Overview

What is Cardiac CT with Photon-Counting CT?

A Cardiac CT (Computed Tomography) scan is a non-invasive imaging test that uses X-rays and advanced computer technology to create highly detailed images of the heart and blood vessels. It helps doctors evaluate the structure of the heart, detect coronary artery disease, assess heart function, and identify other cardiovascular conditions.

At RS Abdi Waluyo, Cardiac CT is performed using the latest Photon-Counting CT (PCCT) technology. Unlike conventional CT scanners, Photon-Counting CT directly detects individual X-ray photons, producing exceptionally sharp images with greater detail while using lower radiation doses. This breakthrough technology allows physicians to visualize even small coronary arteries, plaques, and heart structures with remarkable precision, leading to earlier and more accurate diagnosis.

Why is Cardiac CT Performed?

Your doctor may recommend a Cardiac CT to:

• Evaluate chest pain or other symptoms that may be related to heart disease.
• Detect narrowing or blockage in the coronary arteries.
• Assess calcium buildup in the coronary arteries (Coronary Calcium Score).
• Evaluate congenital heart abnormalities.
• Assess the anatomy of the heart before structural heart procedures or surgery.
• Monitor known coronary artery disease.
• Evaluate bypass grafts or coronary stents in selected patients.
• Assist in planning treatment for cardiovascular conditions.

A Cardiac CT can often help determine whether invasive testing is necessary, allowing many patients to avoid unnecessary procedures.

Details of the Examination

Cardiac CT with Photon-Counting CT is a fast, painless outpatient examination.

Depending on your clinical condition, the examination may include:

• Coronary CT Angiography (CTA)
• Coronary Artery Calcium Scoring
• Assessment of heart chambers and valves
• Evaluation of the aorta and major blood vessels
• Functional assessment of cardiac structures

To obtain the best image quality:

• You may be asked to avoid caffeine, nicotine, or strenuous exercise before the examination.
• Your doctor may prescribe medication to slow your heart rate if necessary.
• An intravenous (IV) line may be inserted to administer contrast dye during Coronary CT Angiography.
• You may be asked to fast for several hours before the scan if contrast material will be used.

Your healthcare team will provide personalized preparation instructions before your appointment.

What Happens During the Examination?

Upon arrival, you will be greeted by the radiology team and prepared for the scan.

During the examination:

1. You will lie comfortably on the CT examination table.
2. Electrodes will be placed on your chest to monitor your heartbeat (ECG-gating).
3. If contrast is required, an IV line will be inserted into your arm.
4. The examination table will move through the Photon-Counting CT scanner while images are acquired.
5. You will be asked to hold your breath for a few seconds during image acquisition to reduce motion and improve image quality.
6. The entire examination usually takes approximately 10–20 minutes, while the actual scan typically lasts only a few seconds.

The procedure is painless. Some patients may experience a brief warm sensation or metallic taste when contrast dye is injected, which usually resolves quickly.

What Should I Expect After the Examination?

Most patients can return to their normal daily activities immediately after the scan.

If contrast dye was used:

• Drink plenty of water to help flush the contrast material from your body.
• Continue taking your regular medications unless instructed otherwise by your doctor.
• You may resume your usual diet unless advised differently.

If you received medication to slow your heart rate, you may be observed briefly before leaving the imaging department.

What Are the Risks?

Cardiac CT is considered a safe diagnostic examination.

Potential risks include:

• Exposure to a small amount of ionizing radiation. Photon-Counting CT technology helps reduce radiation exposure compared with many conventional CT systems while maintaining exceptional image quality.
• Allergic reaction to iodinated contrast dye, although serious reactions are rare.
• Temporary discomfort or bruising at the IV insertion site.
• Contrast-induced kidney problems in patients with severe kidney disease, which is why your doctor may assess your kidney function before the examination.

Your healthcare team carefully evaluates the benefits and risks before recommending the examination.

Results and Follow-Up

After the examination, the images are carefully analyzed by a radiologist with expertise in cardiovascular imaging.

The results are then shared with your referring physician or cardiologist, who will explain the findings and discuss the most appropriate treatment plan based on your condition.

When Will I Receive My Results?

Preliminary findings may be available shortly after the examination.

A comprehensive radiology report is generally available within 24 to 72 hours, depending on the complexity of the examination.

Your doctor will review the results with you during your follow-up appointment.

If the Results Are Abnormal, What Are the Next Steps?

If your Cardiac CT identifies an abnormality, the next steps will depend on the findings.

Your doctor may recommend:

• Lifestyle modifications to reduce cardiovascular risk.
• Medications to manage cholesterol, blood pressure, or heart disease.
• Additional cardiac imaging or functional testing.
• Stress testing to evaluate blood flow to the heart.
• Coronary angiography if significant coronary artery narrowing is suspected.
• Consultation with an interventional cardiologist or cardiac surgeon when appropriate.

Many patients can begin treatment based on Cardiac CT findings without requiring invasive diagnostic procedures.

When Should I Call My Doctor?

Contact your doctor promptly if you experience any of the following after your examination:

• Rash, itching, or swelling after receiving contrast dye.
• Difficulty breathing.
• Persistent nausea or vomiting.
• Fever or signs of infection at the IV insertion site.
• Severe pain, redness, or swelling around the IV site.
• Reduced urination if you have underlying kidney disease.
• Any new or worsening symptoms that concern you.

Seek emergency medical care immediately if you develop chest pain, severe shortness of breath, or symptoms suggestive of a heart attack.

Why Choose RS Abdi Waluyo for Cardiac CT?

RS Abdi Waluyo combines expert cardiovascular care with one of the most advanced CT imaging technologies available today.

