The 8th Bali Cardiology Update Programme Book

ii

CONTENTS

Welcome Message ....................................................................................................................... iv

Greetings ..................................................................................................................................... v

Organizing committee .................................................................................................................. xi

Workshop schedule ..................................................................................................................... xiv

Symposium schedule.................................................................................................................... xviii

Symposium floor plan .................................................................................................................. xxi

ABSTRACT.................................................................................................................................... 1

Implementation of Guideline Directed CV Management with BPJS Coverage:

How Far is the Gap?............................................................................................................. . 2

I Wayan Wita

Decongestion Strategies in the Management of Hypervolemic Hyponatremia in

Heart Failure ............................................................................................... ........................ 4

I Ketut Rina

New Management of Heart Failure with Hyponatremia ........................................................ 5

I Ketut Suwitra

Comorbidities in Heart Failure: How to Manage? .................................................................. 6

I Nyoman Wiryawan

Update of Diagnosis and Management of STE-ACS: What Does the Guideline Tell Us? ........... 7

I Wayan Aryadana

Dual Antiplatelet for ACS Patients: Consideration to Choose P2Y12 Inhibitor to Achieve

Optimum Outcomes: Role of Clopidpgrel ............................................................................. 8

I G. N. Putra Gunadhi

Advanced the Anticoagulant Co-therapy in STE-ACS Patients: Role of Enoxaparine ................ 9

I Made Junior Rina Artha

Practical Approach of Hypertension Management: Which Guideline for Which Patients? ....... 10

Kadek Susila Surya Darma

Hypertensive Crisis and Cardiovascular Damage ................................................................... 11

M. Saifur Rohman

Newest Guideline of Acute Rheumatic Fever ......................................................................... 12

Luh Oliva Saraswati Suastika

vii

Acute Presentations of Heart Valve Stenosis ........................................................................ 13

Wayan Sutarmawan

Pulmonary Hypertension in General and Associated Valvular Heart Disease .......................... 14

Lucia Kris Dinarti

Emerging Risk Factors of CAD: What is New? ......................................................................... 15

I Wayan Aryadana

Management of Dyslipidemia: Focus on Statin ...................................................................... 16

I Wayan Wita

Non-statin Role in Management of Dyslipidemia .................................................................. 17

I. B. Rangga Wibhuti

Diagnosis and Management of Critical Ill Baby with Congential Heart Disease ....................... 18

Eka Gunawijaya

Breaktrough in Congenital Heart Disease Intervention .......................................................... 19

Radityo Prakoso

Burden Risk Stratification and Management in Atrial Fibrillation Patients .............................. 20

Bagus Ari Pradnyana

Differentiation Between NOACs ........................................................................................... . 21

I Putu Gede Budiana

Personalized NOAC Therapy: When to Choose the Right NOAC for the Right Patients ............ 22

I Made Putra Swi Antara

How to Improve Outcomes in Cardiac Arrest Patients: Review of ACLS .................................. 23

Made Satria Yudha Dewangga

Managing Acute Lung Edema in Emergency Setting .............................................................. 25

I Ketut Susila

POSTER PRESENTATION ............................................................................................................... 27

Total Occlusion of RCA as Late Manifestation of Kawasaki Disease in A Young Man ............... 28

Pramana Adiputra, Lena Agustini

Rheumatic Heart Disease with Complication of Atrial Fibrillation: A Case Report ................... 29

Samudra Andi Yusuf, Irma Vitriani, I Gusti Ayu Suryawati

viii

Early Anticoagulation Should Postponed on Acute Cardioembolic Strokes – A Case Report..... 31

I Wayan Gustafa, Raditya Surya

Resolution of Inferior STEMI in A Woman Who Not Undergoing Reperfusion Therapy

(A Problematic Cardiovascular Management in A Remote Area): A Case Report ..................... 32

Kristianto Yusi Adiputra, Achmadi Eko Sugiri

Diabetic Ketoacidosis Complicated by Supraventricular Tachycardia in

A Young Adult: A Case Report .............................................................................................. 33

Vien Stefani, Gilrandy Budiarto Baktiar

Atrial Fibrillation with Rapid Ventricular Respond Treated With

Intravenous Digoxin: A Case Report ..................................................................................... 34

I Putu Gde Fredy Gunawan, Lie Juliawan, Komang Katrini, Putu Kiki Wulandari

Atrial Functional Mitral Regurgitation in Patient with Atrial Fibrillation Associated

Gastroesophageal Reflux Disease Who Successfully Convert to Sinus Rhythm

With Proton Pump Inhibitor: A Case Report .......................................................................... 35

Indana Surya Putra IGA, Badjra Nadha I K, Suryadarma IGA

Case Report: Spironolactone Induced Gynecomastia in

Chronic Heart Failure Patient with High Dose and Long Term Use .......................................... 37

