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All Journal Acta Interna : The Journal of Internal Medicine Journal of the Medical Sciences (Berkala Ilmu Kedokteran) ACI (Acta Cardiologia Indonesiana) YARSI Medical Journal
Hariadi Hariawan
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Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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Ventricular Septal Defect Closure with Perforated Patch in Large Ventricular Septal Defect with Severe Pulmonary Hypertension and Non Reactive Oxygen Test Budi Yuli Setianto; Hariadi Hariawan; Rano Imawan
ACI (Acta Cardiologia Indonesiana) Vol 1, No 2 (2015)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.17813

Abstract

Management of ventricular septal defect (VSD) with severe pulmonary hypertension (PH) had not been extensively studied and is still challenging. The closure of VSD in patients with high pulmonary vascular resistance (PVR) and severe PH is highly risk procedure. If high PVR and severe PH still persist after closure procedure, the patients have poor prognosis. We reported a 24-year-oldwoman whom was diagnosed with large VSD, bidirectional shunt with L to R dominance, dilatation of left ventricle, and mild to moderate mitral regurgitation, mild tricuspid regurgitation and severe PH. Right heart catheterization showed pre-oxygen test: mean aorta pressure 85 mmHg, mean pulmonary artery pressure 65 mmHg, fl ow ratio 5,4, PVR 2,3 WU and pulmonary vascular resistance index (PVRI) 3,22 WU/m2. The results of post-oxygen test: mean aorta pressure 83 mmHg, mean pulmonary artery pressure 63 mmHg, fl ow Ratio 2,2, PVR 0,3 WU and PVRI 0,42 WU/m2. Patient had been performed VSD closure with perforated patch 3 mm. Three month evaluation by echocardiography showed residual VSD 3 mm, L to R shunt, moderate tricuspid regurgitation and mild PH (TVG 36 mmHg). In Baumgartner criteria of VSD operability, this patient was not operable because the ratio of mean pulmonary and systemic circulation more than 2/3, but in Lopez criteria, patient is operable because PVRI below 6 WU/m2. Patient with high and moderate PH and PVR which is still operable, VSD can be closed partially. Partially VSD closure can be performed by transcatheter procedure after PH decrease and stable.Keyword: VSD closure- perforated patch – PH severe
Correlation between Small Dense Low Density Lipoprotein Level with Major Adverse Cardiac Event in Acute Coronary Syndrome Patients Maria Debby Maharatno; Hariadi Hariawan; Budi Yuli Setianto
ACI (Acta Cardiologia Indonesiana) Vol 2, No 1 (2016)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.17817

Abstract

Background: Cardiovascular disease is one of major problems in developed and developing countries. Atherosclerosis process begins with endothelial dysfunction. Lipoprotein is important factor in atherogenesis. Previous study stated that about 50% of cardiovascular events happened in individuals with normal or low LDL, therefore LDL plasma level alone is not enough to identifyindividuals with major adverse cardiac events. Individuals with small dense LDL predominant have 3 times fold to have cardiovascular risk. The goal of this study is to know whether the level of sdLDL has impact on in hospital major adverse cardiac events (MACE) of acute coronary syndrome patients. Methods: This was a cross sectional study, enrolling patients with acute coronary syndrome admitted and hospitalized in ICCU of Dr.Sardjito Hospital since September of 2013 until June 2015. The small dense LDL (sdLDLD) level was measured with previous formula using routine blood lipid component. Major adverse cardiac events (MACE) were determined upon observation during horpitalisation and defi ned as death, reinfarction, cardiogenic shock, acute heart failure, ventricular tachycardia or ventricular fi brillation, prolonged angina pain, and the need for immediate coronary intervention. Results: There were 159 patients with mean age 60.80 ± 9.8 years involved in this study. Onehundred eighteen (118) or 73% of patients were male. The mean of sdLDL level in patients with MACE was 108.34 ± 37.94 g/dl and mean sdLDL level in patients without MACE was 105.54 ± 43.10 g/dl. The level of sdLDL in patients without MACE was lower than patients with MACE (p=0.705). In this study we found the cut- off sdLDL level is ≥ 108.085 for higher sdLDL level and < 108.085 for lower sdLDL level. The higher sdLDL level have the prevalence ratio of 1.25 to develop MACE, however the value was not statistically signifi cant.Conclusion: The sdLDL level did not correlate with MACE in hospitalised patients with acute coronary syndrome.Keywords: small dense LDL, acute coronary syndrome, MACE
Chronic Venous Insuffi ciency in a Woman with Standing Profession Mustika Mahbubi; Muhamad Taufik Ismail; Erika Maharani; Hariadi Hariawan
ACI (Acta Cardiologia Indonesiana) Vol 2, No 1 (2016)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.17821

