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Role of general practitioner in the management of acute myocardial infarction Beeleonie, Beeleonie; Kusmana, Dede
Medical Journal of Indonesia Vol 14, No 4 (2005): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Acute myocardial infarction (AMI) has been the leading cause of death in Western countries, as well as in Indonesia. Delay in diagnosis and incorrect early management often result in failure of thrombolytic reperfusion. General practitioner (GP) as the primary care, needs to be equipped with the ability to diagnose and moreover to manage AMI. A case of fail thrombolytic management in a 47 years old man after seven hours of angina typical chest pain, after previously managed by GP, is being reported. (Med J Indones 2005; 14:249-52)Keywords: acute myocardial infarction, reperfusion, general practitioner

QRS distortion increased risk re-occurrence acute coronary events Kasim, Manoefris; Sunanto, Sunanto; Sewianto, Albertus; Kusmana, Dede
Medical Journal of Indonesia Vol 16, No 4 (2007): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Nearly 50% of patients suffering inferior myocardial infarction will have complications or distinguishing features associated with an increased mortality. This study aimed to identify dominant risk factors related to re-occurrence of acute coronary events in patients with inferior myocardial infarction. This historical cohort included patients with inferior myocardial infarction who received fibrinolytic therapy at emergency department of National Cardiovascular Center Harapan Kita, Jakarta during 2001 to 2004 and was followed-up for two years. Patients with previous myocardial infarction, left bundle branch block, ventricular rhythm, and ventricular pacing were excluded. QRS distortion is ratio between J-point and R wave more than 50% at 2 or more inferior leads. Re-occurrence of acute coronary events is incident of myocardial infarction and unstable angina pectoris. Of 181 subjects with inferior AMI, there were 21 (11.6%) incidents of acute coronary event. Those who had positive than negative QRS distortion had almost three-fold increased risk for re-occurrence of acute coronary events [adjusted relative risk (RRa) 2.88; 95% confidence interval (CI) = 1.05 â 7.90]. In term of TIMI risk score, those with higher than lower risk score had 6.7 times higher risk to be re-occurrence of acute coronary events (RRa = 6.66; 95% CI = 1.94 â 22.92). However, those who had than did not have successful fibrinolysis had 57% lower risk to be re-occurrence of acute coronary event (RRa = 0.43; 95% CI = 0.18 â 1.05; P = 0.065). Re-occurrence acute coronary events were related to QRS distortion, TIMI risk score, and successful fibrinolysis. (Med J Indones 2007; 16:240-4) Keywords: QRS distortion, fibrinolysis, inferior myocardial infarction

The influence of smoking cessation, regular physical exercise and/or physical activity on survival: a 13 years cohort study of the Indonesian population in Jakarta Kusmana, Dede
Medical Journal of Indonesia Vol 11, No 4 (2002): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Preventing atherosclerosis with smoking cessation, regular physical exercise and/or physical activity known as SOK (S-top/ no S-moking, sp-O-rt/ physical exercise, wor-K/ physical activity) is a simple preventive measure, which can be applied in the community. To determine the role of SOK on survival, to create cardiovascular risk score for Indonesian patients and to have a special formula to predict survival. A historical cohort study over thirteen years recruited from the subpopulation MONICA patients who resided at three districts of South Jakarta. Patients were divided into two groups, those with SOK and those without (non-SOK group). Assessment included complete history including cardiovascular risk factors (hypertension, diabetic, hyperlipidemia, obesity), physical examination, laboratory examination, twelve-lead ECG recording and level of physical activity/exercise. Outcomes included survival rate and all-cause of mortality. Statistical analysis included kappa statistic and various survival analyses. 479 participants were included in the SOK study. Mean age 46 years (range 25-64), 56% female. Cardiovascular mortality rate (including stroke) was 1.2% per year and 42.9% of mortality caused by heart disease. Survival rate was higher in SOK group compared with non-SOK (95.7% vs 81.1%) with Hazard Ratio (HR) 0.2 for SOK group (95% CI 0.08-0.57, p=0.002) In relation to the cardiovascular mortality rate: 1) any physical activity/exercise (OK) vs no-OK will lower the risk; low-OK (HR 0.4, p=0.003), medium-OK (HR 0.32, p=0.004), high-OK (HR 0.000, p=0.000) 2) Smoking will increase the risk vs non-smoking (HR 4.99, p=0,000). For predicting the cardiovascular events in ten-year time (CV10), we formulated the Jakarta Cardiovascular Score. The score was divided into low-risk (-7-1) with CV10 <10%, average-risk (2-4) with CV10 = 10-20%, high-risk (score > 5) with CV10 >20%. Smoking cessation, regular physical exercise and/or physical activity is an effective method to reduce cardiovascular death, thus enhances the survival. We formulated a simple method to predict cardiovascular events in our community known as the Jakarta Cardiovascular Score. (Med J Indones 2002; 11: 230-41)Keywords: smoking, physical activity, survival, Jakarta cardiovascular score.

