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Strategi Manajemen Kardiomiopati Peripartum: Perkembangan Dalam Menghadapi Tantangan Kesehatan Maternal Setyowati, Danti Utami; Mayangsari, Veny; Tjahjono, Cholid
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.03.3.7

Cardiomyopathies are uncommon, although they are significant contributors to serious cardiovascular problems during pregnancy. Prior to pregnancy, it is crucial to have a thorough understanding of the potential dangers linked to cardiomyopathies and how to effectively treat them in pregnant women with significant pre-existing diseases. This knowledge is essential for providing appropriate guidance to patients. Given that all interventions relate to both the mother and the fetus, it is crucial to focus on providing the most efficient care for both. Maternal illness complicates pregnancy in approximately 1-4% of instances. There is a lack of comprehensive data on the frequency and occurrence of heart disease connected to pregnancy in most regions of the world including peripartum cardiomyopathy (PPCM) which was the predominant causes of maternal mortality in the UK in the mid of 2000’s. PPCM may result in persistent systolic dysfunction over an extended period of time. Although heart disease is a prominent, if not the primary, cause of death among pregnant or postpartum women across the country. PPCM is frequently misdiagnosed as a result of insufficient awareness among both medical professionals and the general public. The absence of an early and precise diagnosis of this ailment can have life-threatening implications for women affected by PPCM. Patients who had an early diagnosis saw a more expedited recovery compared to patients who received a late diagnosis. Improving the early monitoring, detection and diagnosis is linked to better recovery.

Pivotal Decision for Acute Coronary Syndrome Patient with Left Main Coronary Artery Disease, When to Choose PCI over CABG Setyowati, Danti Utami; Rohman, Mohammad Saifur; Prasetya, Indra
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.2024.005.03.12

Background: Surgery is acceptable as a standard treatment of Left Main Coronary Artery (LMCA) Disease in a stable angina condition. But, in Acute Coronary Syndrome (ACS) setting, LMCA intervention is a still clinical challenge in many cardiac centers. Percutaneous coronary intervention (PCI) has emerged as a suitable alternative to coronary artery bypass grafting (CABG) for high-risk complex coronary artery disease (CAD) scenario. This study aimed to outline the management of NSTEMI patient include LMCA disease. Case Report: A 72-year-old male presented with persistent chest pain, with a confirmed NSTEMI. A coronary angiography was done and revealed Three Vessel Disease (TVD) and Left Main (LM) CAD with highly calcified stenosis in the distal LM and Left Anterior Descending (LAD). An early invasive procedure was successfully performed for severely calcified LAD artery and distal LM lesions, using proper selection of several bail-out pre-dilatation difficult attempts such as scoring ballon and rotational atherectomy (RA). We observed the aftercare period, which showed no subsequent ACS events. Conclusion: Managing ACS patients requires careful consideration and risk assessment before deciding on revascularization procedures, especially in high-risk case such as LMCA disease. PCI can be an effective treatment strategy for this population but require good consideration of patientâ€™s anatomical factors, comorbidities, the availability of appropriate skill and equipment.

A follow-up approach to manage tachyarrhythmia and bradyarrhythmia in Ebstein’s anomaly patient Setyowati, Danti Utami; Ardian Rizal
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.2025.006.01.17

Background: Ebstein’s Anomaly (EA) is a rare heart defect that can cause a number of problems, including arrhythmias. They exhibit a greater rate of recurrence compared to those with normal hearts. High-definition (HD) mapping and three-dimensional (3D) ablation are new techniques that may be suboptimal, attributed to anatomical characteristics. The management tactics employed may necessitate modification in accordance with personal traits. Case Report: A 37-year-old male presented with intermittent palpitations over years. The electrocardiogram (ECG) is changing overtime such as supraventricular tachycardia (SVT), ventricular tachycardia (VT) and atrial fibrillation (AF). Echocardiography shown typical features of EA. During ablation, multiple atrial tachycardias were induced. Throughout the observation period, the patient exhibited complications related to several arrhythmia recurrence. In the end he suffered from total atrioventricular block (TAVB), leading to the decision to undergo a permanent pacemaker procedure. We postulated that specific characteristics of the right atrioventricular groove structure observed in pathological samples of EA could explain less than ideal results in ablation procedures. Conclusion: Managing arrhythmia in EA could be challenging. A prominent ridge alongside the lower atrioventricular groove is a typical characteristic in EA, and is associated with the clinical background of accessory pathways (AP). Understanding this anatomical aspect is important for electrophysiologists who work with this group of patients, since their management approaches may need to be adjusted.

The effectiveness of supervised exercise training regarding NT-pro BNP level as a prognostic value among patients with congenital heart disease-related to pulmonary hypertension Setyowati, Danti Utami; Martini, Heny; Prasetya, Indra
Heart Science Journal Vol. 6 No. 4 (2025): The Pursuit of Precision: Navigating Risks, Refining Diagnosis, and Securing Lo
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.04.5

Congenital heart disease-related to pulmonary hypertension (CHD-PH) constitutes a significant subset of related Pulmonary Hypertension (PH), representing around 11% of all PH patients. Considering the emergence of novel medicines and enhanced patient outcomes in PH, it continues to be a life-shortening condition, and the time frame before diagnosis has not altered. Current strategies to enhance outcomes emphasize on early diagnosis and a treatment methodology designed to put individuals with PH into a low-risk category for one-year mortality. The N-terminal prohormone of BNP (NT-pro BNP) is secreted by cardiomyocytes in reaction to mechanical strain and wall stress. An increased concentration of NT-pro BNP is included in some PH risk stratification methods and screening protocols. The initial recommendation to restrict physical exertion in individuals with PH was based on its adverse impact on their clinical status. But clinicians have recently concentrated on the significance of physical exercise in those with PH. Consistent physical activity can enhance functional capacity, elevate quality of life (QoL), and increase prognosis and life expectancy as well. This literature review seeks to consolidate research about the impact of physical activity on NT-ProBNP levels in individuals with CHD-PH.