Abstract

The prevalence of Chronic Venous Insufficiency (CVI) give a high social impact. InEurope, approximately 40% of the adult population affected by venous disorders. In general, the prevalence of CVI is about 5% - 15%. The prevalence is increasing by age.
Prediction of Failed Fibrinolytic Using Scoring System in ST Elevation Myocardial Infarction Patients Satria Mahendra; Budi Yuli Setianto; Hariadi Hariawan
ACI (Acta Cardiologia Indonesiana) Vol 2, No 2 (2016)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.22601

Abstract

Background: ST elevation myocardial infarction (STEMI) is the most common acute coronary syndrome in adults, and requiring immediate reperfusion. Primary percutaneous coronary intervention (PCI) is the main reperfusion therapy, but because of many limitations, fibrinolytic is often chosen. Fibrinolytic have high failure risk, so it is important to be able to predict whether this therapy will fail or not. This research aim to create a scoring system to predict failed fibrinolytic in STEMI patients. Methods: This is retrospective cohort study using medical records data from Dr. Sardjito General Hospital in Yogyakarta, recorded in June 2014-December 2015. The population was STEMI patients that reperfused with streptokinase regiment. Determination of failed fibrinolytic was using the difference in the ST segment elevation of the pre and post fibrinolytic electrocardiogram (ECG). The clinical variables of subjects were recorded. The statistical analysis was done and scoring system was constructed. Results: A total of 105 patients with mean age of 57.82±9.59 years were included in this study. Subjects with failed fibrinolytic was 53 patients (50.5%). Several variables were independently associated with failed fibrinolytis, i.e. the onset of ≥ 6 hours, hyperglycemia, and the location of anterior infarction (OR = 11.3, p = 0.000; OR = 6.11, p = 0.003 and OR = 10.5, p = 0.001, respectively). After scoring system was constructed, it was found that score ≥ 2 predict failed fibinolytic, with 53% sensitivity and 94% specificity. Conclusions : Scoring system consisting of onset ≥ 6 hours, hyperglycemia in arrival, and anterior infarct location, can be used to predict failed fibrinolytic in STEMI patients using streptokinase with 53% sensitivity and 94% specificity. Keywords: failed fibrinolytic scoring; fibrinolytic; STEMI; streptokinase
Association Between Mean Platelet Volume (MPV) with Major Adverse Cardiovascular Events in Acute Coronary Syndrome during Hospitalization Hasanah Mumpuni; Hariadi Hariawan; Lucia Kris Dinarti
ACI (Acta Cardiologia Indonesiana) Vol 2, No 2 (2016)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.22602

Abstract

Background: Platelets play a central role in the pathogenesis of acute coronary syndrome with various clinical manifestations of unstable angina pectoris, myocardial infarction with ST segment elevation, and myocardial infarction without ST segment elevation. Mean platelet volume (MPV), the average size of platelets in blood obtained from routine blood tests, reflects the activation of platelets. Previous study revealed that higher MPV showed a higher thrombotic potential, by increasing the platelet activation, secretion of tromboxan A2 and the expression of glycoprotein Ib and IIb/IIIa receptors. This study aims to determine whether the MPV may predict the major cardiovascular events in patients with acute coronary syndrome.Metode: We perform a retrospective cohort study involving 372 patients with acute coroanry syndrome who admitted to Intensive Cardiac Care Unit Dr. Sardjito Hospital Yogyakarta. The research is conducted between January 2009 to January 2011, comprising 180 (48.3%) STEMI patients, 87 (23.3%)NSTEMI patients and 105 (28.4%) unastable angina patients. Subjects are further grouped as those with high MPV and low MPV. MPV measurement is obtained on routine blood tests of those patients.The major adverse cardiovascular events are cardiovascular death, non fatal reinfarction, stroke, acute heart failure and cardiogenic shock.Result: Cut-off value of MPV in this study is 8.85 fL determined with ROC curve analysis. The major adverse cardiovascular events is significantly higher in those with MPV >8.85 fL compared with those with the MPV ≤8.85 fL (incidence: 28.4% vs. 18.9%, p = 0.034), with the relative risk (RR) 1.65, 95% CI 1.037-2.783. The mean MPV in patients with major adverse cardiovascular events was significantly higher as compared to those without major adverse cardiovascular events (9.506 ± 1.76 fl vs.8.96 ± 1.45 fl, p = 0.001).Conclusion: Mean platelet volume (MPV) are associated with major adverse cardiovascular events in acute coronary syndrome. The high MPV may be considered as a predictor of major cardiovascular events in patients with acute coronary syndrome.Keywords: acute coronary syndrome, mean platelet volume, major adverse cardiovascular events.
Bisoprolol Therapy and The Risk of Erectile Dysfunction in Stable Coronary Artery Disease Patients Firman Fauzan; Bambang Irawan; Hariadi Hariawan
ACI (Acta Cardiologia Indonesiana) Vol 2, No 2 (2016)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.22603

