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All Journal Indonesian Journal of Cardiology J-Dinamika: Jurnal Pengabdian Kepada Masyarakat Heart Science Journal Jurnal Klinik dan Riset Kesehatan
Widito, Sasmojo
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Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Antikoagulan Parenteral Pada Intervensi Koroner Perkutan: Mekanisme Kerja, Monitoring, dan Faktor-Faktor yang Memengaruhi Suprapta, Aloysius; Widito, Sasmojo
Jurnal Klinik dan Riset Kesehatan Vol 4 No 3 (2025): Volume 4 No 3, Juni 2025
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.3.7

Abstract

Background: The increasing number of heart attacks also followed by increases percutaneous coronary intervention (PCI). Coronary heart disease and PCI itself will increase the incidence of thrombosis in the coronary blood vessels. The use of parenteral anticoagulants and antiplatelets is necessary before, during and after PCI. Objective: Appropriate use of anticoagulants will provide expected benefits and avoid side effects such as bleeding. Accurate use of anticoagulants requires understanding the mechanism of action, monitoring drug consentration, and considering factors that influence the mechanism of action of anticoagulants. Discussion: There are three anticoagulants commonly used in Indonesia, namely unfractionated heparin, low molecular weight heparin (LMWH), and fondaparinux. These three anticoagulants affect the coagulation process by inhibiting thrombin formation. The profile of each anticoagulant has unique characteristics with heparin as an anticoagulant that is often used and easily available in health facilities, but has different reactions in each person, therefore requires regular monitoring. LMWH and fondaparinux have a more stable reaction so rarely require monitoring. Conclusion: Parenteral anticoagulants are useful in preventing the occurrence of thrombi before and during PCI procedures. Giving the right dose will reduce the effects of bleeding. Unfractionated heparin is an anticoagulant that often be used and available in health facilities but requires regular monitoring. Several factors can influence the mechanism of action of anticoagulants such as gender, body weight, kidney function, platelet count, smoking, and diabetes.
Analisis Activated Clotting Time pada Intervensi Koroner Perkutan Elektif dengan Heparin Bolus dan Kontinu di RSUD Dr. Saiful Anwar Malang Suprapta, Aloysius; Widito, Sasmojo
Jurnal Klinik dan Riset Kesehatan Vol 5 No 1 (2025): Edisi Oktober 2025
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.05.1.4

Abstract

BACKGROUND: Unfractionated heparin effectively prevents thrombosis during percutaneous coronary intervention (IKP). Analysis between sex, age, BMI, diabetes, smoking, CHF, hypertension, stroke, lesion characteristics, CHA2DS2-VASc score, platelet, eGFR, and bleeding events with activated clotting time (ACT) achievement aims to elucidate the correlation in elective IKP procedures using heparin bolus administration followed by continuous heparin. OBJECTIVE: To evaluate the relationship of sex, age, BMI, diabetes, smoking, CHF, hypertension, stroke, lesion characteristics, CHA2DS2-VASc score, platelet, eGFR, and bleeding events on achieving an ACT of ≥300 seconds in elective IKP patients at RSSA. METHODS: This observational study analysed medical records of elective IKP patients at RSSA from July 2022 to August 2024. Data were collected via consecutive sampling. Univariate analysis described sample characteristics, while bivariate analysis assessed variable relationships. Logistic regression was used to develop a predictive model if significant variables was found. RESULTS: Among 43 samples, 34.8% achieved ACT ≥300 seconds. No significant relationship was found among sex, age, BMI, diabetes, smoking, CHF, hypertension, stroke, lesion characteristics, CHA2DS2-VASc score, platelet, and eGFR (p=0.078; p=0.936; p=0.264; p=0.139; p=0.063; p=0.535; p=0.64; p=0.324; p=0.349: p=0.885; p=0.677; p=0.15 respectively). There is no bleeding event after procedure. CONCLUSION: There is no relationship between variables sex, age, BMI, diabetes, smoking, CHF, hypertension, stroke, lesion characteristics, CHA2DS2-VASc score, platelet, and eGFR to ACT achievement in elective IKP patients receiving bolus and continuous heparin. Further research with larger sample sizes and standardized ACT measurements is recommended.
The Effect of HbA1C Variability and Lipid Profile on Carotid Intima-Media Thickness (cIMT) and Flow-mediated Dilatation (FMD) in children and adolescent with Type 1 Diabetes Mellitus at Saiful Anwar Hospital Malang Ikeningrum, Dyah Ayu; Tjahjono, Cholid Tri; Kurnianingsih, Novi; Widito, Sasmojo; Putri, Valerina Yogibuana Swastika
Heart Science Journal Vol. 3 No. 3 (2022): Cardiovascular Disease in Young Adulthood: Who, When, and How to Screen?
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.03.4

