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A CHILD WITH TETRALOGY OF FALLOT PRESENTING WITH COMPLICATIONS OF INFECTIVE ENDOCARDITIS, CEREBRAL ABSCESS, AND UNDERNUTRITION Yasmin, AA Ayu Dwi Adelia; Gunawijaya, Eka
Medicina Vol 46 No 1 (2015): Januari 2015
Publisher : Medicina

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (236.99 KB)

Tetralogy of Fallot (TOF) is a congenital heart disease that consists of four anatomical anomalies,namely ventricular septal defect, pulmonary stenosis or obstruction of the right ventricular outflowtract, right ventricular hypertrophy, and overriding aorta. Tetralogy of Fallot is frequently associatedwith complications that could affect morbidity and mortality because of its complex cardiac lesions.Good understanding of the natural history and complications of this disease is very important to guidethe management of patients. We reported a 4-year old girl with classic TOF with complications ofinfective endocarditis, cerebral abscess, and undernutrition. Despite optimal medical therapy, thepatient?s condition showed no satisfying improvement. Since the parents were refused to take moreaggressive measure by undergoing surgical therapy, so that patient care remains focused on supportiveand palliative aspects. [MEDICINA 2015;46:37-41].Tetralogy of Fallot (TOF) merupakan suatu penyakit jantung kongenital yang terdiri dari empat anomalianatomis, antara lain ventricular septal defect, pulmonary stenosis atau obstruksi pada right ventricleoutflow tract, hipertrofi ventrikel kanan, dan overriding aorta. Tetralogy of Fallot sering disertai denganberbagai komplikasi yang dapat mempengaruhi morbiditas dan mortalitas karena kelainan inimerupakan kelainan kongenital kardiak yang kompleks. Pemahaman yang baik mengenai perjalananalamiah dan komplikasi penyakit ini sangat penting untuk mengetahui penatalaksanaan pasien.Kami melaporkan seorang anak perempuan berusia 4 tahun dengan TOF klasik yang juga menderitakomplikasi endocarditis infektif, abses serebral, dan gizi kurang. Walaupun telah memperoleh terapimedikamentosa yang optimal, kondisi pasien tidak menunjukkan perbaikan yang memuaskan.Orangtua pasien telah menolak pemberian tindakan yang lebih agresif, yaitu dengan terapipembedahan, oleh karena itu penatalaksanaan pasien lebih difokuskan pada aspek suportif danpaliatif. [MEDICINA 2015;46:37-41].

DISLIPIDEMIA SEBAGAI PREDIKTOR KEJADIAN KARDIOVASKULAR MAYOR PADA PASIEN INFARK MIOKARD AKUT Gek Marlathasia Aswania; A.A. Ayu Dwi Adelia Yasmin
E-Jurnal Medika Udayana Vol 9 No 11 (2020): Vol 9 No 11(2020): E-Jurnal Medika Udayana
Publisher : Universitas Udayana

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24843/MU.2020.V09.i11.P15

ABSTRAK Pasien dengan Infark Miokard Akut (IMA) memiliki angka morbiditas dan mortalitas tinggi yang disebabkan oleh komplikasi dari IMA yaitu kejadian kardiovaskular mayor (KKM), meliputi syok kardiogenik, gangguan irama jantung, dan kematian akibat IMA. Sebagian besar morbiditas dan mortalitas yang disebabkan oleh komplikasi IMA merupakan akibat dari perubahan patofisiologi yang terjadi pada kondisi IMA, salah satunya akibat faktor dislipidemia. Penelitian ini merupakan penelitian observasional dengan rancangan kohort retrospektif. Sebanyak 70 sampel pasien IMA yang dirawat di UGD dan ruang perawatan RSUP Sanglah diambil secara systematic random sampling selama periode Agustus-Oktober 2018. Penderita IMA dikelompokkan menjadi 2 kelompok yaitu kelompok penderita IMA dengan dislipidemia dan kelompok penderita IMA non-dislipidemia. Kemudian dilakukan pengamatan selama pasien dirawat di rumah sakit. Luaran yang dimonitor adalah KKM. Penelitian ini menghasilkan Hazard Ratio (HR) dan kurva survival dari faktor prognostik tersebut terhadap KKM. Pengaruh dislipidemia terhadap KKM pada pasien IMA dilihat dengan nilai HR yaitu sebesar 5,4 (IK 95% 1,86-15,63, p = 0,002). Analisis multivariat menggunakan cox regression menunjukkan bahwa dislipidemia terbukti sebagai prediktor independen terjadinya KKM pada pasien IMA dengan nilai HR sebesar 4,67 dan nilai p=0,003. Kesimpulan dari penelitian ini adalah dislipidemia merupakan prediktor kejadian KKM pada pasien IMA saat perawatan di rumah sakit. Kata kunci: Dislipidemia, infark miokard akut, kejadian kardiovaskular mayor.

