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All Journal Jurnal Kedokteran Brawijaya Heart Science Journal Jurnal Klinik dan Riset Kesehatan
Rizal, Ardian
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Ablasi 3-Dimensi pada Pasien dengan Takikardia Right Ventricular Out-flow Track (RVOT) Origin: Pengalaman Pertama di RSUD Dr. Saiful Anwar Provinsi Jawa Timur Cik, Kahadi; Rizal, Ardian
Jurnal Klinik dan Riset Kesehatan Vol 3 No 3 (2024): Edisi Juni
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.03.3.9

Abstract

Latar Belakang: Premature ventricular complexes (PVCs) umum terjadi pada populasi. PVC dapat terjadi tanpa disertai dengan penyakit jantung struktural atau penyakit jantung lain. Umumnya PVC tidak menimbulkan gejala, namun pada pasien dengan PVC yang frekuen, dapat menimbulkan gejala seperti berdebar, pingsan, mudah lelah, atau bahkan sesak napas. Beberapa studi, mengatakan bahwa PVC memiliki risiko kardiovaskular dua kali lipat lebih tinggi, termasuk stroke, kematian, dan juga aritmia serta kardiomiopati. Obat-obatan dapat digunakan untuk menekan PVC, namun jika dengan obat tidak efektif, maka ablasi PVC dapat dilakukan untuk menghilangkan gejala atau mencegah terjadinya kardiomiopati akibat PVC. Ilustrasi Kasus: Wanita, 57 tahun dengan hipertensi dan menopause, sejak tahun 2017, sering mengeluh berdebar disertai sesak, pusing, dan terkadang hampir pingsan, baik saat istirahat maupun beraktivitas ringan. Dari hasil Holter monitoring, ditemukan frekuent PVC (39%) yang berasal dari RVOT. Dari echocardiography didapatkan penurunan fraksi ejeksi (EF 48%) tanpa didapatkan regional wall motion abnormalities (RWMA) sehingga dicurigai disebabkan oleh Tachycardia-Induced cardiomyopathies. Pasien kemudian dilakukan Electrophysiology Study (EP Study) dan kemudian dilanjutkan dengan Ablasi 3-Dimensi dengan RFA pada RVOT di RSUD Dr. Saiful Anwar Provinsi Jawa Timur (RSSA), yang merupakan tindakan ablasi 3-Dimensi pertama di RSSA Malang. Follow-up 1 tahun kemudian tidak menunjukkan kekambuhan dan berhasil meningkatkan kualitas hidup pasien Diskusi: Berdasarkan guideline, Catheter ablation direkomendasi kelas I untuk pasien dengan gejala, pada outflow tract ventricular arrhythmias jika penggunaan obat tidak efektif, tidak dapat ditoleransi, atau pilihan pasien. Kesimpulan: Ablasi 3-Dimensi pada pasien dengan takikardia RVOT-Origin, berhasil menghilangkan PVC dan tidak mengalami rekurensi dalam 1 tahun evaluasi.
The Effect of Lipopolysaccharide Challenge in RAW 264.7 Cells on Nitric Oxide Release and Cell Viability Suprapto, Ratih Paramita; Kusumastuty, Inggita; Rizal, Ardian; Adi Nugroho, Dwi
Jurnal Kedokteran Brawijaya Vol. 33 No. 2 (2024)
Publisher : Fakultas Kedokteran Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.jkb.2024.033.02.2

Abstract

Lipopolysaccharide (LPS) is a major component of a gram-negative bacterial wall that is widely used and well-established to induce inflammation in vitro. In addition, the in vitro model using RAW 264.7 cells is the most commonly applied in screening the anti-inflammatory and elucidating the pathophysiology of inflammation-based disease, as well.  However, there is still limited data on the efficacy of different doses of LPS in inducing inflammation in RAW 264.7 cells. This study aimed to evaluate the effect and safety of LPS at various doses in RAW 264.7 cells. RAW 264.7 cells were exposed to LPS at different dose ranges (10ng/mL-10µg/mL) for 24 hours. The nitric oxide (NO) release as inflammatory responses and viability test were evaluated using Griess assay and CCK-8 assays, respectively. The result showed that NO production was increased at different doses of LPS compared to the control although not significant. Whereas, All LPS-treated RAW 264.7 cells tended to increase but not significantly compared to the control groups. This study showed that the LPS treatment effectively induced inflammation in RAW 264.7 cells as shown by NO production and was considerably safe as the viability was comparable between LPS and control group for RAW cells 264.7 at least up to 10µg/mL for 24 hours.
Validation of Self-Assessment-Based Chest Pain Algorithm (DETAK) as An Early Identification Tool for Acute Coronary Syndrome Nugraha, Krishna Ari; Rohman, Mohammad Saifur; Rahimah, Anna Fuji; Anjarwani, Setyasih; Rizal, Ardian; Astiawati, Tri; Adi, Andi Wahjono; Haryati, Lina
Heart Science Journal Vol 4, No 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac C
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.5

