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Penggunaan Β-Blockers Pada Pasien Gagal Jantung Fraksi Ejeksi Menurun Purwowiyoto, Sidhi Laksono; Dwi Delima, Febriany Syafitri; Batuul, Marindam; Saputra, Anugrah
Sanus Medical Journal Vol. 7 No. 1 (2025)
Publisher : Universitas Muhammadiyah Prof. Dr. Hamka (UHAMKA Press)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22236/sanus.v7i1.15792

Pendahuluan: Pengertian dari gagal jantung adalah sebuah sindroma klinis dimana jantung mengalami kegagalan dalam menjalankan tugasnya baik. Fungsi dari Beta- blocker adalah menghambat adrenoreseptor beta di jantung, pembuluh darah perifer, bronkus, pankreas, dan hati. Artikel ini menjelaskan mengenai kegunaan Beta- blocker pada pasien gagal jantung dengan fraksi ejeksi yang menurun beserta pengaruhnya terhadap komorbid kardiovaskular dan non kardiovaskular.Pembahasan: Beta-blocker merupakan terapi yang direkomendasikan diberikan pada pasien heart failure dengan ejection fraction yang menurun. Obat golongan beta-blocker membantu mencegah gejala heart failure, meningkatkan remodeling ventrikel kiri, menurunkan resiko rawat inap dan kematian dini. Beta-blocker tidak digunakan pada gangguan nafas fase akut karena dapat memperburuk gagal jantung, bradikardia atau blok jantung dan hipotensi. Pemberian beta-blocker juga direkomendasikan pada pasien aritmia karena berperan dalam kontrol laju ventrikel serta memperlihatkan mortalitas yang lebih rendah dan prognosis yang lebih baik pada pasien atrial fibrilasi yang mendapatkan terapi beta-blocker.Kesimpulan: Beta-blocker direkomendasikan sebagai terapi pada pasien gagal jantung dengan fraksi ejeksi menurun. Tetapi, perlu diperhatikan adanya komorbid kardiovaskular maupun non-kardiovaskular yang dapat mempengaruhi pemberian terapi beta-blockers. Pemberian terapi beta-blocker diharapkan dapat mengurangi mortalitas atau morbiditas pada pasien gagal jantung dengan fraksi ejeksi yang berkurang (HFrEF).

Late diagnosis of Ebstein anomaly after pregnancy: A rare case report Lesmana, Jesse; Ramadhan, Muhammad; Barri, Muhammad; Purwowiyoto, Sidhi Laksono; Nurusshofa, Zahra
Qanun Medika - Jurnal Kedokteran FK UMSurabaya Vol 8 No 01 (2024): Qanun Medika Vol 08 No 01 January 2024
Publisher : Universitas Muhammadiyah Surabaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30651/jqm.v8i01.15327

Congenital heart disease is a concerning disease among those affected since it affects the patient's quality of life. One of which is Ebstein Anomaly (EA), with a prevalence of 1 in 200,0000 births with a clinical characteristic of displacement of the tricuspid valve that causes atrialization of the right-side heart. Women of childbearing age are at risk because they especially have asymptomatic EA, compromised to hemodynamic consequences, and risk of maternal complications. A 25-year-old woman visited the emergency department with worsening shortness of breath since last week, during rest, accompanied by decreased physical activity tolerance, bilateral ankle edema, cyanosis to the lips, and nail bed. She had echocardiography and cardiac multi-slice computed tomography to identify EA before and after her first child's birth. She was well controlled with a loop diuretic, phosphodiesterase type 5 inhibitor, and beta-blocker but could not care for her child due to her condition. The patient was discharged after symptoms subsided, awaiting further interventional evaluation. Although EA is rare, it has high morbidity and mortality, especially in women of childbearing age since it may be asymptomatic during childhood. Therefore, early recognition of EA is probably necessary for women who are planning pregnancy.

Skrining Kardiovaskular pada Pasien dengan Sindroma Marfan: Suatu Laporan Kasus dan Tinjauan Singkat Purwowiyoto, Sidhi Laksono; Asanti, Rismarini
Health and Medical Journal Vol 6, No 2 (2024): HEME May 2024
Publisher : Universitas Baiturrahmah

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33854/heme.v6i2.1485

Sindroma Marfan (SM) merupakan penyakit jaringan ikat herediter yang diturunkan secara autosomal dominant yang melibatkan multiorgan, salah satunya adalah sistem kardiovaskular. Tidak ada terapi kuratif, namun diagnosis dini, skrining dan pemantauan berkala, serta perubahan gaya hidup dapat memperbaiki prognosis pada penderita SM. Penegakan diagnosis SM dapat dikonfirmasi dengan revised Ghent criteria. Sebagai penyebab morbiditas dan mortalitas yang utama pada pasien dengan SM, perlu dilakukan penapisan dan follow-up rutin untuk mendeteksi terjadinya komplikasi pada sistem kardiovaskular utamanya pada aorta dan katup mitral. Dipaparkan kasus laki- laki, usia 25 tahun, rujukan dari sejawat ortopedi dengan kecurigaan SM. Keluhan utama pasien hanya nyeri pada tulang ekor. Riwayat keluhan nyeri dada, sesak, dan berdebar disangkal oleh pasien. Hasil EKG menunjukkan adanya right atrial enlargement dan LVH. Pada pasien dikerjakan pemeriksaan transtorakal ekokardiografi sebagai bagian dari skrining kardiovaskular. Tidak dijumpai adanya dilatasi root aorta, katup- katup masih dalam batas normal, serta fungsi sistolik ventrikel kanan dan kiri baik. Follow up minimal 1 tahun sekali perlu dikerjakan untuk pemantauan serta pencegahan komplikasi kardiovaskular di masa mendatang.

