Acute heart failure itself is a life-threatening medical condition that needs urgent medical attention. The cases of acute heart failure are expected to rise in the future due to the increase in life expectancy and advancement of therapy of myocardial infarct that causes the improvement of life expectancy among patients with decreased cardiac function. This study was aimed to obtain the characteristics of acute heart failure patients at Prof. Dr. R. D. Kandou from January to December 2018. The results showed a total of 130 patients that had acute heart failure in 2018, however, only 89 patients fulfilled the inclusion criteria consisting of 52 males (58%) and 37 females (42%). The highest percentages among the patients’ character-istics were, as follows: age >60 years (55%), hypertension as the etiology (37%), hemodynamic profile was wet-warm (56.2%), ejection fraction <40% on echocardiography (41.6%), atrial tachycardia/flutter/fibrillation on ECG (39.1%), CTR >50% on X-ray images (98%), and diuretics usage inpatients and outpatients (89% and 82%). In conclusion, the majority of patients with acute heart failure in 2018 were male, age >60 years, had hypertension as the etiology, wet-warm hemodynamic profile, ejection fraction on echocardiogram <40%, atrial tachycardia/flutter/fibrillation on ECG, CTR >50% on X-ray images, and diuretics usage.Keywords: acute heart failure, characteristics of patients Abstrak: Gagal jantung akut merupakan suatu kondisi medis yang mengancam jiwa dan membutuhkan penanganan yang cepat dan tepat. Kejadian gagal jantung diperkirakan akan semakin meningkat di masa depan, karena semakin bertambahnya usia harapan hidup dan berkembangnya terapi penanganan infark miokard yang mengakibatkan perbaikan harapan hidup penderita dengan penurunan fungsi jantung. Penelitian ini bertujuan untuk mendapatkan karakteristik pasien gagal jantung akut di RSUP Prof. Dr. R. D. Kandou periode Januari-Desember 2018. Hasil penelitian mendapatkan total pasien gagal jantung akut sebanyak 130 orang dan yang memenuhi kriteria inklusi sebanyak 89 orang, terdiri dari 52 orang (58%) laki-laki dan 37 orang (42%) perempuan. Persentase tertinggi pada karakteristik pasien ialah usia >60 tahun (55%), etiologi hipertensi (37%), profil hemodinamik wet-warm (56,2%), fraksi ejeksi pada ekokardiogram <40% (41,6%), gambaran EKG atrial takikardia/flutter/fibrilasi (39,1%), CTR >50% pada foto polos dada (98%), dan penggunaan obat diuretik baik selama perawatan dan saat keluar rumah sakit (89% dan 82%). Simpulan penelitian ini ialah mayoritas pasien gagal jantung akut pada tahun 2018 berjenis kelamin laki-laki, usia >60 tahun, etiologi hipertensi, profil hemodinamik wet-warm, fraksi ejeksi pada ekokardiogram <40%, gambaran EKG atrial takikardia/ flutter/fibrilasi, CTR >50% pada foto polos dada, dan penggunaan obat diuretik.Kata kunci: gagal jantung akut, karakteristik pasien
Heart failure is a major clinical and public health problem with a prevalence of more than 23 million worldwide. Treatment of Heart Failure consists of pharmacological and non-pharmacological measures including physical exercise or cardiac rehabilitation. Cardiac rehabilitation is a set of integrated efforts or programs carried out to control the underlying causes of cardiovascular disease, improve physical, mental condition and as a secondary preventive measure. Cardiac rehabilitation aims to increase the patient's functional capacity, psychological adaptation to the chronic disease process, the foundation for long-term behavior and lifestyle changes to favorably influence long-term prognosis, and maintain an independent lifestyle as long as possible. The method that was used in this research is literature review by comparing the secondary data from literatures that was published in medical journal database such as PubMed, ClinicalKey and Google Scholar by following the inclusion and exclusion criteria. Reviews had been done in ten literatures that fulfill the inclusion and exclusion criteria. Those ten literature states that cardiac rehabilitation has many benefits in patients with heart failure. In conclusion, cardiac rehabilitation programs in patients with heart failure have many benefits on a patient's fitness. Cardiac rehabilitation programs can improve the quality of life in patients. The cardiac rehabilitation program increases Vo2Max and the endurance capacity of the heart. Cardiac rehabilitation program as a preventive step because it can prevent worsening heart health.Keywords: Heart failure, chronic heart failure, rehabilitation Abstrak: Gagal jantung adalah masalah klinis dan kesehatan masyarakat yang utama dengan prevalensi lebih dari 23 juta di seluruh dunia. Penananganan Gagal Jantung terdiri dari penanganganan farmakologis dan non farmakologis yang antara lain latihan fisik atau