Impact of supervised physical activity as adjunctive therapy on functional capacity and NT-pro BNP in patients with negative-reactivity test pulmonary hypertension related to congenital heart disease patient in Saiful Anwar Hospital Malang : A preliminary study Setyowati, Danti Utami; Martini, Heny; Prasetya, Indra; Tjahjono, Cholid Tri; Yogibuana, Valerinna
Heart Science Journal Vol. 6 No. 4 (2025): The Pursuit of Precision: Navigating Risks, Refining Diagnosis, and Securing Lo
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.04.10

Background: Appropriate levels of physical activity (PhA) provide health benefits to patients with chronic diseases, including patients with pulmonary hypertension-related to congenital heart disease (CHD-PH), representing around 4-10% of all PH patients. Objective: The purpose of this analysis was to determine the benefits and effectiveness of PhA as an additional therapy to optimal medication vs. control group on the functional capacity and N-terminal prohormone of B-type natriuretic peptide (NT-pro BNP) in patients with inoperable CHD-PH. Methods: A clinical preliminary study was conducted with 26 consecutive patients in stable condition before the study. Each patient was educated about the benefits of PhA and efficacy parameters of the six-minute walking distance (6MWD) and NT-Pro BNP levels have been evaluated at baseline and after 12 weeks. Results: The study included participants aged 33 ± 11 years, 84% of whom were female. All patients tolerated PhA without severe adverse events. Patients significantly improved the mean 6MWD compared to baseline by 382.9 ± 64.7 (p=0,000) and 318.3 ± 74 (p=0,041) meters after 12 weeks (training vs. control group). Ln NT-pro BNP improved significantly in the training group (p=0,002). There were no differences at week 12 in the delta 6MWD and NT-pro BNP levels, with all P values >0,05. Likewise, there is no correlation between the two variables Conclusions: PhA as an add-on to medical therapy may enhance work capacity and other prognostic relevant parameters in patients with inoperable CHD-PH. However, further larger, multi-center randomized controlled trials, is warranted to validate these preliminary findings

Strategi Manajemen Kardiomiopati Peripartum: Perkembangan Dalam Menghadapi Tantangan Kesehatan Maternal Setyowati, Danti Utami; Mayangsari, Veny; Tjahjono, Cholid
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.03.3.7

Cardiomyopathies are uncommon, although they are significant contributors to serious cardiovascular problems during pregnancy. Prior to pregnancy, it is crucial to have a thorough understanding of the potential dangers linked to cardiomyopathies and how to effectively treat them in pregnant women with significant pre-existing diseases. This knowledge is essential for providing appropriate guidance to patients. Given that all interventions relate to both the mother and the fetus, it is crucial to focus on providing the most efficient care for both. Maternal illness complicates pregnancy in approximately 1-4% of instances. There is a lack of comprehensive data on the frequency and occurrence of heart disease connected to pregnancy in most regions of the world including peripartum cardiomyopathy (PPCM) which was the predominant causes of maternal mortality in the UK in the mid of 2000’s. PPCM may result in persistent systolic dysfunction over an extended period of time. Although heart disease is a prominent, if not the primary, cause of death among pregnant or postpartum women across the country. PPCM is frequently misdiagnosed as a result of insufficient awareness among both medical professionals and the general public. The absence of an early and precise diagnosis of this ailment can have life-threatening implications for women affected by PPCM. Patients who had an early diagnosis saw a more expedited recovery compared to patients who received a late diagnosis. Improving the early monitoring, detection and diagnosis is linked to better recovery.

A follow-up approach to manage tachyarrhythmia and bradyarrhythmia in Ebstein’s anomaly patient Setyowati, Danti Utami; Ardian Rizal
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.2025.006.01.17

Background: Ebstein’s Anomaly (EA) is a rare heart defect that can cause a number of problems, including arrhythmias. They exhibit a greater rate of recurrence compared to those with normal hearts. High-definition (HD) mapping and three-dimensional (3D) ablation are new techniques that may be suboptimal, attributed to anatomical characteristics. The management tactics employed may necessitate modification in accordance with personal traits. Case Report: A 37-year-old male presented with intermittent palpitations over years. The electrocardiogram (ECG) is changing overtime such as supraventricular tachycardia (SVT), ventricular tachycardia (VT) and atrial fibrillation (AF). Echocardiography shown typical features of EA. During ablation, multiple atrial tachycardias were induced. Throughout the observation period, the patient exhibited complications related to several arrhythmia recurrence. In the end he suffered from total atrioventricular block (TAVB), leading to the decision to undergo a permanent pacemaker procedure. We postulated that specific characteristics of the right atrioventricular groove structure observed in pathological samples of EA could explain less than ideal results in ablation procedures. Conclusion: Managing arrhythmia in EA could be challenging. A prominent ridge alongside the lower atrioventricular groove is a typical characteristic in EA, and is associated with the clinical background of accessory pathways (AP). Understanding this anatomical aspect is important for electrophysiologists who work with this group of patients, since their management approaches may need to be adjusted.

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