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"Junior doctors working in the coronary care unit for the first time are faced with a daunting challenge. Management of the patients is complex and has changed dramatically throughout the 1980s and 90s, not least because of the advent of throbolytic therapy. This manual covers the majority of problems encountered in the coronary care unit. It offers advice on diagnosis, acute management and follow-up treatment of patients with myocardial infarction and its complications. The text is complemented by illustrations of ECG traces and algorithms designed to help junior doctors cope with emergency situations. Brief guidelines on performing common practical problems are included. This manual aims to provide a reassuring reference amidst intensity and complexity of modern acute cardiac care. It should also be a useful reference for more experienced medical and nursing staff working with cardiac patients."

"Junior doctors working in the coronary care unit for the first time are faced with a daunting challenge. Management of the patients is complex and has changed dramatically throughout the 1980s and 90s, not least because of the advent of throbolytic therapy. This manual covers the majority of problems encountered in the coronary care unit. It offers advice on diagnosis, acute management and follow-up treatment of patients with myocardial infarction and its complications. The text is complemented by illustrations of ECG traces and algorithms designed to help junior doctors cope with emergency situations. Brief guidelines on performing common practical problems are included. This manual aims to provide a reassuring reference amidst intensity and complexity of modern acute cardiac care. It should also be a useful reference for more experienced medical and nursing staff working with cardiac patients."

"Latar Belakang: Major Adverse Cardiac Events (MACE) merupakan penyebab utama meningkatnya morbiditas dan mortalitas pada pasien sindrom koroner akut (SKA). Skor prediksi MACE merupakan model yang dapat memprediksi prognosis untuk terjadinya MACE berdasarkan faktor risiko yang dimiliki oleh pasien SKA. Tujuan: Untuk membuat skor prediksi sederhana, mudah dikalkulasi dan aplikatif, yang mampu mengidentifikasi pasien SKA dengan risiko terjadinya MACE. Metode: Dilakukan penelitian kohort retrospektif pada 1002 subyek pasien SKA yang dirawat di intensive coronary care unit RSCM dalam periode waktu Januari 2010 - Desember 2013. Dilakukan evaluasi terhadap faktor risiko jenis kelamin, usia, riwayat keluarga penyakit jantung koroner, diabetes, hemoglobin, leukosit, kreatinin, asam urat, enzim jantung, tekanan darah sistolik, denyut jantung, henti jantung, deviasi segmen ST dan kelas killip. Hasil: Major Adverse Cardiac Events didapatkan pada 112 subyek (9,21%), faktor prediktor jenis kelamin wanita, leukosit, kreatinin, asam urat, enzim jantung, tekanan darah sistolik, denyut jantung, henti jantung dan kelas killip pada analisis multivariat mempergunakan regresi logistik didapatkan berhubungan bermakna dengan MACE dengan RR (95% IK) masing-masing 2.66 (1.35-5.25), 2.06 (1.02-4.16), 2.84 (1.43-5.66), 3.79 (1.90-7.54), 3.26 (1.51-7.05), 3.48 (1.57-7.70), 2.46 (1.20-5.01), 42.04 (18.90-93.51), dan 6.31 (3.19-12.50) serta didapatkan akurasi prediksi yang baik dengan nilai area under curve 0,95, 95% IK, 0,93-0,97. Kesimpulan: Pada pasien SKA didapatkan probabilitas MACE sebesar 3,6% bagi yang memiliki skor total 0-6 dan 83,5% bagi yang memiliki skor > 6 berdasarkan faktor-faktor prediktor jenis kelamin wanita (skor 1), leukositosis (skor 1), peningkatan kreatinin (skor 1), hiperurisemia (skor 2), peningkatan enzim jantung (skor 1), hipotensi (skor 2), takikardi (skor 1), henti jantung (skor 5) dan kelas killip III-IV (skor 3).

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Background: Major Adverse Cardiac Events (MACE) have been known as the cause of increasing morbidity and mortality among acute coronary syndrome (ACS) patients. Prediction score have been used as prognostic to prediction MACE based on risk factor in ACS patients.

