INTRODUCTION

It’s almost been four years since our last offline event in 2019. We are
looking forward to welcoming you back to the 6th Lombok Cardiovascular Update
(LCU) event to be held at Lombok this year.

Our national and local speakers are all ready to share their insight, tips, and
tricks. We have selected many interesting cardiovascular topics for physicians,
nurses, students, and allied professionals. We provide a conducive venue for you to
interact and share the experiences.

The 6th LCU 2023 will be held within 2 days that consist of workshops,
symposiums, and abstract poster presentation. We hope that this programs can
offer many relevant topics that keep you updated to the latest management of
cardiovascular practices.

Last but not least, we also provided many valuable prizes for the lucky
participants and the winner of poster session. So get your best abstract prepared..!
Foreword
Welcome the 6th LCU 2023!

Cardiovascular disease is still the number one cause of death worldwide. Various kinds of
cardiovascular diseases such as coronary heart disease, arrhythmia, heart failure, valvular heart
disease are still common in West Nusa Tenggara (NTB).

Various advances in science and technology in the diagnosis and management of

cardiovascular disease have not been matched by a decrease in patient mortality and
morbidity. Therefore, various efforts to improve, knowledge and skills are needed for clinicians
and health practitioners who are the first line of health services in terms of recognition and
management of cardiovascular cases and their comorbidities and complications.

This scientific event is an annual routine activity that aims to update the latest knowledge and
guidelines in order to increase medical knowledge and skills in cardiovascular.

Through this scientific event, we hoped that clinicians will become more confident in handling
cardiovascular cases and all their complications.

LCU 6th Scientific Director

Santi P Ramdhani, MD, FIHA

Arzia Pramadi Rahman, MD, FIHA
CR-01

A Case Report Of A Child With Cardiac Tamponade : Collaboration To Rescue The Sinking
Heart
Dilla Elysmasia , Putu D. Vedaswari2,Lalu M. S. I. W. Atmapraja3
1

1
General Practitioner, Praya Regional Public Hospital
2
Pediatrician, Praya Regional Public Hospital
3
Cardiologist, Praya Regional Public Hospital

ABSTRACT

Background: Indonesia is on the list of 30 countries with the highest burden of tuberculosis in the
world. Tuberculosis pericarditis is a rare form of extrapulmonary tuberculosis and can produce
pericardial effusion. Massive pericardial effusion can develop into cardiac tamponade.
Pericardiocentesis must be performed in a life-threatening situation.

Case Ilustration: A 4-year-old pediatric patient was consulted by a pediatrician to a cardiologist

complained of shortness of breath for the 3 days ago . The patient also complained of fever and cough
since 1 week ago. On physical examination, the vital signs found were blood pressure: 60/palpable
mmHg; pulse 114 x/minute; temperature 38,9 and respiratory rate 30 x/minute. Lungs: ictus cordis is
not visible and not palpable, the heart border seems widened, muffle heart sound, cold extremities +/+.
On chest X-ray examination, a "water bottle-shaped heart" was obtained which indicated a massive
pericardial effusion. On echocardiographic found accumulation of pericardial effusion with the sign of
cardiac tamponade. The patient was diagnosed with massive pericardial effusion and cardiac tamponade.
Pericardiocentesis was performed collaboration between the cardiologist and pediatrician, and we found
blood in the pericardial fluid. The patient was given antituberculosis drug and aspiration of bloody fluid
from the pericard was performed periodically.

Conclusion: In pediatric patients finding blood in the pericardial fluid indicates infection rather than
malignancy. The high mortality rate associated with untreated tuberculous pericarditis, together with the
long culture periods required for traditional tests, means that clinical and therapeutic decisions are often
made before results become available. However, Pericardiocentesis with echocardiography guided more
riskier to be done despite fluoscopy guided, except in emergency situations and limited facility. An
experienced operator and staff who perform pericardiocentesis in a limited facility are required.

Keywords: Cardiac Tamponade, management, limited facility

CR-02

A Rare Case of Lutembacher Syndrome in A Middle Age Woman: Misery from Double Defects
Hartomarasiddin1, Audrey Kumala1 Lalu M. S. I. W. Atmapraja2.
1
Internship Doctor, Praya General Hospital
2
Cardiologist, Praya General Hospital

Background: Lutembacher's syndrome (LS) is a rare entity in cardiac disorders that refers to the
presence of congenital or iatrogenic atrial septal defects (ASD) that coincide with mitral stenosis (MS).
The prevalence of LS is about 0.001 million per population, more prevalent in rural areas, and the
majority occurs in women. The clinical features, hemodynamic effects, and prognosis of these disorders
depend on the defects characteristics and RV compliance. However, the occurrence of secondary
pulmonary hypertension and congestive heart failure is associated with a poor outcomes. Thus, early
diagnosis and prompt treatment were mandatory.
Case Report: We reported a case of a 57-year-old woman who presented with dyspnea of effort,
palpitations, and fatigue. She had a history of orthopnea and paroxysmal nocturnal dyspnea. During
examination, it was found that the patient had an elevated jugular venous pulse (JVP), irregular first and
second heart sounds, a systolic murmur in the pulmonary area, a diastolic murmur in the mitral area,
and bilateral pedal oedema. The electrocardiogram showed atrial fibrillation with rapid ventricular
response with RAD, ICRBBB, and RVH. Echocardiography revealed left-to-right shunt secundum ASD
and severe MS with rheumatic morphology. The patient was administered optimal heart failure therapy
with significant clinical improvement.
Conclusion: Congenital heart disease called Lutembacher syndrome is rare and complicated. The
possibility of LS should be taken into concern in MS patients with unusual clinical features. The gold
standard for diagnosing this condition is still echocardiography. The survival rate had to be raised
through early diagnosis and appropriate treatment.
Keywords: Lutembacher Syndrome, Atrial Septal Defect, Mitral Stenosis
CR-03

Abdominal Aortic Aneurysm Rupture, Which Surgical Management is The Best?: A Case
Report
Putu E. D. Putri1, Agung P. Suwirya2, I W. P. Wisuda3, Bagus A. P. D. Sutanegara2
1
Faculty of Medicine, Hang Tuah University, Surabaya, East Java, Indonesia
2
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University,
Denpasar, Bali, Indonesia
3
Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia

Background: Rupture of Abdominal Aortic Aneurysmal (AAA) is a fatal complication of AAA treated
either by endovascular aortic repair (EVAR) or open surgery. Therefore, this study aims to present a case
of AAA rupture with dilemmatic management choices.
Case Illustration: A 61-year-old male patient with a 10-year history of hypertension, coronary artery
disease, and AAA complained of sharp and stabbing pain in his lower left abdomen, radiating to the
back and left leg a day before. At presentation, he was in moderate pain with stable vital signs except a
rapid, irregular heart rate as well as a palpable, pulsating mass at the hypochondrium measuring about
6 cm. And further examination showed atrial fibrillation and left ventricle concentric remodeling. The
CT scan with contrast showed a saccular and fusiform dilatation of the abdominal aorta about 17.6 cm
in length from 4.2 cm bellow renal artery to common iliac artery with the largest diameter about 10 cm
at 3rd Lumbal Vertebral. There is also an intraluminal thrombus, accumulation of blood density material
at retroperitoneal space with draped aorta sign, followed by contrast extravasation around the left
common iliac artery. The patient was planned to have EVAR, where finally underwent open repair of
the abdominal aorta with aortic-bifemoral bypass and left common iliac artery ligation.
Conclusion: EVAR is preferred over open surgical repair in appropriate patient selection, such as
rupture AAA in hemodynamically stable patients.
Keywords: Chronic Contained Ruptured Abdominal Aortic Aneurysm, Open Repair Surgery,
Endovascular Aneurysm Repair
CR-04
ABSTRACT

Infective Endocarditis

Humam Sungkar1, Yanna Indrayana2, G.A.R Prawisanthi3

1
Faculty of Medicine, Mataram University, West Nusa Tenggara
2,3
Departement of Cardiology, General Hospital, West Nusa Tenggara
Introduction: Infective endocarditis is a disease that has a high mortality rate, reaching 20-25%
despite adequate treatment. In Indonesia itself, case reports of infective endocarditis cases are still
relatively rare, based on case reports found 3 months after therapy the patient still experienced
worsening and died. Regarding this exposure, this case report will discuss the findings of infectious
endocarditis cases to the therapy given to these patients.

Case presentation: A 45-year-old male patient came to the emergency room with complaints of
tightness since the last 2 weeks, complaints of tightness felt all the time until the patient had
difficulty speaking. The patient's complaint was accompanied by leg edema and fever since 2
weeks ago, pain in the joints that were not specific, and headache. Echocardiography supporting
examination results found vegetation in the aortic and mitral valves. Blood culture results showed
no specific bacteria. After 2 weeks of empirical antibiotics, the echocardiography results showed
that the size of the vegetation did not decrease. The patient was then planned to be referred to a
type A hospital for vegetation evacuation and heart valve repair.

Conclusion: This case reports the incidence of infective endocarditis in a patient with vegetation
size that did not shrink after empirical antibiotics. Due to unfavorable prognosis, we referred this
patient for vegetation evacuation and heart valve repair.

Keywords: Infective endocarditis, Endocarditis,

CR-05

ABSTRACT

Post-Installation Care of a Permanent Pacemaker

Tomy D. Refandy1, Romi Ermawan1

1
Faculty of Medicine, Mataram University, West Nusa Tenggara
Background: AV block is one of the cardiac conduction disorders that occurs when the impulse from
the atria to the ventricles is obstructed, so that there is an image on the ECG with a prolonged PR
interval. The prevalence of cases of total AV block is relatively rare, which is around 0.02% to 0.04%.
Studies conducted on patients at the Veterans Health Administration showed that as many as 1.1%
occurred in individuals who had a history of diabetes mellitus and 0.6% in individuals with
hypertension. The management of patients with total AV block is to install a pacemaker. Pacemakers
are divided into permanent pacemakers (PPM) and temporary pacemakers (TPM).

Case illustration: 76 years old male, with total AV block. This patient was diagnosed with total AV
block because based on the history the patient had experienced a decrease in consciousness. On
supporting examinations using the ECG, the results showed a pulse rate of 42 bpm, the appearance of
a P wave without being followed by a QRS, the PR interval was constantly elongated and the QRS
complex was widened. Then the patient is planned to have placement of a permanent pacemaker.

Conclusion: Installation of a permanent pacemaker (PPM) with a single-chamber type in patients is

carried out to replace the function of the SA node as pacing and sensing in the event of conduction
disturbances. Several things must be considered after installing a permanent pacemaker, including
sleeping positions and types of activities that should not be done.

Keyword: total AV block, permanent peacemaker

CR-06

ABSTRACT

Ischemia of Non Obstructive Coronary Artery: A Case Report

Athala Rania Insyra1, Lalu Rifal Hadi Anugra1 Putu Diva Gayatri Jaya Putri1,
Tri Riskinie Istiharah1, Anak Agung Sagung Mas Meiswaryasti Putra2
1
Faculty of Medicine, Mataram University, West Nusa Tenggara, Indonesia
2
Department of Cardiovascular, NTB Provincial General Hospital, Indonesia

Background : Myocardial ischemia with no obstructive coronary arteries (INOCA) is a

chronic coronary syndrome condition that is increasingly being recognized
as a substantial contributor to adverse cardiovascular mortality and
outcomes, including myocardial infarction and heart failure with preserved
ejection fraction (HFpEF).While INOCA occurs in both women and men,
women are more likely to have the finding of INOCA and are more
adversely impacted by angina, with recurrent hospitalizations and a lower
quality of life with this condition.

Case Illustration : A 51 year old female patient came to the Emergency Department with
the main complaint of fainting. This patient's consciousness is
progressively decreased after falling incidence. This patient also
complains of repeated and prolonged chest pain without shortness of
breath. There are no abnormalities from physical examination and
supporting examination. This patient also underwent coronary
angiography and found there is no obstruction in coronary arteries.

Conclusion : Patients whose symptoms are suspicious of INOCA are often dismissed
and underdiagnosed in clinical practice. To establish a confirmatory
diagnosis of INOCA, coronary blood flow, microvascular resistance, and
vasoreactivity are required to be assessed as mandatory to define the
presence of INOCA and discriminate its underlying mechanisms.
Mechanism-specific management of INOCA might be more beneficial,
and ongoing studies will shed light on this issue.

Keyword : INOCA, chest pain, coronary angiography

CR-07

Acute Coronary Syndrome - Stemi

Nafatasya A. Rahmansyah1, Anak Agung S.M.M. Putra2

1
Medical Faculty of Mataram University

2
Cardiology Departement of Nusa Tenggara Barat Province Hospital

Background: Acute Coronary Syndrome (ACS) is a term that refers to a group of clinical symptoms
associated with acute myocardial ischemia and or infarction usually caused by a sudden decrease in
coronary blood flow. This syndrome is included in coronary heart disease.