Electrophysiological characteristics and radiofrequency ablation of right atrial flutter Yuniadi, Yoga; Munawar, Muhammad; Rachman, Otte J.; Setianto, Budhi; Kusmana, Dede
Medical Journal of Indonesia Vol 16, No 3 (2007): July-September
Publisher : Faculty of Medicine Universitas Indonesia

This study aimed to elaborate the electrophysiology characteristics and radiofrequency ablation (RFA) results of atrial flutter (AFL) which has not been established in Indonesia. Three multipolar catheters were inserted percutaneously and positioned into coronary sinus (CS), His bundle area and around tricuspid annulus. Eight mm ablation catheter was used to make linear ablation at CTI of typical and reverse typical AFL. Bidirectional block was confirmed by conduction time prolongation of more than 90 msec from low lateral to CS ostium and vice versa, and/or by means of differential pacing. Thirty AFL from 27 patients comprised of 19 typical AFL, 5 reverse typical AFL and 6 atypical AFL enrolled the study. Mean tachycardia cycle length (TCL) were 261.8 Â± 42.84, 226.5 Â± 41.23, and 195.4 Â± 9.19 msec, respectively (p = 0.016). CTI conduction time occupied up to 60% of TCL with mean conduction time of 153.0 Â± 67.37 msec. CS activation distributed to three categories which comprised of proximal to distal, distal to proximal and fusion activation. Only nine of 27 patients had no structural heart disease. RFA of symptomatic typical and reverse typical AFL demonstrated 96% success and 4.5 % recurrence rate during 13 Â± 8 months follow up. Typical AFL is the predominant type of AFL in our population. The majority of AFL cases suffered from structural heart disease. RFA was highly effective to cure typical and reverse typical AFL. (Med J Indones 2007; 16:151-8) Keywords: atrial flutter, electrophysiology, ablation

The profile of physical activity and coronary risk factors in Monica Jakarta survey Kusmana, Dede
Medical Journal of Indonesia Vol 10, No 1 (2001): January-March
Publisher : Faculty of Medicine Universitas Indonesia