rehabilitasi jantung. Rehabilitasi jantung adalah sekumpulan upaya atau program yang terintegrasi yang dilakukan untuk mengontrol penyebab dasar penyakit kardiovaskular, memperbaiki kondisi fisik, mental dan sebagai langkah preventif sekunder. Rehabilitasi jantung bertujuan untuk meningkatan kapasitas fungsional pasien, adaptasi psikologis terhadap proses penyakit kronis, landasan bagi perubahan perilaku dan gaya hidup jangka panjang untuk mempengaruhi prognosis jangka panjang secara menguntungkan, dan mempertahankan gaya hidup mandiri selama mungkin. Metode penelitian yang digunakan adalah literature review (studi pustaka) dengan membandingkan data sekunder dari literatur-literatur yang dipublikasi dalam database jurnal kedokteran PubMed,ClinicalKey dan Google Scholar sesuai dengan kriteria inklusi dan eksklusi yang ada. Studi pustaka dilakukan pada sepuluh literatur yang memenuhi kriteria inklusi dan eksklusi. Sepuluh literatur tersebut menyatakan bahwa rehablitasi jantung memiliki banyak manfaat pada kebugaran pasien dengan gagal jantung. Sebagai simpulan, program rehabilitasi jantung pada pasien dengan gagal jantung memiliki banyak maanfaat pada kebugaran pasien. Program rehabilitasi jantung dapat meningkatkan kualitas hidup pada pasien. Program rehabiltasi jantung meningkatkan Vo2Max dan kapasitas daya tahan jantung. Program rehabilitasi jantung sebagai langkah preventif karena dapat mencegah perburukan kesehatan jantung.Kata Kunci: Heart failure, chronic heart failure, rehabiltasi jantung
To date, AMI is still an important global health problem because of relatively high morbidity and mortality rates. Diagnosis of AMI can be established if there are at least two of the three criteria to be met, namely chest pain (anamnesis), persistent changes in electrocardiographic (ECG), as well as cardiac biomarker creatine myocardial band (CK-MB), cardiac troponin T (cTnT), or cardiac troponin I (cTnI). Treatment for AMI patients consists of reperfusion therapy and pharmacological therapy. This study aimed to determine the role of troponin examination in the diagnosis and management of AMI. This was a literature review study with a total of 13 literature reviews. The results showed that diagnosis of AMI could be established by conducting a cardiac biomarker examination, the troponin. Troponin was almost specific and highly sensitive to detect the presence of AMI. Moreover, minor damage of myocardium could be demonstrated by checking troponin level. In addition, changes in troponin levels could also be used as predictors of side effects that could occur after treatment or even an increase in late mortality. However, increased troponin level sould also occur in other conditions, such as chronic kidney disease, pulmonary embolism, and sepsis. Therefore, the execution of its interpretation should fit the context of the clinical situation in the patient. In conclusion, troponin plays an important role in the diagnosis and management of AMI.Keywords: troponin; diagnosis and management; acute myocardial infarction Abstrak: Hingga saat ini IMA masih menjadi suatu masalah kesehatan penting dunia dikarenakan angka morbiditas dan mortalitas yang relatif tinggi. Diagnosis IMA dapat ditegakkan jika terdapat minimal dua dari tiga kriteria yang harus dipenuhi, yaitu nyeri dada (anamnesis), gambaran elektrokardiografi (EKG) yang berubah secara persisten, serta pelepasan biomarker jantung yaitu Creatine Kinase Myocardial Band (CK-MB), Cardiac Specific Troponin T (cTnT), atau Cardiac Specific Troponin I (cTnI). Penanganan IMA berupa terapi reperfusi dan terapi farmakologik. Penelitian ini bertujuan untuk mengetahui peran pemeriksaan troponin pada diagnosis dan penanganan IMA. Jenis penelitian ialah suatu literature review, dengan jumlah literatur yang diteliti sebanyak 13 literatur. Hasil penelitian mendapatkan bahwa diagnosis IMA dapat ditegakkan salah satunya dengan melakukan pemeriksaan biomarker jantung, dalam hal ini kadar troponin. Troponin sendiri berperan penting dalam diagnosis IMA dikarenakan hampir spesifik dan sangat sensitif dalam mendeteksi adanya IMA. Kerusakan kecil pada miokard dapat ditunjukkan melalui pemeriksaan kadar troponin. Perubahan kadar troponin juga dapat digunakan sebagai prediktor efek samping yang dapat terjadi setelah penanganan atau bahkan peningkatan mortalitas lanjut. Peningkatan kadar troponin tidak hanya terjadi pada IMA, tetapi juga dapat terjadi pada kondisi lain sehingga dalam pelaksanaan interpretasi nilainya harus sesuai dengan konteks situasi klinis yang terjadi pada pasien. Simpulan penelitian ini ialah pemeriksaan troponin berperan penting dalam diagnosis dan penatalaksanaan IMA.Kata kunci: troponin; diagnosis dan penanganan; infark miokard akut