Case report: A 60 year-old male with complaints of weakness accompanied by chest pain in left chest,
feels like being crushed by a heavy object, does not radiate, and does not decrease with rest. The pain
lasts for more than 20 minutes. Pain accompanied by cold sweat and shortness of breath.The ECG
showed sinus bradycardia and ST segment elevation in leads II, III, aVF.

Conclusion: The ECG of STEMI patients in the time of first visit can illustrate the initial risk. ECG
features in angina patients can be normal, non-diagnostic, new LBBB, persistent ST segment elevation
> 20 minutes or not persistent, ST depression with or without inverted T. The ST elevation assessment
is seen at the J point and is found in the two adjoining leads.

Keyword: ACS, Stemi

CR-08

ABSTRACT

Ischemic Induce Ventriculat Tachycardia in Patient with Acute Coronary Syndrome

Athala Rania Insyra 1, Romi Ermawan 2

1
Medical Faculty of Mataram University, West Nusa Tenggara, Indonesia

2
Departement of Cardiovaskular, NTB Provincial General Hospital, Indonesia

Background : Ventricular tachycardia is a broad complex arrhythmia of ventricular origin, defined as

three or more consecutive beats at a rate >100 beats/min. When a coronary artery occludes in an ACS,
adequate blood flow to heart tissue is interrupted, causing ischemia (lack of oxygen) and necrosis (cell
death) in the affected part of the heart. In some cases, areas of tissue affected by ischemia or necrosis
can trigger abnormal heart rhythms, including VT.

Case report : A 67 year old man with a chief complaint of The patient came to the emergency room at
the NTB Provincial Hospital with complaints of palpitations since 6 hours of the before come to the
hospital. In the above case is VT caused by ischemia in ACS patients. The incident in this patient was
seen from the anamnesis, the patient felt his heart pounding continuously and did not go away in a
state of rest. VT in patients can be seen from the ECG before cardioversion is performed. Then the
patient underwent a cathlab procedure and found CAD SVD results with a heavy calcified lesion.

Conclusion: ACS can cause VT through damage to the heart muscle due to blockage of the coronary
arteries Ischemia: Blockage of a coronary artery resulting in insufficient blood flow to the affected
parts of the heart. This causes ischemia or lack of oxygen in the heart muscle. This ischemia can cause
irritability in cardiac cells and can trigger ventricular arrhythmias, including VT.

Keyword: Ventricular Tachycardia, Acute Coronary Syndrome

CR-09

Acute Decompensated Heart Failure due to the Presence of Coronary Artery Disease alongside
Pneumonia
Uci P. Maulida1, Hazmi A.1, Dwi F. O. Hidayat2
1
General Practitioner at Mandalika Hospital, Central of Lombok
2
Cardiologist at Mandalika Hospital, Central of Lombok and Patut Patuh Patju Regional Public
Hospital, West of Lombok

Background: ADHF is defined as the sudden or gradual onset of signs or symptoms of heart failure
which increases the hospitalization rate. Acute heart failure is a life-threatening condition and more than
70% of cases are comorbid with CAD, which raises the notion of its role as a strong predictor of death
in patients with acute heart failure. It is important to provide therapy that is adjusted to the patient's
hemodynamic profile and precipitating factors to get a better outcome.
Case Illustration: A 70-year-old patient with ADHF and severe community-acquired pneumonia was
admitted to hospital. The patient had shortness of breath that worsened when was active, fever and
headache since the night before. Patient had been using two pillows when sleeping and had a cough
since a week ago, also was diagnosed with Pneumonia, Hypoalbuminemia, and Hyponatremia two days
before hospitalization. Patient was somnolent with a pained expression, tachypnea, feverish,
normotensive, decreased oxygen saturation, which improved with NRBM 10lpm, rhonchi at left-lung
and pitting-oedema in the lower limbs. The rhonchi decreased after 1 gram of Paracetamol and 2x20mg
of Furosemide had been administered and urine-output was 2300cc after 5 hours. Laboratory tests
showed elevated leucocytes and transaminase enzymes, hyponatremia, hypokalemia, and
hypoalbuminemia. MTB is not detected on Xpert-MTB-examination. The chest-X-ray showed
radioopaque at the apex of the left-lung and CTR 52%, which points to suspected Lung Tuberculosis
with different-diagnosis Pneumonia. Electrocardiography showed LBBB-complete with CAD-
Anteroseptal.
Conclusion: The patient was experiencing CAD which caused LBBB and over time led to HF, which
the patient did not receive proper treatment. The presence of pneumonia as a comorbid can trigger the
ADHF condition. After being given emergency therapy and 12 hours observations, the patient still had
shortness of breath and was referred to another hospital for intensive treatment.
Keywords: Heart Failure, CAD, Pneumonia
CR-10

Massive Pericardial Effusion In A Patient With Pulmonary Tuberculosis: Management In Rural

Hospital
Dwi A. Wulandari1
1
Internship General Practitioner, H.L Manambai Abdulkadir Hospital,

Background Tuberculosis is a potential cause of pericardial effusion. A large pericardial

effusion may proceed to cardiac tamponade and possible dangers to hemodynamic
outcomes. Pericardiocentesis is recommended for moderate to severe effusions.
However, decision, timing, and equipment to do a pericardiocentesis is sometimes
quite challenging, especially in limited hospital facility.
Case Illustration A man, 36 years old came to the outpatient clinic with shortness of breath with
moderate effort and chest pain. Three months ago, the patient was diagnosed with
tuberculosis confirmed by bacteriology and a chest X-ray showed pericardial
effusion with marked cardiomegaly. This patient currently undergoing his 3rd
month of OAT treatment. No additional sound was found on the chest
auscultation. Laboratory showed normal values, EKG sinus tachycardia, chest X-
ray showed water bottle appearance, and echocardiography showed massive
pericardial effusion mainly on the right side of the heart. Pericardiocentesis was
performed with subxiphoid approach on the first day with an aspirate of 140 ml
serous fluid. Pericardiocentesis used a needle and double-lumen CVC with a depth
of 12 cm. Cytology analysis of the pericardial on the second day showed exudate
fluid accompanied by neutrophilia. The patient in this case was tapped on the
effuse every 6 hours with 1.5 cc of diluted injection at the beginning and end of
the tapping procedure. Adjunctive therapy with NSAIDs was also given.
Improvements were clear and the patient got discharged after 10 days of
hospitalization.
Conclusion Pericardial effusion is not uncommon complication of pulmonary TB. History
taking, physical exam, and imaging remains the important step to establish the
diagnosis and make the right decision when to do the pericardiocentesis. Double
lumen CVC can be used as alternative equipment to perform continuous
pericardial fluid aspiration in limited setting hospital.
Keywords Pericardial effusion; tuberculosis; pericardiocentesis;CVC catheter
CR-11

ABSTRACT

Pulmonary Embolism

Putu Diva Gayatri Jaya Putri1, Anak Agung Sagung Mas Meiswaryasti Putra 2

1
Medical Faculty of Mataram University, West Nusa Tenggara, Indonesia

2
Departement of Cardiovascular, NTB Provincial General Hospital, Indonesia

Background : Pulmonary embolism (PE) is a condition characterized by obstruction of the pulmonary

arterial system by one or more emboli. Pulmonary embolism is a common and potentially fatal
cardiovascular disorder that must be diagnosed and treated promptly. The cause of PE is generally a
blockage by a thrombus in the arteries in the lungs. Pulmonary embolism can be small and moderate,
multiple, and massive. There are several factors that influence the occurrence of PE such as age over 40
years, major surgery, fractures, and long bed rest.

Case report : A 64 year old woman with a chief complaint of decreased consciousness, beginning with
sudden weakness on the left side of the body and slurred speech. Based on heteroanamnesis, there are
blood vessels in the patient's brain that have long been ruptured from the results of radiological
examination of the head. The blood resulting from this breakdown can form a clot which clogs other
blood vessels resulting in a stroke manifestation, namely sudden weakness on the left side of the body
followed by a loss of consciousness. The patient previously had pain, swelling, and redness of the leg
for 2 months leading to VTE.

Conclusion: PE is an acute and serious disease that has a bidirectional relationship with
cardiopulmonary disease, although it is not directly related to cardiovascular disease. The physiological
and clinical consequences of PE vary from asymptomatic to hemodynamic compromise and death. An
understanding of the pathophysiology of PE is important in stratifying at-risk patients to determine
treatment with anticoagulants alone or consideration for therapy requiring catheters, systemic
thrombolytics, or surgical intervention.

Keyword: Pulmonary embolism

CR-12

Acute Bilateral Ischemic Stroke Secondary to Aortic Dissection: A Critical Diagnosis

Ni W.A.H. Mayakosa1, Intan Karmila1, Lalu M.S.I.W. Atmapraja2, Baiq H. Kholida3
1
General Practitioners, Praya Regional General Hospital
2
Department of Cardiology, Praya Regional General Hospital
3
Department of Neurology, Praya Regional General Hospital

ABSTRACT
Background:
Aortic dissection is a rare disease and life-threatening in which there is a tear in the intimal layer of
aorta. Aortic dissection has an incidence of approximately 3 cases per 100.000 patients. The Standford
classification distinguishes 2 types: Type A aortic dissection affects the ascending aorta and type B
aortic dissection affects the descending aorta. Aortic dissection can lead to organ ischemia secondary
to arterial obstruction which is defined as malperfusion syndrome. This can lead to acute ischemic
strokes which initially present with neurological symptoms and can make aortic dissection diagnosis
delayed. Although pain is the main symptom of aortic dissection, one-third of patients with associated
ischemic stroke did not experience pain. Aortic dissection itself is rapidly fatal and if acute ischemic
stroke happened secondary to aortic dissection the therapy selection can be different.
Case Illustration:
A 55-year-old female came to the emergency room with chief complaints of decrease of
consciousness. The patient was initially diagnosed with stroke and the imaging of head Computed
Tomography confirmed bilateral infarction. The patient is then referred to cardiology to evaluate the
cardiac causes of stroke. Echocardiographic findings revealed an intimal flap at the aortic arch suggest
type A aortic dissection. This is supported by an increase in D-dimer. During the treatment period, the
patient worsened and unfortunately died.
Summary:
Aortic dissection is a critical diagnosis to make and it is still challenging to diagnose aortic dissection.
Therefore collaboration across disciplines is essential in diagnosing this disease. A high index of
suspicion with history taking and further examination should be considered to maximize the therapy
and increase the optimal chance of patient survival.
Keywords:
Aortic dissection, ischemic stroke, life-threatening, critical
CR-13

Aorto Right Atrial Tunnel: A Case Report

Audrey Kumala, Hartomarassidin, Lalu M. S. I. W. Atmaja

Department of Cardiology, Yatofa Islamic Private Hospital, West Nusa Tenggara, Indonesia

BACKGROUND: Aorto-Right Atrial Tunnel (ARAT) is a rare aberration of the heart that can be
brought on by a variety of congenital or acquired disorders. The clinical presentation varies, which can
range from completely asymptomatic to symptoms related to the volume overload to the ventricles.
ARAT is thought to be uncommon, making up fewer than 1% of congenital cardiac disorders, but its
prevalence is unknown. There is currently no information on incidents in Indonesia. This report's
objective is to discuss a case of ARAT with clinical signs and evidence from echocardiography that was
misidentified as a gerbode ventricular septal defect previously.

CASE ILLUSTRATION: A week before being admitted, a 20-year-old male patient presented with a
cough that got worse when lying down came into the cardiology department at Yatofa Islamic Hospital.
A pansystolic murmur was found during the physical examination in the left sternal border (ICS 3-4).
Echocardiography results, meantime, showed an 8 mm-diameter aorto-RA tunnel with continuous L-R
shunt flow and pericardial effusion in the superior right atrium.

A Transesophageal echocardiography revealed a sinus valsalva aneurysm rupture with mild tricuspid
regurgitation and continued drainage to the right atrium. After being hospitalized, the patient received
treatment with spironolactone, digoxin, ramipril, and furosemide and planned to surgery.
CR-14
The Role of Guideline Directed Medical Therapy for Heart Failure Reduced Ejection
Fraction Therapy in Cancer Therapy-Related Cardiac Dysfunction: A Case Report

Farah Inayati1, Santi P. Ramdhani1

1
Bima Regency General Hospital, West Nusa Tenggara, Indonesia

Background
Cancer therapy-related cardiac dysfunction (CTRCD) is one of the most undesirable side effects of
chemotherapy. Breast cancer ranks first in terms of malignancy among women worldwide.
Chemotherapy agents that are widely used in breast cancer treatment, such as anthracycline,
cyclophosphamide, and taxanes are known for their cardiotoxic characteristics. Guideline Directed
Medical Therapy (GDMT) for patients with heart failure with reduced ejection fraction (HFrEF) caused
by cancer therapy may improve recovery of myocardial dysfunction and prevent further progression of
cardiovascular damage.