Our Cardiac CT service offers:

• Advanced Photon-Counting CT technology for exceptional image clarity.
• Lower radiation exposure compared with many conventional CT systems.
• High-resolution visualization of coronary arteries, plaques, heart valves, and surrounding structures.
• Experienced radiologists and cardiologists specializing in cardiovascular imaging.
• Comprehensive heart care, from early diagnosis to advanced treatment planning.
• Patient-centered care focused on comfort, safety, and clinical excellence.

With Photon-Counting CT, RS Abdi Waluyo provides more precise cardiac imaging that supports earlier diagnosis, personalized treatment decisions, and better outcomes for patients with cardiovascular disease.

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Overview

What is Cardiac MRI?

Cardiac Magnetic Resonance Imaging (Cardiac MRI) is a non-invasive imaging examination that uses a powerful magnetic field, radio waves, and advanced computer technology to produce highly detailed images of the heart and surrounding blood vessels—without exposing patients to ionizing radiation.

Widely regarded as the gold standard for evaluating cardiac structure, function, and myocardial tissue, Cardiac MRI provides comprehensive information about the heart’s anatomy, pumping function, blood flow, heart valves, and tissue characteristics. It enables physicians to diagnose a broad range of cardiovascular diseases with exceptional accuracy and precision.

Unlike other imaging modalities, Cardiac MRI can characterize heart muscle tissue and detect inflammation (myocarditis), fibrosis, edema, scar tissue, infiltrative heart disease, and damage from previous heart attacks. This makes it an invaluable tool for diagnosing complex cardiovascular conditions, assessing disease severity, and guiding personalized treatment.

At RS Abdi Waluyo, Cardiac MRI is performed using an advanced 3 Tesla (3T) MRI system, which delivers significantly higher image resolution, faster scan times, and superior tissue characterization compared with conventional MRI systems. Combined with specialized cardiac imaging protocols and interpretation by experienced radiologists and cardiologists, our Cardiac MRI service provides highly accurate and comprehensive evaluation of cardiovascular disease.

Why is Cardiac MRI Performed?

Your doctor may recommend a Cardiac MRI to:

• Evaluate heart muscle structure and function.
• Assess left and right ventricular function (ejection fraction).
• Diagnose cardiomyopathies (heart muscle diseases).
• Detect myocarditis (heart muscle inflammation).
• Evaluate previous heart attack damage and myocardial scarring.
• Assess myocardial viability before coronary revascularization.
• Diagnose congenital heart disease.
• Evaluate heart valve abnormalities.
• Assess diseases of the pericardium (the lining around the heart).
• Detect cardiac tumors or masses.
• Evaluate diseases of the aorta and major blood vessels.
• Assess infiltrative heart diseases such as cardiac amyloidosis and sarcoidosis.
• Monitor disease progression and response to treatment.

Details of the Examination

Before the examination, your healthcare team will review your medical history and determine whether Cardiac MRI is appropriate for you.

You may undergo:

• Physical examination.
• Electrocardiography (ECG).
• Blood tests if contrast material is required.
• Kidney function assessment before gadolinium contrast administration.

Before the scan, you may be instructed to:

• Avoid eating for several hours if contrast is planned.
• Remove all metal objects, including jewelry, watches, hearing aids, and credit cards.
• Inform your healthcare team if you have:
  • A pacemaker or implantable cardiac device.
  • Metallic implants.
  • Aneurysm clips.
  • Cochlear implants.
  • Pregnancy
  • Kidney disease.
  • Claustrophobia
  • Allergies to MRI contrast agents.

The examination generally takes 30 to 60 minutes, depending on the complexity of the study.

What Happens During the Examination?

During the examination:

1. You will lie comfortably on the MRI examination table.
2. ECG leads will be attached to monitor your heartbeat throughout the examination.
3. A specialized cardiac imaging coil will be placed over your chest.
4. The examination table will move into the 3 Tesla MRI scanner.
5. You will be asked to remain still and occasionally hold your breath for several seconds while images are acquired.
6. If contrast-enhanced imaging is required, gadolinium contrast material will be administered through an intravenous (IV) line.
7. Multiple high-resolution images will be obtained from different planes to evaluate cardiac anatomy, ventricular function, myocardial perfusion, blood flow, heart valves, and myocardial tissue characteristics.

Throughout the examination, the radiographer will communicate with you using an intercom system while continuously monitoring your condition.

What Should I Expect After the Examination?

After Cardiac MRI:

• Most patients can return to their normal daily activities immediately.
• If contrast material was used, drinking plenty of water is recommended to help eliminate the contrast from your body.
• Most patients experience no side effects.
• Mild bruising at the IV insertion site may occasionally occur.

If sedation was required, you may need someone to accompany you home.

What Are the Risks?

Cardiac MRI is considered a very safe imaging examination.

Potential risks include:

• Mild allergic reactions to gadolinium contrast (rare).
• Temporary discomfort from lying still during the examination.
• Claustrophobia in some patients.
• MRI may not be suitable for patients with certain implanted medical devices.
• Very rare complications related to severe kidney disease and gadolinium contrast administration.

Your healthcare team will carefully screen you before the examination to ensure it is safe and appropriate for you.

Results and Follow-Up

A radiologist and cardiologist specializing in cardiovascular imaging will evaluate:

• Heart chamber size.
• Heart muscle thickness.
• Left and right ventricular function.
• Heart valve function.
• Blood flow through the heart.
• Myocardial inflammation.
• Fibrosis and scar tissue.
• Myocardial viability.
• Cardiac tumors or masses.
• Congenital heart abnormalities.
• Diseases of the aorta and surrounding structures.

These findings help your doctor establish an accurate diagnosis, assess disease severity, and determine the most appropriate treatment plan.