Abstract

BackgroundThe most common reason of prehospital delay in ACS patients is inability to pay attention to symptoms in order to act fast and effectively. Patient oriented machine learning algorithms has the opportunity to reduce the total ischemic time, that determines the clinical outcome of ACS patients.AimAssessing the accuracy of the chest pain self-assessment algorithm (DETAK) in identifying ACS.MethodThis study included seven hospitals, five PCI capable hospitals and two of non-PCI capable hospitals. The study was conducted from August 2021 to June 2022. The study included all patients with chest pain who visited the hospital and used the DETAK algorithm. Patients were interviewed after being confirmed hemodynamically stable. Patients with UAP, as well as those who died or declined to participate in this study were excluded. The area under the curve receiver operating characteristic (AUROC) was used to verify DETAK's performance in identifying SKA. We compare the DETAK algorithm's diagnosis with the definitive diagnostic based on ECG and/or troponin results.ResultsA total of 539 patients (mean age 58 years) with a higher proportion of male patients (n=424). An AUC value of 0.854 was obtained, where the cut of point accuracy of DETAK in identifying ACS for the entire sample had a sensitivity of 89.5% and a specificity of 81.2%. The algorithm's specificity decreased in certain subgroups, including type 2 diabetes (79.4%), women (77.3%), and hypertensive patients (80.9%). Algorithm reliability test obtained moderate to strong level of agreement values.ConclusionDETAK's self-assessment-based chest pain algorithm offers an excellent diagnostic performance in early identification of ACS.
Sudden Cardiac Death In Young Age, What Should We Know? Rochmawati, Icmi Dian; Rizal, Ardian; Putri, Valerinna Yogibuana Swastika; Prasetya, Indra
Heart Science Journal Vol 5, No 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.7

Abstract

While young sudden cardiac death (SCD) is statistically uncommon, its dramatic presentation and the impact it has on families and communities make it a newsworthy issue. Nonetheless, it is important to view SCD in children and adolescents as a public health concern and devise strategies based on research and consensus to address it. Both individuals with and without a history of cardiovascular illness are susceptible to sudden cardiac death. Employing cardiovascular disease risk screening for healthy individuals and those with a family history of sudden cardiac death can serve as a preventive approach against sudden cardiac death. Assessing the severity of cardiovascular disease in people becomes essential in order to prevent disease progression and minimize the risk of mortality from cardiovascular conditions.
Management of Pregnant Women with Atrial Septal Defect and Pulmonary Hypertension: A Case Report Wicaksono, Arif; Martini, Heny; Rizal, Ardian; Rahimah, Anna Fuji
Heart Science Journal Vol 5, No 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.13

Abstract

Backgrounds:Pulmonary Hypertension (PH) is a condition where there is an increase in Pulmonary Vascular Resistance (PVR) and an increase in the mean Pulmonary Arterial Pressure (mPAP) to more than 20 mmHg. PH can occur in someone with Congenital Heart Disease (CHD). PH conditions can aggravate pregnancy in women with CHD. So that women with PH are recommended not to undergo pregnancy. However, it is possible for women with CHD with PH conditions to undergo pregnancy. In these conditions, optimizing PH therapy is important so that pregnant women with PH do not experience a worsening of the condition and can carry out their pregnancy well until delivery. Case Presentations:A 38-year-old female patient with a history of Atrial Septal Defect-Pulmonary Hypertension came for routine control to the cardiac clinic with the condition of pregnancy of her 4th child who was just discovered when she was 6 months pregnant. Since giving birth to her third child, the patient began to complain of being easily tired when doing activities accompanied by swollen legs that disappeared with rest. At that time, the patient went to a cardiologist for an echocardiography examination and was diagnosed as Atrial Septal Defect (ASD)-Pulmonary Hypertension (PH). Since then, the patient has been routinely treated at a cardiologist with Pulmonary Hypertension drugs, including Phospodiesterase5 (PDE5) inhibitors (Sildenafil) and Prostacyclin Analogue (Dorner). The patient had done Transesophageal Echocardiography (TEE) with the results of ASD secundum suitable for closure by device. Patients with Right Heart Catheterization (RHC) results, ASD secundum with PH High Flow High Resistance reactive to Vasoreactivity Test. Since the patient was found to be pregnant, the patient continued to use Sildenafil and discontinued the use of Dorner. The patient then continued treatment in a multidisciplinary team. Conclusion :Management of pregnant women with CHD and PH is important because the condition of PH itself further aggravates the condition of pregnancy. Medical management for PH in pregnant women follows the guidelines for the safety of drugs in pregnancy. So that the choice of therapy is crucial related to the goal of treatment to control the PH condition in the patient but still pay attention to safety in pregnancy conditions.
Impact of Strict and Lenient Heart Rate Control on Six-Minute Walk Test and Quality of Life in Atrial-Fibrillation Patients with Rheumatic Mitral Stenosis : Randomized Control Trial Dwigustiningrum, Nur Kaputrin; Rizal, Ardian; Putri, Valerinna Yogibuana Swastika; Rahimah, Anna Fuji; Rohman, Mohammad Saifur; Wikananda, Adhika Prastya; Waranugraha, Yoga; Astiawati, Tri; Laitupa, Fitranti Suciati
Heart Science Journal Vol 5, No 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.8