Abstract

BackgroundThere is a correlation between diabetes mellitus type 1 (T1DM) and a higher risk of heart disease. Atherosclerosis, which can be discovered early with cIMT (Carotid Intima-Media Thickness) and Flow Mediated Dilation (FMD) tests, contributes to the development of cardiovascular disease. HbA1c fluctuation and lipid profile can have an impact on cIMT and FMD.AimThe aim of this study is to determine the influence of HbA1c variability and lipid profile on cIMT and FMD levels in children T1DM patients treated at Dr Saiful Anwar Hospital Malang.MethodsThe study utilized a cross-sectional design and included 82 participants with Type 1 Diabetes Mellitus who were routinely treated at the Dr. Saiful Anwar Hospital Malang's pediatric outpatient clinic between January - July 2019 and December 2021 and- January 2022.ResultsThe correlation test revealed no significant connection between HDL (ρ=-0,029; p=0,796), LDL (ρ=-0.213; p=0.055), TG (ρ= -0.179; p= 0.107), and total cholesterol (ρ=-0.182; p= 0.101). Association tests revealed a positive correlation between LDL (ρ=0,318; p=0,004) and total cholesterol (ρ=0,230; p=0,038) levels and IMT. The correlation coefficient between HbA1C variability and FMD as evaluated by HVS was -0.498 (ρ=0.000; p=0.05), as was the correlation coefficient between HbA1c-SD (ρ=-0.467; p=0.000) and HbA1c-CV (ρ=-0.400; p=0.000). Additionally, a significant positive connection was discovered between IMT and the value of HbA1c variability utilizing HVS (ρ=0.455; p=0.000), HbA1c-SD (ρ=0.434; p=0.000), and HbA1c-CV (ρ=0.325; p=0.003). The linear regression analysis revealed that the three variables with the greatest influence on FMD were HVS (R=0.398), LDL (R=0.316), and HbA1c-SD (R=0.293). HVS (R=0.468), LDL (R=0.268), and total cholesterol (R=0.198) were the three most impactful variables on IMT. It is known that the combination of lipid profile and HbA1c fluctuation contributes 25.1% to FMD using this model. Meanwhile, the lipid profile and HbA1c variability together accounted for 34.5% of the variance in IMT.ConclusionVariability in HbA1c and lipid profile (LDL and total cholesterol) can contribute to an increase in intima-media thickness and a decrease in brachial artery FMD in children with T1DM.  
Troubleshooting for Kinked Coronary Catheter: How to Manage? ; A Case Series Noverike, Nikhen; Satrijo, Budi; Widito, Sasmojo; Kurnianingsih, Novi; Abusari, Muchamad
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.7

Abstract

Background: Catheter entrapment and knotting are two problems that might arise during coronary angiography, regardless of the method used. It is not uncommon for the catheter shaft to become kinked during diagnostic or interventional procedures. Still, if the manipulation fails, an invasive retrieval method is usually necessary for cases with extensive catheter kinking.Case Illustration: We present two cases illustrating how different angiography approaches could lead to severe catheter kinking. Because of the significant tortuosity of the vasculature, even a gentle opposite rotation maneuver and the antegrade advancement of multiple guidewires failed to untwist the guide catheter. Once a twisted catheter has been identified via fluoroscopy, the twist can be eased by gently twisting the catheter in the opposite direction. It is not always easy. It could lead to using other interventional techniques such as snare, balloon, or surgical procedures. In our cases, we used a snare to snag the catheter's tip and untied the loop's knot. This prevented the need for unscheduled surgical intervention. We evaluated from angiography. There were no further complications. The patients were released from the hospital the following day.Conclusion: Although a kinked catheter could become entrapped, various approaches can be taken to deal with this difficulty and prevent the need for surgical intervention.
A 56 Year Old Male with Acute Stent Thrombosis During Percutaneous Coronary Intervention, How to Resolve This Problem? Millisani, Hayla Iqda; Rohman, Mohammad Saifur; Prasetya, Indra; Widito, Sasmojo
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.8