When Will I Receive My Results?

A comprehensive report is generally available within 24 to 72 hours, depending on the complexity of the examination.

Your doctor will review the findings with you and discuss any additional treatment or follow-up if needed.

If the Results Are Abnormal, What Are the Next Steps?

Depending on the findings, your doctor may recommend:

• Lifestyle modification.
• Medication adjustments.
• Coronary CT Angiography.
• Coronary Angiography.
• Echocardiography
• Electrophysiological evaluation.
• Cardiac catheterization.
• Angioplasty and stenting (PCI).
• Coronary Artery Bypass Grafting (CABG).
• Valve repair or replacement.
• Regular follow-up with a cardiologist.

Treatment recommendations will be tailored to your diagnosis, symptoms, and overall cardiovascular health.

When Should I Call My Doctor?

Contact your doctor promptly if you experience after the examination:

• Persistent pain or swelling at the IV site
• Rash or allergic symptoms
• Fever
• Shortness of breath
• Chest pain
• Palpitations
• Any new or worsening symptoms

Seek emergency medical attention immediately if you experience severe chest pain, difficulty breathing, or symptoms suggestive of a heart attack or stroke.

Why Choose RS Abdi Waluyo for Cardiac MRI?

At RS Abdi Waluyo, our Cardiac MRI service combines next-generation 3 Tesla (3T) MRI technology, artificial intelligence (AI)-enhanced imaging, and expert cardiovascular interpretation to provide one of the most comprehensive, accurate, and patient-friendly non-invasive evaluations of heart disease.

Our Cardiac MRI service offers:

• Advanced 3 Tesla (3T) MRI technology, delivering exceptional image quality, higher spatial resolution, superior tissue characterization, and faster image acquisition than conventional MRI systems.
• AI-powered image acquisition and reconstruction, enabling faster examinations, sharper image quality, reduced motion artifacts, and improved diagnostic accuracy while shortening scan times.
• Wide-bore MRI design (70 cm opening) that provides a more spacious environment, helping reduce feelings of claustrophobia and improving comfort throughout the examination.
• Lightweight, ergonomically designed cardiac coils, making the examination more comfortable compared with conventional heavier MRI coils.
• A quieter and more patient-friendly examination experience, with the option to listen to your favorite music during the scan to help you relax and reduce anxiety.
• Comprehensive evaluation of heart anatomy, ventricular function, myocardial perfusion, heart valves, great vessels, myocardial viability, and myocardial tissue characteristics in a single examination.
• Advanced tissue characterization, including Late Gadolinium Enhancement (LGE), T1 Mapping, T2 Mapping, and Extracellular Volume (ECV) analysis, allowing early detection of myocarditis, infiltrative cardiomyopathies, hypertrophic cardiomyopathy, dilated cardiomyopathy, cardiac amyloidosis, fibrosis, and myocardial scarring.
• Precise quantitative assessment of ventricular volumes, cardiac function, and myocardial viability to support diagnosis, treatment planning, and long-term follow-up.
• A completely non-invasive examination without exposure to ionizing radiation.
• Interpretation by experienced Radiologists and Cardiologists specializing in Cardiovascular Imaging, ensuring highly accurate and clinically meaningful results.
• Integrated Heart Center services, with seamless collaboration among radiologists, cardiologists, interventional cardiologists, electrophysiologists, and cardiac surgeons to provide comprehensive cardiovascular care.
• A patient-centered approach focused on safety, comfort, efficiency, and clinical excellence.

By combining AI-enhanced 3 Tesla MRI technology, superior patient comfort features, and multidisciplinary cardiovascular expertise, RS Abdi Waluyo provides one of Indonesia’s most advanced Cardiac MRI services. Our commitment to innovation enables earlier disease detection, more precise diagnosis, personalized treatment planning, and better long-term cardiovascular outcomes—all while ensuring a faster, quieter, and more comfortable imaging experience for every patient.

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Overview

What is Transcatheter Mitral Valve Repair (TMVr)?

Transcatheter Mitral Valve Repair (TMVr) is a minimally invasive procedure used to treat mitral regurgitation (MR), a condition in which the mitral valve does not close properly, allowing blood to leak backward from the left ventricle into the left atrium.

Unlike conventional open-heart surgery, TMVr repairs the mitral valve through a catheter inserted into a vein, usually in the groin, without the need to open the chest or temporarily stop the heart. Using advanced imaging guidance, a specialized repair device is delivered to the mitral valve to improve leaflet coaptation (closure), significantly reducing valve leakage while preserving the patient’s native valve.

TMVr is an important treatment option for patients with severe mitral regurgitation who are considered at high or prohibitive risk for conventional heart surgery due to age, frailty, or other medical conditions.

At RS Abdi Waluyo, Transcatheter Mitral Valve Repair is performed by a multidisciplinary Structural Heart Team comprising interventional cardiologists, cardiac surgeons, cardiac imaging specialists, cardiac anesthesiologists, and specialized nurses. Procedures are carried out in a state-of-the-art Hybrid Catheterization Laboratory (Hybrid Cath Lab) equipped with advanced imaging technology to maximize precision, safety, and clinical outcomes.

Why is Transcatheter Mitral Valve Repair Performed?

Your cardiologist may recommend TMVr if you have:

• Severe mitral regurgitation causing symptoms.
• Degenerative (primary) mitral regurgitation.
• Functional (secondary) mitral regurgitation related to heart failure.
• Shortness of breath during daily activities.
• Fatigue and reduced exercise tolerance.
• Recurrent hospitalization for heart failure.
• High or prohibitive surgical risk for open-heart valve surgery.
• Persistent symptoms despite optimal medical therapy.

