in the outcome of patients with acute myocardial infarction during the last three decades, room for improvement exists in the elderly patients and in patients who are not candidates for throm-bolysis. Statistical analysis of randomized trials of magnesium in myocardial infarction reveals a gradient of response. When higher risk patients were enrolled, a greater benefit of magnesium was observed; progressively smaller benefits of magnesium occur as control group mortality approached 7%, at which point no benefit was detected. Although the ISIS-4 study enrolled more than 58,000 patients, no reduction in mortality was seen, probably as a result of low control group mortality and relatively late administration of magnesium. Because the potential benefits of magnesium in myocardial infarction remains an open question, additional trials are needed before this inexpensive and early-administered therapy is prematurely cast aside."

"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."

"Latar Belakang. Stratifikasi risiko merupakan bagian integral dari managemen pasien sindrom koroner akut (SKA). Identifikasi pasien yang berisiko tinggi menjadi sangat penting untuk meningkatkan kewaspadaan sekaligus mengurangi tindakan berlebih terhadap pasien dengan risiko rendah. Meskipun TIMI pada STEMI dan UAPINSTEMI merupakan skor risiko yang baik dan telah divalidasi dan dipergunakan secara luas, tetapi penelitian mengenai perfonnanya belum pernah dilakukan di Indonesia. Adanya perbedaan karakteristik antara pasien SKA di Indonesia dengan populasi di negara maju dapat mempengaruhi prognosis pasien sehingga perlu dilakukan penelitian mengenai perfonna dari kedua sistem skoring tersebut. Tujuan. Menilai perfonna kalibrasi dan diskriminasi skor TIMI dalam memprediksi mortalitas 30 hari pasien STEMI dan 14 hari pasien UAPINSTEMI di Indonesia Metodologi. Studi kohort retrospektif menggunakan data rekam medis pasien SKA yang dirawat di IeeU RSeM 2003-2010 dengan metode pengambilan sampel konsekutif. Perfonna kalibrasi skor TIMI dinyatakan dengan plot kalibrasi dan uji Hosmer-Lemeshow sedangkan perfonna diskriminasi dinyatakan dengan nilai AUe. Hasil. Selama penelitian terkumpul 714 pasien STEMI dan 787 pasien UAPINSTEMI yang dirawat di IeeU RSeM. Skor TIMI STEMI mempunyai perfonna kalibrasi dan diskriminasi yang baik dengan plot kalibrasi 0,98, uji Hosmer-Lemeshow 0,93 dan nilai AUe 0,801 (Kl 95% 0,759-0,844). Perfonna kalibrasi dan diskriminasi skor TIMI UAPINSTEMI juga cukup baik dengan plot kalibrasi mencapai 0,88, uji Hosmer lemeshow 0,86 dan nilai AUe 0,727 (KI95% 0,668-0,786). Simpulan. Skor TIMI mempunyai perfonna kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas pasien SKA di Indonesia.

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Background. Risk Stratification in acute coronary syndrome patients is an integral part in the management of patients. Risk stratification is important to avoid overtreatment in high risk patients, as well as undertreatment in low risk patients. Although TIMI STEMI and TIMI UAiNSTEMI are scores that have been validated and used widely, but to date no study of its appicability has been done in Indonesia. Differences in characteristic of acute coronary syndrome patients in Indonesia compared to developed countries can have influence on the prognostic of the patient hence a study is needed regarding performance of TIM I scoring system. Objectives. To obtain the calibration dan discrimination performance of TIMl risk score to predict 30 day dan 14 day mortality in STEMI and UAPINSTEMI patients in Indonesia Methods. A retrospective cohort study with consecutive sampling was done in ACS patients hospitalized in the ICCU Cipto Mangun Kusumo Hospital between the period 2003 until 2010. Calibration performance of TIM I risk score was evaluated by calibration plot and Hosmer-Lemeshow test while discrimination performance was done with A Uc. Results. A total of 714 STEMI patients and 787 UAPINSTEMI patients entered the study. TIMI STEMI risk score have a good calibration and discrimination performance with calibration plot of 0, 98, Hosmer-Lemeshow test 0,93 and AUC 0,801 (CI95% 0,759-0,844). A good calibration and discrimination performance of TIMI UAPINSTEMI risk score was observed with calibration plot of 0,88, Hosmer-Lemeshow test 0,86 and AUC 0,73 (CI 95% 0,668-0,786). Conclusion. TIM! risk score has a good calibration and discrimination performance in predicting mortality of ACS patients in Indonesia."

"ABSTRAKAcute upper back pain as one of the atypical symptoms of acute myocardial infarction (AMI) is more frequently encountered in women, elderly, diabetics, and patients with prior stroke or heart failure.1 Failure to recognize atypical clinical presentation of AMI conveys to delayed diagnosis, which are associated with increased morbidity and mortality.2 Abstract : Acute upper back pain as one of the atypical symptoms of acute myocardial infarction (AMI) is more frequently encountered in women, elderly and diabetics. Failure to recognize atypical clinical presentation of AMI conveys to delayed diagnosis, which are associated with increased morbidity and mortality. Herein we report a case of 46 yearsold male presenting with a sudden onset of severe acute upper back pain 6 hours prior to hospital admission. Diagnosis of AMI was delayed until 12 hours later after typical ischemic chest pain manifested and ECG reading showed evolution of ST-Elevation Myocardial In- farction (STEMI). Due to the atypical clinical presentation, diagnosis of AMI in this patient was delayed. Vigilant observation and low threshold for acute coronary syndrome (ACS) work-up are obligatory to prevent delayed diagnosis and management. "

"Tuburlensi laju jantung heart rate tuberlence {HRT} baru-baru ini dianggap sebagai prediktor terbaru paling kuat untuk terjadinya kematian mendadak (sadden cardiac death (SCD) melebihi prediktor lain yang telah ada sebelumnya."