Abstract

Background :Bisoprolol is an anti angina and ischemic therapy in patient with stable coronary artery disease (CAD). Moreover it can decrease mortality and rehospitalization rate up to 34 % and 28 %. However it is also known to increase erectile dysfunction risk. Leydig cells has beta receptor which contribute in testosterone release. The blockade of beta receptor by bisoprolol can inhibit testosterone release and cause erectile dysfunction (ED) Method :This retrospective case control study was done by age matched paired method. Men with CAD as diagnosed by angiography were evaluated for ED. Erectile function was assessed by a 5-item version of the International Index of Erectile Function (IIEF-5). History of disease and medical record were evaluated to check history of bisoprolol therapy for the last 6 month. Depression was screened using Indonesian version of Hospital Anxiety and Depression Scale (HADS). Result : From 157 total subject, patients were divided into 105 patients in case group and 52 patients in control group. Ninety patients (85.7%) had history of bisoprolol therapy. The odd ratio of bisoprolol to have ED risk was 2, but there was not significant statistically (95% CI 0.85- 2.93; p= 0.262). From sub analysis result 5 mg bisoprolol therapy have significant statistic result to ED risk (OR 2.65, 95% CI 1.12-6.25; p=0.026). Diabetes was another confounding factor which have significant risk to ED from multivariate analysis result (OR 3.8, 95 % CI 1.65-8.88, p=0.002). Conclussion : Stable CAD patients with bisoprolol therapy have a higher risk of ED compare with stable CAD patient without bisoprolol, however it was not statistically significant.Keywords : Bisoprolol; erectile dysfunction; stable coronary artery disease
The Dynamic Electrocardiogram Pattern of T Wave Inversion Following ST Segment Elevation in Acute Coronary Syndrome with Non Significant Coronary Artery Disease Anggoro Budi Hartopo; Hariadi Hariawan; Nahar Taufiq
ACI (Acta Cardiologia Indonesiana) Vol 2, No 2 (2016)
Publisher : Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.22146/aci.22608

Abstract

ST segment elevation acute myocardial infarction (STEMI) is sometime indicated by typical electrocardiogram pattern, and rarely by atypical pattern. The definite diagnosis of STEMI is important to be determined rapidly and timely and becoming the key management success. The 12 lead electrocardiogram is the main diagnostic tool which should be completed and interpreted as soon as possible on patient admission. In the case, a female patient with anginal chest pain and initial ST segment elevation in electrocardiogram with non significant coronary artery disease. The subsequent electrocardiogram shows T wave inversion evolution pattern.Keywords: STEMI; T wave inversion; variant angina; evolution
Co-Authors Agus Siswanto Agus Siswanto Anggia Endah Satuti Anggoro Budi Hartopo Arief Wibawa Budi Yuli Setianto Diyantie Saputri Erdiansyah Zulyadaini Erika Maharani Firman Fauzan Ghozali, Ahmad Gusti Hariadi Maulana Hasanah Mumpuni Krisdinarti, Lucia Lucia Kris Dinarti Lucia Krisdinarti Maemonah, Maemonah Maria Debby Maharatno Marsetyawan HNE Soesatyo Maulana, Gusti Hariadi Muhamad Taufik Ismail Muhammad Munawar Mustika Mahbubi Nahar Taufiq Rano Imawan Ruchanihadi Ruchanihadi Satria Mahendra Wibawa, Arief