The procedure aims to reduce mitral valve leakage, improve heart function, relieve symptoms, and enhance quality of life.

Details of the Procedure

Before undergoing TMVr, you will undergo a comprehensive evaluation, including:

• Consultation with an interventional cardiologist and cardiac surgeon.
• Physical examination and medical history review.
• Blood tests.
• Electrocardiogram (ECG).
• Transthoracic Echocardiography (TTE).
• Transesophageal Echocardiography (TEE) to assess mitral valve anatomy.
• Cardiac CT scan when appropriate.
• Coronary angiography if indicated.

Before the procedure, you may be instructed to:

• Fast for several hours.
• Temporarily stop certain medications according to your physician’s instructions.
• Inform your doctor of any allergies, kidney disease, bleeding disorders, or implanted medical devices.

The procedure generally takes 2 to 4 hours, depending on the complexity of the valve anatomy.

What Happens During the Procedure?

During TMVr:

1. The procedure is usually performed under general anesthesia.
2. A catheter is inserted through the femoral vein in the groin.
3. Using advanced fluoroscopic imaging and real-time Transesophageal Echocardiography (TEE), the catheter is guided into the heart.
4. The catheter crosses the interatrial septum to access the left atrium.
5. A specialized mitral valve repair device is positioned across the leaking valve.
6. The device grasps the mitral valve leaflets, improving valve closure and reducing regurgitation.
7. The degree of residual leakage is carefully assessed using TEE before the device is released.
8. Once satisfactory results are achieved, the delivery system is removed and the access site is closed.

Throughout the procedure, your heart rhythm, blood pressure, oxygen level, and overall condition are continuously monitored.

The Role of the Hybrid Cath Lab

At RS Abdi Waluyo, TMVr is performed in an advanced Hybrid Catheterization Laboratory (Hybrid Cath Lab) specifically designed for complex structural heart procedures.

The Hybrid Cath Lab offers several important advantages:

• High-resolution fluoroscopic imaging combined with real-time 3D Transesophageal Echocardiography (3D TEE) for precise device positioning.
• Simultaneous visualization of cardiac anatomy and catheter movement throughout the procedure.
• Immediate collaboration between interventional cardiologists and cardiac surgeons for complex cases.
• The ability to convert to surgical intervention immediately if necessary without transferring the patient.
• Enhanced patient safety through integrated imaging, anesthesia, and surgical capabilities.
• A comprehensive Heart Team approach, ensuring individualized treatment planning for every patient.

What Should I Expect After the Procedure?

After TMVr:

• You will be monitored in the intensive care unit or cardiac recovery unit.
• Most patients remain in the hospital for 1 to 3 days.
• Walking is usually encouraged within 24 hours after the procedure.
• Most patients experience significant improvement in symptoms over the following weeks.
• Your doctor will prescribe medications and provide instructions regarding activity, wound care, and follow-up appointments.

Regular echocardiographic follow-up is important to monitor mitral valve function.

What Are the Risks?

TMVr is considered a safe and effective treatment for appropriately selected patients.

Potential risks include:

• Bleeding or bruising at the catheter insertion site.
• Damage to blood vessels.
• Heart rhythm disturbances.
• Residual mitral valve leakage.
• Device malposition or embolization (rare).
• Injury to the mitral valve requiring surgery.
• Cardiac perforation (rare).
• Kidney injury related to contrast dye.
• Death (rare).

Your healthcare team carefully monitors you throughout the procedure to minimize these risks.

Results and Follow-Up

Following TMVr, your cardiologist will evaluate:

• Reduction in mitral regurgitation.
• Improvement in heart function.
• Relief of symptoms.
• Left ventricular function.
• Pulmonary artery pressure.
• Overall quality of life.

Follow-up care typically includes:

• Regular cardiology consultations.
• Medication optimization.
• Heart failure management when appropriate.
• Lifestyle modification and cardiac rehabilitation.

When Will I Know the Results?

Your cardiologist can usually discuss the immediate procedural results shortly after the procedure.

Before discharge, you will receive information regarding:

• The success of the mitral valve repair.
• The degree of residual mitral regurgitation.
• Heart function.
• Recovery recommendations.
• Long-term follow-up plans.

If the Results Are Abnormal, What Are the Next Steps?

If significant mitral regurgitation persists or additional structural heart disease is identified, your Heart Team may recommend:

• Adjustment of heart failure medications.
• Repeat echocardiographic evaluation.
• Additional transcatheter intervention.
• Surgical mitral valve repair or replacement.
• Ongoing follow-up with the Structural Heart Team.

Treatment recommendations will be individualized based on your symptoms, valve anatomy, and overall health.

When Should I Call My Doctor?

Contact your doctor immediately if you experience:

• Increasing shortness of breath.
• Chest pain.
• Persistent bleeding or swelling at the catheter insertion site.
• Palpitations or rapid heartbeat.
• Leg swelling.
• Sudden fatigue or weakness.
• Any new or worsening symptoms.

Seek emergency medical attention immediately if you develop severe chest pain, stroke symptoms, difficulty breathing, or loss of consciousness.

Why Choose RS Abdi Waluyo for Transcatheter Mitral Valve Repair?

At RS Abdi Waluyo, our Structural Heart Program provides comprehensive, minimally invasive treatment for patients with complex mitral valve disease using advanced technology and internationally accepted treatment standards.

