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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.

The role of exercised-based cardiac rehabilitation in unrevascularized complex coronary artery disease patients: a case series Aryanugraha, Teguh; Tjahjono, Cholid Tri; Mayangsari, Veny; Satrijo, Budi; Anjarwani, Setyasih
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.2024.005.04.13

Background: Coronary artery disease (CAD) is a common type of heart disease that elevates the risk of morbidity and mortality significantly. Although revascularization techniques like coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are advised for CAD patients, some people may not be eligible for or choose not to undergo revascularization. Even though cardiac rehabilitation (CR) enhances cardiovascular outcomes, quality of life, and general well-being, the utilization of CR is still very low.Case illustration: The first patient was a 72-year-old man, and the second patient was a 60-year-old man. They were referred for CR after refusing revascularization, and both are left-main and three-vessel disease patients. The first patient underwent CR for six months and the second patient for 18 months, then the Six Minutes Walking Test (6MWT) and 36-Item Short Form Health Survey (SF-36) were performed before and following CR. The evaluation is an increase in walking distance and patient quality of life.Conclusion: By enhancing quality of life, exercised-based CR programs offer an approach to managing CAD, especially in those who may not be suitable candidates for or choose to avoid revascularization procedures.

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.

Optimizing Cardiac Rehabilitation for Patients with Complex Coronary Disease without Revascularization Afifuddin, Mokhammad; Tjahjono, Cholid Tri; Mayangsari, Veny
Clinical and Research Journal in Internal Medicine Vol. 6 No. 2 (2025): Volume 6 No 2, November 2025
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2025.006.02.10

Patients with complex coronary artery disease (CAD) ineligible for revascularization present considerable management challenges and a high ischemic burden. Cardiac rehabilitation (CR), a comprehensive, multidisciplinary intervention, emerges as an essential non-pharmacological therapy. This review synthesizes the principles of CR, focusing on its profound pathophysiological benefits in this specific cohort. Mechanistically, CR confers pleiotropic effects: it enhances endothelial function via the eNOS/NO pathway, mitigates systemic inflammation through myokine regulation, promotes coronary collateralization (HIF-1α/VEGF pathway), and restores autonomic balance (HRV). Furthermore, CR integrates essential psychosocial support to address the high prevalence of depression and anxiety, which are independent risk factors. A primary objective, the improvement of quality of life (QoL), is consistently achieved through reduced anginal symptoms and enhanced functional status. Despite robust clinical and economic evidence demonstrating CR's efficacy in reducing MACE, mortality, and healthcare utilization, significant barriers to referral and adherence persist. Vigilant supervision and protocol adaptations are mandated for high-risk anatomical subsets, such as those with chronic total occlusions or severe left ventricular dysfunction

Supervised cardiac rehabilitation in patients with severe left ventricular dysfunction : Case series on functional and structural improvements Pratiwi, Bunga Bella; Mayangsari, Veny
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.15

Background: Patients with coronary artery disease (CAD) frequently develop severe left ventricular (LV) dysfunction, which can lead to a worsening quality of life due to disease-related symptoms. Recently, cardiac rehabilitation (CR) has been recommended by international clinical guidelines to improve survival and functional recovery in these high-risk patients. Case Presentations: Two patients with CAD and heart failure with reduced ejection fraction (HFrEF) underwent supervised cardiac rehabilitation. First patient is a 43-year-old man with a left ventricular ejection fraction (LVEF) of 30% with risk factor as smoker and family history of heart disease, 6-minute walk test (6MWT) only 532 meters, VO2 max 19.94 mL/kg/min, and MET 5.69 has completed 89 sessions of cardiac rehabilitation (treadmill, calisthenics, and ergometer exercise). His 6MWT to 630 meters, VO₂ max improved to 22.58 mL/kg/min, and METs improved to 6.40. Before CR, the left ventricle (LV) was 7.5 cm long and had a biplane ejection fraction (EF) of 32%. After CR, structural improvements were found, increasing the LV length to 9.3 cm and the biplane EF to 58.4%. with improvements in execise capacity and symptoms. In Patient 2, a 50-year-old man with ST-elevation acute anterior myocardial syndrome (STEACS) (Killip I) with an LVEF of 20% with history of smoking and alcoholism, 6MWT 214 meters, VO2 mac 10.40 mL/kg/min, and MET 3.00 has completed 50 CR sessions ((treadmill, calisthenics, and ergometer exercise), demonstrating improvements in his 6MWT to 465 meters, VO₂ max to 17.93 mL/kg/min, and MET to 5.10. Echocardiography before CR found EF 20% and LV end-systolic volume index (LVESV) 20.7 ml and after eight months of rehabilitation showed improvement in EF to 47% and LVESV 53 ml with significant reduction in clinical symptoms. Conclusions: Supervised intensive cardiac rehabilitation resulted in functional and clinical improvements in high-risk CAD patients, including improved cardiac function in the context of heart failure. These findings demonstrate the important role of supervised rehabilitation programs in managing CAD patients with comorbid heart failure as the primary non-pharmacological management.

Cardiopulmonary exercise testing in heart failure and chronic coronary syndromes: From mechanistic diagnosis to CPET-guided management and prognosis in cardiac rehabilitation rakhmadhani, irzal; Mayangsari, Veny; Tri Tjahjono, Cholid
Heart Science Journal Vol. 7 No. 3 (2026): Predicting Restenosis in Coronary Artery Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.03.4

Cardiopulmonary exercise testing (CPET) provides an integrated physiological assessment to explain exercise intolerance at the individual-patient level. By integrating breath-by-breath gas exchange with ECG, blood pressure, and symptom monitoring during graded exertion, CPET helps differentiate impaired oxygen delivery (e.g., limited stroke volume augmentation, chronotropic limitation, or ischemia-limited reserve) from ventilatory inefficiency, pulmonary constraint, peripheral deconditioning, or mixed phenotypes—mechanistic information that is directly actionable in heart failure (HF) and chronic coronary syndromes (CCS). In HF, key CPET variables such as peak oxygen uptake (peak VO₂) and ventilatory efficiency consistently reflect clinical severity and are associated with outcomes, supporting decisions from optimization of guideline-directed medical therapy to advanced care planning in selected patients. In CCS, CPET is particularly useful when symptoms are disproportionate to resting findings, when conventional testing is inconclusive, or when microvascular dysfunction or vasospastic angina is suspected; CPET patterns can help refine the dominant mechanism and individualize cardiac rehabilitation intensity and symptom-limited training thresholds. This review proposes a pragmatic workflow aligned with routine practice: (1) mechanism-based interpretation using a compact CPET panel, (2) translation into management and rehabilitation prescriptions, and (3) prognosis and follow-up supported by serial reassessment. Tables 1–2 translate CPET outputs into practical interpretation and exercise-prescription steps, and Figures 1–2 provide worked visual examples of the trajectories discussed in the text.

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