ABSTRAK ABSTRACTBackground: Q-wave myocardial infarction (QMI) has higher mortality and lower myocardial viability than non-Qwave myocardial infarction (NQMI), suggesting the existence of pathological Q waves reflects the worse ventricular function. The aim of the study is to determine difference in left ventricular ejection fraction (LVEF) between QMI and NQMI.

Latar belakang: Hipertensi adalah masalah kesehatan utama di dunia, termasuk Indonesia. Penggunaan obat bahan alam untuk hipertensi telah meningkat dalam dekade terakhir. Biaya penggunaan obat bahan alam dianggap lebih murah dengan efek samping yang lebih sedikit. Penelitian ini bertujuan untuk melihat tingkat kepatuhan penggunaan obat pada pasien hipertensi yang berobat ke Pusat Kesehatan Masyarakat (Puskesmas) di Kota Samarinda, Kalimantan Timur. Metode: Penelitian dilaksanakan di Puskesmas Lempake Kota Samarinda pada bulan Juli hingga Agustus 2017.Responden penelitian adalah 63 pasien hipertensi yang datang berobat dan memenuhi kriteria penelitian. Pasien hipertensi selanjutnya diwawancarai menggunakan kuesioner MMAS (Morisky Medication Adherence Scale). Hasil: Sebanyak 56% pasien hipertensi juga menggunakan obat bahan alam selain obat konvensional untukhipertensi. Daun sirsak (Annona muricata), daun salam (Syzygium polyanthum), dan buah mentimun (Cucumissativus) adalah bahan alam yang paling banyak digunakan oleh pasien hipertensi. Rerata tekanan darah sistolik(p=0,004; 95% CI -19,8 – -3,8) dan diastolik (p=0,038; 95% CI -9,6 – -0,29) untuk pengguna bahan alam lebihrendah jika dibandingkan dengan pengguna obat konvensional. Rerata MMAS untuk pengguna bahan alam lebih tinggi jika dibandingkan dengan pengguna obat konvensional (p=0,004; 95% CI 0,31 – 1,6). Hal ini menunjukkan bahwa pasien lebih patuh menggunakan obat bahan alam dibandingkan obat konvensional untuk hipertensi. Kesimpulan: Hasil penelitian menunjukkan perlunya edukasi pengobatan hipertensi ke komunitas, baik itu obat bahan alam maupun konvensional. Hasil penelitian juga menunjukkan kepatuhan yang lebih baik pada penggunaan obat bahan alam dibandingkan obat konvensional untuk hipertensi. Hal ini menunjukkan potensi menjanjikan penggunaan obat bahan alam untuk hipertensi di masa depan. (Health Science Journal of Indonesia 2018;9(2):82-6) Kata kunci: Kepatuhan, obat bahan alam, hipertensi, Puskesmas Lempake Kota Samarinda Abstract Background: Hypertension is major health problem worldwide, including Indonesia. The use of herbal medicines for hypertension has increased in the past decade. The price of herbal medicines considered cheaper with fewer side effects. This study tried to see the level of adherence to the use of medicine by hypertensive patients in community health center at Samarinda City, East Kalimantan. Methods: This study conducted at Lempake Community Health Center in Samarinda City from July until August2017. The subjects of this study are 63 hypertensive patients and meet the sample criteria set by the researchers. The study interviewing hypertensive patients with MMAS (Morisky Medication Adherence Scale) questionnaire. Results: The results showed 56% of hypertensive patients also use herbal other than conventional medicine. Soursop (Annona muricata) leaves, salam (Syzygium polyanthum) leaves, and cucumber (Cucumis sativus) fruit were the most frequent herbal medicines used by hypertensive patients. The mean blood pressure of herbal medicine users was significantly lower when compared with conventional medicine users for systolic (p=0.004; 95% CI -19.8 – -3.8) and diastolic blood pressure (p=0.038; 95% CI -9.6 – -0.29). The mean score of MMAS in herbal medicine users was significantly higher when compared with conventional medicine users (p=0.004; 95% CI 0.31 – 1.6). This suggests that patients are more adherent in using herbal than the conventional medicine for hypertension. Conclusion: The result of the study shows the need for herbal and conventional medicine education forhypertension in the community. The result also shows better patient adherence to herbal medicine compared to conventional medicine, as the promising future of herbal medicine for hypertension. (Health Science Journal of Indonesia 2018;9(2):82-6) Keywords: Adherence, herbal medicine, hypertension, Lempake Public Health Center Samarinda City  

Introduction: The de Winter pattern (dWP) was first described by de Winter and colleagues in 2008 as static pattern associated with anterior myocardial infarction. A recent study showed the evolution sequence of this pattern into typical ST-elevation myocardial infarction (STEMI). This case discussed dWP who present as pre-anterior STEMI. Case Illustration: A-56-year old Male arrived in the emergency room complained chest pain about 3 hours. The patient also complained of diaphoresis, nausea, and fatigue. The patient has a previous history of hypertension. The vital signs were stable with an unremarkable physical examination. The initial electrocardiogram (ECG) revealed sinus rhythm with j-point depression followed by prominent T wave in precordial leads, slight ST-segment elevation in aVR, and loss of precordial R-wave progression. The initial-troponin-T was 31 pg/mL. Follow-up 1-hour after initial ECG showed typical ST-segment-elevation in V1-V4. The patient undergoing thrombolytic, followed by angiography that showed subtotal occlusion in the proximal left anterior descending (LAD) artery, occlusion in the proximal circumflex artery and stenosis in proximal right coronary artery, echocardiography revealed regional wall motion abnormality in the septal and anterior segments and preserved ejection fraction 58%, the patient was discharged after 8-days treated in intensive cardiac care unit. Conclusion: dWP has been shown as static and dynamic pattern in some conditions and associated with acute LAD occlusion. In this case, we showed dWP as early anterior STEMI, recognition of this pattern lead to early reperfusion and better myocardial salvage as anterior STEMI has a poor outcome.

Background: The appearance of ST-segment elevation (STE) and pathological Q wave were signs of worse myocardial damage and function, the quantitative measurement of the waves have a potential prognosis role. This study assesses the performance of the quantitative measurement of the waves in predicting in-hospital mortality and compares it with the Global Registry of Acute Coronary Events (GRACE) score as the standard recommended risk score. Methods: This was a cross-sectional study included patients with ST-elevation myocardial infarction (STEMI) that hospitalized in Abdul Wahab Sjahranie General Hospital Samarinda during January to December 2016. Standard 12-lead electrocardiograms (ECG) were assessed at patient admission as well as other data for GRACE score. The subjects were grouped into non-survivor and survivor group based on hospitalization survival state, and six quantitative ECG characteristics performance will be assessed. The performances were assessed using receiver operating characteristics (ROC) curve and area under the curve (AUC). Results: There were 57 subjects consisting of 9 non-survivor subjects. The AUC of the four ECG characteristics highest STE amplitude, deepest Q amplitude, total Q amplitude, and total STE amplitude did not significantly different with GRACE score (p>0.05). Highest STE amplitude has the best performance than the other ECG characteristics (AUC=0.81, 95% CI:0.65 to 0.97), and cut off point 4.5mm provides 56% sensitivity and 94% specificity. Conclusion: The quantitative measurement of ST-segment deviation and pathological Q wave have the prognosis role for predicting in-hospital mortality.