Our TMVr program offers:

• Advanced Hybrid Catheterization Laboratory (Hybrid Cath Lab) equipped with state-of-the-art fluoroscopic imaging and real-time 3D Transesophageal Echocardiography (3D TEE).
• Experienced Structural Heart specialists, including interventional cardiologists, cardiac surgeons, imaging cardiologists, and cardiac anesthesiologists.
• Comprehensive Heart Team evaluation, ensuring every patient receives an individualized treatment strategy.
• Minimally invasive treatment that avoids open-heart surgery in appropriately selected patients.
• Reduced procedural risk, shorter hospital stay, faster recovery, and earlier return to normal activities.
• Comprehensive care, from diagnosis and advanced imaging to intervention, rehabilitation, and long-term follow-up.
• A patient-centered approach focused on safety, precision, clinical excellence, and improved quality of life.

By combining advanced structural heart expertise, Hybrid Cath Lab technology, and multidisciplinary collaboration, RS Abdi Waluyo provides world-class Transcatheter Mitral Valve Repair, offering patients with severe mitral regurgitation a safe, effective, and less invasive alternative to conventional open-heart surgery.

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Overview

What is Minimally Invasive Cardiac Surgery (MICS)?

Minimally Invasive Cardiac Surgery (MICS) is an advanced surgical technique that allows surgeons to perform complex heart operations through small incisions between the ribs instead of the traditional median sternotomy (splitting the breastbone). By avoiding a full chest incision, MICS minimizes surgical trauma while providing the same treatment effectiveness as conventional open-heart surgery for appropriately selected patients.

Depending on the patient’s condition, MICS may be performed to treat:

• Coronary artery disease requiring coronary artery bypass grafting (CABG)
• Mitral valve disease
• Tricuspid valve disease
• Atrial septal defect (ASD)
• Cardiac tumors
• Selected congenital heart diseases
• Certain heart rhythm disorders

Compared with conventional open-heart surgery, MICS offers less pain, reduced blood loss, lower risk of infection, faster recovery, shorter hospitalization, and improved cosmetic results.

At RS Abdi Waluyo, Minimally Invasive Cardiac Surgery is performed by an experienced Cardiac Surgery Team using advanced surgical techniques and supported by a state-of-the-art Hybrid Catheterization Laboratory (Hybrid Cath Lab), enabling seamless collaboration between cardiac surgeons, interventional cardiologists, anesthesiologists, cardiac imaging specialists, and intensive care teams.

Why is Minimally Invasive Cardiac Surgery Performed?

Your cardiologist or cardiac surgeon may recommend MICS to treat:

• Severe coronary artery disease
• Mitral valve regurgitation or stenosis
• Tricuspid valve disease
• Atrial septal defect (ASD)
• Benign cardiac tumors, such as atrial myxoma
• Selected congenital heart defects
• Patients who are suitable candidates for minimally invasive cardiac surgery

MICS aims to restore heart function while reducing surgical trauma and promoting a faster recovery.

Details of the Procedure

Before surgery, you will undergo a comprehensive evaluation, which may include:

• Consultation with a cardiac surgeon and cardiologist
• Blood tests
• Electrocardiography (ECG)
• Echocardiography
• Coronary Angiography or Coronary CT Angiography
• Cardiac CT scan
• Chest X-ray
• Pulmonary function tests when indicated

Before surgery, you may be instructed to:

• Fast for several hours
• Temporarily discontinue certain medications, such as blood thinners
• Stop smoking before surgery
• Inform your healthcare team of allergies or other medical conditions

The operation generally takes 3 to 6 hours, depending on the complexity of the procedure.

What Happens During the Procedure?

During MICS:

1. General anesthesia is administered
2. A small incision, typically 4–8 cm in length, is made between the ribs on the right or left side of the chest
3. Specialized long-shafted surgical instruments and high-definition cameras are used to access the heart
4. Depending on the condition being treated, the surgeon performs valve repair or replacement, coronary artery bypass surgery, closure of congenital defects, or removal of cardiac tumors
5. Advanced imaging and surgical guidance ensure precise treatment while minimizing trauma to surrounding tissues
6. After the procedure is completed, the incision is closed using cosmetic techniques

Throughout the operation, your heart function, blood pressure, oxygen levels, and other vital signs are continuously monitored

What Should I Expect After Surgery?

Following MICS:

• You will initially recover in the Intensive Care Unit (ICU)
• Most patients are transferred to a regular cardiac ward within one to two days
• Hospital stay is typically 4 to 7 days, depending on recovery
• Pain is generally less than with conventional open-heart surgery
• Walking is encouraged as early as possible
• Most patients resume normal daily activities within 2 to 6 weeks, considerably faster than after conventional sternotomy

Your healthcare team will provide instructions regarding wound care, medications, activity, and cardiac rehabilitation

What Are the Risks?

Although MICS is considered safe and effective, all cardiac surgery carries potential risks, including:

• Bleeding
• Infection
• Stroke
• Heart rhythm abnormalities
• Blood clots
• Heart attack
• Lung complications
• Kidney dysfunction
• Need to convert to conventional open-heart surgery if necessary
• Death (rare)

Your surgical team carefully evaluates every patient to minimize these risks.

Results and Follow-Up

After surgery, your cardiac surgeon and cardiologist will evaluate:

• Success of the surgical repair
• Heart valve function
• Coronary blood flow, when applicable
• Cardiac function
• Symptom improvement
• Overall recovery

Follow-up care may include:

• Regular clinic visits
• Echocardiography
• Electrocardiography (ECG)
• Cardiac rehabilitation
• Medication management
• Lifestyle modification to promote long-term cardiovascular health

When Will I Know the Results?

Your cardiac surgeon will discuss the initial results shortly after surgery

During your hospital stay, additional evaluations—including echocardiography and clinical assessments—will confirm the success of the procedure before discharge

If the Results Are Abnormal, What Are the Next Steps?