Putu Giani Anabella Bestari Putri, Nurfitriani, I Gusti Ayu Suryawati

Prevalence and Comorbidity of Atrial Fibrillation in Kuningan,

West Java: A Descriptive Study ............................................................................................. 39

Gilrandy Budiarto Baktiar, Vien Stefani

Autolysis in CAD STEMI Anteroextensive Wall

Appropriate Initial Management Related to Clinical Improvement: A Case Report ................. 40

Agung Adhyaksa Bhaskara, Arinta Setyasari, Sherly Yosephina, Nizamuddin Ubaidillah

Remote Ischemic Preconditioning Reduces the Incidence of Contrast-Induced Nephropathy in

Patients Undergoing Coronary Angiography/Intervention– Systematic Review And Meta-

Analysis Of Randomized Controlled Trials ............................................................................ . 41

Raymond Pranata, Rachel Vania, Bambang Budi Siswanto

ix

Transjugular Approach for Permanent Pacemaker (PPM) Implantation in

Octogenarian with Inaccessible Upper Limb Venous System .................................................. 42

Rido Mulawarman, Muhammad Hatta, Alexander Edo Tondas

Case Report: A Month Preterm Infant Girl with Patent Ductus Arteriosus

Treat or No Treat ................................................................................................................. 44

A A Gede Agung Angga Kesuma, Samudra Andi Yusuf, I Gusti Ayu Suryawati

Enteric Myocarditis in a 9 Year Old Girl: A Case Report .......................................................... 46

Fenila E. J. U. Sitompul, Mahendria Sukmana

Acute Cardiorenal Syndrome and Cardiac Hepatopathy in Heart Failure: A Case Report ........ 47

Alexsandro R, Pratama MG, Tsai YR, Sinurat BC, Kirana IR, Nadhira F, Shakita TGD

Obesity and Hypertension Among Adolescents:

A Systematic Review and Meta-Analysis ff Cross Sectional Studies ........................................ 48

Abdi Baskara Mayun, Dwipa Krisna Devi, Raditya Rizki M

Prevalence of Essential Hypertension Based on AHA/ACC Guideline 2017 Compared

with JNC 7 Among Pre-Elderly and Elderly in Kintamani, Bali ................................................. 49

Yuliantini N.N., Utomo M.F.P., Sudewa I.B.A., Khrisna N.E.A., Erawan I.G.N.A.T

Association Between Hyperuricemia with Hypertension Among Female-adult

Population in Suter Village, Kintamani, Bali .......................................................................... 50

Muhammad Faisal Putro Utomo, Ni Nyoman Yuliantini, Maya Paramita Wijaya, Ni Putu Eka

Umarista Apriliani, I Gusti Ngurah Agung Tresna Erawan

Tricuspid Atresia with Transpotition of the Great Arteries Patient: What Can Be Done? ......... 51

Suprayoga IM, Dewi A, Paramita D, Sukandar A

Assessing Anxiety as an Indicator of Risk of Peripartum Cardiomyopathy: A Case Report ....... 52

Hans Nuari, Niyata Hananta Karunawan, Dhani Tri Wahyu Nugroho

ORAL PRESENTATION ................................................................................................................... 53

High Level of Individual Lipid Profile and Lipid Ratio as A Predictive Marker of Poor Glycemic

Control in Type-2 Diabetes Mellitus ..................................................................................... 54

Agha Bhargah

Diabetes and Premature Ventricular Contractions, Do They Linked? ...................................... 55

Ida Bagus Ananta Wijaya, Yusuf Dwiyanto, Ronally Rasmin, Muhammad Bachtiar Rachmat Jati,

Rizky Aulia Fanani

x

Evaluation of The Use of Antitrombothic Based on CHA2DS2-VASC Score and

Has Bled Score on the Pattern of Treatment in Stroke Ischemic Patient

with Atrial Fibrilation ........................................................................................................... 56

Gusti Ayu Putu Ika Bella Saptaning Astyari, Rizaldy Taslim Pinzon, Lidwina Tarigan

Characteristics of Therapy of Hypertensive Crisis Patients in Emergency Room

RSUD Kabupaten Penajam Paser Utara from January to May 2019 ........................................ 57

Putra B, Manuputty F

The Monocyte-HDL Ratio in Patients with Acute Coronary Syndrome in

ICCU Surya Husadha Hospital During September 2017-2018 .................................................. 58

I Wayan Gustafa, Raditya Surya

A Time-To-Event Analysis on Air Pollutants with The Risk of Cardiovascular Disease

and Mortality – A Systematic Review and Meta-Analysis of 84 Cohort Studies ....................... 60