A Case of Malignant Right Coronary Artery: Frequent Angina in Young Person Purwowiyoto, Sidhi Laksono; Surya, Steven Philip
Folia Medica Indonesiana Vol. 57, No. 4
Publisher : Folia Medica Indonesiana

Show Abstract | Download Original | Original Source | Check in Google Scholar

Highlight: • A young adult has activity-triggered atypical chest pain and diagnosed malignant RCA. • Congenital anomalies needed to be aware by cardiologists to help clinical practice. • Planning a treatment about management of the CAAs condition should be undertaken by the inter-specialist team. Abstract: We presented a case a young adult with activity-triggered atypical chest pain and diagnosed with anomalous origin of right coronary artery (RCA) from the left coronary sinus with an interarterial course between the aorta and the main pulmonary artery that was detected by CT coronary angiography. This anomaly has been called malignant RCA. Coronary artery anomaly is a congenital condition. Most of the cases remain asymptomatic. This condition is also one of the most causes of sudden cardiac death, because the coronary artery examination is not regularly done. Nevertheless, during high intensity activity, it could be symptomatic and might be lethal. Diagnosing coronary artery anomalies might be tricky and cardiologists must be aware of this. The CAAs condition is a rare situation. The CAAs condition is associated with sudden death, especially intense physical activity. There was no rigid guideline for the management of the CAAs condition, so that planning a treatment in the inter-specialist team should be done.

Early De-resuscitation Strategy using Diuretics Targeting Low Central Venous Pressure in the Management of Septic Shock with Acute Kidney Injury Gabriana, Jessica; George, Yohannes W.H.; Purwowiyoto, Sidhi Laksono
Jurnal Komplikasi Anestesi Vol 12 No 3 (2025)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v12i3.22141

Septic shock remains a critical condition associated with high morbidity and mortality rates, particularly when complicated by Acute Kidney Injury (AKI). Traditional management strategies have predominantly emphasized fluid resuscitation to restore hemodynamic stability; however, the adverse effects of fluid overload are most pronounced in situations such as septic shock, which predisposes patients to acquired AKI. This case report presents an early de-resuscitation strategy using diuretics to target low central venous pressure (CVP) in a 58-year-old male with Urosepsis-associated AKI. The initial treatment included fluid loading and antibiotics, but his condition worsened, leading to ICU admission. A central venous catheter was placed, and a furosemide infusion was started due to positive fluid balance and high CVP. Over the next few days, the patient's condition improved significantly, with reduced ventilator and vasopressor support and improved renal function. The success of this strategy underscores the importance of re-evaluating fluid resuscitation practices and incorporating de-resuscitation as a key component of patient care.

Cryptogenic Stroke: A Challenge in Diagnosis and Management Purwowiyoto, Sidhi Laksono; Setianto, Budhi; Panindhita, Gea; Halomoan, Reynaldo; Wiryawan, I Nyoman
Jurnal Kardiologi Indonesia Vol 42 No 3 (2021): Indonesian Journal of Cardiology: July - September 2021
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1149

Ischemic stroke is responsible for 85% of all stroke globally. However, the etiology of around a quarter of ischemic stroke are undetermined, this is called cryptogenic stroke. This kind of stroke affects younger population. Several mechanism are associated with the incidence of cryptogenic stroke such as paroxysmal atrial fibrillation, patent foramen ovale, atherosclerosis, and atrial cardiopathy. Despite many advanced knowledge on stroke generally, cryptogenic stroke is still a challenge in clinical settings. To understand more about cryptogenic stroke, a new term of embolic strokes of undetermined source (ESUS) is proposed and may need a specific workup. Specific workup aims to detect any silent risk factors and also to evaluate the cardiac structure. The term of ESUS also leads to the understanding that cryptogenic stroke is highly related to embolic mechanism and anticoagulation administration might benefit the patients. However, the result of several recent studies showed that anticoagulant was not superior to antiplatelet, and antiplatelet is still the preferred treatment. Studies on PFO closure also shows different result, but the majority of the trials showed benefit of PFO closure in reducing the risk of stroke recurrence.

Early De-resuscitation Strategy using Diuretics Targeting Low Central Venous Pressure in the Management of Septic Shock with Acute Kidney Injury Gabriana, Jessica; George, Yohannes W.H.; Purwowiyoto, Sidhi Laksono
Jurnal Komplikasi Anestesi Vol 12 No 3 (2025)
Publisher : This journal is published by the Department of Anesthesiology and Intensive Therapy of Faculty of Medicine, Public Health and Nursing, in collaboration with the Indonesian Society of Anesthesiology and Intensive Therapy , Yogyakarta Special Region Br

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/jka.v12i3.22141

Septic shock remains a critical condition associated with high morbidity and mortality rates, particularly when complicated by Acute Kidney Injury (AKI). Traditional management strategies have predominantly emphasized fluid resuscitation to restore hemodynamic stability; however, the adverse effects of fluid overload are most pronounced in situations such as septic shock, which predisposes patients to acquired AKI. This case report presents an early de-resuscitation strategy using diuretics to target low central venous pressure (CVP) in a 58-year-old male with Urosepsis-associated AKI. The initial treatment included fluid loading and antibiotics, but his condition worsened, leading to ICU admission. A central venous catheter was placed, and a furosemide infusion was started due to positive fluid balance and high CVP. Over the next few days, the patient's condition improved significantly, with reduced ventilator and vasopressor support and improved renal function. The success of this strategy underscores the importance of re-evaluating fluid resuscitation practices and incorporating de-resuscitation as a key component of patient care.

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