If additional treatment is required, your Heart Team may recommend:

• Medication adjustments
• Additional cardiac imaging
• Catheter-based intervention
• Repeat surgery (rare)
• Cardiac rehabilitation
• Ongoing follow-up with your cardiologist and cardiac surgeon

Treatment recommendations will depend on your specific condition and overall health

When Should I Call My Doctor?

Contact your doctor immediately if you experience:

• Fever
• Increasing chest pain
• Shortness of breath
• Redness, swelling, or drainage from the incision
• Persistent palpitations
• Leg swelling
• Sudden weakness or dizziness
• Any new or worsening symptoms

Seek emergency medical attention immediately if you develop severe chest pain, stroke symptoms, difficulty breathing, or loss of consciousness.

Why Choose RS Abdi Waluyo for Minimally Invasive Cardiac Surgery?

At RS Abdi Waluyo, our Cardiac Surgery Program combines advanced surgical expertise, innovative technology, and a multidisciplinary Heart Team approach to provide world-class treatment for patients with cardiovascular disease.

Our Minimally Invasive Cardiac Surgery program offers:

• Advanced Hybrid Catheterization Laboratory (Hybrid Cath Lab) integrating a modern operating room with advanced cardiovascular imaging for greater precision and patient safety.
• Experienced cardiac surgeons specializing in minimally invasive heart surgery and complex cardiovascular procedures.
• Comprehensive Heart Team collaboration, involving cardiac surgeons, cardiologists, interventional cardiologists, cardiac imaging specialists, anesthesiologists, intensivists, and rehabilitation specialists.
• Smaller incisions, resulting in less pain, reduced blood loss, lower infection risk, and improved cosmetic outcomes.
• Faster recovery, allowing earlier mobilization, shorter hospital stays, and quicker return to work and daily activities.
• Comprehensive cardiac services, from advanced diagnostics and cardiac imaging to surgery, rehabilitation, and long-term follow-up.
• Patient-centered care focused on clinical excellence, safety, comfort, and long-term cardiovascular health.

By combining minimally invasive surgical techniques, advanced Hybrid Cath Lab technology, and an experienced multidisciplinary Heart Team, RS Abdi Waluyo provides comprehensive, personalized cardiac care that delivers outstanding clinical outcomes while helping patients recover faster and return to their daily lives with greater confidence.

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Overview

What is Coronary Artery Bypass Grafting (CABG)?

Coronary Artery Bypass Grafting (CABG), commonly known as heart bypass surgery, is a surgical procedure performed to restore blood flow to the heart muscle in patients with significant narrowing or blockage of the coronary arteries.

Coronary artery disease occurs when fatty deposits (plaques) build up inside the coronary arteries, reducing blood flow and oxygen supply to the heart. When these blockages become severe, patients may experience chest pain (angina), shortness of breath, heart failure, or even a heart attack.

During CABG, a cardiac surgeon creates a new pathway (“bypass”) for blood to flow around the blocked artery by using a healthy blood vessel taken from another part of the body, such as the internal mammary artery (IMA), radial artery, or saphenous vein from the leg. This restores adequate blood flow to the heart muscle, relieves symptoms, and reduces the risk of future cardiac events.

CABG remains the gold standard treatment for many patients with complex coronary artery disease, particularly those with multiple blocked arteries, left main coronary artery disease, diabetes, or reduced heart function.

At RS Abdi Waluyo, CABG is performed by an experienced Cardiac Surgery Team using advanced surgical techniques and supported by a state-of-the-art Hybrid Catheterization Laboratory (Hybrid Cath Lab). A multidisciplinary Cardiac Team collaborates to determine the most appropriate treatment strategy for each patient.

Why is CABG Performed?

Your cardiologist or cardiac surgeon may recommend CABG if you have:

• Severe coronary artery disease involving one or more coronary arteries.
• Significant narrowing of the left main coronary artery.
• Triple-vessel coronary artery disease.
• Coronary artery disease associated with diabetes.
• Persistent chest pain despite optimal medical therapy.
• Coronary artery disease not suitable for angioplasty or stent placement.
• Reduced heart function due to poor blood supply.
• Certain emergency situations following a heart attack.

The goal of CABG is to improve blood flow to the heart, relieve symptoms, improve quality of life, preserve heart function, and reduce the risk of heart attack and death.

Details of the Procedure

Before surgery, your healthcare team will perform a comprehensive evaluation that may include:

• Consultation with a cardiologist and cardiac surgeon.
• Physical examination and medical history review.
• Blood tests.
• Electrocardiography (ECG).
• Coronary Angiography.
• Cardiac CT scan when indicated.
• Chest X-ray.
• Pulmonary function tests when appropriate.

Before surgery, you may be instructed to:

• Fast for several hours.
• Temporarily discontinue certain medications such as blood thinners.
• Stop smoking.
• Inform your doctor about allergies or other medical conditions.

CABG typically takes 3 to 6 hours, depending on the number of bypass grafts required and the complexity of the surgery.

What Happens During the Procedure?

During CABG:

1. General anesthesia is administered.
2. The cardiac surgeon accesses the heart through the chest.
3. Healthy blood vessels are harvested from the chest, arm, or leg.
4. The surgeon creates one or more bypass grafts around the blocked coronary arteries.
5. Depending on the patient’s condition, the operation may be performed using a heart-lung machine (on-pump CABG) or on the beating heart (off-pump CABG).
6. Blood flow is restored to the heart muscle through the new grafts.
7. After confirming satisfactory blood flow, the surgical incision is closed.

Throughout the procedure, your heart rhythm, blood pressure, oxygen level, and other vital signs are continuously monitored.

The Role of the Hybrid Cath Lab

At RS Abdi Waluyo, CABG is supported by an advanced Hybrid Catheterization Laboratory (Hybrid Cath Lab) that integrates high-resolution cardiovascular imaging with a modern cardiac operating environment.

