Indonesian Journal of Cardiology <p><strong>Indonesian Journal of Cardiology (IJC)&nbsp;</strong>is a peer-reviewed and open-access journal established by Indonesian Heart Association (IHA)/<em>Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI)</em>&nbsp;[] on the year 1979. This journal is published to meet the needs of physicians and other health professionals for scientific articles in the cardiovascular field. All articles (research, case report, review article, and others) should be original and has never been published in any magazine/journal. Prior to publication, every manuscript will be subjected to double-blind review by peer-reviewers. We consider articles on all aspects of the cardiovascular system including clinical, translational, epidemiological, and basic studies.</p> <p>Subjects suitable for publication include but are not limited to the following fields:</p> <ul> <li class="show">Acute Cardiovascular Care</li> <li class="show">Arrhythmia / Cardiac Electrophysiology</li> <li class="show">Cardiovascular Imaging</li> <li class="show">Cardiovascular Pharmacotherapy</li> <li class="show">Cardiovascular Public Health Policy</li> <li class="show">Cardiovascular Rehabilitation</li> <li class="show">Cardiovascular Research</li> <li class="show">General Cardiology</li> <li class="show">Heart Failure</li> <li class="show">Hypertension</li> <li class="show">Interventional Cardiology</li> <li class="show">Pediatric Cardiology</li> <li class="show">Preventive Cardiology</li> <li class="show">Vascular Medicine</li> </ul> The Indonesian Heart Association en-US Indonesian Journal of Cardiology 0126-3773 <p>Authors who publish with this journal agree to the following terms:<br><br></p> <ol type="a"> <ul> <li class="show">Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="" target="_new">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> </ul> </ol> <ol type="a"> <ul> <li class="show">Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> </ul> </ol> <ol type="a"> <ul> <li class="show">Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a href="" target="_new">The Effect of Open Access</a>).</li> </ul> </ol> Menulis Pandemi <p>Dunia saat ini menghadapi situasi yang tidak pernah terjadi sebelumnya dalam sejarah manusia: pandemi Covid-19 (Gambar). Pengetahuan manusia mengenai penyakit Covid-19 secara pesat berkembang sejak laporan kasus awal dari Wuhan.<sup>1</sup> Secara pesat, banyak laporan kasus, seri kasus, kohor dan belakangan studi mengenai Covid-19 dan tatalaksananya dilaporkan di berbagai jurnal. Beberapa jurnal esensial, seperti NEJM dan Lancet, bahkan menerbitkan isu khusus mengenai Covid-19. Pengetahuan tentang Covid-19 secara mayor boleh dikatakan berasal dari tiga klaster kohor epidemi; yaitu di China (terutama Wuhan), Italia, dan Amerika Serikat. Beberapa <em>klaster</em> lainnya, seperti dari Korea Selatan dan Jerman, melaporkan keberhasilan meredam perluasan epidemi.</p> Sunanto Ng ##submission.copyrightStatement## 2020-05-29 2020-05-29 41 2 43 5 10.30701/ijc.1026 Break the chain of COVID-19 transmission: Perspective from a cardiologist-in-practice <p>Indonesia is currently suffering through a pandemic outbreak of severe respiratory syndrome coronavirus 2 (SARS-CoV-2) known as Coronavirus Disease 2019 (COVID-19). Every day this infection raises double, health community is fighting COVID-19 with their armamentarium and policy. Indonesian Heart Association (IHA) has already issued the statement about cardiovascular services during the outbreak of COVID-19. The policy is rescheduling non urgent outpatient visits as necessary, social distancing strategy in outpatient clinic and using personal protective equipment (PPE) in outpatient clinic or during the cardiac examination (echocardiography, cardiac CT, electrophysiology and invasive cardiology). Most of international recommendations have recommended social distancing and reschedule non urgent visits. This document gives a general information about the prevention of COVID-19 in cardiology department.