KELAINAN KARDIOVASKULER PADA PENDERITA LEPTOSPIROSIS BERAT DI RU1VIAH SAKIT SE-KOTA SEMARANG

Abstract

Human leptospirosis, a worldwide zoonosis, is endemic in Indonesia. Clinical manifestation of human leptospirosis vary front mild as syndrome to severe disease with multi-organs involvement such as jaundice, renal failure,haemorrhagic pneumonitis, myocarditis. Cardiovascular involvement in leptospirosis may include inflammation of the conductive system, acute coronary arteritis, myocarditis, endocarditis and shock Electrocardiographic (ECG) findings in patients with severe leptospirosis may present as atrial fibrillation (AP), Ventricular tachycardi, ventricular extra-systole (VES), AV block, infra ventricular conduction defect (IVCD), ST depression or elevation, left / right bundle branch block (LB1313 / RBBB), and lefi anterior hemiblock (LAHB) etc. The association between leptosirosis and injury to cardiac muscle has long been recognized but the frequency ofECG alterations is rarely reported in Indonesia. OBJECTIVE OF STUDY. To know the frequency and types of electrocardiographic alterations in patients with severe leptospirosis during acute phase of infection, early convalescence and after recovering from disease. METHODS A cross sectional and observation Kohort study was done during period of November 2002. to March 2004. Subjects were patients with confirmed diagnosis of severe leptospirosis admitted to the hospitals (Dr. Kariadi, Telogorejo, St. Elisabeth, Roemani, Pantiwilasa and Municipal) located in Semarang city. ECG was performed in all patients (who fulfilled the intake criteria and agreed to follow the study) on admission day (ECG-I), at seventh day of hospitalization (ECG-2) and one month after the first ECG (ECG-3). RESULT A total of 42 patients included in the study consited of 28 males, with mean age 46,1 years. On admission day alterations of ECG-1 were found in 81,0% (34 of 42) patients with sinus tachycardia was most frequent findings 10 (/7,6%), followed by (from the highest to the least .frequen) AF 6 (10,6%), left anterior hemiblock 6 (10,6%), ischemic patterns 5 (8,8%), VES 4 (7,0%), SVES 3 (5,3%), non-specific S7'-T changes 3 (5,3%), RBBB 3 (5,3%), early repolarisation 2 (3,5%), IVCD 2 (3,5%), AV block 1 (1,8%) and ST elevation mimicking acute myocardial infarction in one patient (1,8%) At the seventh day of hospitalization 8 (22,6%) op I patients with abnormal ECG-I, had a normal sinus rhytm on their ECG-2. In the remaining, the ECG-2 showed myocardial ischemia in 9 (20,2%) patients, sinus tachycardia 6 (13,5%), nonspecific ST-T changes 5 (11,2%), AF 3 (6,7%), LAHB 3 (6,7%), RBBB 2 (4,5%) non progressing 1? 2 (4,5%), and sinus arhytmia 1 (2,2%). Of 30 evaluable patients, 17 (56,7%) patients had normal ECG-3. Patienis with abnormality of ECG-1 were found abnormal CPK 43% and abnormal LDH 68%. While patients with abnormality ECG-2 had abnormal CPK ( 8%) and abnormal LDH (52%). CONCLUTION In this study, 81,0% of patients with severe leptospirosis had at least one type of ECG alteration on admission day and the alterations may change over time. The frequent types of ECG alterations detected during the period of evaluation were sinus tachycardia, ischemic patterns and atrial .fibrillation. One month after admission, 43,3% patients still had persistent ECG alterations although they have fully recovered from the disease. Unknown EGG alterations due to pre-existing heart disease