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All Journal Heart Science Journal
Galuh, Lukitasari Ayu
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Health Professions Immunology & microbiology Medicine & Pharmacology

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Clinical Features and Multimodality Diagnostic Tools of Pulmonary Hypertension Galuh, Lukitasari Ayu; Rahimah, Anna Fuji; Martini, Heny; Rizal, Ardian
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.2024.005.02.4

Abstract

Pulmonary hypertension (PH) is characterized by an increase in mean pulmonary artery pressure (mPAP) above normal, which is > 20 mmHg and an increase in pulmonary vascular resistance (pulmonary vascular resistance / PVR) above normal, in resting conditions.The pathophysiology of PH involves remodeling of the pulmonary vessels, from the main pulmonary arteries, lobar arteries, segmental arteries, distal arteries, pulmonary arterioles, capillaries to the postcapillary pulmonary veins. In general, the epidemiological figures for PH are not known with certainty. The UK reported a PH prevalence of 97 cases/1,000,000 population with a female:male ratio of 1.8. The diagnostic approach to PH is mainly focused on two things. The primary goal is to raise the initial suspicion of PH and ensure fast-track referral to a PH center in patients with a high probability of PAH, CTEPH, or other forms of severe PH. The second aim is to identify the underlying disease, particularly left heart disease (Group 2 PH) and lung disease (Group 3 PH), as well as comorbidities, to ensure appropriate classification, risk assessment, and treatment. The Gold Standard diagnosis and classification of pulmonary hypertension is by examining the right heart catheterization (RHC). Clinical scoring in the form of shortness of breath without any obvious cause accompanied by physical examination, ECG and Thorax X-ray images which depict an enlarged right heart have good sensitivity and specificity for the diagnosis of pulmonary hypertension in patients with congenital heart disease. A high right ventricular pressure, mean PAP, and BNP values during observation, as well as heart size on chest X-ray can be predictors of a poorer prognosis in this population.
Cardiac imaging in cardiovascular complications due to COVID-19 Galuh, Lukitasari Ayu; Sargowo, Djanggan; Satrijo, Budi; Handari, Saskia Dyah; Rahimah, Anna Fuji
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.2024.005.04.6

Abstract

Cardiovascular complications are a common manifestation of acute phase and chronic phase of coronavirus disease 2019 (COVID-19) infection. Complications include cardiomyopathy, myocardial infarction, arrhythmias, heart failure, and deep venous thrombosis. Imaging is widely used in patients with suspected myocardial injury or myocarditis. Because of its availability and portability, transthoracic echocardiography (TTE) is used as the initial imaging modality in patients with suspected COVID-19 myocarditis. Echocardiographic studies performed on patients with suspected or confirmed COVID-19 should be as focused as necessary to obtain diagnostic views but should also be comprehensive enough to avoid the need to return for additional images. Following COVID-19 infection, a variety of persistent respiratory, neurological, cardiovascular, and other symptoms can persist for weeks, months, or even years. A cardiac examination and any resulting abnormalities in the structure and function of the heart may occasionally last for several months following a COVID-19 diagnosis. This is referred to as long  COVID syndrome. Cardiac magnetic resonance (CMR) imaging has often been used clinically to complement echocardiography, particularly tissue characterization imaging which demonstrated subclinical myocardial edema with or without fibrosis in patients recovered from illness.
How to Recognize and Overcome Pulmonary Hypertension Crisis During Patent Ductus Arteriosus Closure by Device in Adult Galuh, Lukitasari Ayu; Martini, Heny
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.2024.005.02.11

Abstract

BACKGROUND: Managing a patent ductus arteriosus (PDA) with severe pulmonary hypertension (PH) is challenging since closing the PDA can result in reduced cardiac output and right ventricular (RV) failure. The latest guideline for Adult Congenital Heart Disease (ACHD) stated it is harmful to close the defect in patients with pulmonary vascular resistance (PVR) ≤5 WU and flow ratio (FR) <1.5.  CASE ILLUSTRATION: A 37-year-old female was referred with cough, fever, low saturation, and murmur findings. After serial examination, she was diagnosed with large PDA and severe PH her peripheral saturation (SaO2) was 88%-89% and non-responder to acute vasoreactivity test. After a year of PH therapy, vasoreactivity showed a response to the vasoreactivity test and improved on clinical presentation with SaO2 91%-92%. Patient fell in to PH crisis condition during the procedure of device closure, prostacyclin analogue intravenous (IV) and phosphodiesterase inhibitors inhalation was administered, and the procedure was carried on. The device was successfully implanted, and the patient had SaO2 97% in all four extremities before discharge.CONCLUSION: With established PH therapy, PDA with severe PH can underwent PDA closure by device with satisfying outcome. 
Scoring system for early detection in pulmonary hypertension type I based on clinical presentation, electrocardiography, and chest X-ray at RSUD dr. Saiful Anwar Galuh, Lukitasari Ayu; Martini, Heny; Rahimah, Anna Fuji
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.2024.005.04.12

Abstract

Background: In Indonesia, pulmonary hypertension prevalence is 1:10.000 population. Due to its atypical symptoms, often PH patients come as a late presenters thus they have a worse prognosis. The golden standard to diagnose is Right Heart Catheterization (RHC) which is not widely available.Objectives: To generate a scoring system based on clinical presentation, electrocardiogram, and chest x-ray for early detection.Methods: A hospital-based cross-sectional survey was conducted in RSUD dr. Saiful Anwar, East Java from July 2020 – November 2023 with data from the medical record in which all variables are obtained at one period. Data were analyzed using bivariate analysis, multiple logistic regression, and Area Under Curve (AUC) from Receiver Operating Characteristic (ROC).Results: A total of 244 patients who were above 18 years old were conducted RHC at RSUD dr. Saiful Anwar East Java. We found a total score of 12 consisting of Dyspnea on Effort (DOE) score 2, Palpitation score 1, Increasaed P2 score 2, Increased JVP (Jugular vein pressure) score 2, RV (Right Ventricular) Heaves score 2, Right bundle branch block (RBBB) score 1, and Cardiomegaly (CTR >50%) score 2. With a 2 x 2 table, we found that a score of ⩾5 is likely for pulmonary hypertension diagnosis.Conclusion: Our study is a predictive model with a scoring system that has good sensitivity and specificity in selected populations where one of its limitations is sampling bias thus cannot yet be applied to the general population and needs further research for validation.
Co-Authors Djanggan Sargowo Martini, Heny Rahimah, Anna Fuji Rizal, Ardian Saskia Dyah Handari Satrijo, Budi