</p> sidhi laksono purwowiyoto Budhi Setianto Purwowiyoto ##submission.copyrightStatement## 2020-05-20 2020-05-20 41 2 46 8 10.30701/ijc.1000 COVID 19 with Cardiac Injury Complication, A case Report <ul> <li class="show"><strong>Background </strong>: The Corona virus Disease COVID-19 have been independently associated with the cause of pneumonia and acute respiratory distress syndrome with high risk of mortality. Mounting evidence substantiates the presence of cardiac injury in patients with COVID-19. Although a recent study reported that 12% of patients had COVID-19 associated acute cardiac injury.</li> <li class="show"><strong>Case presentation</strong> : A 38 year old male was admitted with pneumonia and cardiac symptoms. He was genetically confirmed as COVID-19 by swab PCR testing, 1 week after admission. He also had elevated CKMB and Hs troponin T level, high Ferritin level, CRP, lymphopenia, and a slight increase in N/L ratio. Chest radiography showed bilateral pneumonia. The patient was confirmed to the diagnosis of Myocardial injury. After receiving tocilizumab and immunoglobulin, his condition improved gradually with the declining laboratory inflammation marker, but there was a secondary infection with an increased of leucocyte and worsen chest radiography, escalating antibiotic and metilprednisolon was given, the patient gradually improving.</li> <li class="show"><strong>Conclusion</strong> : COVID-19 patients may develop cardiac complication such as cardiac injury or myocarditis, and this is our first case of COVID-19 infection complicated with cardiac injury.</li> </ul> Puti Sarah Saus Dicky Hanafy Rossana Barack ##submission.copyrightStatement## 2020-05-29 2020-05-29 41 2 49 53 10.30701/ijc.1011 Primary PCI in COVID-19 Pandemic: Be Cautious, It Might Reveal Itself Later <p><strong>Background:</strong> Acute ST-segment–elevation myocardial infarction (STEMI) is a disease of high mortality and morbidity, and primary percutaneous coronary intervention (PPCI) is the preferred therapy for patient in golden period or with hemodynamic instability.<sup>1,2 </sup>Currently the world has been declared under COVID-19 (coronavirus disease 2019) pandemic by the World Health Organization (WHO).<sup>3 </sup>Signs and symptoms of COVID-19 patients can mimic acute decompensated heart failure, or induce acute cardiovascular problem.<sup>3 </sup>Screening is key, but there are conditions where physicians might miss positive COVID-19 cases, especially in critical cardiovascular emergency.</p> <p><strong>Case Illustration:</strong> A 60-year old male came to emergency room with breathlessness and chest pain 8 hours prior. He was diagnosed as acute inferior STEMI with acute lung edema and cardiogenic shock (KILLIP IV, acute heart failure wet and cold). COVID-19 screening was negative. Patient underwent PPCI, found to have total occlusion of right coronary artery (RCA) with thrombus and tight stenosis in left coronary artery (LAD). Successful PPCI to RCA was performed with TIMI 3 flow result, and hemodynamic improved. Ten hours after PPCI, hemodynamic deteriorated and peripheral oxygen saturation dropped. Patient was intubated and put on ventilator. Repeated chest X-Ray and thoracic CT showed lung condition has abruptly worsened&nbsp; – with ground glass opacity (GGO) found. His condition worsened quickly, and family agreed to a do not resuscitate (DNR) consent.</p> <p><strong>Conclusion:</strong> Acute cardiovascular condition in COVID-19 Pandemics represent big challenges, especially in early diagnostic and cardiovascular intervention decision. We were presenting a case where signs and symptoms of COVID-19 might appear later. Therefore, in this pandemic era every emergency cardiovascular intervention with signs of respiratory problem should be performed as if patient was a positive COVID-19 case.