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Anjarwani, Setyasih
Department Of Cardiology And Vascular Medicine, Faculty Of Medicine, Universitas Brawijaya, Malang, Indonesia
Health Professions Immunology & microbiology Medicine & Pharmacology

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Perioperative Myocardial Infarction After Coronary Artery Bypass Grafting: How to Identify? Diah Ivana Sari; Setyasih Anjarwani; Ardian Rizal
Heart Science Journal Vol 4, No 1 (2023): Optimizing Outcome in Acute Cardiac Care
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.01.6

Abstract

Introduction. Perioperative myocardial infarction (PMI) associated with the surgical revascularization (CABG) occurs in about 3–5% of patients. Myocardial necrosis and ischaemia after CABG are caused by direct cardiac trauma from manipulation, reperfusion injury, incomplete revascularization, hypotension, bleeding, ventricular arrhythmia, acute graft closure, inadequate perioperative myocardial protection and others.Case report. The introduced case report explains the rupture of right ventricle result in periprocedural myocardial infarction following the surgical myocardial revascularization. 62-year-old man has undergone the coronary bypass surgery with arterial graft of left mammary artery (LIMA) to left anterior descending artery (LAD) and savenous graft to left circumflex coronary artery (LCx). Early in the post-surgery period a perioperative myocardial infarction (PMI) developed, with laboratory correlation of cardio-specific enzymes elevation and ECG changes in terms of ischaemia in the diaphragmatic region. Echocardiography showed akinesia of the apex, apical septal and apical inferior segments accompanied by the decrease in ejection fraction (EF) of the left ventricle.Conclusion. Early detection of PMI may therefore, prompt institution of therapeutic measures to relieve the ischaemia and decrease the incidence and the size of PMIKey words: Perioperative Myocardial Infarction, CABG
Ventricular Tachycardia Storm Management in Acute Cardiac Care: Prompt response to life-threatening conditions Puspa Lestari; Setyasih Anjarwani; Mohammad Saifur Rohman; Ardian Rizal
Heart Science Journal Vol 4, No 1 (2023): Optimizing Outcome in Acute Cardiac Care
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.01.7

Abstract

Background: Ventricular Tachycardia (VT) storm or electrical storm (ES) is defined as cardiac electrical instability and refers to the occurrence of three or more ventricular tachyarrhythmias (VT and or ventricular fibrillation (VF)) in a 24-hour period, or VT recurring soon (within five minutes) after termination of another VT episode, or sustained or no sustained VT with total ectopic beats greater than sinus beats in a 24-hour period. The frequency of VT storms varies on population. When ICDs are implanted for primary prevention (4 percent), it is lower than when they are implanted for secondary prevention (20 percent).Case Summary: We presented patient with Ventricular Tachycardia (VT) storm. A 63-year old woman was admitted to emergency room with chief complaint frequent episodes of palpitation. She was found to have monomorphic VT with unstable hemodynamic. Then she got cardioversion 100 Joule, continued with lidocaine drip and VT reverted to sinus rhythm. Patient admitted to cardiovascular care unit, but she had VT refractory. She got complete revascularization for coronary artery before, but the episodic of VT still occurred with cardiogenic shock (CS) and pulmonary edema. She got cardioversion, amiodarone iv and inotropes, then observed this patient at CVCU. After the condition stable, this patient was discharged and planned for ICD insertion at the next admission.Discussion: We discuss the various available treatment options for VT storm and practical challenges faced in management of hemodynamically unstable VT storm. Initial management involves identifying and correcting the underlying ischemia, electrolyte imbalances, or other inciting factors.
Benefits of Low Dosage of Colchicine Administration on Decreasing Rehospitalization and Mortality within 30 Days in Post-Acute Coronary Syndrome Patients with ST-Segment Elevation Undergoing Percutaneous Coronary Intervention Budi Satrijo; Yordan Wicaksono Ashari; Mohammad Saifur Rohman; Setyasih Anjarwani; Cholid Tri Tjahjono
Heart Science Journal Vol 4, No 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascula
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.6