Case Illustration
We present a case of a 42-year-old woman who was referred to our emergency room (ER) on January
30th, 2023 with a chief complaint of dyspnea. Upon examination, she was hypotensive at 80/60 mmHg,
slight tachycardia with a heart rate of 102/min, and oxygen saturation at 98% room air. History of
hypertension and prior cardiac diseases were denied. The patient had a history of breast cancer and had
completed chemotherapy consisting of doxorubicin, paclitaxel, and cyclophosphamide which ended
three weeks before the visit. Chest radiography at the ER showed cardiac enlargement compared to the
one taken before chemotherapy started. Echocardiography showed LVIDd at 4.86 cm, LVEF at 22.7%
and mitral regurgitation. The patient was then given Uperio (sacubitril-valsartan) with starting dose of
50 mg b.i.d up titrated to 100 mg b.i.d within two weeks, spironolactone 50 mg b.i.d, and bisoprolol up
to 5 mg. After treatment, blood pressure and heart rate showed normal levels at 131/76 mmHg and
63/min, respectively. Echocardiography for evaluation showed LVIDd at 4.36 cm and LVEF at 34.0%
two months later.

Conclusion
Screening of cardiac function using echocardiography is recommended for cancer patients who will
undergo chemotherapy. In heart failure patients after chemotherapy, GDMT is beneficial in improving
cardiac function.

Keywords
cancer therapy-related cardiac dysfunction, echocardiography, heart failure, breast cancer,
chemotherapy
CR-15

Case Report : Infective Endocarditis

Annisa Pratiwi, B dr. ; Dian Asriana P, NLP dr. SpJP

Background

Infective endocarditis (IE) is a disease caused by infection with microorganisms on the

endocardial surface of the heart. Infection mostly affects heart valves (including prosthetic valves), but
can also affect the septum and mural endocardium. The typical lesion is a vegetation consisting of
aggregates of platelets, fibrin, inflammatory cells, and bacteria. Even though there have been
developments in management, IE is still associated with severe complications and high mortality rates.

Case Illustration

A 28 year old man complained of severe shortness of breath since 1 week before being admitted
to the hospital. It accompanied by left chest pain, cough, and intermitten high fever since 1 month ago.
He also complained of pain in the joints in both legs which increased when moved. Patient previously
had a history of anemia and also received blood transfusion. Vital signs showed hypotension,
tachycardia, tachypnea, and fever. On physical examination, there were anemic conjunctiva, systolic
murmur at the apex of the heart radiating to the axillae, crackles in both lung, and oedema in both lower
extremities. Electrocardiogram (ECG): Supraventricular Tachycardia (SVT) rhythm. Echocardiography:
Severe Mitral Regurgitation (MR), an oscillating mass was seen in the Anterior Mitral Leaflet (AML)
with a diameter of 0.85 x 0.75 cm. Patient was diagnosed as a possible IE based on the modified Duke
criteria, because he had 1 major symptom, which is vegetation on echocardiography and 1 minor
symptom, which is fever. Blood culture examination found Streptococcus pyogenes bacteria. Patient
was given antibiotic therapy with Ampicillin injection 2 gram/4 hours and Gentamicin injection 150
mg/24 hours. Other management with diuretics, vasopressors, and inotropic. Families and patients are
given education about surgery for vegetation resection, but decided to refuse to do it. The patient died
after undergoing 8 days of treatment at the hospital.

Figure 1. Echocardiography: Severe MR, an oscillating

mass was seen in the Anterior Mitral Leaflet (AML)
CR-16

Challenges in Managing Total Atrioventricular Block in ST Elevation Inferior Myocardial

Infarction with Atypical Chest Pain in Rural Areas

Desi M. Utami1, Khairul Mawaris2

1
General Practitioner, H.L. Manambai Abdulkadir Hospital, Sumbawa, Indonesia

2
Cardiologist, H.L. Manambai Abdulkadir Hospital, Sumbawa, Indonesia

Background: Total Atrioventricular Block (TAVB) is a common complication of myocardial infarction.

The Right Coronary Artery (RCA) supplies blood to the inferior heart wall and the AV node. The
presence of an obstruction in the RCA causes inferior myocardial infarction and affects the cardiac
conduction system, such as TAVB. Diabetes mellitus (DM) in acute coronary syndrome (ACS) can
affect the characteristics of chest pain. It causes delays for patients seeking medical treatment, delays
in diagnosis and management, and significantly increases mortality.

Case Illustration: A 56-year-old female patient with an uncontrolled history of type 2 diabetes mellitus
was referred to the emergency room with complaints of weakness and heartburn three days prior,
followed by shoulder pain with intermitten delirium within 8 hours before hospital admission. Vital
signs showed BP 103/61 mmHg, HR 51 bpm, RR 26 bpm, and SpO2 98%. Electrocardiography (ECG)
at previous hospital showed inferior ST-elevation and bradycardia AV block 2:1 resembling the grade I
AV block. The patient had previously received loading dose of dual antiplatelet, continuous intravenous
infusion of dopamine, and atropine sulfate. She was given fibrinolytic therapy. ECG showed >50%
reduction in ST-elevation after the fibrinolytic agent was administered. Dopamine was replaced with
theophylline to increase ventricular rate. The patient experienced improvement and showed successful
resolution of TAVB within 6 days of treatment.

Conclusion: In this case, the experience was gained regarding the importance of increasing attention
to a female patient with a history of type 2 DM who has atypical chest pain symptoms with tricky ECG
of AV block. Appropriate management of TAVB caused by inferior STEMI may be reversible, even in
limited-service facilities. Fibrinolytic therapy is a reperfusion therapy in STEMI patients when PCI
cannot be performed. AV block in AMI requires a waiting period to determine further management. In
this case, the TAVB in AMI was resolved less than a week additional theophylline administration as a
drug of choice in AMI patient, so the permanent pacing was not necessary.

Keywords: Total Atrioventricular Block, ST-Elevation Myocardial Infarction Inferior, Atypical Chest
Pain, Type 2 Diabetes Mellitus, Theophylline
CR-17

Double-edged Sword Effect of Anticoagulant in Acute Anterior Myocardial Infraction Patient

with Soft Thrombus and Stroke: A Risk and Benefit Analysis

Nadira F. Amanda1, Santi P. Ramdhani1

1
Bima Regency General Hospital, West Nusa Tenggara, Indonesia

Background

Acute myocardial infraction (MI) incidence reaches 3 million cases globally. 1 In Indonesia, cardiac
event prevalence including MI is 1.5% in population.2 Percutaneous coronary intervention (PCI) is
preferred in patient with MI patient with high thrombus burden or grade ≥ 4 although it faces challenge
due to limited PCI center.3 Meanwhile, soft thrombus on carotid artery in stroke patient is uncommon.4
Although highly effective for thrombosis, the risk of bleeding is significantly higher with anticoagulant.
Anticoagulant therapy usage should consider individual risk of bleeding and ischemic risk.5

Case Illustration

We report a case of 59 years old man with chest pain since last night as chief complaint. The chest pain
was penetrating through the back. The patient had multiple history of stroke, 3 weeks and 3 months ago,
not controlled. Examination showed a blood pressure of 130/80 mmHg with slightly tachycardia heart
rate which beats 104 times/minute. After electrocardiography in emergency room, patient was diagnosed
with anterior ST elevation MI (STEMI). Patient underwent doppler ultrasound (DUS) and
echocardiography examination when hospitalized. DUS showed soft plaque > 2 cm in left carotid artery
and soft thrombus in carotid artery. Meanwhile, thrombus wasn’t seen in echocardiography. The patient
was given aspilet 80 mg, atorvastatin 40 mg, clopidogrel 300 mg, candesartan 8 mg, and fondaparinux
injection 2,5 mg. Patient didn’t want to be referred to the PCI center. Neurologist assessed the patient
had acute stroke. Although anticoagulant can increase bleeding risk, anticoagulant benefit is way bigger
considering patient had STEMI and ischemic stroke. Thus, permission was asked.

Conclusion

A proper risk measurement in myocardial infract case is important. The use of anticoagulant in STEMI
patient with soft thrombus and stroke should be considered after measuring the risk and benefit since it
could lead to hemorrhagic manifestation in the brain.

Keywords: soft thrombus, STEMI, stroke, anticoagulant, risk and benefit

CR-18

Early Pharmacological Cardioversion in Paroxysmal Atrial Fibrillation Decreased Reccurence

Within 4 Weeks Follow-up

Maz’uliyah A. Pratama1, I W. Sudiharta2

1
General Practicioner at RSUD Kabupaten Dompu
2
Internis at RSUD Kabupaten Dompu

Background

Atrial fibrillation is the most common type of aritmia incidence in emergency departmen, contributing
to higher long-term risk of stroke, heart failure, and all-cause mortality and morbidity. Although
paroxysmal atrial fibrillation can resolve itself within 48 hours until 7 days, but the early restoration and
maintenance of sinus rhythm has been shown to be associated with reduced atrial remodeling, improved
left ventricular function, reduced symptoms, greater exercise tolerance, increased ability to perform
activities of daily living, and improved quality of life. This case report exhibits early pharmacological
cardioversion to decreased the reccurence of first time atrial fibrillation.

Case Ilustration

Female, 45 years-old, come to emergency department with nausea and vomiting and diagnosed with
cholelithiasis. Patient was observed and after 4 hours of evaluation, patient complained of palpitation,
short of breathing, also chest and abdominal discomfort. Vital sign on the first admission was normal,
compared with 4 hours after observed, patient’s heart rate 159 bpm irregularly irregular.

There was no sign and symptoms of lung edema. ECG was performed, shown an image of paroxysmal
atrial fibrillation with extreme tachycardia. There was no significant result of laboratory test, but
electrolyte test was not performed. Therapy of choice at that time in the emergency department was to
strive for convert rhythm used anti-arrhythmia drugs. Patient was given amiodarone 500 mg iv for 1
hour. 3 hours after drug administration, patient was evaluated. There was a changes in decrease heart
rate and patient breath more comfortable, with ECG shown a sinus rhythm with several PAC.

Conclusion

Early pharmacological cardioversion may reduce the recurrence in patients with paroxysmal AF within
4 weeks follow up.

Keywords : atrial fibrilation, pharmacological cardioversion, reccurence

CR-19

Hypoplastic Left Heart Syndrome: Rare And Deadly Clinical Condition. A Case Report
Intan Karmila1, Ni Wayan A.H. Mayakosa1, Lalu M.S.I.W. Atmapraja2, Putu D. Vedaswari3, Cok E.
Merlin4
1
Internship doctor, Praya General Hospital
2
Cardiologist, Praya General Hospital
3
Pediatrician, Praya General Hospital
4
General Practitioner, Praya General Hospital
Background:
Hypoplastic left heart syndrome (HLHS) is a rare and fatal congenital heart defect in which the
left side of the heart is underdeveloped, and affecting one in 5,000 newborns. The process to palliate
this congenital cardiomyopathy is quite complex, involves a stepwise repair with 3 surgical procedures
at different points in time: the Norwood surgery, Glenn and the Fontan procedures. It has been reported
that survival rates for all infants undergoing combination staged treatments range from 63% to 80% at
one year of age to 58% to 72% at five years of age. Meanwhile the prognosis for the infant if left
untreated is certain death. Although the prognosis for children with this disease has significantly
improved over the years, it is still heavily influenced by a number of modifiable and non-modifiable
factors.

Case Report:
This is a case report of a newborn baby boy who presented with tachypnea, moderate retractions,
SpO2 72%, cyanosis even with 35% CPAP, and audible grunting 5 hours after birth. Later,
echocardiography showed situs solitus with left sided hypoplastic that confirmed the HLHS diagnosis.
Unfortunely, the newborn died.

Summary:
One of the rare congenital cardiac illnesses with a high fatality rate is hypoplastic left heart
syndrome. To develop the ideal surgical palliative technique, an immediate diagnosis is required.
Echocardiography is a standard diagnostic of HLHS.

Keywords: mitral atresia; aortic atresia; aortic stenosis; left ventricular hypoplasia; hypoplastic
ascending aorta
CR-20
ESTABLISHING DIAGNOSIS OF PULMONARY HYPERTENSION IN RURAL HOSPITAL

Anggianet G.Putri1, Khairul Mawaris2

1
General Practitioner, H.L. Manambai Abdulkadir Hospital, Sumbawa, Indonesia
2
Cardiologist, H.L. Manambai Abdulkadir Hospital, Sumbawa, Indonesia

Background: Pulmonary hypertension (PH) is a pathophysiological disorder that may involve multiple
clinical conditions and may be associated with a variety of cardiovascular and respiratory diseases.
Pulmonary hypertension is defined by a mean pulmonary arterial pressure (mPAP) >20 mmHg at rest.
Measured by right heart catheterization. However establishing diagnosis of PH in limited facility hospital
has been challenging.