</p> Arief Luthfi Parama Dmitri Rifanda Wishnu Aditya Widodo Daniel Ruslim ##submission.copyrightStatement## 2020-05-20 2020-05-20 41 2 54 8 10.30701/ijc.1009 Gangguan Kardiovaskular pada Infeksi COVID 19 <p><em>Severe acute respiratory syndrome coronavirus 2</em> (SARS-CoV-2) yang dikenal dengan COVID-19 adalah penyakit yang baru dan telah menyebar dengan cepat dari Wuhan (provinsi Hubei) ke provinsi lain di Cina dan seluruh dunia termasuk Indonesia. Secara umum, COVID-19 adalah penyakit akut yang bisa sembuh tetapi juga mematikan, dengan <em>case fatality rate</em> (CFR) sebesar 4%. Spektrum klinis pneumonia COVID-19 berkisar dari kondisi ringan sampai dengan berat. COVID 19 diduga memiliki risiko potensiasi proses patofisiologi terhadap timbulnya komplikasi kardiak, dan telah diketahui bahwa mekanisme penyakit kardiovaskular serupa dengan mekanisme jalur imunologi. Penyakit kardiovaskular adalah komorbid terbanyak pada pasien COVID 19, SARS, dan MERS. Prevalensi diabetes mellitus (DM) dan penyakit kardiovaskular pada SARS adalah 11% dan 8% dan membawa angka kematian meningkat 2 kali lipat. Pada kasus COVID 19, komorbid penyakit kardiovaskular lebih banyak menunjukkan kasus yang berat. Bagaimana mekanisme komorbid ini memperburuk keluaran pasien masih tidak jelas, namun beberapa hipotesisnya antara lain usia lanjut, gangguan sistem imun, peningkatan kadar ACE2 atau mungkin ada hubungan antara COVID 19 dengan penyakit kardiovaskular. Tinjauan pustaka ini akan menjelaskan berbagai gangguan kardiovaskular yang mungkin terjadi pada infeksi COVID 19 secara lebih mendalam.</p> <p>&nbsp;</p> Dian Yaniarti Hasanah Siti Elkana Nauli Vebiona Kartini Prima Putri Habibie Arifianto Nana Maya Suryana Lita Dwi Suryani Wahyu Aditya Paskariatne Probodewi ##submission.copyrightStatement## 2020-05-29 2020-05-29 41 2 60 9 10.30701/ijc.994 Deteksi dan Penanganan Awal Miokarditis dan Miokarditis Fulminan <p>Myocarditis is commonly caused due to systemic viral infection with cardiotropic nature. In the acute phase, this disorder could cause lethal hemodynamic or arrhythmic disorders. Newest studies showed that the use of guideline-directed medical care in the care of myocarditis will lead to better outcomes. This condition varies in presentation ranging from mild to life-threatening such as cardiogenic shock. With the current advances in early detection and circulatory support using extracorporeal membrane oxygenation (ECMO), myocarditis could be managed very well. Cases of myocarditis related to COVID 19 has been reported, however as per this time there has no confirmed pathological evidence regarding direct causation between COVID19 and myocarditis, however, in these severely ill patients, elevations in cardiac biomarkers (cTn, BNP and NTproBNP) occurs, and the administration of immunosuppressant could increase the chance of remission.</p> <p>Keyword: Myocarditis, fulminant, COVID 19.</p> Siti Elkana Nauli Hawani Sasmaya Prameswari ##submission.copyrightStatement## 2020-05-27 2020-05-27 41 2 71 82 10.30701/ijc.995 Cardiovascular Implications of Coronavirus Disease 2019: Review of Current Literatures <p>The coronavirus disease-2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) that first appeared in Wuhan, China. COVID-19 was found to have significant connection with the cardiovascular system by causing complications such as myocarditis and arrhythmias. Furthermore, medications for COVID-19 have been shown to induce cardiovascular side effects. The emergence of COVID-19 spreading also raised questions on the need for modification of life support algorithms to protect vulnerable healthcare workers.