Aim: To develop a simple risk score, easily calculated and applicability that can identifies ACS patients with risk for MACE.

Methods: A cohort retrospective study involving 1002 ACS patients in intensive coronary care unit RSCM from January 2010 through December 2013. Sex, age, family history, diabetes, hemoglobin, leucocyte, creatinine, uric acid, cardiac enzyme, systolic blood pressure, heart rate, cardiac arrest, deviation ST segment and killip class as risk factor for MACE was assessed.

Results: Major Adverse Cardiac Events was found in 112 (9,21%) of ACS patients, predictor factor woman, leucocyte, creatinine, uric acid, cardiac enzyme, systolic blood pressure, heart rate, cardiac arrest and killip class in multivariate logistic regression analysis were associated with MACE in ACS patients with (RR 95% CI) 2.66 (1.35-5.25), 2.06 (1.02-4.16), 2.84 (1.43-5.66), 3.79 (1.90-7.54), 3.26 (1.51-7.05), 3.48 (1.57-7.70), 2.46 (1.20-5.01), 42.04 (18.90-93.51), and 6.31 (3.19-12.50) respectively, and the best predictive accuracy for MACE was obtained by area under curve 0,95, 95% CI, 0,93-0,97.

Conclusions: In ACS patients we found probability MACE was 3,6% in patients with total score 0-6 and 83,5% for who have total score > 6 based on predictor factor woman (score 1), leukocytosis (score 1), elevated creatinine level (score 1), hyperuricemia (score 2), elevated cardiac enzyme (score 1), hypotension (score 2), tachycardia (score 1), cardiac arrest (score 5) and killip class III-IV (score 3)."

"Latar belakang. Penyakit Ginjal Kronik (PGK) stadium 3 merupakan faktor risiko tinggi terjadi Nefropati Akibat Kontras (NAK) setelah Percutaneous Coronary Intervention (PCI). Hidrasi merupakan salah satu modalitas mencegah NAK, demikian juga N-Acetyl Cysteine (NAC) walaupun efek proteksinya terhadap NAK masih kontroversial.Tujuan. Mengetahui apakah kombinasi hidrasi dan NAC dapat menurunkan risiko NAK pada pasien PGK stadium 3 setelah PCI pada pasien Pelayanan Jantung Terpadu (PJT) RSCM.Methoda penelitian. Studi kohort prospektif mengukur kreatinin plasma sebelum dan 48 jam sesudah PCI, sambil mencatat ada atau tidaknya perlakuan pemberian kombinasi hidrasi dan NAC pada pasien PGK stadium 3 tersebut.Hasil. Terdapat 38 pasien yang memenuhi kriteria penerimaan dan tidak mencakup kriteria penolakan serta menuntaskan penelitian dalam kurun waktu Agustus 2013 ? Januari 2014. Dua puluh tiga (43,4%) dari total 53 pasien PGK stadium 3 yang awalnya masuk studi ini diberikan perlakuan hidrasi dan NAC dan sisanya tidak mendapat perlakuan tersebut. Insidens kejadian NAK terdapat pada 2 dari 38 pasien yang menuntaskan studi (5.26%) yaitu pada kelompok yang tidak mendapat hidrasi dan NAC. Attributable Risk% sebesar 100%, kejadian NAK dapat dihilangkan 100% apabila diberikan hidrasi dan NAC.Simpulan. Kombinasi hidrasi dan NAC cenderung memproteksi kejadian NAKpada populasi PGK stadium 3 yang menjalani PCI

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Background. Stage 3 Chronic Kidney Disease (CKD) is known as a high risk factor for Contrast Induced Nephropathy (CIN) after Percutaneous Coronary Intervention (PCI). Hydration is a modality which is widely used to prevent CIN, and so is N-Acetyl Cysteine (NAC) eventhough there are controversial issues regarding their effectiveness to prevent CIN.