Background: The ischemic process in stable Coronary Artery Disease (CAD) causes cardiac remodeling and dysfunction, signaling the progress towards irreversible heart failure. Early identification for the presence of Left ventricular (LV) remodeling and dysfunction is important. Several methods can be used to assess LV dysfunction using echocardiography, including peak Global Longitudinal Strain (GLS) and ejection fraction measurements. Short-term Heart Rate Variability (HRV) and QT interval are considered practical parameters in electrocardiography identifying LV dysfunction. This study aimed to determine the relationship between short-term HRV and QT interval with LV systolic function in stable angina pectoris patients.Methods: This cross-sectional study was conducted in Prof. Dr. R. D. Kandou Hospital, Manado, from March to September 2021. All study subjects who met the inclusion criteria underwent a clinical history and further examinations, including electrocardiography, laboratory, and echocardiography examinations. The relationship of HRV variables and QT interval with LV systolic function were analyzed using Pearson correlation and linear regression models by SPSS version 21 for Windows.Results: A total of 33 subjects were included with a mean age of 62.3±8.9 years. Non-parametric correlation analysis between HRV variables and left ventricular systolic function showed no significant correlation. There was a significant correlation between QTc interval by Fridericia and LV peak GLS, but not with ejection fraction (r=0.426; p=0.013). The univariate regression analysis showed a relationship between QTc interval by Bazett and Fridericia with peak GLS (Bazett B=0.036; ?=0.35; R2=0.122; p=0.046; Fridericia B=0.052; ?=0.426; R2=0.181; p=0.013).Conclusion: There was a weak and moderate positive correlation between the QTc interval by Bazett and Fridericia formula with left ventricular systolic function. There was no statistically significant correlation between the short-term HRV variable and left ventricular systolic function.
Inflammation has a vital role in the pathogenesis of heart failure (HF) and coronary artery disease (CAD). Neutrophil-to-lymphocyte ratio (NLR) is an inflammation marker proposed to have a correlation with ejection fraction (EF). This is a simple examination and can be obtained routinely in clinical practice. This study aimed to evaluate the correlation of NLR with EF in hospitalized patients with CAD. This was an observational and analytical study with a cross-sectional design. Samples were eligible CAD patients from May until August 2019 at Prof Dr. R. D. Kandou Hospital in North Sulawesi. All patients underwent echocardiography for EF calculation, and blood examination for NLR measurement and risk factor screening. The patients were treated according to the guideline. Data were analyzed using the Spearman test in SPSS v26. The results showed that the majority of patients were male (70.2%) with mean age of 60 years old. Hypertension was found in 76.6% and smoking history in 51.1% patients. NLR was shown to have a significance correlation with EF in patients with CAD (p=0.014). In conclusion, NLR has a significant correlation with EF. Moreover, it could be a useful tool for the clinicians to predict heart failure in a specific population. Keywords: neutrophil-to-lymphocyte ratio; ejection fraction; heart failure; coronary artery disease. Abstrak: Peradangan memiliki peran penting dalam patogenesis gagal jantung (HF) dan juga penyakit arteri koroner (CAD). Rasio neutrofil-limfosit (NLR) merupakan penanda inflamasi yang diduga berkorelasi dengan fraksi ejeksi (EF), serta merupakan pemeriksaan sederhana yang dapat diperoleh secara rutin dalam praktik klinis. Penelitian ini bertujuan untuk mengetahui korelasi NLR dengan EF pada pasien rawat inap dengan CAD. Jenis penelitian ialah observasional analitik dengan desain potong lintang. Sampel penelitian ialah pasien CAD yang memenuhi syarat dirawat dari bulan Mei hingga Agustus 2019 di Rumah Sakit Prof Dr. R. D. Kandou, Sulawesi Utara. Pasien diperiksakan dengan ekokardiografi untuk perhitungan EF, dan dilakukan pemeriksaan darah untuk penilaian NLR dan skrining faktor risiko. Semua pasien dirawat sesuai dengan pedoman. Data dianalisis menggunakan uji Spearman dengan SPSS v26. Hasil penelitian mendapatkan mayoritas sampel ialah laki-laki (70,2%) dengan usia rerata 60 tahun. Hipertensi ditemukan pada 76,6% dan riwayat merokok pada 51,1% pasien. NLR terbukti memiliki korelasi bermakna dengan EF pada pasien CAD (p=0,014). Simpulan penelitian ini ialah NLR terbukti memiliki korelasi bermakna dengan EF pada pasien CAD. Selain itu NLR dapat menjadi alat bantu yang berguna bagi klinisi untuk memrediksi gagal jantung pada populasi tertentu.Kata kunci: neutrophil-to-lymphocyte ratio; fraksi ejeksi; gagal jantung; penyakit arteri koroner
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