Factors Affecting Chronic Heart Failure in Patients with End-Stage Renal Disease at Bhayangkara Hospital Denpasar Ni Gusti Ayu Putu Lestari Santika Dewi; A. A. Ayu Dwi Adelia Yasmin; Ni Made Citra Riesti Wulan; I Gede Catur Wira Natanagara
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 7 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i7.545

Background: Patients with end-stage renal disease (ESRD) have a twofold risk of developing heart failure. A number of factors in ESRD patients are related to chronic heart failure (CHF). The intervention of cardiovascular risk factors in the early stages of chronic kidney disease (CKD) can reduce mortality from heart disease and slow the severity of kidney deterioration. This study aims to examine the factors that affect CHF in patients with ESRD. Methods: This study was a cross-sectional analytic observational study of 49 patients with ESRD based on consecutive sampling. The data collected were primary and secondary data on ESRD patients at the Cardiac Polyclinic, Internal Medicine Polyclinic, and the Medical Records Unit Bhayangkara Hospital Denpasar. Results: In this study, it was found that most patients were in the age group ≥40 years (92%) and male gender (63%). From the chi-square test analysis, it was found that the factors affecting CHF in patients with ESRD are hypertension (HT) (p-value < 0.001) with prevalence ratio (PR) 11.19 (1.69-73.92), type 2 diabetes mellitus (T2DM) (p-value = 0.008) with PR 1.72 (1.18-2.51), obesity (p-value < 0.001) with PR 6.67 (2.34-18.92), and smoking (p-value = 0.027) with PR 1.6 (1.02-2.49). Conclusion: It can be concluded that the factors affecting CHF in patients with ESRD are HT, T2DM, obesity, and smoking. The results of this study are expected to be used as an illustration so that in the future, prevention can be made for factors affecting CHF in ESRD patients.

Factors Affecting Chronic Heart Failure in Patients with End-Stage Renal Disease at Bhayangkara Hospital Denpasar Ni Gusti Ayu Putu Lestari Santika Dewi; A. A. Ayu Dwi Adelia Yasmin; Ni Made Citra Riesti Wulan; I Gede Catur Wira Natanagara
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 6 No. 7 (2022): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v6i7.545

Background: Patients with end-stage renal disease (ESRD) have a twofold risk of developing heart failure. A number of factors in ESRD patients are related to chronic heart failure (CHF). The intervention of cardiovascular risk factors in the early stages of chronic kidney disease (CKD) can reduce mortality from heart disease and slow the severity of kidney deterioration. This study aims to examine the factors that affect CHF in patients with ESRD. Methods: This study was a cross-sectional analytic observational study of 49 patients with ESRD based on consecutive sampling. The data collected were primary and secondary data on ESRD patients at the Cardiac Polyclinic, Internal Medicine Polyclinic, and the Medical Records Unit Bhayangkara Hospital Denpasar. Results: In this study, it was found that most patients were in the age group ≥40 years (92%) and male gender (63%). From the chi-square test analysis, it was found that the factors affecting CHF in patients with ESRD are hypertension (HT) (p-value < 0.001) with prevalence ratio (PR) 11.19 (1.69-73.92), type 2 diabetes mellitus (T2DM) (p-value = 0.008) with PR 1.72 (1.18-2.51), obesity (p-value < 0.001) with PR 6.67 (2.34-18.92), and smoking (p-value = 0.027) with PR 1.6 (1.02-2.49). Conclusion: It can be concluded that the factors affecting CHF in patients with ESRD are HT, T2DM, obesity, and smoking. The results of this study are expected to be used as an illustration so that in the future, prevention can be made for factors affecting CHF in ESRD patients.