The Hybrid Cath Lab provides several important advantages:

• Advanced real-time imaging for improved procedural planning and precision.
• Seamless collaboration between cardiac surgeons and interventional cardiologists.
• The ability to perform hybrid coronary revascularization, combining minimally invasive bypass surgery with coronary angioplasty and stenting when appropriate.
• Immediate access to catheter-based interventions if required during surgery.
• Enhanced patient safety through integrated imaging, surgical, and anesthetic capabilities.
• A multidisciplinary Heart Team approach that ensures individualized treatment planning based on each patient’s coronary anatomy and overall health.

What Should I Expect After Surgery?

After CABG:

• You will recover initially in the Intensive Care Unit (ICU).
• Most patients are transferred to a regular cardiac ward within one to two days.
• Hospital stay generally ranges from 5 to 7 days, depending on recovery.
• Walking and light activity are encouraged early to promote healing.
• Full recovery usually takes 6 to 12 weeks, although this varies among patients.

Your healthcare team will provide instructions regarding medications, wound care, activity restrictions, diet, and cardiac rehabilitation.

What Are the Risks?

CABG is a well-established procedure with excellent long-term outcomes. However, as with any major surgery, potential risks include:

• Heart attack.
• Abnormal heart rhythms (arrhythmias).
• Blood clots.
• Lung complications.
• Kidney dysfunction.
• Memory or temporary cognitive changes.
• Death (rare).

Your surgical team carefully evaluates each patient to minimize these risks.

Results and Follow-Up

Following CABG, your cardiac surgeon and cardiologist will evaluate:

• Blood flow through the bypass grafts.
• Relief of angina symptoms.
• Improvement in heart function.
• Recovery of physical activity.
• Long-term cardiovascular health.

Follow-up care includes:

• Regular cardiology consultations.
• Electrocardiography (ECG).
• Medication optimization.
• Cardiac rehabilitation.
• Lifestyle modification to reduce cardiovascular risk.

When Will I Know the Results?

Your cardiac surgeon will discuss the initial results shortly after surgery.

During your hospital stay, additional clinical assessments and imaging studies will evaluate the success of the bypass grafts and monitor your recovery before discharge.

If the Results Are Abnormal, What Are the Next Steps?

If additional treatment is required, your Heart Team may recommend:

• Medication adjustments.
• Additional cardiac imaging.
• Coronary CT Angiography.
• Coronary Angiography.
• Percutaneous Coronary Intervention (PCI) with angioplasty and stenting.
• Repeat surgery in selected cases.
• Ongoing cardiac rehabilitation and follow-up.

Treatment recommendations will depend on your coronary anatomy, symptoms, and overall health.

When Should I Call My Doctor?

Contact your doctor immediately if you experience:

• Increasing chest pain.
• Shortness of breath.
• Redness, swelling, or drainage from the surgical incision.
• Persistent palpitations.
• Leg swelling.
• Sudden weakness or dizziness.
• Any new or worsening symptoms.

Seek emergency medical attention immediately if you develop severe chest pain, stroke symptoms, difficulty breathing, or loss of consciousness.

Why Choose RS Abdi Waluyo for CABG?

At RS Abdi Waluyo, our Cardiac Surgery Program combines internationally accepted surgical techniques, advanced technology, and multidisciplinary expertise to deliver outstanding outcomes for patients with coronary artery disease.

Our CABG program offers:

• Advanced Hybrid Catheterization Laboratory (Hybrid Cath Lab) integrating modern cardiac surgery with advanced cardiovascular imaging.
• Experienced cardiac surgeons specializing in coronary artery bypass surgery and complex cardiovascular procedures.
• Comprehensive Cardiac Team collaboration, involving cardiologists, interventional cardiologists, cardiac surgeons, cardiac imaging specialists, anesthesiologists, intensivists, and cardiac rehabilitation specialists.
• Hybrid coronary revascularization, combining minimally invasive surgery and catheter-based coronary intervention for selected patients.
• Comprehensive preoperative evaluation and individualized treatment planning.
• Advanced postoperative intensive care and cardiac rehabilitation programs.
• Integrated cardiovascular services, from diagnosis and coronary angiography to surgery, rehabilitation, and lifelong follow-up.
• A patient-centered approach focused on safety, clinical excellence, faster recovery, and long-term heart health.

By combining advanced surgical expertise, state-of-the-art Hybrid Cath Lab technology, and a multidisciplinary Cardiac Team approach, RS Abdi Waluyo provides comprehensive Coronary Artery Bypass Grafting (CABG) services, helping patients achieve improved heart function, lasting symptom relief, and better long-term cardiovascular outcomes.

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Overview

What is Electrocardiography (ECG)?

Electrocardiography (ECG), also known as an Electrocardiogram or EKG, is a simple, non-invasive diagnostic test that records the electrical activity of the heart. By measuring the timing and strength of electrical signals, an ECG provides valuable information about your heart rate, heart rhythm, and overall cardiac function.

At RS Abdi Waluyo, ECG is one of the most commonly performed cardiac tests. It is quick, painless, and plays an essential role in detecting heart conditions, evaluating symptoms, and monitoring heart health.

Why is an ECG Performed?

Your doctor may recommend an ECG to:

• Evaluate symptoms such as chest pain, palpitations, dizziness, fainting, or shortness of breath.
• Detect abnormal heart rhythms (arrhythmias).
• Diagnose signs of a heart attack or previous heart damage.
• Assess the heart’s electrical conduction system.
• Monitor the effectiveness of medications or cardiac treatments.
• Evaluate heart health before surgery or certain medical procedures.
• Monitor patients with known heart disease or cardiovascular risk factors.
• Investigate unexplained fatigue or reduced exercise tolerance.