Case Illustration: We reported a 25 years old female with complain shortness of breath, fatigue, and lower
extremity edema. Physical examination revealed enlarged heart border with RV heaving, holosystolic
murmur at left lower sternal border, and clubbing finger. The Electrocardiography results showed Right
Axis Deviation, P Pulmonale, and Right Ventricle Hyperthrophy. Chest X-ray showed normal lung with
hilar compaction resembles inverted coma sign with dilated main pulmonary artery and enlarged right
ventricle. On Echocardiography Examination, RA RV dilatation was found, accompanied by Mild to
Moderate TR and Decreased RV Function with TAPSE 9 mm. Estimated mPAP, normal calculated PCWP,
and intact both atrial and ventricular septum. The patient was treated with sildenafil 20 mg t.i.d, furosemide
40 mg, spironolactone 25 mg, and digoxin 0.125 mg. And showed significant clinical improvement.

Conclusion: Pulmonary hypertension is one rare cause of right heart failure in patient without pulmonary
problems nor congenital heart disease. Echocardiography plays a major role in establishing diagnosis since
it can be a surrogate by providing estimated mPAP and PCWP. Ideally, chest CT-scan is needed to exclude
chronic thromboembolic at pulmonary artery (PH group IV). In this case, sildenafil therapy has showed
significant clinical improvement by relaxing pulmonary artery thus it is reasonable to narrow down the
probability of cause to pulmonary arterial hypertension. During the treatment, there was an improvement in
patients. In one study, giving sildenafil could reduce mPAP values and increase cardiac output index.

Key words: Pulmonary hypertension, Sildenafil

CR-21
Permanent Pacemaker Implantation in Patient with Total Atrioventricular Block

I G P Adistana1, Romi Ermawan2

1
Medical Faculty of Mataram University

2
Cardiology Departement of Nusa Tenggara Barat Provincial Hospital

Background: Atrioventricular (AV) block is a condition characterised by disturbance of the heart's

electrical conduction pathways between the atria and ventricles. Total AV block (TAVB) is the complete
loss of electrical communication between the atria and ventricles. This causes supraventricular electrical
impulses to not conduct the ventricles, but ventricular conduction is taken over by junctional or
ventricular escape rhythms. Treatment of TAVB includes correction of underlying reversible disorders.
Definitive treatment of TAVB is a permanent pacemaker (PPM) implantation.

Case ilustration: A 72-year-old female patient came to the emergency room at the Nusa Tenggara Barat
Provincial Hospital with complaints of weakness felt all over the body since the past year and had gotten
worse one month before entering the hospital. Other complaints include dizziness and decreased
appetite. There is no chest pain, palpitations, nausea, vomiting, fever, cough, shortness of breath, or
abnormal bowel movements and urination. She has a history of uncontrolled hypertension. For the
physical examination before PPM implantation, this patient is alert with BP: 146/67 mmHg, HR:
78x/minute, RR: 24x/minute, T: 36.5 degrees Celsius, and SpO2: 98% with 4 lpm NC. On physical
examination, there was an irregular pulse. The EKG results of the patient showed an electrical activity
suggestive of TAVB while the chest X-ray showed cardiomegaly and aortosclerosis. Laboratory tests
revealed an increase in leukocytes and neutrophil count. In addition, there was also a decrease in
eosinophil count, sodium concentration and eGFR.

Conclusion: Total AV block without any reversible underlying disorder should be recommended for
PPM implantation. Single chamber PPM and even better dual chamber PPM is a definitive treatment for
the correction of electrical blockade. This patient undergoes single chamber PPM with excellent
outcome and can be discharge next day.

Keywords: Total AV Block, Arrhytmia, Permanent Pacemaker

CR-22

Left Atrial Myxoma: A Tumor Blocking The Heart

Lovely P. Arief1, Diyana I. Lestari2, Lalu M. S. I. W. Atmapraja3
1
Internship doctor, Praya General Hospital
2
General practitioner, Praya General Hospital
3
Cardiologist, Praya General Hospital
ABSTRACT
Background:
Primary cardiac tumor is extremely rare, cardiac myxoma is the most common primary cardiac tumor.
Most of cardiac myxoma originate from the left atrium (over 70%), 20% from the right atrium and about
5% stem from both atria and the ventricle. Manifestation depends on size, location, mobility and
architecture of the tumor. Manifestation varies from constituents, embolic or obstructive manifestations.
Some patients are asymptomatic and mostly found as accidentally finding in cardiac imaging
examination. Left atrial myxomas manifested in mitral valve obstruction or regurgitation, left sided heart
failure and pulmonary hypertension. Right atrial myomas manifested in tricuspid stenosis and right heart
failure. Congested heart failure, arrhythmia, valvular defect, thromboembolic events and infection can
occur as complications. Cardiac tumor should be differentiated with other cardiac mass or lesion like
thrombus. Surgical resection of myxomas gives good prognosis, but in delayed case who urgent surgical
resection is needed the prognosis is poorer.
Case illustration:
A 39 years old woman was admitted to the emergency department due to shortness of breath, lower
extremities oedema and ascites. In this patient, stroke manifested as extracardiac complication of
myxoma. Echocardiography demonstrated a left atrial mass protruding to the left ventricle causing
mitral inflow obstruction. Unfortunately the patient died from acute cardiac hemodynamic disturbance.
Biopsy is the gold standard of diagnosis of myxoma. However, in this case the diagnose was made base
on clinical manifestations and tumor characteristics from basic imaging, since we have limited resources
in remote area.
Conclusion:
Patients with left atrial myxoma commonly are asymptomatic in initial presentation. It commonly
becomes an accidental finding as a result of it’s complication. Public awareness for early diagnosis is
crucial to prevent life threatening complication. Careful and detailed assessment is important for
clinician to avoid misdiagnosis.
Keywords:
Left atrial myxoma, mitral stenosis, stroke, asymptomatic
CR-23

Management Of Tuberculosis Pericarditis With Cardiac Tamponade In Limited Facility

Dilla Elysmasia1, Putu D. Vedaswari2,Lalu M. S. I. W. Atmapraja3

1
General Practitioner, Praya Regional Public Hospital
2
Pediatrician, Praya Regional Public Hospital
3
Cardiologist, Praya Regional Public Hospital

ABSTRACT

Background: Indonesia is on the list of 30 countries with the highest burden of tuberculosis in the
world. Tuberculosis pericarditis is a rare form of extrapulmonary tuberculosis and can produce
pericardial effusion. Massive pericardial effusion can develop into cardiac tamponade.
Pericardiocentesis must be performed in a life-threatening situation.

Case Ilustration: A 4-year-old pediatric patient was consulted by a pediatrician to a cardiologist

complained of shortness of breath for the 3 days ago . The patient also complained of fever and cough
since 1 week ago. On physical examination, the vital signs found were blood pressure: 60/palpable
mmHg; pulse 114 x/minute; temperature 38,9 and respiratory rate 30 x/minute. Lungs: ictus cordis is
not visible and not palpable, the heart border seems widened, muffle heart sound, cold extremities +/+.
On chest X-ray examination, a "water bottle-shaped heart" was obtained which indicated a massive
pericardial effusion. On echocardiographic found accumulation of pericardial effusion with the sign of
cardiac tamponade. The patient was diagnosed with massive pericardial effusion and cardiac tamponade.
Pericardiocentesis was performed collaboration between the cardiologist and pediatrician, and we found
blood in the pericardial fluid. The patient was given antituberculosis drug and aspiration of bloody fluid
from the pericard was performed periodically.

Conclusion: In pediatric patients finding blood in the pericardial fluid indicates infection rather than
malignancy. The high mortality rate associated with untreated tuberculous pericarditis, together with the
long culture periods required for traditional tests, means that clinical and therapeutic decisions are often
made before results become available. Pericardiocentesis with echo guided must not be used to avoid
the risk of laceration of the heart or other organs, except in very rare situations that are immediately life
threatening. An experienced operator and staff who perform pericardiocentesis in a limited facility are
required.

Keywords: Tuberculosis Pericarditis, Cardiac Tamponade, management, limited facility

CR-24
Post Fibrinolytic Accelarated Idioventricular Rhythm in Patient with ST Elevation Myocardial
Infarction: Is It a Good or Bad Indicator?
Baiq V. F. M. Putri1, Zakiyuddin A. Azam2, Lalu M. S. I. W. Atmapraja3
1
General Practioner, Praya General Hospital, West Nusa Tenggara
2
Faculty of Medicine, University of Mataram, West Nusa Tenggara
3
Cardiologist, Praya General Hospital, West Nusa Tenggara

ABSTRACT

Background: Reperfusion therapy is an important treatment for myocardial survival in the patients with
acute myocardial infarction to minimize the infarct size and improve patient's clinical outcome.
Accelerated Idioventricular Rhythm (AIVR) is one of the most common arrhytmias found in patient
with myocardial infarction with the prevalence of 8-20%. However, it also could be a sign of the
successful reperfusion therapy especially with fibrinolytics in patients with acute myocardial infarction
with ST segment elevation (STEMI). It is not clear how much value AIVR has in predicting successful
reperfusion therapy, because several studies have found no association between the incidence of AIVR
and the successful reperfusion therapy.
Case Illustration: We present a case of a 40-year-old male patient who came to the emergency
department with complaint of typical chest pain with the onset of 1 hour before arriving at the ER. The
12-lead ECG examination showed an elevation of the ST segment in the anterior lead and cardiac marker
examination showed an increase in troponin I. The patient was then given dual antiplatelet therapy,
nitrate and underwent reperfusion therapy with fibrinolytic (streptokinase). The 12-lead ECG
examination at 1 hour after fibrinolytic showed the presence of more than three sequential premature
ventricular rhythms, indicating an AIVR. The patient's chest pain also decreased as measured by the
VAS scale (from VAS 6-7 to VAS 4-5).
Conclusion: Early AIVR could be a sign for successful reperfusion therapy. The mechanism of post
reperfusion AIVR is still unclear. However, most cases of AIVR probably occur as a result of enhanced
automaticity in Purkinje fibers on the endocardial surface near or within the infarction zone owing to
the washout phenomenon during infarct-related artery reperfusion.
Keywords: AIVR, Reperfusion, Myocardial infarction.
CR-25

Pulmonary Embolism In A 71 Year Old Woman: A Case Report

Ismini A. Kamilia1, Lalu M. S. I. W. Atmapraja2

1
Internship doctor, Islamic Hospital Yatofa

2
Cardiologist, Praya General Hospital

ABSTRACT
Background: Pulmonary embolism (PE), one of the cardiovascular emergencies, has a high risk of
morbidity and mortality. The term pulmonary embolism refers to a substance that originates elsewhere
in the body and passes through the bloodstream but blocks blood flow within the pulmonary artery
vasculature. PE has a 0.6 per 1,000 annual incidence rate overall. PE ranges from clinically insignificant
accidental events to sudden death. The notorious variety of symptoms and signs that characterize
pulmonary embolism continue to make diagnosis challenging, especially in the elderly.
Case illustration: A 71 year old woman was admitted to the emergency department of Islamic Hospital
Yatofa due to dyspnea. Further questioning revealed that she was an inpatient for several days at Praya
General Hospital due to difficult intake and immobilization a few days ago. Medical history was
significant is a hypertensive heart disease. During admission, the patient developed sudden hypotension,
desaturation, and chest pain. The differential diagnosis must take into consideration and may include
pulmonary embolism. The echocardiography supports pulmonary embolism as a high-probability
diagnosis based on findings of McConnell’s sign with severely reduced right ventricular function.
Anticoagulant and fibrinolytic therapies were administered, and the clinical outcome improved.
However, the patient was transferred to the West Nusa Tenggara Province General Hospital for further
treatment. The patient was in an improved hemodynamic state with minimal support when they were
transferred.
Conclusions: Identifying clinically suspected PE and the underlying cause of shock could enable
immediate specific treatment, which could decrease morbidity and mortality linked to PE.
Echocardiography may be a screening tool in a remote area with limited tools.
Keywords:Pulmonary embolism, echocardiography, anticoagulant, fibrinolytic
CR-26

Pulmonary Embolism Mimics Acute Coronary Syndrome : A Case Report

Dilla Elysmasia1, Fariz A. M. Dailami2 , Alya T. Nurjanah3, Lalu M. S. I. W. Atmapraja3

1,2,3
General practitioners, Praya General Hospital
3
Cardiologist, Praya General Hospital

ABSTRACT

Background : Pulmonary embolism (PE) was the third most common cause of cardiovascular death.
PE is a life threatening disease and unfortunately the symptoms of PE are often refracted by ACS
because of the similarity of signs and symptoms. Physical examination cannot distinguish these two
diagnoses. It is important to distinguish the two entities because they have a high mortality.