Hipertensi sebagai prediktor kejadian kardiovaskular mayor pada pasien infark miokard akut pada tahun 2018 di RSUP Sanglah Denpasar, Bali-Indonesia A A Ayu Kaivalya Kirthi; A. A. Ayu Dwi Adelia Yasmin; I Made Junior Rina Artha; Agha Bhargah
Intisari Sains Medis Vol. 10 No. 3 (2019): (Available online: 1 December 2019)
Publisher : DiscoverSys Inc.

Introduction: Acute Myocardial Infarction (AMI) is a leading cause of morbidity and mortality in developed countries, as well as emerged as a very important health problem in developing countries. Despite of management and treatment of AMI strategies has been evolving. Complications due to AMI cause high morbidity and mortality. To minimalize complications in AMI patients need some risk stratification. Risk stratification have been made based on AMI pathophysiology. Hypertension is a factor that directly influences the development of atherosclerosis through mechanical stress.Method: This study was a retrospective cohort observational study that enrolled 70 patients with AMI as the subject of research by consecutive sampling from January 2018 â€“ September 2018. Data retrieval is done by taking data from medical records of patients in the Sanglah General Hospital. Outcome observed was in-hospital MACE (cardiovascular death, cardiogenic shock, heart failure, and malignant arrhythmias).Result: In this study, it was found that hypertension is a predictor of major cardiovascular events by almost 5-fold (HR = 5,02, 95% CI = 1,32-19,20, p = <0.018in patients with AMI that were treated at Sanglah General Hospital.Conclusion: The conclusion of this study is hypertension is a predictor of major cardiovascular events in patients with AMI on admission to hospital. The results of this study are expected to be used as baseline data for subsequent larger studies.

Gambaran karakteristik pasien in hospital cardiac arrest dan luaran pasca resusitasi jantung paru oleh tim code blue di RSUP Sanglah Made Satria Yudha Dewangga; Hendy Wirawan; Anak Agung Ayu Dwi Adelia Yasmin
Intisari Sains Medis Vol. 13 No. 1 (2022): (Available Online : 1 April 2022)
Publisher : DiscoverSys Inc.

Background: Cardiac arrest is a medical emergency due to the sudden cessation of the heart’s mechanical function. Cardiac arrest can be reversible with appropriate intervention, but otherwise, it can be fatal and result in death. The incidence of cardiac arrest in hospital or in-hospital cardiac arrest (IHCA) needs to be considered because it is associated with high mortality and describes an early detection system and hospital response speed. In this study, the authors examined the characteristics of the incidence of IHCA and cardiopulmonary resuscitation carried out by the code blue team at the Sanglah Central General Hospital (RSUP), including outcome trends and survival of IHCA patients after cardiopulmonary resuscitation.Methods: The authors analyzed the incidence of IHCA at Sanglah Hospital in 2021 in a retrospective cohort by tracing the patient’s medical records from January to December 2021. The sample was collected using a non-randomized consecutive sampling technique, then univariate analysis was performed to get an overview of the proportion and percentage distribution, as well as analysis. Bivariate method to determine the relationship between age group, comorbidities, response time of the code blue team, and the etiology of cardiac arrest on resuscitation outcomes.Results: In IHCA patients who were resuscitated at Sanglah Hospital, 26.2% had a successful return of spontaneous circulation (ROSC), with >50% of patients dying within <24 hours and only 1% returning home recovering. The majority of IHCA patients were men aged 40 years or older, with a Charlson Comorbidity Index (CCI) 3, with noncardiac causes. Most resuscitation was performed within 5 minutes of the sound of the code blue signal. There was no significant relationship between age group, CCI score, etiology of cardiac arrest, and response time of the code blue team with resuscitation outcomes.Conclusion: IHCA patients at Sanglah Hospital have a relatively low survival rate, but the code blue efforts have been going well. There were no significant differences in the outcome of ROSC and death based on age group variables, comorbidities, response time of the code blue team, and the etiology of cardiac arrest. Latar Belakang: Henti jantung adalah keadaan darurat medis akibat berhentinya fungsi mekanis jantung secara tiba-tiba. Henti jantung dapat bersifat reversible dengan intervensi yang tepat, namun sebaliknya dapat bersifat fatal dan mengakibatkan kematian. Kejadian henti jantung di dalam rumah sakit atau in hospital cardiac arrest (IHCA) perlu diperhatikan karena berkaitan dengan mortalitas yang tinggi serta menggambarkan sistem deteksi dini dan kecepatan respon rumah sakit. Pada penelitian ini, penulis meneliti gambaran karakteristik kejadian IHCA dan resusitasi jantung paru yang dilakukan oleh tim code blue di Rumah Sakit Umum Pusat (RSUP) Sanglah, termasuk tren luaran dan kesintasan pasien IHCA pasca resusitasi jantung paru.Metode: Penulis menganalisis kejadian IHCA di RSUP Sanglah pada tahun 2021 secara kohort retrospektif melalui penelusuran rekam medis pasien dari bulan Januari hingga Desember 2021. Sampel dikumpulkan dengan teknik non randomized consecutive sampling, kemudian dilakukan analisis univariat untuk mendapat gambaran proporsi dan distribusi persentase, serta analisis bivariat untuk mengetahui hubungan antara kelompok usia, komorbid, waktu respon tim code blue, dan etiologi henti jantung terhadap luaran resusitasi.Hasil: Pada pasien yang IHCA yang diresusitasi di RSUP Sanglah, 26,2% yang berhasil mengalami return of spontaneous circulation (ROSC), dengan >50% pasien meninggal dalam waktu <24 jam dan hanya 1% yang pulang dalam kondisi sembuh. Mayoritas pasien IHCA adalah laki-laki usia 40 tahun atau lebih, dengan Charlson Comorbidity Index (CCI) ?3, dengan penyebab nonkardiak. Sebagian besar resusitasi sudah dilakukan dalam waktu 5 menit setelah dibunyikannya tanda code blue. Tidak terdapat hubungan yang signifikan antara kelompok usia, skor CCI, etiologi henti jantung, serta waktu respon tim code blue dengan luaran resusitasi.Simpulan: Pasien IHCA di RSUP Sanglah memiliki angka kesintasan yang relatif rendah, namun upaya code blue sudah berjalan dengan baik. Tidak ada perbedaan kejadian luaran ROSC maupun meninggal yang signifikan berdasarkan variabel kelompok usia, komorbid, waktu respon tim code blue, dan etiologi henti jantung.

