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All Journal Heart Science Journal Jurnal Klinik dan Riset Kesehatan Deka in Medicine
Kurnianingsih, Novi
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Peran Vital Ultrasonografi Dupleks pada Fistula Arteriovenosa sebagai Akses Hemodialisis Firdaus, Achmad Jauhar; Kurnianingsih, Novi
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.03.3.6

Abstract

The global incidence of end-stage renal disease (ESRD) is rising, amounting to more than 800 million individuals are suffered, in line with the rise of the number of patients undergoing hemodialysis as treatment modalities. Hemodialysis requires vascular access, and the arteriovenous fistula (AVF) access is considered the most ideal vascular access option due to its long-term patency and low complication rate compared to other access options. However, up to one-third of hospital admissions for ESRD patients are caused by AVF dysfunction, which is also one of the main causes of morbidity and mortality in ESRD patients. AVF creation requires careful pre- and post-operative evaluation to ensure the vascular access maturation and patency. While the latest guidelines have not explicitly emphasized the role of vascular mapping and surveillance, routine duplex ultrasonography before and after AVF creation procedures holds great potential advantages to ensure the success of AV access for hemodialysis.
Successful Management of High-Risk Acute Pulmonary Embolism in Patients with Undetected Hepatocellular Carcinoma: A Case Report zunardi, Lutfi hafiz; Kurnianingsih, Novi; Martini, Heny
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.2023.004.04.6

Abstract

AbstractBackground: Acute pulmonary embolism (PE) as the earliest manifestation of hepatocellular carcinoma (also known as HCC) is an extremely uncommon discovery and a very uncommon illness. It is a serious condition that can be life-threatening and has high morbidity and mortality rates. Despite the high prevalence of PE, the diagnosis is still challenging, mainly due to the unpredictability of symptoms and physical signs and the unexplained cause. The stratification of acute pulmonary embolism is important because it determines the right steps in decision-making.Case Illustration: A 45-year-old man presented to the ER at a private hospital with complaints of sudden shortness of breath after taking a bath. His family brought him to the private hospital 30 minutes after the onset. He came with desaturation and shock conditions. He was assessed as having an acute coronary syndrome (ACS). He got loaded with dual antiplatelets and was referred to our hospital. Because the patient's complaint is not angina but sudden shortness of breath accompanied by desaturation, we rule out ACS. We considered the possibility of a pulmonary embolism, so we performed bedside TTE in the ER and found RV dysfunction and McConnell's sign leading to acute PE. We continued with the CT examination and found a thrombus in the pulmonary artery. We assessed patients with high-risk pulmonary embolism and performed thrombolysis with rTPA. The patient's complaints gradually improved. Initially, we suspected unprovoked PE because we did not find a clear trigger, such as malignancy, prolonged bedriddenness, recent surgery, or old age. We accidentally found HCC from the patient's CTPA evaluation, and HBSAG was reactive.Conclusion: Every case of dyspnea that shows up at an emergency room should have acute PE taken into consideration in the differential diagnosis. In patients with suspected PE without obvious risk factors, we can use CT to triple-rule out ACS, Aortic dissection, and pulmonary embolism. Patients treated with thrombolytic therapy show rapid improvement, which may lead to a lower rate of mortality and morbidity.
The Consequences of a Heart Condition: Acute Stroke and Limb Ischemia Secondary to Massive Intracardiac Thrombus in a Young Female with Dilated Cardiomyopathy Lestari, Defyna Dwi; Tjahjono, Cholid Tri; Kurnianingsih, Novi
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.2024.005.03.13