Abstract

Background: Acute stent thrombosis is the complete occlusion of a coronary artery of the previously implanted stent. This unusual complication occurs in percutaneous coronary intervention (PCI), development of myocardial ischemia, and poor prognosis for the patient. After PCI, acute stent thrombosiscan occur within 0-24 hours and cause the symptoms like acute coronary syndrome. Incidents of stent thrombosis are about 0.6% to 3.4% for Drug Eluting Stent (DES) implantation, depending on the lesion and patient factors. The etiology of acute stent thrombosis is multifactorial, and early detectioncan reduce the mortality rate.Case Illustration: A 56 yo male visited Rumah Sakit Saiful Anwar Malang with stable angina pectoris (Class III symptoms with medical therapy) planned for elective cardiac catheterization with routine medical treatment. During PCI, he complained the chest pain, and from cine angiography evaluation showed no flow at the diagonal branch because of the acute thrombosis. Then got thrombosuction and got a white thrombus. After the PCI procedure, he got fibrinolytic with streptokinase 1.5 million units for 60 minutes. He was transferred to CVCU for observation and discharged after five days.Conclusion: Acute stent thrombosis is a severe complication during and after PCI because it is related to high mortality. The mechanisms by which ST arises are complex and multifactorial and must be early detection.
Interleukin-6 (IL-6) as a Marker of Endothelial Dysfunction Confirmed Using Flow Mediated Dilatation in Active Smoker Wicaksono, Arif; Kurnianingsih, Novi; Tjahjono, Cholid Tri; Widito, Sasmojo; Swastikaputri, Valerina Yogibuana; Wihastuti, Titin Andri
Heart Science Journal Vol. 5 No. 1 (2024): Inflammation and Cardiovascular Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.01.4

Abstract

Background: The pro-inflammatory cytokine interleukin-6 (IL-6) is thought to be the catalyst for endothelial dysfunction caused by smoking. Flow-mediated dilatation (FMD) is a non-invasive method to identify the development of blood vessel endothelial dysfunction at an early stage. However, several studies have not sufficiently explained how smoking and IL-6 interact.Objective: This study focuses on the role of Interleukin-6 (IL-6) in the process of endothelial dysfunction confirmed using non-invasive modalities such as Flow Mediated Dilatation (FMD) in smokers related to the risk of cardiovascular disease in the future with the hope of providing insight in education to smokers to quit smoking.Material and Methods: In this study, we gathered 116 male participants, of which 56 were nonsmokers, and 60 were smokers, and we used IL-6 and FMD testing. SPSS for Windows version 23 will be used to analyze the data.Result: According to the analysis of laboratory tests, the average IL-6 level in light smokers was 67.7±3.2 and in moderate smokers it was 95.1±11.0; with a p-value of 0.009, indicating a significant difference among the groups. The average FMD in the smoking group was 5.4±0.4% (p-value 0.000), whereas the average FMD in the non-smoker samples was 10.9±0.9%. We also looked at the average FMD among light and moderate smokers based on Brinkman Index, which was 5.5±0.4% and 5.0±0.4%, with a p-value of 0.780, indicating no significant difference between the groupsConclusion: Compared to non-smokers, this study demonstrates a correlation between IL-6 and smoking activity. However, there was no statistically significant difference between the prevalence of endothelial dysfunction and the degree of smoking dependence in this investigation.
Challenge case of ventricular arrhythmia in young women Kaputrin, Nur; Rizal, Ardian; Karolina, Wella; Widito, Sasmojo
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.16

Abstract

Background: Torsade de pointes (TdP) and ventricular fibrillation can cause rapid mortality. The etiological cause the ventricular arrhythmia must be detected and treated early, especially in the ER. Objective: We report a patient with severe hypokalemia and TdP following the administration of Amiodarone in QT-interval prolongation Case Report: A 32-year-old girl with diarrhea and vomiting for two days arrived to the ED with a seizure with her hand flexed and leg straight down. Her family reported she didn't take prescriptions regularly. She was GCS 224, hemodynamically stable, typical ECG showed extended QTc and her head CT was normal. During observation at the ED, she had seizure and the monitor revealed a Torsade de Pointes (TdP) ) with a pulse rate of 160-180 bpm. She was given Amiodarone and peroral Bisoprolol 5 mg. She returned to sinus rhythm with PVC bigeminy and was admitted to the ICU Laboratory data showed hypokalemia (1.9) improved (2.9) after treatment. Eight hours later, she experienced a TdP without pulse palpability for less than 1 minute, then Ventricular Fibrillation, began CPR, and the doctor in charge gave her a defibrillation operation once. She returned with sinus tachycardia 110-130 bpm. The next day, she was having recurring TdP episodes without a pulse. The doctor conducted CPR and defibrillation and returned with 120-130 bpm sinus tachycardia. The patient consulted a cardiologist and was prescribed lidocaine 1 mg/hour and continued Bisoprolol 5 mg for long QT problem. Observation The seizure ended 12 hours later, the patient was alert, GCS 456, and the ECG showed sinus rhythm with extended QTc. Over the days before discharge, electrocardiography demonstrated reduced QT-interval prolongation. Conclusion: Life-threatening ventricular arrhythmia in a young female can be caused by QT-interval prolongation. It must be diagnosed and treated immediately to avoid mortality.
An alternative retrograde access puncture for EVLA: a case report Kurniawan, Catur Rizky; Kurnianingsih, Novi; Widito, Sasmojo
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.18