Aim. To know whether hydration and NAC combined has an effect of lowering CIN incidence in stage 3 CKD patients after PCI in Integrated Cardiac Services (ICS) in Cipto Mangunkusumo Hospital.

Methods. A prospective cohort is conducted examining plasma creatinine before and 48 hours after PCI in stage 3 CKD patients, meanwhile recording which patients are given combined hydration and NAC and which are not.

Results. Total 38 patients were collected whom fulfill the inclusion criteria and not meet the exclusion criteria and finished the study, from August 2013 until January 2014. Twenty-three (43,4%) of total 53 patients with stage 3 CKD whom enter the study at first were given hydration and NAC, and the did not received the combination. Incidence of CIN occurred in 2 of 38 patients whom finished this study (5.26%), all belonging to the non-hydration and NAC group. Attributable Risk% is 100%, means CIN can be 100% prevented if hydration and NAC is given.

Conclusion. Combination of Hydration and NAC is indicated to be protective against the risk of CIN in stage 3 CKD patients undergoing PCI."

"Buku yang berjudul "Handbook of coronary care" ini ditulis oleh Joseph S. Alpert dan Gary S. Francis. Buku ini merupakan sebuah buku panduan mengenai penanganan penyakit jantung."

"Latar Belakang : Indonesia memiliki angka kematian karena penyakit kardiovaskular yang semakin meningkat, dengan angka kematian diperkirakan sebanyak 17,3 juta kematian. Mengingat tingkat mortalitas yang sangat tinggi pada pasien dengan sindrom koroner akut SKA, maka diperlukan sebuah prediktor Major Adverse Cardiac Event MACE yang objektif dan terukur untuk manajemen pasien SKA dalam jangka panjang. Pada SKA dapat ditemukan heterogenitas repolarisasi ventrikel yang dapat dilihat pada elektrokardiografi EKG sebagai QTmax-QTmin, atau dapat disebut sebagai QTD.QTD disinyalir dapat dijadikan penanda untuk risiko MACE pada pasien SKA. Tujuan : Mengetahui peran dispersi QT dan QTcD sebagai prediktor MACE pada pasien sindrom koroner akut SKA. Metode : Penelitian ini merupakan studi kohort retrospektif pada 230 rekam medis pasien SKA yang dirawat di ICCU RSCM dalam rentang waktu Januari 2016 hingga November 2017. EKG standar 12 sadapan saat serangan dianalisis dan dilakukan pengukuran interval QTmax dan QTmin yang kemudian dihitung QTd. Selanjutnya dikoreksi dengan frekuensi nadi menggunakan rumus Bazett QTcD. Hasil : Pemanjangan QTD lebih dari 100mdet dapat menjadi prediktor MACE pada pasien dengan SKA OR 1,25 IK95 0,17 ndash; 2,71 . Setelah dikoreksi dengan frekuensi nadi menggunakan rumus Bazett, pemanjangan QTcD juga dapat menjadi prediktor MACE pada pasien SKA 1,89 IK95 0,05 ndash; 67,37. Kesimpulan : Pemanjangan QTD lebih dari 100mdet atau QTcD lebih dari 12,72mdet dapat menjadi prediktor MACE.

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Background: In Indonesia, the number of death due to cardiovascular disease is rapidly rising and it was approximated to have resulted in 17,3 million deaths. Due to this steadily increasing cases, it is necessary to find a predictor for Major Adverse Cardiac Event MACE that is objective and standardized for long term care of patients with acute coronary syndrome ACS. In ACS, one of the underlying mechanisms is the presence of heterogeneity in ventricle repolarization that is seen on ECG machine as QTmax ndash QTmin, or what is identified as QTD. QTD is hypothesized to have role as marker in patients with MACE in ACS.

Aim: Identify the role of QTD and QTcD as MACE predictor in patients with acute coronary syndrome.