Raymond Pranata, Rachel Vania, Budhi Setianto Purwowiyoto

Primary Pulmonary Hypertension During Pregnancy. What Should We Do? ........................... 61

Suprayoga IM, Dewi A, Paramita D

Prediction of MACE by Integrated ST-Segment Elevation Scores in STEMI

Patiens Undergoing Primary PCI ........................................................................................... 62

D. Gde A. Diprabawa, H. Wirawan, R. Paramitha I. Maliawan, AAA. Dwi A. Yasmin, IGN Putra

Gunadhi

Relationship of General Practitioner Distribution with Prevalence of ACS:

Towards a Better Indonesian Health System ......................................................................... 64

Maya Paramita Wijaya, Muhammad Faisal Utomo, Luh Oliva Saraswati Suastika, I Made Putra Swi

Antara

Defisiensi Selenium (Se) Sebagai Faktor Risiko Dilated Cardiomyopathy (DCM) di Rumah Sakit

Umum Pusat Sanglah, Bali : Studi Kasus – Kontrol ................................................................. 65

Luh Nyoman Ananda Mahayati

49

PREVALENCE OF ESSENTIAL HYPERTENSION BASED ON AHA/ACC GUIDELINE 2017 COMPARED WITH

JNC 7 AMONG PRE-ELDERLY AND ELDERLY IN KINTAMANI, BALI

Yuliantini N.N.1, Utomo M.F.P.1, Sudewa I.B.A. 1, Khrisna N.E.A. 1, Erawan I.G.N.A.T.2

1Medical Student, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia 2Department of Internal Medicine, Faculty of Medicine, Udayana University/Sanglah General Hospital,

Bali, Indonesia

ABSTRACT

Introduction: Hypertension is a non-communicable disease that prevalence is increased by the years in

Indonesia. Based on Riskesdas 2018, approximately 34.1% adult had hypertension in Indonesia, where

previously in 2013 only 25.8% with the highest prevalence in elderly. The diagnosis of hypertension that

commonly used in Indonesia was systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pressure

(DBP) ≥90 mmHg based on JNC 7, but the AHA/ACC released new guideline in 2017 where threshold of

hypertension changed to SBP ≥130 mmHg or DBP ≥80 mmHg.

Methods: A cross-sectional study who involved pre-elderly and elderly population (above 45 y.o.) in 8

village in Kintamani, Bangli, Bali. Primary data were taken from “Posyandu Lansia” and “Puskesmas

Keliling” program on July-August 2018. Demographic data and blood pressure (BP) measurement were

collected and analyzed by SPSS with univariate analysis.

Results: This study involved 380 samples between 45-98 y.o and the most were female (58.7%).

Prevalence of hypertension from total samples was 51.3% (JNC 7) and increased to 77.1% patients

(AHA/ACC 2017). According to each stage, there were no different prevalence between the two guidelines

for normal BP (12.4%) and stage 1 hypertension (25.8%). In AHA/ACC 2017, the term of prehypertensive

stage (JNC 7) was replaced with elevated BP and the prevalence of pre-hypertension stage (36.3%) was

higher than elevated BP (10.5%). The markedly increased can be found in stage 2 hypertension, where the

prevalence in JNC 7 was 25.5 %, but in AHA/ACC 2017 was 51.3%.

Conclusions: Compared with JNC 7, AHA/ACC 2017 guidelines result markedly increased of hypertension

prevalence in Kintamani-Bali. The difference of hypertension definition can affect various factor,

especially threshold for initial therapy, cost for therapy, and target BP for minimizing complication. The

physician must be wise to choose by considering the benefit of each guideline to reduce morbidity and

mortality due to hypertension.

Keyword: Blood pressure, hypertension, AHA/ACC Guideline 2017, JNC 7, elderly

Tabel 1. The classification of blood pressure based on AHA/ACC Figure 1. Prevalence o Guideline 2017 line 201

The increase of prev

2017 also found in US

Health and Nutrition Ex

ment Longitudinal Study

Chinese adult populatio

pertensive would increa

respectively. The increa

increase in the recomm

China, respectively, 7.5

recommended for treat Tabel 2. The classification of blood pressure based on JNC 7

A cross-sectional study conducted and involved pre-elderly and el- Compared with JNC 7,

derly population (above 45 years old) in 8 village in Kintamani, Bangli, creased of hypertension

Bali. Primary data were taken from “Posyandu Lansia” and “Puskesmas hypertension definition c