among older patients might influence this figure. There non-significants correlated between ECG pattern and CPK or LDH. values Leptpspirosis pada manusia, snatu penyakit zoonosis yang menyebar di seluruh dunia, endemik di Indonesia. Manifestasi klinik pada manusia bervariasi dark yang ringan seperti sindroma flu sampai yang berm dengan kelainan multi organ berupa ikterik, gagal ginjal, pneumonitis haemoragis, miokarditis. Kelainan pada kardiovaskuler pada leptospirosis dapat meliputi gangguan sistem konduksi, arteritis koronaria akut, miokarditis, endokarditis dan syok. Elektrokardiogram (EKG) pada pasien leptospirosis berat mepunyai gambaran berupa atrial fibrilasi (AF), ventrikel takikardi, ventrikel ekstra sistol (VES), AV blok, intraventricular conduction defect (IVCD), ST depresi / elevasi , Righ/ left bundle branch block (RBBB / LBBB) , dan lefi anterior hemiblock (LAHB), dan lain-lain. Hubungan antara leptospirosis dan cidera otot jantung telah diketahui sejak dulu, tetapi masih jarang dilaporkan di Indonesia. TUJUAN Untuk mengetahui jenis dan kejadian gambaran elektrokardiogram pada penderita leptospirosis bent selama fase infeksi akut, awal convalesen dan sesudah sembuh dark sakit. METODE PENELITIAN Cross sectional dan observasi Kohort studi selama November 2002 sampai Maret 2004. dengan sampel yang terdiagnosis pasti leptospirosis berat yang dirawat di rumah sakit (Dr. Kariadi, Telogorejo, St. Elisabeth, Roemani, Pantiwilasa, dan RSU kodya ) yang berada di kota Semarang. EKG dibuat untuk semua penderita (semua yang masuk kriteria dan bersedia ikut dalam penelitian) pada hari pertama perawatan (EKG-1), tujuh hari di rumah sakit (EKG-2) dan satu bulan setelah EKG pertama. BASIL 42 penderita masuk dalam penelitian terdiri 30 laki-laki dengan rata-rata urnur 46,1 talum. Pada hari pertama perawatan memberikan gambaran EKG-1 abnormal 81,0% ( 34 dark 42) penderita dengan gambaran sinus takikardi 10 (17,6%), AF frekuensi cepat atau lambat 6 (10,6%), left anterior hemibleck 6 (10,6%), iskemia 5 (8,8%), VES 4 (7,0%), SVES 3 (5,3%), perubahan ST-T non spesific 3 (5,3%), early repolaritation 2 (3,5%), RBBB 3 (5,3%), IVCD 2 (3,5%), AV blok 1 (1,8%). Tujuh hari perawatan di rumah sakit 7 (21%) dark 32 penderita dengan EKG-1 abnormal menjacii normal pada EKG-2., EKG-2 menunjukkan iskemi miokardial 9 (20,2%), sinus takikardi 6 (13,5%), perubahan ST-T non spesifik 5 (11,2%), AF 3 (6,7%), LAHB 3 (6,7%), early repolaritation 2 (4,5%),non progressing R 2 (4,5%) incomplit RBBB 2 (4,5'%), sinus antinia 1 (2,2%) dark 31 penderita yang dievaluasi. 17 (54,7%) penderita nenunjukkan EKG-3 yang normal. Penderita dengan EKG-1 abnormal mempunyai nilai CPK abnormal 43% dan LDH abnormal 68%, sedang dengan EKG-2 abnormal menpunyai nilai CPK abnormal 8% dan LDH abnormal 52%. KESIMPULAN Dark penelitian, didapatkan 81,0% penderita leptospirosis berat mempunyai salah satu tipe kelainan EKG pada hari pertama perawatan dan kelainan ini dapat membaik dengan berjalanya waktu. Frekuensi tipe kelainan EKG dideteksi selama periode evaluasi dimana terdapat sinus' talcikardi, atrial fibrilasi dan blok. Satu bulan setelah perawatan, 43,3% penderita tetap memiliki kelainan EKG walaupun sudah sembuh sepenulutya dark sakit. Kelainan EKG yang tidak diketahui sebelumnya yang diperkirakan berhubungan dengan pre existing heart disease diantara penderita usia lanjut. Tidal( ada hubungan yang bennakna antara gambaran EKG dengan nilai CPK maupun LDH.