Abstract

Background: The role of inflammation in myocardial infarction and post-infarction MI remodeling has become a concern for the development of treatment in the last decade. Colchicine can prevent increased inflammation during acute injury.Objective: This study focused on the role of colchicine as an on-top medical treatment, hoping it can reduce mortality and short-term rehospitalization in patients with STEMI.Methods: 347 AMI patients (18-80 year old adults) who visited RSUD dr. Saiful Anwar Malang, between February 2022 and January 2023, participated in this prospective, randomized, double-blinded, placebo-controlledexperiment. Patients were split into two groups and given either a placebo or  colchicine 0.5 mg daily for a month. Standard medical therapy was administered concurrently to both groups as an approachable guideline. The study endpoints were mortality and rehospitalization rates.Result: After one month of follow-up, there was a reduction in rehospitalization due to cardiovascular causes (2 [1.3%] vs. 4 [2.7%], HR 3.42 [1.36-8.56], p<0.05), which was significant in the treatment group compared to the control group. Also, there was a reduction in all-cause mortality, but not statistically significant (2 [1,3% v 3 [2,0%], HR 3,38 [0,53-7,48], p>0,05). In the treated group, there was also a lower non-cardiovascular rehospitalization rate compared to placebo, but not significant (4 [2.6%] vs. 7 [4.7], HR 0.42 [0.15-1.02], p<0.05).Conclusion: The administration of low-dose colchicine for one month has shown benefits in reducing rehospitalization in patients with STEMI who receive PCI therapy.
CARDIOPROTECTIVE EFFECT OF REMOTE ISCHEMIC PRECONDITIONING: FROM BENCH TO BEDSIDE Imam Mi&#039;raj Suprayoga; Setyasih Anjarwani
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.2024.005.02.6

Abstract

Remote ischemic preconditioning (rIPC) refers to a cardioprotective phenomenon in which short episodes of ischemia, followed by reperfusion, in one organ or tissue might provide future protection against ischemia/reperfusion damage in other organs, namely the heart. The process involves the activation of humoral, neural, or systemic communication channels, which in turn induce various intracellular signals inside the heart. The primary objective of this review is to provide a concise overview of the potential processes implicated in rIPC cardioprotection, as well as to elucidate current clinical studies aimed at establishing the effectiveness of these techniques in safeguarding the heart from detrimental ischemia/reperfusion injury. In this context, many variables contribute to the attenuation of subcellular processes of rIPC in patients, including advanced age, presence of comorbidities, medication use, and variations in anaesthetic protocols. These factors may account for the observed variability in outcomes across different clinical studies. Additional research, meticulously planned, is needed in order to enhance our comprehension of the pathways and mechanisms associated with both early and late rIPC. A comprehensive understanding of the various routes is crucial in facilitating the translation of medical advancements to the benefit of patients.
Weaning Failure in Mechanical Ventilation: a Literature Review Pradhika Perdana Sakti; Setyasih Anjarwani
Heart Science Journal Vol 4, No 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac C
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.2

Abstract

Mechanical ventilation is a method of ventilation support through positive pressure breath application. It is used in cases of ventilation and/ or oxygenation failure. Due to its related complications mechanical ventilation should be withdrawn from the patient as soon as possible, called a weaning process. The result of the weaning of mechanical ventilation determines the patient’s prognosis. Patient will go through several assessments before a weaning decision is made. Subsequently, patient will be placed on an unconstrained breathing test (SBT) to check whether the patient's respiratory muscle is equipped for accepting its work of relaxing. Weaning disappointment is characterized as disappointment on SBT or reintubation at 48 hours following extubation. Several factors related to weaning failure are increasing airflow resistance, decreasing compliance, respiratory muscle fatigue, and the patient’s underlying conditions. Techniques to conquer these variables are expected to lessen the pace of disappointment of the weaning system.
Utilizing APACHE IV and GRACE Scores as Predictors of Mortality Compared with SAPS-3 Scores for Acute Coronary Syndrome Patients in the Cardiac Vascular Care Unit Tria Yudha Nugraha; Indra Prasetya; Setyasih Anjarwani
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.2024.005.03.8