A population study was done to know the profile of daily physical activity including sports, and its influence on major coronary risk factors in three districts of Jakarta using questionnaire, physicaL and laboratory examination, and 12 leads ECC. The questionnaire gave the data about physical activity (work load and sport), and smoking habit. Work load was divided into light, moderate and heavy. Sport activity was divided into regular (â¥ twice a week, 20 minutes or more), irregular (â¤ once or occasional), and no sport activity. In addition, blood pressureÂ (hypertension was grouped according to WHO criteria), total cholesterol (regarded as hypercholesterolemia when > 200 mg%), and ECG were measured. ECG interpretation was done using Minnesota Code. Statistical analysis was done using SPSS. Out of 2400 people there wereÂ 2073(86.4%)Â respondents that consist of 1086 females and 987 males. The profile of physical activity as a whole showed 33.4% light, 50.7% moderate and 15.8% heavy activity. OnLy 22.5% of respondents had sport regularly, while 30.3% had sport irregularly, and 47.2% had no sport activity. The type of sport was walking (45.0%), callisthenic (22.0%) jogging/running (15.6%), badminton (6.5%), volley ball/soccer (4.1%), tennis (3.8%), and golf (0.1%). There was a significant difference in the prevalence of hypertension between people with heavy (12.0%), moderate (44.8%) and light work load (43.2%) (P<0.003), in the prevalence of hypercholesterolemia (13.2%: 50.8%: 36%) (P<0.0003), and smoking (19.7%; 44.1%: 36.2%) (P<0.00001), respectively. The difference also occurred in the prevalence of abnormal ECG (Q/QS, ST and TÂ abnormalities) between people having regular sport (19.0%), irregular (22.7%), and no sport activity (58.3% (P<0.05). The number of respondents having enough physical activity (including regular sport) was relatively low. Therefore, promotion should be done as a preventive method to overcome cardiovascular risk factors. (Med J Indones 2001; 10: 34-41)Keywords: Sport, ECG

High intensity interior aircraft noise increases the risk of high diastolic blood pressure in Indonesian Air Force pilots Siagian, Minarma; Basuki, Bastaman; Kusmana, Dede
Medical Journal of Indonesia Vol 18, No 4 (2009): October-December
Publisher : Faculty of Medicine Universitas Indonesia

Aim: To analyze the effects of aircraft noise, resting pulse rate, and other factors on the risk of high diastolic blood pressure (DBP) in Indonesian Air Force pilots.Methods: A nested case-control study was conducted using data extracted from annual medical check-ups indoctrination aerophysiologic training records at the Saryanto Aviation and Aerospace Health Institute (LAKESPRA) in Jakarta from January 2003 â September 2008. For analysis of DBP: the case group with DBP â¥ 90 mmHg were compared with contral group with DBP < 79 mmHG. One case matched to 12 controls.Results: Out of 567 pilots, 544 (95.9%) had complete medical records. For this analysis there were 40 cases of high DBP and 480 controls for DBP. Pilots exposed to aircraft noise 90-95 dB rather than 70-80 dB had a 2.7-fold increase for high DBP [adjusted odds ratio (ORa) = 2.70; 95% confi dence interval (CI ) = 1.05-6.97]. Pilots with resting pulse rates of â¥ 81/minute rather than â¤ 80/minute had a 2.7-fold increase for high DBP (ORa = 2.66; 95% CI = 1.26-5.61). In terms of total fl ight hours, pilots who had 1401-11125 hours rather than 147-1400 hours had a 3.2-fold increase for high DBP (ORa = 3.18; 95% CI = 1.01-10.03).Conclusion: High interior aircraft noise, high total flight hours,Â and high resting pulse rate, increased risk for high DBP. Self assessment of resting pulse rate can be used to control the risk of high DBP. (Med J Indones 2009; 276: 276-82)Keywords: diastolic blood pressure, aircraft noise, resting pulse rate, military pilots

Combine proper exercise and regular taking antihypertensive medicine was better to lower diastolic blood pressure among diastolic prehypertensive and hypertensive subjects Ilyas, Ermita I.; Basuki, Bastaman; Kusmana, Dede
Medical Journal of Indonesia Vol 19, No 3 (2010): August
Publisher : Faculty of Medicine Universitas Indonesia