Keliling” programs on July-August 2018. Demographic data from inter- initial therapy, cost for th

view and blood pressure (BP) measurement using sphygmomanometer in which can be studied in

the sitting position were collected and analyzed by SPSS with univariate choose by considering t

analysis. and mortality due to hyp

PREVALENCE OF ESSENTIAL HYPERTENSION BASED ON AHA/ACC GUIDELINE 2017 COMPARED WITH JNC 7

AMONG PRE-ELDERLY AND ELDERLY IN KINTAMANI, BALI

Ni Nyoman Yuliantini1, Muhammad Faisal Putro Utomo1, Ida Bagus Ari Sudewa1, I Nyoman Endi Ananda Khrisna1, I Gusti Ngurah

Agung Tresna Erawan2

1Medical Student, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia 2Department of Internal Medicine, Faculty of Medicine, Udayana University/Sanglah General Hospital, Bali, Indonesia

Keywords : blood pressure, hypertension, AHA/ACC Guideline 2017, JNC 7, elderly

BACKGROUNDS

RESULTS

Hypertension is a non-communicable disease that prevalence is in-

creased by the years in Indonesia. Based on Riskesdas 2018, approxi-

mately 34.1% adult had hypertension in Indonesia, where previously in

2013 only 25.8% with the highest prevalence in elderly. The increases of

hypertension prevalence make the physician more concerned and many

guidelines for hypertension management released to reduce the compli-

cation. The diagnosis of hypertension that commonly used in Indonesia

was systolic blood pressure (SBP) ≥140 mmHg or diastolic blood pres-

sure (DBP) ≥90 mmHg based on JNC 7, but the AHA/ACC released new

guideline in 2017 where threshold of hypertension changed to SBP ≥130

mmHg or DBP ≥80 mmHg. The different of hypertension definition get

various responses from clinicians, because in addition to the different hy-

pertension threshold, AHA/ACC guideline 2017 also have a lower blood

pressure target than JNC 8 (modified from JNC 7 for hypertension

management guideline), which is less than 130/80 mmHg.

BP Category Systolic BP Diastolic BP

Normal Elevated

Hypertension stage I

Hypertension stage II

<120 mmHg

120-129 mmHg

130-139 mmHg

≥140 mmHg

and

and

or

or

<80 mmHg

<80 mmHg

80-89 mmHg

≥90 mmHg

BP Category Systolic BP Diastolic BP

Normal <120 mmHg and <80 mmHg

Prehypertension 120-139 mmHg or 80-89 mmHg

Hypertension stage I 140-159 mmHg or 90-99 mmHg

Hypertension stage II ≥160 mmHg or ≥100 mmHg

This study involved 380 samples between 45-98 years old and the

most were female (58.7%). Prevalence of hypertension from total sam-

ples was 51.3% (JNC 7) and increased to 77.1% patients (AHA/ACC

2017). According to each stage, there were no different prevalence be-

tween the two guidelines for normal BP (12.4%) and stage 1 hyperten-

sion (25.8%). In AHA/ACC 2017, the term of prehypertensive stage (JNC

7) was replaced with elevated BP and the prevalence of pre-hypertension

stage (36.3%) was higher than elevated BP (10.5%). The markedly in-

creased can be found in stage 2 hypertension, where the prevalence in

JNC 7 was 25.5 %, but in AHA/ACC 2017 was 51.3%.

f blood pressure based on AHA/ACC Guide-

7 with JNC 7 in Kintamani, Bali

alence of hypertension with AHA/ACC Guideline

and Chinese population based on US National

amination Survey and China Health and Retire-

, where they found the proportion of the US and

n aged between 45 and 75 years classified as hy-

se from 49.7% to 63.0% and 38.0% to 55.0%,

se of prevalence would be accompanied by the

endation to start treatment, where in the US and

million and 55.3 million people would be newly

ment based on AHA/ACC Guideline 2017.

METHODS CONCLUSION

AHA/ACC 2017 guidelines result markedly in-

prevalence in Kintamani-Bali. The difference of

an affect various factor, especially threshold for

erapy, and target BP for minimizing complication

future research. The physician must be wise to

he benefit of each guideline to reduce morbidity

ertension.

REFFERENCES

1. Kementrian Kesehatan Republik Indonesia. Hasil Utama Riskesdas 2018.

2.American College of Cardiology Foundation and American Heart Association. Clinical Practical Guideline: 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/

NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. Journal of American College of Cardiology. 2018

May;71(19):127-248.

3. U.S. Department of health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute. The Seventh Report of the Joint National Com-

mittee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. NIH Publication No 03-5233. 2003 December.

4. Muntner P, Carey RM, Gidding S, et al. Potential US Population Impact of the 2017 ACC/AHA High Blood Pressure Guideline. Circulation. 2018 January; 137:109-118.

5. Khera R, Lu Y, Lu J, et al. Impact of 2017 ACC/AHA guidelines on prevalence of hypertension and eligibility for antihypertensive treatment in United States and China:

nationally representative cross sectional study. BMJ Publishing Group. 2018 July;362:k2357.