Evaluation of Cardiometabolic Factors Affecting Chronotropic Incompetence: A Cross-Sectional Retrospective Study in Sanglah General Hospital, Bali Prana Jagannatha, Gusti Ngurah; Yasmin, AA Ayu Dwi Adelia; Surya Pradnyana, I Wayan Agus; Kamardi, Stanly; Wiryawan, I Nyoman; Wita, I Wayan
Jurnal Kardiologi Indonesia Vol 43 No 1 (2022): Indonesian Journal of Cardiology: January - March 2022
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1189

Background: Recent studies have identified that chronotropic incompetence is correlated with poor cardiometabolic health and systemic inflammation that results in exercise intolerance, impaired quality of life and death due to cardiovascular disease (CVD). Unfortunately, there’s still paucity of data regarding cardiometabolic factors associated with chronotropic incompetence. The purpose of this study was to identify the cardiometabolic factors associated with chronotropic incompetence. Methods: This study was a cross-sectional retrospective study using cardiac treadmill stress test data at Sanglah General Hospital from May 2018 - May 2020 and 136 patients were enrolled. Data analysis used SPSS version 21. Pearson chi-square test was used to compare categorical variables based on cardiometabolic risk factors in chronotropic incompetence. Results: Patients were divided based on the characteristics of age, gender, smoking status, body mass index, coronary artery disease, heart failure, hypertension, dyslipidemia, type 2 diabetes mellitus (T2DM), the levels of HbA1C, total cholesterol, LDL, HDL, and triglyceride. In this study, it was found that T2DM (PR 2.29; 95%CI 1.16–3.37), HbA1C (PR 3.13; 95%CI 2.31-4.22), dyslipidemia (PR 1.773; 95%CI 1.170–2.687), high total cholesterol (PR 2.396; 95%CI 1.650-3;481), and high LDL level (PR 1.853, 95%CI 1.229-2.794) were significantly associated with chronotropic incompetence (all p-value <0.05), while other factors were not significantly related. Conclusion: Chronotropic incompetence can impair quality of life and contribute to cardiovascular mortality. However, T2DM, high HbA1C, dyslipidemia, high total cholesterol and LDL levels were found to be associated with chronotropic incompetence. This may contribute to higher cardiovascular risk attributed to those factors.

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