Case Ilustration : A 51-year-old woman came to the emergency room at the Praya General Hospital
with chest pain and shortness of breath since 1 days ago. The patient also have a fever and cough since
1 week ago. The patient has medical history of diabetes mellitus type II. Physical examination revealed:
a regular pulse rate 123beats/min, blood pressure was 130/80mmHg, respiratory rate was 24
breaths/min, oxygen saturation was 99% at room air and temperature was 38,5°C. An initial ECG
showed a sinus rhythm, an ST segment elevation of 2 mm in V1-V3, with T invertion in lead II,III,avF.
Laboratory results on CKMB are elevated, blood glucose 432 mg/dL. We assess patients with ST
elevation myocardial infarction with pneumonia and diabetes mellitus type II. The patient was treated
with low molecular weight heparin, broad spectrum antibiotics and insulin for five days and show
improvement in symptoms. On fifth day, the patient suddenly experience cardiogenic shock and
decreased saturation. The cardiologist then performed bedside echocardiography and found a pulmonary
embolism.

Conclusion: The conclusion was even the patient already receiving heparinization for 5 days didn’t
exclude the possibility of PE because of multifactorial and high burden thrombus. Thus clinicians must
be aware of PE because there are similar symptoms between PE and ACS, the ability to differentiate
ACS and PE in the first place could help increase the chance of survival.

Keywords: Pulmonary embolism, Acute coronary syndrome, ST elevation

CR-27

Patent Ductus Arteriosus : A Case Report and Overview of Conservative Treatment on A 16-
Years Old Girls with Pulmonary Hypertension
Siska P. Utami1* , Mochamad B. Ferdiawan1 , Lalu M. S. I. W. Atmapraja2
1
General physicians, Yatofa Islamic Hospital
2
Cardiologist, Yatofa Islamic Hospital
*Corresponding author : Siska Putri Utami (siskap729@gmail.com)

ABSTRACT
Background Patent Ductus Arterious (PDA) is the most common asyanotic congenital heart defect in
which the ductus arteriosus, a tunnels between the left pulmonary artery and proximal part of descending
aorta of the neonate, fails to close within 3 weeks of life. Had more common discovered in preterm
infants, PDA also reported to be resist in adult usually within Pulmonary Hypertension (PH) as known
complication of these condition, which eventually lead to Eisenmenger syndrome, leading to death,if
left uncorrectly.
Case Illustration We present a 16-year-old female student that taken to the Emergency Department
(ED) at Yatofa Islamic Hospital with a 7-years history of reccurent shortness of breath and palpitation,
with easy fatigability that heavier since this morning also cough that sometimes occurs. There was no
associated fever, weight lost nor body swelling. Physical examination revealed 86% oxygen saturation
at room air, distended of jugular vein with crackles found bilaterally, with loud P2 sound and hazy
continous machinery murmur heard. Chest X-Ray showed prominent PA segment with toracoscoliosis,
Electrocardiograph (ECG) showed ther is right ventricular involvement that hypertrophy, coincide with
right atrial enlargement. Echocardiology had confirmed with RA-RV dilatation, LV-D shaped, and
moderate PDA with bidirectional shunt (dominant left-to-right shunt) plus there is sign of PH. Patient
were treated as a Heart Failure (HF) condition with conservative management, given at optimal HF
therapy.
Conclusion PDA that persist on adulthood usually accompanied with PH, and obviously lead to
eisenmenger syndrome, if left untreated. Management of complicating PDA in late onset is quite
challenging, as the original common sign of PDA seems no longer appears, making more difficult to
diagnose and worsens the prognosis. High index of suspicion and proper evaluation of patient including
echocardiography will lead the diagnosis better.

Keyword : Patent Ductus Arteriosus, echocardiography, heart failure, imaging, conservative treatment
CR-28
Serial Case Report: Pericardial Effusion Management in Province of Nusa Tenggara Barat General
Hospital

Dita K. Nurlalwani, Fahmi A. Utomo, Bella I. Kamil, Mona R.Y. Marbun, Nafatasya A. Rahmansyah, I
Gede P. Adistana

Medical Faculty of Mataram University

ABSTRACT

Background: Pericardial effusion is the accumulation of blood or excess fluid in the cavity between the
heart and the pericardium sac. The space between these layers typically contains a thin layer of fluid. But
if the pericardium is injured, the resulting inflammation can lead to excess fluid. Pericardial effusion can
be caused by malignant and non-malignant causes. Pericardial effusion may be present in up to 6.5% of
the general adult population. Prevalence increased with age, from <1% in patients ages 20 to 30 years to
more than 15% in patients ages 80 years and over. Most people in the study had small effusions and no
recognizable cardiac disease. Pericardiocentesis is the gold standard assessment method for pericardial
effusion etiology.

Case Illustration: First case was A 41 year old man came with complaints of shortness of breath since 2
months before entering the hospital, left chest pain, the patient also complained of coughing. Sleep in a
sitting position. There was no history of trauma, swelling or fever. From the results of the examination,
this patient was diagnosed with pericardial effusion ec. Susp. pulmonary tumor and clinical tuberculosis.
The second case was A 38 year old man complaints of heartburn since 2 weeks before entering the
hospital. The pain is felt intermittent and the pain is felt through to the back. The patient also feels weak
all over the body, the patient complains of nausea and vomiting, the stomach looks swollen. Shortness of
breath is also felt in patients. The patient has a history of drinking alcohol 20 years ago. This patient was
diagnosed with Pericardial effusion with Acute Kidney Injury. So, they are planned for pericardiocentesis.

Conclusion: The aim of this study was to identify the types of pericardiocentesis in the two of pericardial
effusion patients.

Keywords: Pericardial effusion, pericardiocentesis.

CR-29
Twiddler’s Syndrome: A Simple Approach to Prevent An Unusual
but Lethal Complication of Pacemaker Treatment
Putri Amelia1, Santi P. Ramdhani1
1
Bima Regency General Hospital, West Nusa Tenggara, Indonesia

Background
Twiddler’s syndrome is a rare (0.07-7%) cause of pacemaker malfunction when a pulse generator
within its skin pocket is manipulated and rotated by the patient inadvertently or deliberately. This event is
potentially fatal as it leads to dislodgement, diaphragmatic stimulation, and failure to pace. Patients with
1,2

Twiddler’s syndrome are typically elderly females with or without symptoms such as dizziness, syncope,
chest pain, fatigue, abdominal pulsation, rhythmic arm movements, and bradyarrhythmias within the first
year of pacemaker implantation. We report a case of a patient with Twiddler’s syndrome who was admitted
3,4

to the emergency room.

Case Illustration
A 74-year-old female whom we had referred to a provincial referral hospital for permanent
pacemaker implantation because of symptomatic bradycardia presented to us again in the emergency room
three weeks later, with fatigue and abdominal pulsation. She appeared uncomfortable as she was found
occasionally touching the pacemaker generator that was still covered with a bandage. Physical examination
revealed a heart rate of 29 beats/minute, blood pressure of 140/110 mmHg, and visible abdominal pulsation.
An immediate 12-lead electrocardiogram showed nonsustained ventricular tachycardia. A chest X-
ray revealed a looping of proximal lead around the pulse generator. Both chest X-ray and echocardiography
showed that the lead had displaced into the right atrium. Afterward, we referred her back with a diagnosis
of Twiddler’s syndrome for lead repositioning and educated her to avoid further manipulation.

Conclusion
Twiddler’s syndrome is a potentially dangerous condition that should be considered in elderly
patients with symptomatic bradyarrhythmias following pacemaker implantation. Strong education and
counseling to the patients and their caretakers against further manipulation are key to its prevention. All
healthcare workers should be more aware of this condition and take part in managing post-pacemaker
implantation patients, even in primary health care settings.

Keywords
Twiddler’s syndrome, post-pacemaker management, lead dislodgement, pacemaker failure

References
1. Bayliss CE, Beanlands DS, Baird RJ (1968) The pacemaker-twiddler's syndrome: A new
complication of implantable transvenous pacemakers. Can Med Assoc J 99: 371-373.
CR-30
Fever unmasking Type 1 Brugada Syndrome : A Case Report
Fariz. A. M. Dailami1, Alya. T. Nurjanah2, Dilla Elysmasia3, Lalu. M. S. I. W. Atmapraja4
1,2,3
General practitioners, Praya General Hospital
4
Cardiologist, Praya General Hospital

ABSTRACT
Background: Brugada syndrome is one of the rarest cardiology cases in the world, only 3-5 cases in
every 10.000 patients and mainly occurred in an older population. Brugada syndrome is caused by a
genetic mutation in the cardiac voltage-gated sodium channel gene SCN5A. Brugada syndrome is
inherited in an autosomal dominant pattern. The characteristics of brugada syndrome based on ECG
examination only. Brugada syndrome can cause a heightened risk for ventricular tachyarrhythmias and
sudden cardiac death. Stimuli that can unmask brugada such as fever.
Case illustration: We report one case of fever that unmasking type 1 brugada syndrome, a 27 years
old male patient came to emergency room with the chief complaint of chest pain and fever (39.0 C)
since 3 days ago, with no history of cardiac disease and no family history of sudden cardiac death,
ECG examination shows sinus rhythm with coved ST elevation more than 5 mm in V2 and V3
continued with T wave inversion, the Echocardiography result showed normal cardiac dimension with
good LV and RV function (EF 72%). The patient also received antipyretic therapy during the
treatment and serial ECG examination on day 3 of admission showed complete resolution coved ST
elevation.
Conclusion: Brugada syndrome can increase the risk of ventricular tachyarrhythmias and sudden
cardiac death. Most cases of brugada syndrome are usually unmasked by fever. The underlying
mechanism may involve the effect of fever on Na ion channel function. In our patient detailed history
taking and further examinations are needed to determine the risk stratification of brugada syndrome.
Keywords: Type 1 brugada syndrome, SCN5A mutation, ST Elevation, Fever Unmasking.
CR-31
URGENT HEMODYALISIS CAN
CONVERT SINE WAVE ECG TO
NORMAL SINUS RHYTHM ON PATIENT
WITH ESRD : A CASE REPORT
Y. Pintaningrum, L. B. B. Getas

Cardiology and Vascular Department of West Nusa

Tenggara General Hospital, Mataram, Indonesia

Background : Hyperkalemia is described as a serum

potassium level that exceeds the normal upper limits
(5.0 mmol/L to 5.5 mmol/L). Extreme hyperkalemia
can be life-threatening, leading to ventricular
tachycardia, fibrillation, and cardiac arrest.
Immediate identification and treatment of
hyperkalemia are crucial for preventing cardiac arrest,
one of which is urgent hemodialysis. We present an
intriguing electrocardiogram with a sine wave pattern
as a result of acute hyperkalemia in a patient with end-
stage renal disease, which reverses to sinus rhythm
following hemodyalisis.