Abstract

Background :Dilated cardiomyopathy (DCM) is associated with the increased occurrence of left ventricular (LV) thrombosis caused by cardiac dysfunction. This condition is associated with significant mortality and morbidity because of its significance as a potential source of systemic emboli. We are reporting a case of Acute Stroke and Limb Ischemia in a Young Female Patient with DCM.Case Illustration :A 20-year-old female was referred to our hospital due to pain in her right lower extremities and weakness in her right limb. She had been diagnosed with peripartum cardiomyopathy five years earlier. A general physical examination found her right lower limbs to be cold and pulseless. A neurological examination revealed hemiparesis involving the right side of her body. The chest radiograph showed cardiomegaly. Electrocardiography indicated sinus rhythm with LVH. The transthoracic echocardiograms revealed significant LV systolic failure with a massive thrombus at LV. The Duplex ultrasound showed a thrombus at the right dorsal pedis artery, and a head CT scan revealed an acute infarct. The patient was started on heparin and bridged with warfarin 5mg orally daily, and she was uneventfully discharged after one week.Conclusion :DCM had been associated with thrombosis, stroke, and an increased risk of thromboembolism. Previous studies had documented decreased thromboembolic events due to administering anticoagulants.
Comparison of Clinical Outcomes of Patients With Chronic Vein Insufficiency Underwent Endovenous Laser Ablation With Puncture Above The Knee And Below The Knee Techniques Based on Venous Clinical Severity Score And Venous Disability Score Assessment Suprayoga, Imam Mi'raj; Kurnianingsih, Novi; Sargowo, Djanggan
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.2024.005.03.9

Abstract

Background: In chronic venous insufficiency (CVI), a puncture below the knee is done to access the great saphenous vein for endovenous laser ablation (EVLA). Getting a puncture below the knee is difficult in some conditions. Puncture above the knee to access the incompetent saphenous vein is another option. Objective: This study compared CVI patients' clinical results after EVLA with above- and below-the-knee punctures.Methods/Design: This retrospective, single-centre cohort study compared clinical outcomes after two EVLA technical punctures. Puncturing the GSV below the knee was one way. An above-knee GSV puncture was chosen as an alternative. At all follow-up visits, clinical outcomes, closure rate, and complications such as thrombosis, bruising, burn damage, and paresthesia were assessed.  Results: This study has recruited 248 patients, with 132 patients in the below-knee group and 116 patients in the above-knee group. Similar clinical outcomes after the procedure with the Venous Clinical Severity Score (VCSS) were seen in both groups (p = 0.875) and with the Venous Disability Score (VDS) were seen in both groups (p = 0.777) without significant difference. The closure rate in both groups was 100%. Complications, including thrombosis, did not show statistical significance between groups (p = 1.000). Bruising, burn injuries, and paresthesia were absent in both groups.Conclusion: The EVLA for incompetence GSV using an above-knee puncture was safe and effective and should be considered as an alternative method if the below-knee puncture fails.
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.
Tailoring Management of May-Thurner Syndrome : Case Comparison Suprapta, Aloysius Yuwono; Kurnianingsih, Novi; Elizabeth Damanik, Gracelia Ruth
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.2024.005.03.15

Abstract

BACKGROUND: May-Thurner syndrome (MTS) is a post-thrombosis syndrome (PTS) of the lower extremity. This disorder results from compression and/or irritation from adjacent crossing the right common iliac artery to the left iliac venous. In this report, we present two management comparisons of patients with left lower DVT with consideration of MTS.CASE ILLUSTRATION: A 49-year-old male soldier presented with chronic unilateral left leg edema and a mild clinical presentation for 9 months. Previous Doppler ultrasonography (DUS) revealed a thrombus in the left venous femoralis. Anticoagulant was given for six months. DUS and CT venography following anticoagulant treatment revealed a thrombus in the left venous femoralis. Venography revealed entire blockage of the left common femoral and left iliac veins, with adequate collateral flow. PTV was attempted twice and failed both times. The patient was following a conservative therapy (walking exercise and stocking compression) that yielded positive outcomes. A 53-year-old male soldier has had unilateral left leg edema for three years, which has increased during the previous three months with ulceration and active bleeding.Previous Doppler ultrasonography revealed a thrombus in the left iliac externa. Anticoagulants and compression stockings were given for eight months, but the symptoms persisted. CT and venography revealed a complete blockage from the left popliteal vein to the iliac vein. Femoral crossover bypass surgery yielded favorable results.CONCLUSION: Clinically moderate MTS demonstrated fair results with conservative treatment, whereas clinically severe MTS showed superior results with bypass surgery.
Carbon dioxide (CO2) as an alternative contrast agent in percutaneous transluminal angioplasty procedures for chronic limb-threatening ischemia patients with chronic kidney disease Vori, Ira; Kurnianingsih, Novi
Heart Science Journal Vol 5, No 4 (2024): The Current Perspective About Cardiometabolic Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2024.005.04.16

