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"The purpose of this case repots are to evaluate the role of ST elevation in aVR lead and to make analysis between both cases. There are some atypical electrocardiogram (ECG) presentations which need prompt management in patient with ischemic clinical manifestation such as ST elevation in aVR lead. In this case study, we report a 68-year old woman with chief symptoms of shortness of breath and chest discomfort. She was diagnosed with cardiogenic shock, with Killip class IV, and TIMI score of 8. The second case is a 57-year-old man with typical chest pain at rest which could not be relieved with nitrate treatment. He was diagnosed with ST elevation in inferior and aVR lead, and occlusion in left circumflex artery (LCX). Both patients underwent primary percutaneous coronary intervention (PPCI). Subsequently, both cases presented remarkable clinical improvements and improved ST elevation myocardial infarction (STEMI) in aVR lead."

"Current guidelines for the management of patients with acute coronary syndromes (ACSs) focus on the electrocardiogram to divide patients into ST-elevation acute myocardial infarction (STEMI) or non-ST-elevation acute myocardial infarction (NSTEMI)/unstable angina (UA). Patients with STEMI in the earliest time will receive reperfusion therapy to destruct occlusive thrombus. An ST segment elevation is the sine qua non for diagnosing acute total coronary occlusion causing transmural myocardial infarction. Left circumflex coronary artery (LCx) occlusion is often categorized as NSTEMI because of the absence of significant ST-elevation on the 12 lead standard electrocardiogram. An ST segment elevation is presented in fewer than 50% of patients with LCx total occlusion, such that the reperfusion therapy is delayed. We reported a 77 years old woman whom being diagnosed with NSTEMI because a 12 lead electrocardiogram showed ST segment depression in lead V2-V5. On coronary angiography, we found a total occlusion in the LCx artery as the culprit lession."

"Pandemi COVID-19 berdampak pada penurunan jumlah pasien ST-Elevation Miocard Infarct (STEMI) tetapi terdapat peningkatan presentasi pasien dengan tindakan reperfusi yang mengalami penundaan. Penundaan ini berakibat pada pemanjangan waktu reperfusi yang memengaruhi Health Related Quality of Life (HRQOL). Penelitian cross-sectional ini bertujuan untuk mengidentifikasi faktor-faktor yang memengaruhi HRQoL pada pasien STEMI yang menjalani terapi reperfusi selama masa pandemi. Sampel penelitian berjumlah 110 responden dengan teknik consecutive sampling. Analisa bivariat menunjukkan jenis kelamin, status hubungan pernikahan, ketepatan waktu reperfusi, tingkat depresi, dan persepsi sakit berhubungan signifikan dengan HRQoL. Analisis multivariat menunjukkan persepsi sakit, ketepatan waktu reperfusi dan status pernikahan merupakan faktor dominan yang memengaruhi HRQoL. Ketiga faktor tersebut menjelaskan variabel HRQoL sebesar 32,6% dan selebihnya 67,4% dijelaskan oleh faktor lain. Peneliti menyarankan untuk dilakukan penelitian lanjutan dengan menggunakan jumlah sampel yang lebih representatif untuk mendapatkan hasil prediktor R2 yang lebih baik dalam mengidentifikasi faktor-faktor lain yang berkontribusi terhadap HRQoL, evaluasi paska tindakan reperfusi menggunakan HRQoL yang multidimensional, edukasi kepada pasien maupun pasangannya, serta evaluasi secara berkala terhadap efektivitas screening COVID-19 untuk pasien STEMI yang datang ke IGD dalam mempertahankan target terapi reperfusi.