Methods: This study is a retrospective cohort with the subject of 230 ACS patients that was hospitalised on RSCM ICCU among January 2016 to November 2017. Data was taken from medical record and 12 lead ECG during attack were taken and analysed manually to calculate QTmax and QTmin and substraction of both into QTD. Followed by correction using the heart rate with Bazett formula QTcD.

Result: QTD prolongation of more than 100ms in patients with ACS may lead to MACE OR 1,25 IK95 0,17 ndash 2,71 . Following correction with Bazett formula, QTcD prolongation is also predictor 1,89 IK95 0,05 ndash 67,37.

Conclusion: QTD prolongation of more than 100ms or QTcD of more than 12.72ms might lead to MACE "

"Percutaneous and coronary interventions, used to treat narrow arteries of the heart caused by/found in those with coronary heart disease. This book is a detailed guide for performing percutaneous procedures and it covers in-depth the procedures that cardiologists and interested specialists must be aware of in order to use the devices proficiently."

"Latar belakang: Major adverse cardiac events MACE merupakan masalah yang besar yang meningkatkan morbiditas dan mortalitas pada penderita sindrom koroner akut. Belum banyak data MACE pada penderita sindrom koroner akut SKA pasca intervensi koroner perkutan IKP . Tujuan penelitian: mengetahui faktor faktor yang menjadi prediktor MACE 7 hari penderita SKA yang dilakukan IKP. Metode: Untuk mengetahui faktor-faktor yang menjadi prediktor terjadinya major adverse cardiac events pada penderita sindrom koroner akut yang dilakukan intervensi koroner perkutan dilakukan dengan metode kasus kontrol tanpa penyetaraan. Penelitian melibatkan 461 pasien SKA yang dirawat di unit perawatan intensif jantung RSCM dari tanggal 1 Januari 2015 sampai 30 November 2017. Umur, jenis kelamin wanita, diabetes melitus, hipertensi, gagal jantung, gangguan fungsi ginjal, renjatan kardiogenik, fraksi ejeksi le; 40 , stenosis di left main, aritmia, stenosis 3 arteri koronaria, stenosis di left anterior descending artery LAD dan stenosis di left main LM dilakukan penelitian prediktor terjadinya MACE. Hasil: Renjatan kardiogenik OR=10,65 p=0,001 , stenosis LAD OR=15,23 p=0,02 , fraksi ejeksi le; 40 OR=10,8 p=0,00 , faktor stenosis 3 arteri koroner atau lebih OR= 3,47 p=0,01 , gagal jantung OR=3,1 p=0,02 dan gangguan fungsi ginjal OR=4,76 p=0,00 terbukti sebagai prediktor terjadinya MACE 7 hari pada penderita SKA yang dilakukan IKP. Faktor jenis kelamin wanita, renjatan kardiogenik, stenosis LAD dan fraksi ejeksi le; 40 secara independen berhubungan dengam kejadian MACE pada pasien SKA yang dilakukan IKP, secara berturut-turut OR 95 CI 6.33 1.32-30.50 , 17.56 1.85-167.06 , 26.61 1,38-513,81 , dan 7.6 1.86-31.09. Kesimpulan: Renjatan kardiogenik, stenosis LAD, fraksi ejeksi le; 40 , faktor stenosis 3 arteri koroner atau lebih, gagal jantung dan gangguan fungsi ginjal merupakan prediktor terjadinya MACE 7 hari penderita SKA pasca IKP. Renjatan kardiogenik, stenosis LAD, wanita dan fraksi ejeksi le; 40 merupakan prediktor independen terjadinya MACE 7 hari penderita SKA pasca IKP.

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Introduction: Major Adverse Cardiac Events MACE are a big problem increasing morbidity and mortality to acute coronary syndrome patients. There is not much MACE data of acute coronary syndrome ACS patients who underwent percutaneous coronary intervention PCI . Therefore, the researcher investigated predictors factors of major adverse cardiac events.

Objective: To investigate the predictors factors of seven day MACE on ACS patients underwent PCI.