</p> <p>&nbsp;</p> Rissa Ummy Setiani Bayushi Eka Putra Rini Istisakinah Ruth Grace Aurora Amanda Halimi ##submission.copyrightStatement## 2020-05-29 2020-05-29 41 2 83 90 10.30701/ijc.1008 Challenges in STEMI Management during COVID-19 Pandemic <p><em>The necessity of timely management of ST-elevation myocardial infarction (STEMI) is now disrupted by the Covid-19 pandemic. This paper discussed the challenge to manage STEMI in Indonesia due to Covid-19. It also discussed the alternative strategies for solution. Challenge can occur in term of the healthcare safety as well as STEMI patient safety. Healthcare safety potentially impaired by the problem of STEMI mimicry due to cardiovascular complication of Covid-10, inaccuracy of Covid-19 screening, lack of effective personal protection equipment for the healthcare and&nbsp; appropriate catheterisation laboratory to anticipate virus contamination. The safety of STEMI patient is potentially impaired due to prolonged ischemia time, and the risk of cross-infection. Solution for this challenge should include mass screening, rapid and accurate test to rule-out Covid-19, dual system of hospital units - Covid and non-Covid, and algorithm for triage patients with STEMI and Covid-19.</em></p> Sunanto Ng Dafsah Arifa Juzar ##submission.copyrightStatement## 2020-05-27 2020-05-27 41 2 92 7 10.30701/ijc.1023 Recommendations of RAAS Blockers Use Amidst the Coronavirus Pandemic <p><span style="font-weight: 400;">With a rapidly growing pandemic of coronavirus disease of 2019 (COVID-19), a public health emergency of international concern, the medical communities and national health systems are being tested for their preparedness. The culprit that is responsible for this viral respiratory disease, is a novel type of coronavirus, now identified as severe acute respiratory syndrome coronavirus - 2 (SARS-CoV2). At the present time, there are gaps in the knowledge regarding the safety of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) for COVID-19 patients due to concern of ACE2, which is critical for viral entry and their levels are upregulated when using these (Renin Angiotensin Aldosterone System) RAAS blockers</span><span style="font-weight: 400;">.</span><span style="font-weight: 400;"> ACE2 is a glycoprotein metalloprotease that plays an essential role in physiologic and pathological states and it is ubiquitously found in human organs. Despite sharing homology, ACE is different from ACE2, and while the former cleaves angiotensin 1 to angiotensin 2, the latter cleaves angiotensin two to angiotensin 1-7. Extrapolated from experimental animal studies, ACE2 and angiotensin 1-7 are important and protective for the lung physiology based on mice model of acute lung injury by various causes. Other evidence also demonstrates harm over benefits when stopping RAAS blockers, particularly in patients with cardiovascular disease, in which using these drugs are proven to be life-saving. In the light of the paucity of evidence derived from well-designed study, societies and colleges recommend continuing RAAS blockers until new evidence says otherwise.</span></p> Joshua Henrina, doctor Iwan Cahyo Santosa Putra, doctor Hoo Felicia Hadi Gunawan, doctor Irvan Cahyadi, doctor Leonardo Paskah Suciadi, doctor ##submission.copyrightStatement## 2020-05-20 2020-05-20 41 2 98 107 10.30701/ijc.1007 How to manage QT prolongation in COVID-19 patients <p>Indonesia has declared a COVID-19 outbreaks because of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in March 2020. COVID-19 has significantly increased morbidity and mortality worldwide. Some studies have shown good clinical outcomes with the use of combination of chloroquine or hydroxychloroquine and azithromycin. That drugs can prolong the QT interval and increase the risk of Torsade de Pointes (TdP). The risk is increasing in several conditions such as in critical patients, metabolic disorders, sepsis, multiorgan dysfunction and with drug-drug interactions. Cardiologists need to know how to manage this condition to reduce the risk of TdP.</p> sidhi laksono purwowiyoto Dony Yugo Hermanto Muhammad Iqbal ##submission.copyrightStatement## 2020-05-20 2020-05-20 41 2 108 11 10.30701/ijc.1002 Routine Exercise to Improve Immunity in Hypertensive Patients During COVID 19 Pandemic. <p>Hipertensi merupakan salah satu komorbid yang paling banyak ditemukan pada Coronavirus disease-19 (COVID-19) dan berasosiasi dengan prognostik buruk dari infeksi tersebut. Olahraga rutin ternyata dapat meningkatkan imunitas tubuh, sehingga dapat berperan dalam pencegahan infeksi COVID-19 selain efeknya terhadap penurunan tekanan darah. Olahraga tipe aerobik dengan intensitas sedang 30-60 menit, dengan cara tetap melakukan pembatasan jarak, ataupun dengan teknik <em>home exercise</em> dan virtual dengan daring, dapat dilakukan oleh penderita hipertensi dalam meningkatkan imunitas selama masa pandemi &nbsp;COVID-19.