Abstract

Background: Recent studies showed no outcome difference between strict and lenient rate control in the general Atrial Fibrillation (AF) population. However, for AF and Rheumatic Mitral Stenosis (RMS) patients, evidences were lacking.Objective: To assess the impact of strict and lenient heart rate control on the Six-Minute Walk Test (SMWT) and Health Related Quality of Life (HRQoL) in patients with AF and RMS.Material and Methods: A prospective multicenter trial across tertiary hospitals in East Java assessed strict and lenient heart rate control's impact on the SMWT and HRQoL in AF and RMS patients. Sixty-one participants were randomized into strict and lenient groups over six months from March to August 2023. Medications were adjusted to achieve target heart rates, and HRQoL was assessed using SF-36 and SMWT at baseline and three months post-target heart rate attainment.Result: In our study, 29 patients were under strict heart rate control, and 32 were under lenient control. We found a decrease in HRQoL across all subscales, with significant differences observed in general health perception and physical function among those under strict control (p=0.002 and 0.03, respectively). However, no significant disparity was found in the SMWT distance difference between lenient and strict groups (p=0.529), nor in METs (p=0.326).Conclusion: In the study, lenient heart rate control demonstrates significant effects on the general health perception and physical function subscales compared to strict heart rate control. 
Hypokalemia Induced Ventricular Arrhythmia In Heart Failure Patient With Complete Revascularization: A Case Report Rochmawati, Icmi Dian; Rizal, Ardian; Rohman, Mohammad Saifur; Prasetya, Indra
Heart Science Journal Vol 4, No 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac C
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.7

Abstract

BackgroundSudden mortality due to persistent VT or VF accounted for around half of all fatalities in these high-risk individuals. Myocardial ischemia, acute heart failure, electrolyte abnormalities, hypoxia, and drug-related arrhythmogenicity are all risk factors for electrical storms. The most common electrolyte imbalance is hypokalemia.Case illustration:A 54-year-old man was readmitted to ER with palpitations and chest pain. The patient's heart rate was recorded as sinus bradycardia however, shortly the patient developed ventricular tachycardia of approximately 300 beats per minute (bpm) and unstable. Although multiple synchronized cardioversion dosage was administered, the VT reoccurred again. Complete revascularization was demonstrated at his most recent catheterization three months ago. His potassium in the serum was 2.88 mmol/L and corrected with drip KCl. The patient's potassium levels were then normalized stable for the remainder of their hospital stay.ConclusionCareful medication reconciliation is critical for avoiding the potentially fatal cardiovascular effects of severe hypokalemia. Patients with CHF are more likely to have life-threatening hypokalemia and ventricular arrhythmias. The phenotypic expression of ventricular tachycardia in HF results from alterations in neurohormonal signaling, structural remodeling, and electrophysiology.
Successful Management in Unprovoked Upper Extremity Deep Vein Thrombosis: Case Report Noverike, Nikhen; Kurnianingsih, Novi; Rizal, Ardian; Rahimah, Anna Fuji
Heart Science Journal Vol 5, No 3 (2024): The Science and Art of Revascularization in Acute Coronary Syndrome
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.03.14

Abstract

BackgroundOne to four percent of all cases of deep vein thrombosis (DVT) occur in the upper extremities. Effective thrombolysis for upper extremity deep vein thrombosis (UEDVT) can be achieved with a combination of vascular interventions such as angioplasty, which is continued with catheter-directed thrombolysis (CDT) and anticoagulant therapy.Case IllustrationWe presented the case of a 40-year-old man who developed sudden pain and swelling in his right upper extremity. The thrombus was located in the right subclavian vein, confirmed by duplex ultrasonography. Laboratory results were normal. The patient was diagnosed with unprovoked UEDVT. He underwent venography, which showed an acute-on-chronic lesion at the right subclavian vein. We decided to use double access, tried to inflate the balloon to fragment the thrombus, several times of thrombo-suction, and then continued with Catheter-directed thrombolysis (CDT) using Alteplase. The patient continued oral anticoagulant therapy with Rivaroxaban. After 6 months of follow-up, there wasn’t any complaint. Evaluation of Duplex ultrasonography showed normal results without any recurrent thrombusConclusionThis case revealed how to treat acute-on-chronic lesions of unprovoked UEDVT with a comprehensive management method not only with balloon fragmentation and CDT but also anticoagulant therapy and showed a good outcome and no signs of bleeding complication.
Clinical Features and Multimodality Diagnostic Tools of Pulmonary Hypertension Galuh, Lukitasari Ayu; Rahimah, Anna Fuji; Martini, Heny; Rizal, Ardian
Heart Science Journal Vol 5, No 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.4