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The COVID-19 pandemic has resulted decreasing in the number of ST-Elevation Myocardial Infarct (STEMI) patients but there has been an increase in the presentation of patients with delayed reperfusion. This delay results in a prolonged reperfusion time which affects Health-Related Quality of Life (HRQOL). This cross-sectional study aims to identify the factors that influence HRQoL in STEMI patients undergoing reperfusion therapy during the pandemic. The research sample was 110 respondents with consecutive sampling techniques. Bivariate analysis showed that gender, marital relationship status, the timeliness of reperfusion, level of depression, and illness perception were significantly related to HRQoL. Multivariate analysis showed illness perception, timeliness of reperfusion and marital status were the dominant factors influencing HRQoL. These three factors explained the HRQoL by 32.6% and the remaining 67.4% was explained by other factors. Researcher suggests further research to be conducted using a more representative sample size to obtain better R2 predictor results in identifying other factors that more contribute to HRQoL, post-reperfusion evaluation using multidimensional HRQoL, educating patients and their partners, as well as comprehensive evaluation on the effectiveness of COVID-19 screening for STEMI patients who come to the ED to maintain the target of reperfusion therapy."

"Tujuan : Mengetahui pengaruh pemberian simvastatin dosis tinggi (40 mg) sebelum tindakan lntervensi Koroner Perkutan Primer terhadap perubahan kadar high sensitive C-Reactive Protein pad a pasien Infark Miokard Aleut dengan Elevasi ST Latar Belakang : Pemberian statin telah terbukti dapat memperbaiki luaran pada pasien-pasien angina stabil dan sindroma koroner akut yang menjalani intervensi koroner perkutan secara elektif. Statin terbukti memiliki efek pleiotropik yang mampu menekan respon inflamasi pembuluh darah. Studi yang meneliti pemberian statin pada pasien IMA-EST yang menjalani intervensi kOTOner perkutan primer masih sedikit. Simvastatin merupakan obat statin yang banyak digunakan di Indonesia dengan harga yang relatif lebih murah, sehingga diperlukan penelitian yang dapat membuktikan efektivitas simvastatin dalam menekan respon inflamasi koroner. Metode : Penelitian ini merupakan percobaan klinik teracak dan tersamar ganda (double-blinded, randomized clinical trial) pada penderita infark miokard akut dengan elevasi ST yang menjalani intervensi koroner perkutan primer (IKPP) di Departemen Kardiologi dan Kedokteran Vaskular FKUIIPJNHK. dari bulan Agustus sampai dengan Oktober 20 II . Pasien dibagi dalam dua kelompok, yaitu kelompok simvastatin 40 mg dan plasebo. Dilakukan pemeriksaan hsCRP sebelum dan 24 jam sesudah IKPP. Perubahan hsCRP antara sebelum dan sesudah IKPP dihitung sebagai delta-hsCRP. Hasil : Terdapat 62 pasien yang dirandomisasi kedalam kelompok simvastatin 40 mg (n=31) dan plasebo (n=31). Tidak ada perbedaan yang bermakna pada nilai hsCRP sebelum dan 24 jam sesudah TKPP pada kedua kelompok. Nilai delta-hsCRP pada kelompok simvastatin 40 mg lebih rendah secara bermakna dibandingkan dengan plasebo (15.1 mgIL (0 .5 - 33.3) vs. 23 .0 mglL (5 .6 - 133 .6) ; P=0.016). Kesimpulan : Pemberian simvastatin dosis tinggi (40 mg) segera sebelum tindakan IKPP dapat memperbaiki respon inflamasi 24 jam pasea IKPP yang ditunjukkan dengan perubahan hsCRP (delta-hsCRP) yang lebih rendah dibandingkan dengan plasebo.

