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Abstrak :
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.

Abstrak :
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. ......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.

Abstrak :
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.

Abstrak :
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 Intervention Abstrak 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. ......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.