Case Illustration : A 66-year-old woman presented

to the emergency department with a sudden decrease
of consciousness and one-week history of increasing
shortness of breath. The patient's medical history
includes hypertension and diabetes. On examination,
apathetic consciousness; heartbeat 65 beat per minute,
irregular; Kussmaul breathing pattern; desaturation;
ronchi bilateral and pretibial oedema was found. The
ECG shows a sine wave pattern. Blood sample
confirmed ESRD, severe hyperkalemia 8.2 mmol/l ,
severe metabolic acidosis with pH 7.09 and HCO3
13.2, and severe acute respiratory distress syndrome
(ARDS). Patients were treated with calcium
gluconate, rapid insulin with glucose, and injection of
NaHCO3. The patient immediately shifted for
hemodialysis. After hemodiaylisis, the ECG turns into
a sinus rhythm; potassium drops to 7.5 mmol/l

Discussion : Hyperkalemia can lead to ventricular

rhythms that can be life-threatening. One typical ECG
is the sine wave pattern. It is vital to take immediate
action with urgent hemodialysis and routine therapy
for hyperkalemia, including intravenous calcium
gluconate, insulin via dextrose infusion, intravenous
NaHCO3, and nebulized salbutamol.
OR-01

SUDDENT CARDIAC DEATH IN EARLY REPOLARIZATION SYNDROME: A

META-ANALYSIS AND SYSTEMATIC REVIEWS
Mona Rianta Yolanda Marbun1*, Yusra Pintaningrum2
1
Medical Student, Faculty of Medicine, Mataram University
2
Departement of Cardiology, Faculty of Medicide, Mataram University
*
Email: monariantayolanda29@gmail.com
ABSTRACT
Background and aims: Early repolarization syndrome (ERS), manifested as J-point elevation on
an electrocardiogram, was formerly assumed to be a benign condition, but new research has shown
that it can be associated with a significant risk of life-threatening arrhythmias and sudden cardiac
death (SCD). The prevalence of ERS ranges from 3% to 24%, with age, gender, and J-point being
the key drivers. Patients with ERS have random symptoms and are more likely to have recurrent
cardiac episodes. This meta-analysis was aimed to analyze the risk of SCD in ERS group.
Methods: Searching strategy using PRISMA flowchart in the database such as Pubmed, Cochrane,
Plos and Googlescholar. The data were included such as age, sex, and comorbidities. The primary
outcomes are death-related to SCD in ERS group. The forest plot were conducted using RevMan
5.4.
Results: A total of two studies with a total of 876 samples from the ERS and 5543 samples from
control. The pool risk ratio for mortality is 1.41 (CI95% 1.41-1.75, P=0.002), which favour control
group. Most of populations are male, younger than 60 years old with comorbidities such as
hypertension, diabetes, and myocardial infarction.
Conclusion: our study showed that the risk sudden cardiac death is increased in ERS group 1.41
fold than the control group. For a long period of time ERS was assumed to be benign, but when
compared to patients without an early repolarization pattern, the horizontal/descending pattern was
substantially related with sudden cardiac death in a large general population, but the ascending
pattern had no significant association with sudden cardiac death and commonly found in young
athletes.
Keywords: Early repolarization syndrome, sudden cardiac death, J-point pattern

Figure 1 Forest Plot of Sudden Cardiac Death event in ERS

OR-02
ABSTRACT
CORRELATION BETWEEN NUTRITIONAL STATUS AND QUALITY OF LIFE OF
PEDIATRIC PATIENTS WITH CONGENITAL HEART DISEASE IN DISTRICT
HOSPITAL OF WEST NUSA TENGGARA PROVINCE

Auliya C. Putri1, Linda S. Sari2, Yudhi Kurniawan2, Titi P. Karuniawaty2

1
Faculty of Medicine, University of Mataram, Indonesia
2
Department of Paediatrics, Faculty of Medicine, University of Mataram, Indonesia

Background: Congenital heart disease (CHD) is an abnormality in both the structure and function of
the cardiac circulation that is brought from birth due to a disturbance or failure of the development of
the heart structure in the early stages of foetal development. Problems that often accompany children
with CHD, one of which is developmental disorders and malnutrition that occur in children with CHD
in District Hospital of West Nusa Tenggara Province.

Methods: Cross sectional study conducted involving children with CHD aged 1 month-18 years at the
Paediatric Clinic from February 2021 to May 2022. The assessment of nutritional status in this study
used WHO growth chart as standard anthropometric reference, while quality of life assessed using the
PedsQLTM and PedsQLᵀᴹ infant questionnaires. Statistical analysis used Chi-Square and One-Way
Anova tests.

Results: 28 Subjects with mean age 10,82±6,89 months old were predominantly female (64.3%), and
mostly acyanotic-CHD (96,4%). As 9(33,3%) subjects were underweight, 8(28,6%) were stunted,
3(10,7%) were severe malnutrition. There were 6(21,4%) subjects with impaired quality of life. There
was significant correlation between weight-for-age Z-Score and quality of life impairment (p=0.002),
but further detailed analysis didn’t find any significant mean difference between nutritional status index
and PedsQL-score across age group and domain of quality of life.

Conclusion: There is correlation between nutritional status and quality of life, especially on recent
nutritional status based on weight-for-age parameter.

Keywords: CHD, Quality of Life, Nutritional Status.

OR-03
Angiotensin converting enzyme inhibitors (ACEi), Angiotensin Receptor Blockers (ARB), and
beta-blockers (BB) to Prevent Cardiotoxicity in Breast Cancer Patients: A Systematic Review
and Meta-Analysis

Belva B. Buana,1 Yusra Pintaningrum2

1
Medical Student, Faculty of Medicine, University of Mataram, Mataram, Indonesia
2
Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Mataram, West
Nusa Tenggara General Hospital, Mataram, Indonesia.

ABSTRACT

Background: The standard treatment for breast cancer involves anthracycline-based chemotherapy
with or without trastuzumab, which has been linked to a reduction in left ventricular ejection fraction
(LVEF). In an effort to mitigate this cardiotoxicity caused by anti-cancer therapy, the use of
angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), and beta-
blockers (BB) have been suggested. We aims to investigate the effect of suggested cardioprotective
agents on LVEF in breast cancer patients.
Methods: We systematically searched the electronic databases Cochrane and PubMed, for randomized
controlled trials (RCTs) evaluating the effect of ACEi/ARB/BB. This meta-analysis calculated
weighted mean differences with 95% CI. Pooled analyses were used in a random-effect model. The
primary endpoint was the change of LVEF in the ACEi/ARB/BB alone or in combination group versus
the control group from baseline through completion of the studies.
Results: Our meta-analysis includes 10 studies encompassing 1760 confirmed breast cancer patients.
There was statistically significant different in the change of mean LVEF as the primary outcome, in
patients receiving ACEi [MD = 4.97 (2.56-7.38); I2 = 93% ; p=0.009], ARB [MD = 4.73 (1.18-8.29);
I2 = 95% ; p=0.009], and BB [MD = 3.12 (1.53-4.71); I2 = 98% ; p=0.009] compared with control
groups, with a mean difference of 4.08% (95% CI: 0.8% to 7.35%, P=0.01).
Conclusions: Our findings indicate that the use of ACEi/ARB/BB alone or in combination, can greatly
reduce cardiac damage induced by chemotherapy containing anthracyclines and/or trastuzumab.
However, additional research is necessary to validate this cardioprotective mechanisms involved as well
as other factors relevant to its efficacy.

Keywords: Breast cancer, chemotherapy, cardiotoxicity, angiotensin-converting enzyme inhibitors

(ACEi), angiotensin receptor blockers (ARB), beta blockers (BB).
OR-04
Systematic Review / Meta Analysis

Quality of Life Patient with Heart Failure Preserved Ejection Fraction (HFpEF) in Vericiguat
Therapy via Kansas City Cardiomyopathy Questionnare (KCCQ): Meta-analysis

Yusra Pintaningrum1, Puspasari Mahadewi1

Mataram University1

Background and aims: HFpEF is a subtype of heart failure with left heart pump function ≥ 50%[2].
The incidence of HFpEF over time tends to increase compared to the incidence of HFrEF[2]. One of
many pathophysiology of HFpEF is the suppression of cGMP production which causes myocardial dan
vascular dysfunction[1,3]. Vericiguat is one of the Soluble Guanylate Cyclase (sGC) stimulating drugs
that can increase cGMP activation[3,4]. Based on this, the authors are interested in researching the
effectiveness of vericiguat therapy on the quality of life and health status HFpEF patients with Kansas
City Cardiomyopathy Quistionnare (KCCQ)[3,5].

Methods: This study used a systematic search using PRISMA principle in several online databases
(Pubmed, Cochrane library and Google scholar). The selected study was an RCT or clinical trial with a
population of HFpEF patients who were given vericiguat therapy interventions, and a comparison was
made of the quality of life and health status pf patient in placebo group via KCCQs. Selected study will
be assessed and analyzed using Review Manager software version 5.4 with 95% CI.

Result: The two studies selected in this meta-analysis had a total sample size of 330 in the intervention
group and 341 in the placebo group. Heterogenecity test obtained [p>0,05; I2 35%], indicating the
homogenous data and the study is recommended to use the fixed effect method. The result of the analysis
test related to KCCQs scores of the intervention and placebo groups [RR 3.50 (95% CI 0,13-6.87), p
0.04] Vericiguat 10 mg group have a higher KCCQ score than in the placebo group.

Conclusion: The results showed that vericiguat therapy showed significant improvement on the quality
of life and health status of patient with HFpEF based on KCCQs scoring.

Keyword: Vericiguat, HFpEF, KCCQ, Preserved Ejection Fraction

OR-05
ABSTRACT
Perhexiline in Progression of Cardiomyopathy: A Systematic Review and Meta-Analysis
of Randomized Placebo-Controlled Clinical Trials.
Lalu Rifal Hadi Anugra1 Yusra Pintaningrum2
1
Faculty of Medicine, Mataram University, West Nusa Tenggara, Indonesia
2
Department of Cardiovascular, NTB Provincial General Hospital, Indonesia

Background : Cardiomyopathy is a group of condition that affect of heart’s structures and

functions. Many medical treatment is performed to cure cardiomyopathy.
One of them is perhexiline. The Carnitine palmitoyltransferase-1 (CPT-1) is
inhibited by Perhexiline mechanism to increase cardiac energetic. Cardiac
energetic is evaluated through myocardial PCr/ATP ratio. This PCr/ATP
ratio can be a predictor of mortality in cardiomyopathy.

Objective : To evaluate the efficacy of the perhexiline in progession of cardiomyopathy

Methods : We search the latest 20 years studies using PubMed, ReseacrhGate and
Google scholar database. The Selection article was performed through the
search strategy based on Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) guidelines.

Result : A total of two comparative studies involving 96 patients were included for this
meta-analysis. Perhexiline showed increase of myocardial PCr/ATP ratio.
Perhexiline showed significant increase of myocardial PCr/ATP after
intervention from -0.08 (-0.25 to +0.09, p = 0.34) to +0.36 (+0.04 to +0.68,
p = 0.03). Heterogenity test showed heterogenous data (I2 = 87%, p=0.006).
Perhexiline proved to significantly increase myocardial PCr/ATP ratio.

Conclusion : Perhexiline showed promising result. There is significant increase of

myocardial PCr/ATP ratio. Based on this meta-analysis, we recommended
perhexiline to applicated in cardiomyopathy. Further clinical may need with
bigger population to increase the credibilty of this medical therapy

Keyword : Perhexiline, Cardiomyopathy, PCr/ATP ratio

OR-06
ABSTRACT
Drug of Choice to Prevent Recurrency of Stress Cardiomyopathy
Naurah Nazhifah1 Yusra Pintaningrum1
1
Faculty of Medicine, Universitas Mataram, West Nusa Tenggara

Background : Hypertension is elevation of systolic and diatolic blood pressure.

Hypertension could increase the risk of all-cause mortality, morbidity
and cardiovascular disease. Theraupetical approach is well established
to lower blood pressure. However, salt restriction diet showed
promising result in reducing both systolic (SBP) and diastolic blood
pressure (DBP). In this meta analysis we eould like to evaluate the
potential salt restriction diet to lower SBP and DBP
Objective : To evaluate the efficacy of the salt restriction diet to reduce systolic
and diastolic blood pressure.
Methods : We search the latest 10 years studies using PubMed, ReseacrhGate and
Google scholar database. Article selection was performed through the
search strategy based on Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) guidelines.

Result : A total of two comparative studies involving 149 patients were included
for this meta-analysis. Salt restriction showed promosing result. SBP
significantly reduced by – 1.22 (- 0.24 to - 2.20, p<0.0001) mmHg, The
heterogeneity test showed a homogenous data (I2=47%, P=0.17).
However, no significant reduced DBP by – 0.39 (- 0.24 to - 2.20,
p=0.48) mmHg. Heterogenity test showed heterogenous data (I2 = 63%,
p = 0.01).
Conclusion : Salt restriction diet showed promising result. There is significant
decrease of SBP, but no significant decrase of DBP is observed. Based
on this meta-analysis, we recommended salt restriction diet to
applicaten with patients. Further clinical may need with bigger
population to increase the credibilty of this nutritional therapy
Keyword : Hypertension, Salt restriction diet, Systolic blood pressure, Diastolic
blood pressure.
OR-07
ABSTRACT

Effects of Yoga on Patients with Hypertension

Nofiana A. Risqiana Sari1, Zikriyya M. Rahmani1, Yusra Pintaningrum1

1
Faculty of Medicine, Mataram University, West Nusa Tenggara
Background and aims: Yoga is a combination of muscular activity and internally
mindful focus that results on the body’s homeostasis by balancing the autonomic nervous
system. Some studies mentioned that it is recommended for hypertensive patients in terms
of reducing blood pressure. This systematic review and meta-analysis were conducted to
assess theoutcomes of yoga to reduce systolic and diastolic blood pressure on patient with
hypertension.

Methods: Search for published scientific articles using the PRISMA (Preferred
Reporting, Items for Systematic Reviews and Meta-Analysis) method conducted on
Pubmed NCBI, Pubmed Central, and Proquest databases published in the last 15 years on
“Yoga exercise” AND “hypertension” AND “blood pressure”. Further systematic review
and meta-analysis using RevMan version 5.4 were performed based on the included
published scientific articles.