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Objective : To investigate the influence of high dose simvastatin treatment (40 mg) before primary peiCutaneus coronary intervention (PPCI) with the improvement of high sensitive C=ReaCtive Protem (hsCRP) level in STEMI patients. Background : Pre-treatment of statins had been proven' to improve outcomes in patients with stable angina and acute coronary syndromes undergoing elective percutaneus coronary intervention. Statins have pleiotropic effects which able to suppress inflammatory responses in vessels. However, there are only few of study which investigate the benefit of statin therapy before primary PCI in STEMI patients. Simvastatin is the most common statin used in Indonesia with relatively lower price than another statins. Methods : This is a double-blind randomized clinical trial in STEMI patients undergoing primary percutaneus coronary intervention (PPCI) at Department of Cardiology and Vascular Medicine FKUIlNCCHK. since August to October 2011. The patients was devided into two groups; simvastatin-40 mg and plasebo group. The hsCRP level examination was done before and 24 hours after PPCI. The changes of hsCRP level was labeled as delta-hsCRP. Results : There were 62 patients randomized into simvastatin 40 mg group (n=31) and placebo group (n=31). There were no significant difference between hsCRP levels before and 24 hours after PPCI . for both groups. The delta-hsCRP value in simvastatin 40 mg group were lower significantly compared to placebo (15.1 mg/L (0 .5 - 33.3) vs. 23 .0 mg/L (5 .6 - 133.6) ; P=0.016). Conclusion : Administration of high dose simvastatin (40 mg) immediately before PPCI may improve inflammatory response in 24 hours after PPCI which proven by lower hsCRP changes (delta-hsCRP) compared to placebo ."

"Model Konservasi merupakan proses adaptasi terhadap diri sendiri, lingkungan, kesehatan, dan perawatan yang diperlukan untuk kelangsungan hidup pasien sebagai upaya mempertahankan fungsinya. Prinsip Myra E. Levine tentang konservasi energi, integritas struktur, integritas personal dan integritas sosial memberikan pendekatan yang nyata untuk membuat keputusan dalam pemberian asuhan keperawatan bagi pasien dengan masalah kardiovaskular dengan tujuan akhir pasien adaptif dengan kondisi kesehatannya. Untuk merubah prilaku tidak efektif menjadi prilaku adaptif telah disusun dan dilaksanakan berbagai intervensi keperawatan yang bersifat memberdayakan konservasi energy, integritas structural serta peningkatan integritas personal dan daya dukung integritas sosialnya sehingga pada akhirnya membentuk individu yang adaptif dengan kondisi kesehatannya. Pengelolaan pasien sebagai wujud peran perawat sebagai pemberi pelayanan keperawatan. Selanjutnya residen sebagai peran peneliti telah melakukan pelaksanaan hipnoterapi untuk mengurangi intensitas nyeri pada pasien post operasi CABG dan program inovasi meningkatkan kualitas serah terima pasien dengan menggunakan format handover. Residen sebagai peran pendidik telah menerapkan pendidikan kesehatan kepada mahasiswa, perawat, dan pasien serta keluarga. Kesimpulannya bahwa perawat memiliki beberapa peran yaitu peran sebagai pemberi pelayanan keperawatan, peran peneliti, peran pendidik, dan peran inovator. Residen memberikan saran kepada semua elemen yang berkaitan dengan keperawatan agar memberikan stimulasi untuk berkembangnya peran-peran perawat tersebut melalui pendidikan klinik yang lebih intensif dan terprogram.

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A model conservation is the process of adapting to yourself, the environment, health, and treatment is needed for survival patient as the effort to maintain its function. The principle of Myra e. Levine about energy conservation, the integrity of the structure, the integrity of the personal and social integrity gives a real approach to decision making in the delivery of nursing care for patients with cardiovascular problems with the ultimate goal of the adaptive health conditions of patients. To change unmannerly ineffective be unmannerly adaptive have been compiled and carried out various intervention nursing that is spatially empower energy, conservation structural integrity and improve the integrity of personal power and support the integrity of social so that eventually form an individual being adaptive with the condition of his health. Patient management role as the nurse as nursing service providers. The next resident, as the role of researchers has committed implementation of hypnotherapy to reduce pain intensity in patients post CABG operation and innovation program improves the quality of handover of patients using the format handover. As a resident of educators have implemented health education to students, nurses, and patients and families. The conclusion that the nurses have several roles including the role of giver nursing service, role of researchers, educators, and roles the role of innovators. Resident gives advice to all elements relating to nursing to provide stimulation for the development of the roles of nursing education through more intensive clinical and programmatic."

