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Putri Annisa Kamila
Brawijaya Cardiovascular Research Center Department of Cardiology and Vascular Medicine Faculty of Medicine, Universitas Brawijaya Malang

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Journal : Heart Science Journal

Clinical Management of Syncope in Emergency Department Based on Risk Stratification : A Review Literature Putri Annisa Kamila; Ardian Rizal; Novi Kurnianingsih; Sasmojo Widito
Heart Science Journal Vol 1, No 4 (2020): Acute Coronary Syndrome in Daily Practice : Diagnosis, Complication, and Managem
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2020.001.04.03

Abstract

Background: Background Syncope is a frequent problem among patients who present to the ED, accounts for 3% of emergency department admission and 1% of hospitalization. It is characterized by a comparatively short and self-limited loss of consciousness, which is caused by temporary cerebral hypoperfusion.Objective: Therefore, Risk stratification performed in the ED can guide triage decisions, and Risk-stratifying patients into low, moderate, and high-risk groups can assist medical decisions and determine the patient’s disposition.Discussion: The central point of syncope progression pathophysiology is the reduction of systemic blood pressure (BP) with a drop in global cerebral blood flow. Based on the European Society of Cardiology (ESC) syncope practice guidelines, syncope is classified into three categories, Neurally-mediated syncope (neural reflex syncope), Orthostatic hypotension, Cardiac syncope. Proper evaluation of syncope cases could in turn enable timely hospitalization and treatment by syncope experts. Assessment of a patient with syncope can be difficult, requiring a wide variety of medical testing with high health care costs. Sometimes, even after a careful examina- tion, it may not be possible to determine a definitive etiology for syncope. Given these uncertainties, about one-third of emergency room (ER) syncope/collapse patients are referred for assessment to the hospital, including non to low-risk patients. establish the urgency of any further work-up.Conclusion: Syncope assessment and treatment are very difficult, and syncope cases should be treated and dispositioned properly using proper risk stratification guidelines.
The Added Value of Bioimpedance Analysis to NT-proBNP in Predicting Short-term outcome in Acute Heart Failure Patients Putri Annisa Kamila; Mohammad Saifur Rohman; Setyasih Anjarwani; Djanggan Sargowo; Anna Fuji Rahimah; Indra Prasetya; Muhammad Rizki Fadlan; Salvatore Di Somma
Heart Science Journal Vol 2, No 1 (2021): How to Diagnose Heart Failure and Deal with The Treatment Complexity
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.01.06

Abstract

Background: Acute heart failure (AHF) is a significant clinical problem, which has a high prevalence, mortality, and rehospitalization. Congestion is critical in AHF's pathogenesis, which is also a predictor of mortality and rehospitalization in patients with AHF. Aim: Knowing the effect of adding a %Total body water (TBW) test detected by Bioimpedance Analysis to NT-proBNP as a short-term clinical outside predictor of patients with acute heart failure Method: This research is an analytical observational study using prospective cohort methods. The research was conducted at Dr. Saiful Anwar Malang Hospital in January 2018-July 2019, with research subjects taken consecutively against all AHF patients hospitalized at UD dr.UD dr. Saiful Anwar Malang. The data taken in the form of NT-proBNP value during mission and %TBW before the patient leaves the hospital detected with NICaS examination, then the outside seen is mortality rate and rehospitalization due to AHF within 90 days after exiting the hospital. Results:  This study involved 65 subjects who were 61 years old and the majority male. Non-survivor patients had a higher NYHA class, NT-proBNP, and %TBW predischarge than the survivor group. Based on statistical analysis, we found that NT-proBNP is a good predictor of mortality (HI: AUC 0.74; 95%CI 0.59-0.90) and rehospitalization (HI: AUC 0.88; 95%CI 0.78-0.97). Similarly , %TBW pre-discharge shows good predictors of mortality (HI: AUC 0.72, 95%CI 0.56-0.87) and rehospitalization (HI: AUC 0.83, 95%CI 0.73-0.94). The addition of the %TBW predischarge parameter to NT-proBNP results in the best predictor numbers among the three for both mortality (HI: AUC 0.84; 95%CI 0.72-0.96) and rehospitalization (HI: AUC 0.92; 95%CI 0.85-1.00). Conclusion: The addition of predischarge %TBW examination detected by bioimpedance analysis tool against NT-proBNP increases the predicted value of short-term clinical outpatient in the form of mortality and rehospitalization of acute heart failure patients.Keywords: acute heart failure, NT-proBNP, bioimpedance analysis, total body water
Trapping Technique for Successful Retrieval of a Ruptured Balloon Catheter Entrapped in Coronary Artery : A Case Report Putri Annisa Kamila; Budi Satrijo; Mohammad Saifur Rohman; Heny Martini; Indra Prasetya
Heart Science Journal Vol 1, No 2 (2020): The Assessment of Diagnostic and Treatment Modality in Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (86.487 KB) | DOI: 10.21776/ub.hsj.2020.001.02.8