Abstract

Background: CVI manifests with a variety of clinical symptoms, spanning from varicose veins to venous ulcers, significantly impacting patients' daily lives. While traditional treatments such as compression therapy and surgery remain options, on endovenous laser treatment (EVLT) has emerged as a viable alternative.  This article delves into the management of CVI, with a particular focus EVLT as a minimally invasive intervention. Through two case illustrations, it sheds light on the difficulties encountered when accessing the great saphenous vein (GSV) using the conventional antegrade approach, particularly in cases involving obesity and vasospasm. Consequently, a retrograde EVLT technique utilizing proximal GSV access, resulting in successful vein ablation with minimal complications. Overall, this approach presents a promising addition to the management of CVI, offering enhanced patient care and improved outcomes. Case Presentation: Two patients with CVI and challenging antegrade GSV access underwent retrograde EVLT using proximal GSV access. Despite initial difficulties, including obesity and vasospasm, successful vein ablation was achieved with minimal complications. Post-procedural evaluations demonstrated significant symptomatic improvement, highlighting the efficacy of the retrograde technique. Conclusion: Retrograde EVLT utilizing proximal GSV access proves to be a safe and effective alternative in cases where antegrade access is challenging. The technique offers simplicity, minimal complications, and high patient satisfaction, with outcomes comparable to traditional approaches. Extended follow-up studies are needed to confirm the long-term effectiveness of retrograde EVLT compared to antegrade methods. Overall, retrograde EVLT presents a valuable option for managing CVI, particularly in patients with anatomical complexities or vasospasm, contributing to improved patient care and outcomes.
Revisiting Subspecialty Training in Cardiology in Indonesia: Structural, Regulatory, and Global Perspectives Munawar, Muhammad; Lubis, Anggia Chairuddin; Setianto, Budi Yuli; Octaviono, Yudi Her; Munawar, Andina; Rifqi, Sodiqur; Widito, Sasmojo
Jurnal Kardiologi Indonesia Vol 46 No 4 (2025): October - December, 2025
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1971

Abstract

The rapid expansion of cardiology as a discipline has prompted the emergence of numerous subspecialties that require structured, competency-based training. In Indonesia, however, the development of subspecialty education remains inconsistent, divided between university-based programs known as Spesialis-2 (Sp-2) and hospital-based fellowships. The interchangeable use of the terms “fellowship” and “subspecialty” has generated conceptual ambiguity and regulatory uncertainty. Globally, subspecialty training in cardiology follows a hospital-based apprenticeship model, led by accredited teaching hospitals and closely regulated by professional boards such as ACGME, ACC, or ESC. Indonesia’s deviation from these international norms has implications not only for the quality of advanced cardiovascular training but also for the nation’s ability to attract international fellows—a marker of global academic recognition. This review examines the current landscape of cardiology subspecialty education in Indonesia, contrasting it with global frameworks, and discusses structural, academic, and legal challenges, including those concerning foreign trainees. The article concludes by proposing a policy framework to harmonize Indonesia’s subspecialty education with global standards, thereby strengthening both national capacity and international credibility.
Co-Authors Abusari, Muchamad AJI, BAYU Ananta, Ahmadi Yuli Anjarwani, Setyasih Arif Wicaksono Atma Gunawan Budi Yuli Setianto Budiarti, Arry Cholid Tri Tjahjono Emil Fathoni, Emil Erfan Rohadi Hapsari, Ratih Indri Ikeningrum, Dyah Ayu Imam Fahrur Rozi Indra Prasetya Indrihapsari, Pratiwi Irawan, Ferry Buyung Bakhtiar Kaputrin, Nur Karolina, Wella Kurnianingsih, Novi Kurniawan, Catur Kurniawan, Catur Rizky Lubis, Anggia Chairuddin Millisani, Hayla Iqda Mohammad Saifur Rohman Muhammad Munawar Munawar, Andina Noverike, Nikhen Nurudinulloh, Akhmad Isna Octaviono, Yudi Her Putri, V.Y.S Putri, Valerina Yogibuana Swastika Putri, Valerinna Yogibuana Swastika Rahimah, Anna Fuji Rakhmat Arianto Rizal, Ardian Rudy Ariyanto Ruspiono, Evit Saidi, Zaki Saputra, Zainal Ulu Prima Satrijo, Budi Sholiha, Afifah Sodiqur Rifqi Suprapta, Aloysius Suprayoga, Imam Mi'raj Swastikaputri, Valerina Yogibuana Titin Andri Wihastuti Zakaria, Arief Syukron