Abstract

Background: Chronic limb-threatening ischemia (CLTI) is a very morbid illness that significantly reduces quality of life. The severity of this disease may necessitate revascularization or amputation.Arteriography is frequently performed for the planning of revascularization. Patients with compromised kidney function need alternative contrast agents.CO2 may be utilized in lower extremity vascular diagnostics and intervention, especially in patients at risk for contrast-induced nephropathy (CIN).Case Illustration: An 80-year-old female with bilateral leg pain and leg swelling had an ulcer on her toe for 2 weeks. She had a history of intermittent claudication for 1 year, hypertension for 5 years, kidney stones for 2 years, and chronic kidney disease for 1 year. She underwent an ECG, laboratory, USG, DUS, and CT-angiography examination. From her laboratory result, her initial creatinine was 5.02 mg/dL (eGFR 8 mL/m/1.73 m2). After good hydration, it became 1.28 mg/dL (eGFR 39 mL/m/1.73 m2). After a CT-angiography procedure, her creatinine level was increased (3.7 mg/dL; eGFR 10.9 mL/m/1.73 m2). She was diagnosed with CLTI Rutherford V Fontain 3 left lower extremity. She suggested doing an angioplasty procedure with a safer contrast agent. An angioplasty procedure was done at RSSA Malang with CO2 contrast. After the procedure, her leg pain improved, and her creatinine didn’t elevate.Conclusion: CO2 angiography might be used as a safe alternative contrast medium in patients with CLTI, which benefits the preservation of renal function and prevents limb amputations.
Diagnostic Test for Estimation of Plasma Volume on Assessment of Congestive Status in Acute Heart Failure Patients at Saiful Anwar General Hospital Pamuna, Oktafin Srywati; Prasetya, Indra; Astiawati, Tri; Rohman, Mohammad Saifur; Kurnianingsih, Novi
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.2023.004.04.3

Abstract

BackgroundHeart failure is a severe health issue with high death and morbidity rates globally, including in Indonesia. Congestion is the main symptom of acute heart failure. B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-pro BNP) are well-known markers to confirm the condition. Plasma volume estimation (ePVS)is one of the procedures currently being developed to assess a patient's congestive status at a lower cost. MethodsThis is descriptive observational research with a cross-sectional study method that included all patients with acute heart failure between May 2019-February 2022. Baseline characteristics, medication history, and echocardiography were also included in the statistical analysis. We used univariate and multivariate analysis to assess the effect of each variable on the patient's congestive condition. A diagnostic test of plasma volume estimation was carried out using Receiver Operating Characteristics (ROC) Analysis compared to NT pro-BNP as the gold standard.   Results A total of 506 subjects were diagnosed with acute heart failure at Dr. Saiful Anwar Malang Hospital, who met the inclusion and exclusion criteria. The mean age was older in congestive patients with 62.5% being male. Patients with congestive conditions have a lower ejection fraction with a higher estimated right atrial pressure from echocardiography. The estimation plasma volume status was also higher in congestive conditions (6,90 vs 3,5). The ePVS from ROC analysis has a good diagnostic value with a sensitivity of 91, 7% and specificity of 92,6%. ConclusionThe estimation of plasma volume status has a good sensitivity and specificity value to assess congestive status in patients with acute heart failure who are fluid-overloaded. 
The Relationship Between Cha2ds2-Vasc Scores And The Degree of TIMI Flow in Patients With Acute St-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention at Dr. Saiful Anwar Malang Aji, Bayu; Widito, Sasmojo; Anjarwani, Setyasih; Kurnianingsih, Novi; Ruspiono, Evit
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.2024.005.02.10