Abstract

Introduction: Device entrapment during PCI is an uncommon complication with incidence of less than 1%. Percutaneous retrieval should be favored as the treatment of choice for this condition.Case Illustration: A 61-year-old patient came for an elective percutaneous coronary intervention (PCI) procedure. She suffered from chest pain while doing moderate activities for 1 month. Angiography showed a diffuse lesion with maximum stenosis 90% in the proximal LAD, stenosis 75% in the proximal of Left Circumflex Artery (LCx), and diffuse lesions in the proximal and mid of the Right Coronary Artery (RCA). We decided to perform PCI in the LAD. A transfemoral coronary intervention was performed using a Judkins Left 3.5 (7F) guiding catheter to engage the LAD. A Guidewire ( Run-through NS Floppy) was advanced to the distal LAD. Balloon angioplasty was performed with a 2.75 x 15 mm Fluydo balloon in the proximal LAD at 16 bars, but the balloon was entrapped and while withdrawing the balloon, it accidentally ruptured in the LAD artery with the remaining segment inside the guiding catheter. A second Run-through NS Floppy Guidewire was inserted across the ruptured balloon and a 2.5 x 20 mm Fluydo Balloon was passed on the second wire and was inflated at 16 atm pressure, inside the guiding catheter, trapping the ruptured balloon. The ruptured balloon was successfully removed, by withdrawing the whole system, including the guiding catheter and the wire. Finally, we re-engaged the LAD with the same guiding catheter, passed the wire, and post dilated the stent on the LAD to achieve a good result.Conclusion: Percutaneous retrieval using trapping technique could represent a safe and effective technique for ruptured and entrapment of a balloon-catheter in a coronary artery.
Management of Acute Uncomplicated Stanford B Aortic Dissection in The Era of Endovascular Repair: A Case Report Putri Annisa Kamila; Novi Kurnianingsih; Sasmojo Widito; Djanggan Sargowo; Budi Satrijo
Heart Science Journal Vol 1, No 3 (2020): Management of Coronary Artery Disease: From Risk Factors to The Better Long-Term
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2020.001.03.8

Abstract

Introduction:Uncomplicated type B aortic dissections have been traditionally treated with medication therapy. While it may provide good short-term results, longterm prognosis may be less favorable. With improvements in endovascular repair and the potential risk of disease progression, thoracic endovascular aortic repair (TEVAR) has been considered inpatients with uncomplicated type B aortic dissection. We present the case of 78-year-old gentleman who presented with acute uncomplicated type B aortic dissection managed by endovascular repair Case illustration:A 78 year-old hypertensive patient admitted to the hospital with persistent chest discomfort and cough for 2 weeks. The CT aortic angiogram showed type B dissection. Based on the recent guidelines, TEVAR should be considered in patients with uncomplicated type B aortic dissection, thus we prepared the patient for TEVAR procedure. First we established multidisciplinary vascular team for the pre-procedural preparation of the patient. We perform careful measurement through detailed CT angiography reconstruction from carotid to femoral arteries. We found proximal diameter was 30-35mm, distal diameter was 23mm and landing zone right after left brachial ostium, suitable for stent graft Valiant Captivia 36-32x150mm. The CT also showed that both femoral artery were normal, we decided to use right femoral artery as the access. We proceed to the procedure 2 days later, under general anaesthesia, digital subtraction angiography revealed dissection of descending aorta, and selected device was inserted. Subsequent contrast injection revealed total occlusion of the false lumen. Patient was transferred to ICU for postprocedural care, and extubated the day after. The hospital stay was uneventful, and one-month follow up CT shows no endoleak. Conclusion :Management of uncomplicated Stanford B dissections is very challenging. TEVAR has emerged as an alternative to surgery with lower morbidity and mortality rates that might offer good long-term results.