Results: Based on 4 studies included that assess the outcomes of yoga exercise in
reducing blood pressure on the patient with hypertension, the analytical results showed a
statistically significant overall effect (P < 0.0001) and reduced mean difference in systolic
blood pressure of the hypertensive patients group that undergoes yoga exercise program
compared to the control group. This result showed yoga exercise program has a significant
effect to lower the systolic blood pressure of a hypertensive patient by 5.93 (MD = -5.93:
95% CI: -10.70 – -1.12) mmHg compared to the control group.

Conclusions: Results of this study showed there is significant effects of yoga exercise
outcomes on patient with hypertension compared to the control group in reducing systolic
blood pressure.

Keywords: Yoga exercise , hypertension, blood pressure

OR-08
Preoperative Use of Intra-aortic Balloon Pump in High-Risk Stable Patients Undergoing
Coronary Artery Bypass Grafting: A Meta-analysis of Mortality and Length of Stay

Ericko O. Joyo1, Hari W. Patrihady1

1
General practitioner, Nusa Tenggara Barat Province General Hospital, Mataram, Indonesia

Background and aims: The preoperative use of intra-aortic balloon pump (IABP) in high-risk stable
patients undergoing coronary artery bypass grafting (CABG) has been a subject of debate regarding its
impact on clinical outcomes. This meta-analysis aims to evaluate the effects of preoperative IABP on
mortality, hospital length of stay (LOS), and intensive care unit (ICU) LOS.

Methods: A systematic literature search was performed in multiple databases, including PubMed,
EMBASE, Cochrane Library, Scopus, ProQuest, EBSCO, and ClinicalKey. Studies comparing high-
risk stable patients undergoing CABG with preoperative IABP versus those without IABP were
included. The primary outcome was mortality, and secondary outcomes included hospital LOS and ICU
LOS. Pooled odds ratios (OR) were calculated for mortality, while weighted mean differences (MD)
were calculated for LOS outcomes. Random-effects models were used due to anticipated heterogeneity.

Results: A total of seven randomized controlled trials and 21 observational studies with 8,928 patients
were included in the analysis. The pooled analysis showed that preoperative IABP use in high-risk stable
patients undergoing CABG was not associated with a significant difference in mortality (OR 0.77; 95%
CI 0.51-1.15; p = 0.2). However, a significant reduction in hospital LOS (MD -0.70 days; 95% CI -1.12
to -0.28; p = 0.001) and ICU LOS (MD -16.94 days; 95% CI -33.71 to -0.17; p = 0.05) was observed in
the preoperative IABP group compared to the non-IABP group.

Conclusion: This meta-analysis suggests that preoperative use of intra-aortic balloon pump in high-risk
stable patients undergoing coronary artery bypass grafting does not significantly impact mortality.
However, it is associated with significantly decreased hospital and ICU lengths of stay. These findings
support the consideration of IABP as a potential intervention in this patient population.

Keywords: coronary artery bypass, high risk patients, intra-aortic balloon pump
OR-09
THE CARDIOMETABOLIC EFFECTS FROM COCONUT OIL COMPARE WITH OTHER
OILS: A META-ANALYSIS OF RANDOMIZED CLINICAL TRIALS

Emalisa Gea Rezqi1*, Yusra Pintaningrum2

1
Medical Student, Mataram University
2
Department of Cardiology, Mataram University

*Email: emalisagrzqi@gmail.com

ABSTRACT

Background: Cardiovascular disease is a significant public health issue, particularly coronary heart
disease and stroke. The influence of various dietary fats on cardiometabolic risk has been investigated,
and their role in the development of illnesses generating not significant burdens has been discussed.
Objective: I aim to conduct an updated systematic review and meta-analysis of randomized controlled
trials to investigate the effect of coconut oil consumption on various cardiometabolic outcomes.
Methods: This study's data was scoured via the PubMed, Cochrane, and Medline databases for RCTs
conducted until April 2023. We considered (RCTs) that examined the effects of coconut oil consumption
vs other substances on anthropometric and metabolic profiles in adults published in any language;
however, we omitted non-randomized trials and short follow-up studies. The RoB 2 technique was used
to assess the risk of bias, and GRADE was used to evaluate the certainty of evidence. We used a random-
effects model to do meta-analyses whenever possible.
Results: The meta-analysis comprised seven trials (n=481) with follow-up from four weeks to two years.
The quantity of coconut oil eaten varied and was stated differently among studies: 12 to 30 ml/day (n=5),
as part of the number of SFAs or total daily ingested fat (n=1), a variable of 6 to 54.4 g/day (n=5), or as a
proportion of total caloric energy intake (15 to 21%) (n=6). Coconut oil consumption did not affect body
weight (MD=0.22kg, 95%CI -0.09 kg to 0.53), (LDL-C) (MD=-2.45mg/dL, 95% CI -6.00 to 1.10), or
triglyceride levels (MD= 0.05mg/dL, 95%CI -0.41 to 0.51). However, coconut oil was linked to a rise in
(HDL-C) (MD=3.26mg/dL, 95%CI 0.92 to 5.61) and decrease of TC (MD= -2.59mg/dL, 95%CI -4.59 to
-0.59). The total risk of bias was considerable, and the evidence's confidence was low.
Conclusion: Based on this meta-analysis, the conclusion is that coconut oil, compared to other oils/fats,
showed no clinically significant improvement in lipid profile or body composition.
Keywords: Cardiometabolic, Coconut oil, Lipid profile, Randomized, Saturated fatty acids.
OR-10
Meta-Analysis: Effects of Celery (Apium graveolens) in Reducing Blood Pressure on
Patients with Hypertension

Luthfiyah Kamila Zavitri1, Yusra Pintaningrum1

1
Faculty of Medicine, Universitas Mataram, West Nusa Tenggara

Background : Hypertension is an increase of systolic and diastolic blood pressure.

High blood pressure can cause various complications. Apart from the
use of conventional drugs for hypertension treatment, the use of
traditional medicines can also help to reduce high blood pressure, one
of them is celery (Apium graveolens). Celery contain an active
compound called apigenin that can function as a β-blocker which
slows the heart rate and decreases heart contractions.

Aims : To evaluate the efficacy of celery in reducing blood pressure.

Methods : We searched for appropriate articles from Pubmed, Cochrane, and

Google Scholar using PRISMA principle from their respective
inceptions until June 2023. The selected study was an RCT or clinical
trial with a population of hypertensive patients. The intervention
group is administration of celery-based preparations in any dose
compared to placebo. The primary outcome is the level of SBP and
DBP after intervention. Selected study were reviewed by one reviewer
and were analyzed using software Revman 5.4.

Result : A total of five studies were identified in this study. Compared with the
placebo, this meta-analysis revealed a significant lowering effect of
celery on both SBP and DBP. SBP significantly reduced by -0.50
(CI95% -0.73, -0.26, P=0.0001) mmHg. DBP also significantly
reduced by -0.62 (CI95% -0.86, -0.39, P<0.00001). The heterogenity
test showed heterogenous data in both SBP (I2=90%, P<0.00001) and
DBP (I2 = 80%, p = 0.00004).

Conclusion : The present review suggest that celery is an effective and safe
approach for hypertension which had shown a favorable effect in
reducing blood pressure on patient with hypertension.

Keyword : Celery, Apium graveolens, Hypertension, Blood Pressure, Meta-

Analysis
OR-11
Triple Antiplatelet Therapy (TAPT) vs Dual Antiplatelet Therapy (DAPT) in Diabetic
Patients with Acute Coronary Syndrome: a Five Year-Update Meta Analysis
Abiyyu Didar Haq1, Visakha Vidyadevi Wiguna1, Putu Diah Ananda Putri Atmaja1, Luh Ade
Dita Rahayu1, Yusra Pintaningrum2
1
Medical Student, Faculty of Medicine, Mataram University
2
Department of Cardiology, Faculty of Medicine, Mataram University

Background: Various trials have shown the safety and efficacy of dual antiplatelet therapy for
acute coronary syndrome patients. However, in regards to the impaired fibrinolytic function in
diabetic patients, it is still unclear whether dual therapy is as safe and efficacious as triple therapy.
Objective: To compare safety and efficacy of the current standard therapy (DAPT;
Rivaroxaban+Aspirin/Clopidogrel+Aspirin/Ticagrelor+Aspirin) with TAPT
(Ticagrelor+Aspirin+Tirofiban/Clopidogrel+Aspirin+Cilostazol/Warfarin+Clopidogrel+Aspirin/
Aspirin+Clopidogrel+Tirofiban) in diabetic patients with Acute Coronary Syndrome
Method: A systematic search was done in various databases (PubMed, Cochrane Library, and
ScienceDirect) for studies regarding the safety and efficacy of DAPT and TAPT published in the
last five years. Meta-analysis was done to obtain the statistical result of DAPT vs TAPT in terms
of death, major adverse cardiovascular events (MACE), stent thrombosis, and bleeding.
Results: We identified ten trials involving 48386 ACS patients with diabetes mellitus. Pooled
analysis showed that TAPT has a significantly lower risk to cause MACE [RR 1,54 (95%CI 1,39-
1,70) for DAPT vs 0,70 (95%CI 0,43-1,13) for TAPT; RD 0,04 (95%CI 0,02-0,05; p<0,001)] and
stent thrombosis [RR 1,42 (95%CI 0,94-2,13) for DAPT vs 0,17 (95%CI 0,04-0,54) for TAPT;
RD 0,01 (95%CI 0,00-0,01; p<0,01)] while the risk of death is insignificantly different [RR 1,91
(95%CI 1,63-2,22) for DAPT vs 0,60 (95%CI 0,39-0,93) for TAPT; RD 0,01 (95%CI -0,01-0,02;
p=0,54)]. However, TAPT showed a significant increase in risk of bleeding in comparison with
DAPT [RR 1,63 (95%CI 1,52-1,76) for DAPT vs 1,48 (95%CI 1,19-1,84) for TAPT; RD -0,19 (-
0,22- -0,15); p<0,01)].
Conclusion: TAPT significantly lowers the risk of MACE and stent thrombosis in diabetic patients
with ACS while maintaining a similar risk of death. However, the risk of bleeding increased
significantly which demands a further study to calculate the risk/benefit ratio of TAPT for diabetic
patients with ACS.
OR-12
“Efficacy of Empagliflozin Therapy in Patient with Acute Heart Failure:
Meta-analysis”

Systematic Review / Meta Analysis

Efficacy of Empagliflozin Therapy in Patient with Acute Heart Failure: Meta-analysis

Komang Pranayoga1,Yusra Pintaningrum1

1
Faculty of Medicine, Mataram University, Mataram, Indonesia.

Background and aims: Heart failure is a clinical syndrome that impairs ventricular filling or
ejection of blood into the systemic circulation. Heart failure is still a common disorder with a high
morbidity and mortality rate around the world. New drugs sodium-glucose cotransporter 2
inhibitors (SGLT2i) such as empagliflozin are currently showing promising results across the HF
spectrum. Based on this, the authors are interested in researching the efficacy of Empaglifozin
Therapy in Patient with Acute Heart Failure.

Methods: This study used a systematic search using PRISMA principle in several online databases
(Pubmed, Cochrane library and Google scholar). The selected study was an RCT or clinical trial
with a population of Acute HF patients. The intervention group is Empagliflozin in any dose
compared to placebo. The primary outcome for this meta-analysis is the levels of BNP or NT-
proBNP and mortality after intervention. Selected study will be assessed and analyzed using
Review Manager software version 5.3 with 95% CI.

Result: The two studies selected in this meta-analysis had a total sample size of 290 in the
intervention group and 285 in the placebo group. Heterogenecity test obtained [p=0.44; I2 0%],
indicating the homogenous data and the study is recommended to use the fixed effect method. The
pooled effect size of RR is 0.472 [CI95% 0.24-0.75, P=0.003], meaning that there is a significant
favorable outcome in empagliflozin group than in the placebo group.

Conclusion: The results showed that empagliflozin had shown a favorable effect in reduction of
the risk of death and reducing level of NT-proBNP in patient with acute heart failure.