</p> Badai Bhatara Tiksnadi Nova Sylviana Adi Imam Cahyadi Alberta Claudia Undarsa ##submission.copyrightStatement## 2020-06-30 2020-06-30 41 2 113 9 10.30701/ijc.1016 Cardiomyopathy in COVID-19 Survivors: Mechanism, Management, and Prevention <p>Coronavirus disease (COVID-19) caused by infection of SARS-CoV-2 as of April 2020 has been confirmed&nbsp; in more than 2.3 million people, with more than 150 thousands deaths across the globe. It has been known that COVID-19 patients with underlying cardiovascular diseases and its risks including: hypertension, diabetes, coronary artery disease, and cerebrovascular diseases may develop more severe respiratory track symptoms requiring intensive care. Some patients may presenting with myocarditis or acute cardiomyopathy, which has high mortality and morbidity. There was also evidence of myocardial Injury with an increase of troponin in one-third of those infected by covid-19. &nbsp;It is conceivable that among those who recover from COVID-19 infection, there is a risk of developing further cardiomypathy once the pandemic receding in the future. It is important to pay attention to this survivor group since the pandemic may be lasting for longer period. Optimal medical treatment and comprehensive prevention should be taken to manage those high risk patients of developing cardiomyopathy during hospital care as well post discharge. These includes provide best available COVID-19 drugs, cardiovascular medications, and social preventive measures.</p> Renan Sukmawan ##submission.copyrightStatement## 2020-05-31 2020-05-31 41 2 120 4 10.30701/ijc.1012 Influence of Gender and Cardiovascular Manifestation on COVID 19 <p><em>Cardiovascular manifestations, in the form of myocardial injury, can occur in patients infected with COVID-19. Data collected from various COVID-19 pandemic case reports indicated that male patients experience myocardial injury more frequently than females. However, not any definitive mechanism has been found yet that underlies susceptibility to myocardial injury due to infection with SARS-CoV-2 attributable to gender differences. Some theories propose are differences in the number of X chromosomes, the influence of sex hormones, and differences in immune reactions between males and females. A further comprehensive research needs to be done on the mechanism of cardiovascular manifestations and the effect of gender on COVID-19 disease.</em></p> <p><em>Keywords: Gender, cardiovascular manifestation, myocardial injury, COVID-19.</em></p> Dyana Sarvasti ##submission.copyrightStatement## 2020-06-01 2020-06-01 41 2 126 32 10.30701/ijc.1004 Minimal or No Touch Electrocardiography Recording and Remote Heart Rhythm Monitoring during COVID-19 Pandemic Era <p>At the end of year 2019, the world faced an outbreak of a highly virulent novel Coronavirus disease (COVID-19), which changed the way physicians, including cardiologists, do their routine clinical practice. As distance limitation and efficient use of personal protective devices must be employed to prevent the pandemic spreading, even simple electrocardiogram (ECG) taking that involves directly placing electrode leads on a patient’s body may become riskier. This review will discuss the possibility of minimal or no touch EKG using the latest wireless technologies, beneficial in monitoring COVID-19 patients for cardiovascular problems or patients who seek cardiac care, but with posing risk of concomitant COVID-19.</p> Alexander Edo Tondas Rolando Agustian Halim Moza Guyanto ##submission.copyrightStatement## 2020-06-01 2020-06-01 41 2 133 41 10.30701/ijc.1010