"Role of Collateral Circulation in MR Imaging-Verified Myocardial Infarct Size in Acute Phase of ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary InterventionAbstrak Berbahasa Indonesia/Berbahasa Lain (Selain Bahasa Inggris): Latar Belakang. Intervensi koroner perkutan primer (IKPP) yang dilakukan segera oleh merupakan upaya reperfusi utama dalam tatalaksana infark miokard akut dengan elevasi segmen ST (IMA-EST). Meskipun disadari betapa pentingnya diagnosis dan reperfusi dini pada pasien IMA-EST, keterlambatan waktu reperfusi seringkali tidak dapat dihindarkan. Selama waktu keterlambatan reperfusi ini sirkulasi kolateral koroner (SKK) menjadi sumber alternatif suplai darah yang penting ketika pembuluh darah utama gagal memberikan aliran darah yang cukup ke jaringan karena adanya oklusi. Penelitian ini bertujuan mengetahui pengaruh SKK terhadap luas infark dan myocardial salvage index (MSI) yang diukur dengan pencitraan resonansi magnetik jantung (RMJ) pada pasien IMA-EST dengan onset <12 jam yang menjalani IKPP.Metode. Penelitian dirancang potong lintang melibatkan 33 pasien IMA-EST dengan onset <12 jam yang menjalani IKPP yang diambil secara konsekutif pada bulan November 2012 hingga April 2013 di Pusat Jantung Nasional Harapan Kita, Jakarta. Pasien dibagi dalam 2 kelompok berdasarkan pembagian SKK menurut Rentrop, yakni grup A (Rentrop 0 atau 1) dan grup B (Rentrop 2 atau 3). Pasien menjalani pemeriksaan pencitraan RMJ untuk menilai luas infark dan MSI.Hasil. Dalam studi ini, dua belas dari 33 (36%) pasien memiliki kolateral yang signifikan (Rentrop 2 atau 3). Angina pre-infark merupakan faktor klinis yang berhubungan dengan kemunculan SKK (p<0,001). Luas infark dihitung sebagai persentase massa infark terhadap massa ventrikel kiri (IS %LV). Dari analisa didapatkan IS %LV lebih kecil pada grup B dibandingkan dengan grup A (14,2% vs 23,3%, p=0,036). Hal ini sejalan dengan besarnya nilai MSI pada grup B dibandingkan dengan grup A (0,6 vs 0,1, p<0,001).Kesimpulan. Sirkulasi kolateral koroner memiliki pengaruh dalam menurunkan luas area infark dan meningkatkan MSI yang diukur dengan menggunakan pencitraan RMJ pada fase akut IMA-EST yang menjalani IKPP.

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Background. Primary percutaneous coronary intervention (PPCI) conducted immediately by an expert operator is a primary reperfusion strategy in acute ST-segment elevation myocardial infarction (STEMI) patient. Although fully aware of the importance of early diagnosis and reperfusion in patients with STEMI, time delays are often unavoidable. During this period, coronary collateral circulation be an important alternative supply when the main blood vessels fail to provide adequate perfusion to myocardial tissues due to occlusion. This study aims to determine the effect of collateral circulation in MR Imaging-Verified Myocardial infarct size and myocardial salvage index (MSI) in the acute phase of STEMI treated with PPCI.

Methods. Study was designed as cross-sectional study involving 33 STEMI patients with symptoms < 12 hours who underwent successful PPCI. Samples were taken consecutively from November 2012 to April at the National Cardiovascular Center Harapan Kita Jakarta. Collateral flow was gradded regarding to Rentrop classification. Patients were divided into 2 groups; Group A had absent or weak collateral flow and group B had significant flow. All patients underwent cardiac magnetic resonance (CMR) to assess infarct size and MSI.

Result. In our study, 12 out of 33 (36%) patients had significant collateral circulation (Rentrop grade 2 or 3). Pre-infarction angina was a clinical factors associated with recruitable collaterals (p<0,001). Infarct size expressed as percent LV mass (IS %LV) was significantly smaller in group B (14.2% vs. 23.3%; p = 0.036). Extent of MSI was significantly higher in group B (0,6 vs 0,1; p<0,001).

Conclusion. Well-developed collaterals before reperfusion by PPCI in patients with STEMI are associated with a protective effect on infarct size and MSI."