Keyword: Empaglifozin, Acute Heart Failure, NT-proBNP, Mortality

OR-13
Identifying Predictor Factors and The Most Common Cause of Sudden Cardiac Death in Adults
with Congenital Heart Disease: A Systematic Journal Review

Alya Tanti1*, Fariz A.M. Dailami1, Lalu M.S.I.W. Atmapraja2

1
General Practicioner Praya General Hospital, West Nusa Tenggara, Indonesia

2
Cardiologist Praya General Hospital, West Nusa Tenggara, Indonesia

ABSTRACT

Background and aims: Survival rate of patients with congenital heart disease beyond age 18 years in
newborns are 90%, but, the life expectancy of adults with congenital heart disease are still
compromised. Sudden cardiac death (SCD) is the leading cause of death in young patients with
congenital heart disease (CHD)1 Individuals with congenital heart disease that survived until adulthood
life requiring lifelong tertiary care due to a lot of consequences of the congenital heart deffect 2
Methods: we searched researches used 4 database (ProQuest, PubMed, Google Scholar, Cochrane)
published since January 2018-January 2023.
Results: In total 115 studies that we found, we conclude 11 studies (more than 3000 total patients are
included) are eligable, the result shows that the predictor factors of sudden cardiac death in adults with
CHD are; right heart failure due to eissenmenger syndrome (35,8), hemoptoe (25%) ventricular
myocardial fibrosis (22,3) and Pulmonary Hypertension crisis (16,9). Meanwhile, the most common
cause of sudden cardiac death in adults with CHD are; arrythmia due to cardiomyopathy (60%) followed
by QRS prolongation (25%) and pulmonary artery hypertension (15%)
Conclusion: Based on this study, the leading predictor factors of sudden cardiac death in adults with
CHD is eissenmenger syndrome and the leading cause of sudden cardiac death in adults with CHD is
Arrythmia, Early identification of the population at risk of SCD can warrant the clinician to do a closer
follow up and consider the potential intervention in patient with CHD to prevent mortality3

Keywords: Sudden Cardiac Deaths, Arrythmia, Congenital Heart Disease

OR-14
The Effect Of Moderate Uv Index Exposure To Blood Pressure In Hypertensive Patient: A Pre-
Experimental Study

Moh. Suprayogi1, Yusra Pintaningrum2

1
General Practitioner, Dompu Public Hospital

2
Departement of Cardiovascular, NTB General Hospital

Background and Aims: Most guidelines emphasize the importance of controlling risk factors. Previous
studies have suggested that sun exposure could reduce CVD risk. However, direct and long-term sun
and UV exposure may be detrimental to skin health; hence,this study tested the effect of a moderate UV
Index on blood pressure in hypertensive and normal/pre-hypertensive patients.

Methods: We studied 18 patients, consisting of nine patients in each normal/pre-hypertensive and

hypertensive groups. This pre-experimental study was performed at Dompu Public Hospital, Indonesia.
The patients were asked to sun-bathing at 6-8 am for 15-30 minutes exposing their heads, arms, and feet.
Prior to and after the experiment, BP was recorded by office blood pressure methods recommended by
the ACC/AHA three times to obtain a better result. The patients were asked to record the time and
duration of sunbathing for 14 days.

Results: Female patients comprised 56% of the population with a mean age of 53.61±8.01 years. the
average SBP reduction was -5.22±.4.72 mmHg, the DBP reduction was -2.28±1.93 mmHg. The mean
UV index and Equivalent UV dose were 3.98±0.29 and 129.95±12.43 J/m2. Multivariate analysis
showed a significant result for the exposure time-adjusted UV index to SBP, but not DBP (p=0.0006)
(Fig.1), with no significant difference between the two groups. Age and sex had no significant effect on
blood pressure.

Conclusion: Although the equivalent UV dose was low, it still had a favorable effect and was safe for
the Indonesian skin type. Assuming that people with normal blood pressure have normal Vitamin D
levels, it may be suggested that the antihypertensive effect of UV exposure via nitrite oxide released
upon contact with the skin, which induces vasodilatation or photorelaxation.

Keyword: sun exposure, UV index, blood pressure, hypertension

OR-15
HUBUNGAN INDEKS MASSA TUBUH (IMT) DAN LOW DENSITY LIPOPROTEIN
CHOLESTEROL (LDL-C) DENGAN TEKANAN DARAH PADA PASIEN POLI JANTUNG DI
RSUD PROVINSI NTB

Lendi. L Putri

Background: Hypertension is the number one causes of death in the world. Hypertension is
characterized by increased diastolic blood pressure ≥90mmHg or systolic blood pressure ≥140mmHg.
According to World Health Organization (WHO),in 2019, 22% of world population has hypertension.
The results of Riset Kesehatan Dasar (Riskesdas) 2018 showed the prevalence of hypertension in
Indonesia reached 34.1% of total Indonesian population. BMI is influential factor in the incidence of
hypertension, where excessive BMI or being overweight can lead to higher risk for developing
hypertension than someone with a normal BMI. Increased incidence of hypertension also caused by
dyslipidemia. LDL-C Ratio is a strong predictor of atherosclerosis plaque formation that can lead to
increased blood vessels resistance, and finally lead to increase in blood pressure.

Research purposes: Knowing the relationship between Body Mass Index (BMI) and low density
lipoprotein cholesterol (LDL-C) with Blood Pressure in cardiology polyclinic RSUD Provinsi NTB
patient.

Methods : Methods used in this study is correlational research design with a cross sectional approach.
The population in this study were all patient of polyclinic cardiology RSUD Provinsi NTB, with the
sampling technique used was consecutive sampling, and the sample size is 28 people. The instrument
used in this study was medical record and observation sheet. The Hypothesis analysis was performed
using the Spearman Rho test.

Results: Stastistical analysis shows that there was no relationship between the value of BMI with blood
pressure with p-value 0,765 (p>0,05). And there was no relationship between LDL-C with blood
pressure (r = 0,044; p = 0,823).

Conclusion: The increase in body mass index and low density lipoprotein cholesterol did not have a
significant relationship with blood pressure.

Keywords: Low Density Lipoprotein Cholesterol, Body Mass Index, obesity, hypertension, Blood
Pressure
OR-16
Clinical Outcomes of Coronary Intravascular Lithotripsy Versus Rotational
Atherectomy in Severe Calcified Coronary Lesions: A Systematic Review and
Meta-Analysis
Ketut A. A. P. Pramana1, Yusra Pintaningrum2
1
General Practitioner, North Lombok Regency General Hospital, North Lombok,
Indonesia
2
Interventional Cardiology Division, Cardiology and Vascular Department, Faculty of
Medicine, Universitas Mataram, West Nusa Tenggara General Hospital, Mataram,
Indonesia

ABSTRACT
Background:. Severe coronary artery calcification is linked with poor clinical outcomes
in patients undergoing percutaneous coronary intervention (PCI). Adequate preparation
plays an important role in achieving a good PCI outcomes. Rotational atherectomy (RA)
and intravascular lithotripsy (IVL) are techniques used to optimize lesion preparation
and facilitate stent implantation in this condition. However, their comparative clinical
outcomes remain debatable. The aim of this study is to compare the clinical outcomes
of coronary IVL versus RA in severe calcified coronary lesions.
Methods: Electronic journals searching were performed in PubMed, ScienceDirect, and
Cochrane from January 2020 to March 2023 to identify studies assessing the clinical
outcome of coronary intravascular lithotripsy and rotational atherectomy in calcified
coronary lesions. Our outcome of interest were major adverse cardiovascular events
(MACE), myocardial infarction (MI), target vascular revascularization (TVR), all cause
mortality, stent thrombosis, stroke, and fluoroscopy time. Meta-analyses were
performed on included studies. Odds ratio (OD), Mean Differences (MD) and 95%
Confidence Interval (CI) were estimated using Review Manager v5.4.
Results: A total of three studies were included in our analysis. After follow-up over a
median of 4 months, there is no significant difference on MACE, MI, TVR, all cause
mortality, stent thrombosis and stroke between IVL versus RA in severe calcified
coronary lesions. IVL procedure significantly had shorter fluoroscopy time by 8.23
minutes (P<0.0001; MD -8.23; 95%CI -12.25 - -4.22) compared with RA procedure.
Conclusion: In general, this meta-analysis shows there is no significance difference on
outcome in both IVL and RA for treatment of severe calcified coronary lesions. IVL has
a shorter fluoroscopy time compared with RA.
Keywords: Intravascular lithotripsy, atherectomy, calcified lesion, coronary artery.
OR-17

The Role of Beta Blcoker Treatment in Patients with Persistent Tachycardia

Caused by Sepsis: A Systematic Review and Meta-Analysis of Randomized
Control Trials
Ketut A. A. P. Pramana , Basuki Rahmat2, Yusra Pintaningrum3
1

1
General Practitioner, North Lombok Regency General Hospital, North Lombok, Indonesia
2
Interventional Cardiology Division, Cardiology and Vascular Department, Faculty of Medicine,
Universitas Mataram, Mataram City General Hospital, Mataram, Indonesia
3
Interventional Cardiology Division, Cardiology and Vascular Department, Faculty of Medicine,
Universitas Mataram, West Nusa Tenggara General Hospital, Mataram, Indonesia

ABSTRACT
Background: Sepsis is a dysregulated inflammatory host response to an infection and
often causes persistent tachycardia and associated with a higher mortality rate. There
is an increasing interest in the use of beta blockers for treating tachycardia in sepsis,
but generally beta blockers relatively contraindicated for sepsis because it can cause
cardiac suppression. The aim of this study is to determine the role of beta blcoker
treatment in patients with persistent tachycardia caused by sepsis.
Methods: Electronic journals searching were performed in PubMed, ScienceDirect, and
Cochrane from January 2013 to May 2023 to identify randomized control trials (RCT)
assessing the role of beta blcoker treatment in patients with persistent tachycardia
caused by sepsis. The beta blocker that chosen in this study was the short acting beta
blocker esmolol. Our outcome of interest were all cause mortality, heart rate (HR), and
stroke volume index (SV index). Meta-analyses were performed on included studies.
Odds ratio (OR), Mean Differences (MD) and 95% Confidence Interval (CI) were
estimated using Review Manager v5.4.
Results: A total of five RCTs with a pooled sample size 415 were included in our
analysis. The use of beta blocker in patients with persistent tachycardia and sepsis was
significantly associated with lower risk of all cause mortality (P<0.0001; OR 0.42; 95%CI
0.27 - 0.65). There was also a significant reduction in HR (P<0.00001; MD -18.34;
95%CI -25.62 - -11.06) and significant increase in SV index (P 0.01; MD 2.61; 95%CI
0.62 - 4.59) in the beta blocker group compared with control.
Conclusion: The use of beta blockers such as short acting beta blocker esmolol in
patients with persistent tachycardia caused by sepsis was associated with significantly
lower risk of all cause mortality, reduction in HR, and increase the SV index.
Keywords: beta blocker, tachycardia, sepsis.
OR-18

HEALTH COUNSELING ABOUT RISK FACTORS AND HYPERTENSION PREVENTION

IN THE COMMUNITY TO REDUCE HYPERTENSION RATE IN THE WORK AREA OF
SUNGAI BILU PUBLIC HEALTH CENTER

NAWIS E. WIBOWO MD1, NIKA S. SKRIPSIANA MD M.KES2, WAHYU S. PUTRA3, JESSICA

F. KUMPANG4, ILMA F. ALAINA5
1
Department of Health Center, Sungai Bilu Public Health Center, Banjarmasin, Indonesia
2
Department of Public Health Science, Faculty of Medicine, Lambung Mangkurat University,
Banjarmasin, Indonesia
3
Department of Public Health Science, Faculty of Medicine, Lambung Mangkurat University,
Banjarmasin, Indonesia
4
Department of Public Health Science, Faculty of Medicine, Lambung Mangkurat University,
Banjarmasin, Indonesia
5
Department of Public Health Science, Faculty of Medicine, Lambung Mangkurat University,
Banjarmasin, Indonesia

Background and aims : The results of the 2018 (Riskesdas) survey showed that the prevalence of
hypertension in Indonesia reached 34.11%. South Kalimantan Province ranks first the prevalence of
hypertension based on the results of blood pressure measurements in people aged > 18 years, which is
44.13%. Banjarmasin itself ranks 4th out of 13 regencies/cities, which is 46.79% of the prevalence of
hypertension. At the Sungai Bilu Public Health Center, hypertension has always been ranked first from
2019-2021.
Material and Methods : a survey was conducted on 200 respondents who experienced hypertension
in the Sungai Bilu Health Center work area, it can be seen that there are several internal and external
factors that cause the high incidence of hypertension. Furthermore, priority problem solving is set in
the form of counseling to the public about the risk factors for hypertension with media (leaflets, power
point slides) to prevent the occurrence of hypertension in the community.
Result : Based on the knowledge level category, at the
pretest there were still 96 respondents (48%) who had
deficient knowledge. The number of respondents who
have fair category is 74 people (37%). After receiving
counseling, the category of respondent's knowledge
level was 96.3% (193 people) good, only 7 person
(3.7%) still had fair category. The normality test used
the Shapiro-Wilk test with p=0.034 in the pretest value
and p=0.001 in the posttest value which indicated that