Method: To investigate the predictors factors of seven day MACE on ACS patients underwent PCI, unmatched case control was conducted. The research involved 461 ACS patients who were hospitalized in intensive coronary care unit ICCU RSCM from 1 January 2015 to 30 November 2017. Age, female gender, diabetes mellitus, hypertension, heart failure, renal dysfunction, cardiogenic shock, ejection fraction le 40, left main LM disease, arrhythmia, 3 vessel diseases, and left anterior descending artery LAD stenosis were investigate as the predictors of MACE.

Results: Cardiogenic shock OR 10.65 p 0.001, LAD stenosis OR 15.23 p 0.02 , ejection fraction le 40 OR 10.8 p 0.00 , 3 vessel diseases OR 3.47 p 0.01 , heart failure OR 3.1 p 0.02 and renal dysfunction OR 4.76 p 0.00 had been as the predictors of seven day MACE on ACS patients underwent PCI. Factors of female gender, cardiogenic shock, LAD stenosis and ejection fraction le 40 were independently predictors of seven day MACE on ACS patients underwent PCI OR 95 CI 6.33 1.32 30.50, 17.56 1.85 167.06, 26.61 1.38 513.81, and 7.6 1.86 31.09 respectively.

Conclusions: Cardiogenic shock, LAD stenosis, ejection fraction le 40, 3 vessel diseases or more, heart failure and renal dysfunction were the predictors of seven day MACE on ACS patients underwent PCI. Cardiogenic shock, LAD stenosis, female gender and ejection fraction le 40 were independent predictors of seven day MACE on ACS patients underwent PCI. The other factors were not significant."

"Coronary Artery Disease CAD merupakan kondisi ketidakseimbangan suplai dan kebutuhan oksigen miokardial yang disebabkan oleh berbagai faktor sehingga terapi yang diberikan berupa kombinasi obat. Penggunaan kombinasi obat meningkatkan terjadinya interaksi obat. Penelitian ini bertujuan untuk menganalisis potensi interaksi obat kombinasi golongan nitrat dan calcium channel blocker CCB dengan obat lain pada pasien CAD rawat jalan di RSUD Pasar Minggu tahun 2017. Desain penelitian ini adalah cross-sectional dengan pengambilan data retrospektif. Sampel yang memenuhi kriteria inklusi sebanyak 167 resep. Kejadian interaksi obat diperiksa menggunakan Micromedex. Hasil menunjukkan bahwa terdapat 142 resep yang memiliki potensi interaksi. Potensi interaksi terbanyak terjadi dengan tingkat keparahan mayor 62,2, diikuti keparahan moderat 33,8. Obat yang paling banyak menimbulkan interaksi adalah kombinasi amlodipin dengan simvastatin. Kesimpulan dari penelitian ini adalah penggunaan kombinasi nitrat dan CCB dengan obat lain pada pasien CAD berpotensi menyebabkan interaksi, sehingga perlu disarankan melakukan pemeriksaan laboratorium secara berkala atau penyesuaian rejimen dosis untuk meminimalisasi terjadinya interaksi.

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Coronary Artery Disease CAD is imbalances of supply and demand of myocardial oxygens which is caused by multiple factors, thus requires drug combinations as therapy. The use of such drug combinations may increase the incidence of drug interactions. This study aim is analyze the potentials of drug combinations between nitrate and CCB category with other drugs on outpatients with CAD at Pasar Minggu General Hospital in 2017. Design of this study is cross sectional with retrospective data collection. Samples which corresponds to inclusion criteria are 167 prescriptions. The occurrence of drug interactions are checked using Micromedex . Result showed that there were 142 prescriptions with potentials of interactions. The largest potential in drug interactions occur in major severity 62,23 followed by moderate severity 33,77. The drug that causes drug interactions the most is combination of amlodipin and simvastatin. This study concluded that the use of nitrate and CCB drug combinations with other drugs has the potential to cause interactions, therefore periodic laboratory checkups needs or adjustment of dosage regimen to be recommended to minimize the incidence of drug interactions. "