Abstract

Pulmonary hypertension (PH) is characterized by an increase in mean pulmonary artery pressure (mPAP) above normal, which is > 20 mmHg and an increase in pulmonary vascular resistance (pulmonary vascular resistance / PVR) above normal, in resting conditions.The pathophysiology of PH involves remodeling of the pulmonary vessels, from the main pulmonary arteries, lobar arteries, segmental arteries, distal arteries, pulmonary arterioles, capillaries to the postcapillary pulmonary veins. In general, the epidemiological figures for PH are not known with certainty. The UK reported a PH prevalence of 97 cases/1,000,000 population with a female:male ratio of 1.8. The diagnostic approach to PH is mainly focused on two things. The primary goal is to raise the initial suspicion of PH and ensure fast-track referral to a PH center in patients with a high probability of PAH, CTEPH, or other forms of severe PH. The second aim is to identify the underlying disease, particularly left heart disease (Group 2 PH) and lung disease (Group 3 PH), as well as comorbidities, to ensure appropriate classification, risk assessment, and treatment. The Gold Standard diagnosis and classification of pulmonary hypertension is by examining the right heart catheterization (RHC). Clinical scoring in the form of shortness of breath without any obvious cause accompanied by physical examination, ECG and Thorax X-ray images which depict an enlarged right heart have good sensitivity and specificity for the diagnosis of pulmonary hypertension in patients with congenital heart disease. A high right ventricular pressure, mean PAP, and BNP values during observation, as well as heart size on chest X-ray can be predictors of a poorer prognosis in this population.
Unveiling The Diagnosis Pitfall: Complete Heart Block Presenting In Acute Coronary Syndromes Without Chest Pain And Non-Ischemic Electrocardiography In A Young Adult Suprayoga, Imam Mi'raj; Rizal, Ardian; Widito, Sasmojo; Rahimah, Anna Fuji
Heart Science Journal Vol 4, No 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac C
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.8

Abstract

Background: The majority of studies indicate that the asymptomatic or atypical presentation of acute coronary syndrome (ACS) as a significant manifestation of coronary artery disease (CAD) is associated with a poor prognosis.Objective: The purpose of this study was to characterize the clinical characteristics and management of ACS patients who presented without chest pain and non-ischemic electrocardiogram (ECG).Case presentation: A 31 years old man with syncope was brought to our hospital. ECG revealed total AV block (TAVB) without ST segment changes. First, he was diagnosed with cardiac syncope because his ECG showed no ischemic sign. He had a strong familial history of CAD, so we examined his cardiac enzymes and found an increase in serial cardiac enzymes. Then, he was diagnosed with non-ST elevation myocardial infarction (NSTEMI). Early invasive strategy with chronic total occlusion (CTO) at osteal right coronary artery (RCA) and acute total occlusion at mid RCA with implantation of 1 DES at osteal-proximal RCA was selected for this patient. After five days of hospitalization, he discharged home with medicines. Conclusion: In order to significantly lower their morbidity and mortality, this group of high-risk patients needs to receive improved early diagnostic and treatment choices.
Co-Authors Adi Nugroho, Dwi Adi, Andi Wahjono Alfata, Fandy Hazzy Anjarwani, Setyasih Arif Wicaksono Astiawati, Tri Aziz, Indra Jabbar Baskoro, Shalahuddin Suryo Cik, Kahadi Dwigustiningrum, Nur Kaputrin Galuh, Lukitasari Ayu Haryati, Lina Indra Prasetya Inggita Kusumastuty Kahadi, Cik Kaputrin, Nur Karolina, Wella Kurnianingsih, Novi Laitupa, Fitranti Suciati Martini, Heny Mohammad Saifur Rohman Noverike, Nikhen Nugraha, Krishna Ari Putri, Valerinna Yogibuana Swastika Rahimah, Anna Fuji Rochmawati, Icmi Dian Saerang, Gebryel Dennis Saputri, Vemmy Lian Setiawan, Dion Suprapto, Ratih Paramita Suprayoga, Imam Mi'raj Widito, Sasmojo Wikananda, Adhika Prastya Yoga Waranugraha Yogibuana, Valerinna