Abstract

Background: Acute coronary syndromes (ACS) frequent cause of hospitalization in the cardiovascular care unit. Positive predictive data are being developed and shown to be effective for patients with ACS; the Global Registry of Acute Coronary Events, or GRACE, has shown the most accurate outcomes. In contrast, prognostic scores derived from diverse cohorts of critically ill patients are predominantly employed by intensive care clinicians. Prominent examples of such scores include APACHE IV and SAPS 3. The objective of this research endeavor was to assess and contrast the efficacy of these three scores across an unselected sample of ACS cases.Objective: The Cardiovascular Care Unit of RSUD Dr. Saiful Anwar Malang treats Acute Coronary Syndrome patients. This study compares SAPS 3, GRACE, and APACHE IV score parameters through calibration and discrimination tests to predict patient mortality.Methods: The study included all ACS patients admitted from August 2021 to November 2023. Hospital mortality prediction was assessed using score calibration and discrimination.Results: There were 843 patients in total included. SAPS 3 could not be calibrated appropriately, whereas APACHE IV and GRACE could. Across all scores, discrimination was exceptional (area under the curve values of 0.811 for APACHE IV, 0.740 for GRACE, and 0.732 for SAPS 3).Conclusions: GRACE and APACHE IV were calibrated thoroughly in this cohort of intensive care unit-admitted ACS patients; however, SAPS 3 lacked such calibration. All three scores exhibited exceptional discrimination. GRACE and APACHE IV may be utilized to predict the risk of mortality in patients with ACS.
The Association between CHA2DS2-VASc Score with Increased Serum Creatinine Level in ACS Patients Undergoing PCI at RSUD dr. Saiful Anwar Malang Emil Fathoni; Sasmojo Widito; Setyasih Anjarwani; Budi Satrijo; Valerinna Yogibuana Swastika Putri
Heart Science Journal Vol 4, No 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac C
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.4

Abstract

Background: The current literature on the relationship between the congestive heart failure, hypertension, age, diabetes mellitus, prior stroke or TIA or thromboembolism, vascular disease, age, sex category (CHA2DS2-VASc) score and increased Serum Creatinine (SCr) among Acute coronary syndrome (ACS) patients is noticeably limited in scope. Therefore, the primary objective of this study was to assess the correlation between CHA2DS2-VASc score with increased of Serum Creatinine in patients with ACS undergoing Percutaneous coronary intervention (PCI) procedures.Material and Methods: In this study, a total of 527 participants were recruited, comprising two groups: Increased SCr level (n=159) and normal SCr level (n=368). Data pertaining to clinical information and demographic characteristics, such as gender, age, diabetes mellitus (DM), hypertension (HT), congestive heart failure (CHF), history of stroke or transient ischemic attack (TIA), and vascular disease, were gathered from various sources, including registry data and medical records, diagnostic physical examination, electrocardiography and laboratory records. Logistic regression analysis was employed to assess the association between the CHA2DS2-VASc score and the incidence of increased SCr level.Result: In our study, we observed that the CHA2DS2-VASc scores were significantly higher in the group of patients who increase SCr level compared to those who did not increase SCr level. Furthermore, our Receiver Operating Characteristic (ROC) analysis revealed that a CHA2DS2-VASc score cutoff of 3 was determined to be the optimal threshold for estimating the increased SCr level (AUC= 0.805, 95% CI 0.762-0.848; p<0.01).Conclusion: The CHA2DS2-VASc score serves as a valuable tool for estimating the likelihood of SCr in patients undergoing PCI, offering a foundational assessment. Additionally, in PCI patients, an increase in the CHA2DS2-VASc score exceeding 3 is indicative of a heightened incidence of increased SCr level.
Co-Authors Ardian Rizal Budi Satrijo Cholid Tri Tjahjono Diah Ivana Sari Emil Fathoni Imam Mi&#039;raj Suprayoga Indra Prasetya Mohammad Saifur Rohman Pradhika Perdana Sakti Puspa Lestari Sasmojo Widito Tria Yudha Nugraha Valerinna Yogibuana Swastika Putri Yordan Wicaksono Ashari