Abstract

Background: Suboptimal reperfusion of the compromised myocardium in the area of the culprit coronary arteries is one of the main problems associated with primary PCI that need reliable risk stratification methods to accurately predict the occurrence of decreased TIMI flow given its complex pathophysiology. Some parameters are included CHA2DS2-VASc score.Objective: To understand the relationship between CHA2DS2-VASc and the decreased TIMI flow in STE-ACS patients who had underwent primary PCI at RSUD dr. Saiful Anwar Malang.Material and Methods: The study was cohort retrospective with the inclusion criteria being all STE-ACS patients who underwent primary PCI in RSUD Dr. Saiful Anwar Malang from January 2018 – August 2023. Patients were assigned to TIMI flow grade <3 group (N =169) and TIMI flow grade 3 (N = 677) according to TIMI Flow degree after primary PCI. All the patient’s angiogram were evaluated for TIMI score and CHA2DS2-VASc score is based on a guideline. We concluded data in SPSS program and used the Spearman test and p value of .05 was considered as significant.Result: From a total sample of 846 patients, the correlation between STE-ACS onset and TIMI flow indicates that a higher number of patients with STE-ACS onset <12 hours was found in the TIMI flow <3 and 3 groups (p=0.000). The cutoff CHA2DS2 VASC score's sensitivity and specificity values were ascertained using ROC analysis with cut off value 2.5. The incidence of decreased TIMI flow rate was more significant in the CHA2DS2-VASc ≥3 group with DM (+) and age ≥64 (OR value 0.156, p=0.000) than in the CHA2DS2-VASc ≥3 group without DM and age < 64. With an OR value of 2.94 (p=0.000), Killip class > 2 is another powerful predictor of lower TIMI flow.Conclusion: The only variables in the CHA2DS2-VASc score component that are most strongly associated with the risk of reducing the degree of TIMI flow are DM, age, and Killip class.
Compartment syndrome as reperfusion injury following thrombectomy in acute limb ischemia: A case report Afifuddin, Mokhammad; Kurnianingsih, Novi; Kurniawan, Dea
Deka in Medicine Vol. 1 No. 2 (2024): August 2024
Publisher : PT. DEKA RESEARCH INSTITUTE

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69863/dim.2024.e209

Abstract

BACKGROUND: Compartment syndrome following reperfusion in acute limb ischemia represents a rare but serious complication. Thus, documenting such cases is essential to enhance comprehension and management of this condition. CASE PRESENTATION: A 51-year-old man was referred from an urban hospital presenting with severe right leg pain persisting for 5 days prior to admission, accompanied by pulselessness, paresthesia, poikilothermia, and paralysis. The patient had underlying risk factors including uncontrolled diabetes mellitus and active smoking. Duplex ultrasound confirmed the diagnosis of acute limb ischemia, which was further supported by CT angiography revealing total occlusion from the right common iliac artery to the distal region. Intravenous heparin was administered, and the patient underwent emergency surgical thrombectomy. Following the intervention, the patient developed clinical signs of compartment syndrome as a manifestation of reperfusion injury, necessitating fasciotomy. Subsequent evaluation of the wound post-fasciotomy indicated it was not suitable for closure, and unfortunately, the patient passed away a few days later. CONCLUSION: This case illustrates acute limb ischemia necessitating thrombectomy and surgical fasciotomy due to compartment syndrome resulting from reperfusion injury, emphasizing the importance of rigorous monitoring.
Co-Authors Abusari, Muchamad Afifuddin, Mokhammad AJI, BAYU Anjarwani, Setyasih Astiawati, Tri Cholid Tri Tjahjono Djanggan Sargowo Elizabeth Damanik, Gracelia Ruth Erickatulistiawan, Gallusena Firdaus, Achmad Jauhar Galih Prakosa, Ardani Indra Prasetya Kurniawan, Catur Rizky Kurniawan, Dea Kurniawan, Dea Arie Lestari, Defyna Dwi Martini, Heny Mohammad Saifur Rohman Niazta, Nisa Amnifolia Noverike, Nikhen Pamuna, Oktafin Srywati Rahimah, Anna Fuji Rizal, Ardian Ruspiono, Evit Satrijo, Budi Sekarsari, Calysta Citra Suprapta, Aloysius Yuwono Suprayoga, Imam Mi'raj Tjahjono, Cholid Veliawan, Zhafran Vori, Ira Widito, Sasmojo zunardi, Lutfi hafiz