The Rule of ACE Inhibitor in diastolic heart failure

diastolic heart failure is clinical sysndrom characterized by the symtoms and sign of heart failure, a preserved ejection fraction (EF), and abnormal diastolic function.

treatment of diastolic heart failure can be framed in 3 step :

1. treatement should target symtom reducion, principally by decreasing pulmanary venous presure at rest and during exertion.
2. treatment should target the pathological disease that caused the diastolic hearth failure.
3. treatment should targeet the underlying mechanisms that are altered by the disease procsess.

ACE inhibitor redue systemic vascular resistance, artial presure, LV and right ventricular end-diastolic ressures, cardiac work, and myocardial oxygen consumtion and increase cardiac output. beside that ace inhibitor also improve HF associated with normal LV ejection fraction by decreaseng afterload, lowering elevated blood pressure, decreasing LV mass and artial and arteriolar wall thicness and stiffness by improving LV relaxation and by attenuating the coronary Vasocontriction of angiotensin II.
few observatioanl data available showed ACE inhibitor improved NYHA functiooanl class, LVdiastolic function, mortality and quality of life scores in diastolic heart failure. however data form large scale, prospective, randomized, placebo controlled studied investigating the efficacy of ACE inhibitor on cardiovaskuler mortality and morbidity are needed to establish in the treatment of diastolic HF.

refrence
ASMIHA 16, articel by Idris Idham
National cardiovasculer center harapan kita - jakarta

Read More..

New Treatment of Pulmonary Arterial Hypertension

Ther are several treatmen of PAH (Pulmonary Arterial Hypertension) such as phospodiesterase (PDE) inhibitor eg : sildenafil ; endothelin (ET-1) receptor antagonist, eg : bosentan ; prostacyclin analogue (beraprost Sodium).

at present there is prostacyclin analgue for the treatmen of pulmunari artieal hypertension, wicch provide all charecteristec acton as antiplatelet action, vasodilating action and endothelial protective acton, anti inflammatton, and vascular smoot muscle cell growth inhibitor. with beraprost sodium wich can be administered orally, so it enables the teratmen of administration has been shown (4 year survival rate of 75 %). because of its caracteristic, beraprost sodium considered to be the most soitable first choice drug for PAH.

articel from Annual Scientific Meeting of the indonesia heart associaton
The Current management of pulmunary hypertension by harmani kalim
national cardiovaskuler center harapan Kita jakarta

Read More..

Diabetic Foot and Vasular disease in Diabetic Patient

What Physician should know

diabetic foot ulecer precede 85% of nontraumatic lower-exteremity amputation (LEAs). approximatelly 3- 4 % of individual with diabetes currentyl have foot ulcer or deep infektion. fiiteen percent develop foot ulcer during their lifetime. ther risk of LEA increases by a factor of 8 onece an ulcer develops.

etiology of diabetic foot is including peripheral neuropaty, ischemic vascular disease and immune dficiency. the primary risk factor for the developmen of diabetic foot ulcer is loss of pertectice sensation. abnormal white blood cell fungtion and the presence of peripheral vascular disease allow wounds to become cotaminated and infected by normaly nonpathogenic organism. this explains he indetifiacation of unusual bacteria form the wound of patien with diabetec.
ischemic pherpheral disesase is tehe second risk factor for developing diabetic foot ulcer and infection. this used to be considered a smal vessel disease, but curren research links the vascular pathology to the basement membrane of the artierial wall. the disease is similar to that in those with vasular disease who are not diabetic, except that the distribution is somewhat more scattered and geographic in person who are not diabetic, as opposed to progressive in a distal direction in person who ara diabetic.
the third major risk factor related to the immune deficciency seen in this patient population, glycosylated immune proteins lose efficency, and granulocytes do not perform adequately, leavieng these patients prrone to infection form organisms that not affect a healthy host. each of these potential abnormallities make the diabetic foot susceptible to abnormal mechanical stresses that can lead to a break in the normal soft tissue envelope, which can intiate a foot infection that cannot be resolved easeily
management of diabetic foot and peripheral artery disease in diabetic patient need a comprehensive treatmen consisist of an optimal control of blood glucose, wound care and treating of peripheral artery disease is crucial as well, either medication or evdovascular intervation wich leads to be better outcome in terms of preserving lims.

original article from ASMIHA 16 by Iwan Dakota
Devision of Vascular Medicine, National Cardiovascular Center Harapan Kita - Jakarta

Read More..

Educational Development In Assessment And Evaluation

The Implementation For Medical Education
Nurfitri Bustamam, Ssi, MKes
Department of Physiology Faculty of Medicine University of UPN “Veteren” Jakarta

Abstract

The implementation of competency based curriculum wich incorporating Student centered Problem-based, Integrated, Community-based, Elective and Systematic (SPICES) as educational strategy requires new mwthod of assesment, peer assesment, and performance assesment. The implementation of the new curriculum also requires evaluation. Evaluation is an essential part of the educational process related to quality assurance. The aim of evaluation is quality improvement. Evaluation may cover the process and/or the outcome of any aspect of education. This article also discusses the importance of evaluation in teaching and assessment for medical education.

Readmore

Read More..

Development Of Educational Leadership In The Faculty Of Medicine

Nurfitri Bustamam, Ssi, MKes
Department of Physiology Faculty of Medicine University of UPN “Veteren” Jakarta

Abstract

Academic vitality is dependent upon faculty member’s interest and expertise. Staff development has a critical role to play in promoting academic exellence and innovation. In the future medical schools will face many challenges in their missions of education, research, and patient care that call for effective leadership at all levels of the organization. This article provides a brief overview of methods used in identifying and developing abilities in educational leadership.

Read More

Read More..