Aim To prove that proper exercise and taking antihypertensive medicine may reduce diastolic blood pressure (DBP) by â¥ 5 mmHg.Method A quasi-experimentation study was done on employees of a government bureau in Jakarta, for 8 weeks from March to August 2008. All prehypertensive and hypertensive subjects were detected through a survey prior to the quasi-experimentation study. A talk was given at the beginning of the quasi-experimentation study, and weekly counseling sessions on exercise, taking medications, and other related topics continued for 8 weeks. Cox regression was used for calculating relative risk.Results A total 1,016 employees out of 1,300 were involved in this blood pressure survey. Of these, 318 subjects had a DBP of 80 mmHg or more. Out of 120 subjects who voluntarily participated, 104 subjects completed the quasi-experimentation study. Compared to those who did not exercise properly and did not take antihypertensive medicines, subjects who did exercise properly and took medicines regularly had a lower diastolic blood pressure DBP â¥ 5 mmHg by more than 12-fold [adjusted relative risk (RRa) = 12.32; 95% confidence interval (CI) = 0,65-234,54; P = 0.095. However subjects who exercised properly or took antyhypertensive medicines irregularly were found to lower their DBP â¥ 5 mmHg by almost 11 fold [adjusted relative risk (RRa) = 10.94; 95% confidence interval (CI) = 2.04-58.74]; P = 0.005. Subjects with DBP = 90-99mmHg had a decrease of DBP â¥ 5 mmHg 4.8 fold (RRa = 4.75; 95% CI = 1.19-18.65) compared to those with DBP = 80-89mmHg. Compared to the normal subjects, the obese, resting pulse rate bradycardia, and high average pulse pressure subjects had less probability of lowering DBP â¥ 5mmHg, by 87%, 90%, and 65%, respectively.Conclusion Combine proper exercise and taking antihypertensive medicine was reduce DBP by â¥5 mmHg among DBP (pre-) hypertensive subjects. The obese, bradycardia, or high pulse pressure subjects failed to lowering their DBP â¥5 mmHg by proper exercise and taking antihypertensive medicine. (Med J Indones 2009;19:191-8)Key words: decreased diastolic blood pressure, exercise, medicine intake

The effect of low dose acetylsalicylic acid on platelet aggregation in patients with coronary heart disease at rest and during physical exercise testing Roebiono, Poppy S; Kusmana, Dede; Sani, Aulia; Baraas, Faisal; Yusuf, Andang; Sedyawan, Jetty; Rilantono, Lily I
Medical Journal of Indonesia Vol 1, No 1 (1992): January-March
Publisher : Faculty of Medicine Universitas Indonesia

[no abstract available]

A novel echocardiography formula for calculating predicted pulmonary vascular resistance in patients with mitral stenosis Soesanto, Amiliana M.; Yuniadi, Yoga; Mansyur, Muchtaruddin; Kusmana, Dede
Medical Journal of Indonesia Vol 25, No 2 (2016): June
Publisher : Faculty of Medicine Universitas Indonesia

Background: Pulmonary vascular resistance (PVR) plays an important role in the natural history, prognosis, and outcome after valve intervention in patients with mitral stenosis (MS). The existing formula to estimate PVR by means of echocardiography is not readily applicable in the MS patient subset because it does not specifically calculate the risk of PVR in MS. The aim of this study was to find a new echocardiography formula to estimate PVR in MS.Methods: This diagnostic study was conducted in 2 stages. In the first stage, 58 consecutive subjects with MS were studied to find some model formulas for estimating PVR by multiple regression. Eight echo parameters were analyzed to seek their correlation with the invasive PVR value as a gold standard. The formula that had the best correlation and was easiest to use would be selected. In the second stage, those model formulas were validated by applying them to a further 34 consecutive MS subjects.Results: Four formulas which gave a discriminator coefficient of r2 0.62–0.68 were derived. The best model formula was proposed for further application. The new selected formula PVR=-7.465+3.566 TRvmax –(0.23 TVs’)+6.799 (RV-MPI) showed good correlation (r=0.71, p<0.001) to the invasive PVR value, with good reliability. TRvmax is maximal velocity of tricuspid regurgitation, TVs’ is systolic velocity of tricuspid annulus, and RV-MPI is right ventricle index myocardial performance. ROC curve showed that the cut off point 7.2 has good sensitivity and specificity (90% and 88%, respectively) to predict PVR 7 WU.Conclusion: This study has shown that a novel echocardiography formula can estimate PVR with good correlation and reliability in subjects with mitral stenosis.

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