An ECG is often the first step in evaluating many heart-related symptoms and conditions.

Details of the Test

An ECG is a safe, painless, and non-invasive examination that typically takes only a few minutes.

During the test:

• Small adhesive electrodes are placed on your chest, arms, and legs.
• The electrodes are connected to an ECG machine that records your heart’s electrical activity.
• No electricity is sent into your body—the electrodes only detect the heart’s natural electrical signals.

In most cases, no special preparation is required. However, you may be advised to:

• Wear comfortable clothing that allows easy access to your chest.
• Avoid applying lotions, oils, or creams to your skin before the test, as these may interfere with electrode attachment.
• Continue taking your medications unless instructed otherwise by your doctor.

What Happens During the Test?

The ECG procedure is quick and straightforward.

During the examination:

1. You will be asked to lie comfortably on an examination table.
2. Small adhesive electrodes will be attached to your chest, arms, and legs.
3. The ECG machine will record your heart’s electrical activity while you remain still and breathe normally.
4. You may be asked to briefly hold your breath during part of the recording to reduce interference.
5. Once the recording is complete, the electrodes will be removed.

The entire procedure usually takes 5 to 10 minutes, while the actual recording lasts only a few seconds.

What Should I Expect After the Test?

There is no recovery period after an ECG.

Following the examination:

• You may resume your normal daily activities immediately.
• There are no restrictions on eating, drinking, or physical activity unless your doctor advises otherwise.
• Mild redness at the electrode sites may occur in some individuals but typically resolves quickly.

What Are the Risks?

An ECG is an extremely safe examination with no known medical risks.

Because the electrodes only record electrical activity and do not deliver electricity to your body, the test is painless and non-invasive.

Some patients may experience mild skin irritation from the adhesive electrodes, but this is usually temporary.

Results and Follow-Up

Your ECG will be reviewed by your doctor to assess:

• Heart rate
• Heart rhythm
• Electrical conduction through the heart
• Evidence of heart enlargement
• Signs of reduced blood flow to the heart (ischemia)
• Evidence of a current or previous heart attack
• Other abnormalities affecting the heart’s electrical system

Your doctor will explain what the findings mean and determine whether additional evaluation is necessary.

When Will I Receive My Results?

In many cases, the ECG can be reviewed immediately after the examination.

If the ECG is performed as part of a comprehensive cardiac evaluation, the results will be discussed during your consultation or follow-up appointment.

If the Results Are Abnormal, What Are the Next Steps?

If your ECG shows an abnormality, your doctor may recommend additional tests to better understand your heart condition, such as:

• Echocardiography
• Holter Monitoring (24-hour Ambulatory ECG)
• Exercise Stress Testing
• Cardiac CT or Cardiac MRI
• Blood tests
• Cardiac catheterization or coronary angiography, if indicated

Treatment recommendations may include lifestyle modifications, medications, further monitoring, or specialized cardiac procedures depending on your diagnosis.

When Should I Call My Doctor?

Contact your doctor if you experience:

• Chest pain or pressure.
• Persistent or worsening shortness of breath.
• Palpitations that are frequent or accompanied by dizziness.
• Fainting or near-fainting episodes.
• Unexplained fatigue or weakness.
• Any new or worsening symptoms after your evaluation.

Seek emergency medical attention immediately if you experience severe chest pain, sudden shortness of breath, loss of consciousness, or symptoms suggestive of a heart attack or stroke.

Why Choose RS Abdi Waluyo for ECG?

At RS Abdi Waluyo, we provide comprehensive cardiovascular diagnostic services supported by advanced technology and experienced healthcare professionals.

Our ECG service offers:

• Fast, accurate, and non-invasive cardiac assessment.
• Modern ECG equipment for high-quality recordings.
• Experienced cardiologists who interpret ECG findings with clinical expertise.
• Comprehensive heart care, including advanced diagnostic testing and treatment when needed.
• Personalized, patient-centered care focused on early detection, accurate diagnosis, and effective management of heart conditions.

Whether you are experiencing symptoms or undergoing a routine health evaluation, an ECG at RS Abdi Waluyo provides valuable information to help protect and maintain your heart health.

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Overview

What is Intravascular Ultrasound (IVUS)?

Intravascular Ultrasound (IVUS) is an advanced intravascular imaging technology that uses high-frequency ultrasound waves to produce detailed, real-time images from inside the coronary arteries. Unlike conventional coronary angiography, which shows only the outline (lumen) of the blood vessel, IVUS provides a comprehensive view of the artery wall, atherosclerotic plaque, calcium deposits, and the true size of the vessel.

This detailed information allows cardiologists to accurately assess the severity of coronary artery disease, determine the most appropriate treatment strategy, select the optimal stent size, and confirm that the stent has been fully expanded and properly positioned after implantation.

At RS Abdi Waluyo, IVUS is used during selected Percutaneous Coronary Intervention (PCI) procedures to improve diagnostic accuracy, guide treatment decisions, and optimize long-term clinical outcomes.

Why is Intravascular Ultrasound (IVUS) Performed?

Your cardiologist may recommend IVUS to:

• Determine the severity of coronary artery narrowing.
• Evaluate the composition of atherosclerotic plaque, including calcified lesions.
• Measure the diameter and size of coronary arteries accurately before stent implantation.
• Select the appropriate stent size and length.
• Confirm optimal stent expansion and positioning after implantation.
• Identify causes of stent failure, such as underexpansion, malapposition, or restenosis.
• Evaluate complex coronary artery disease, including left main disease, bifurcation lesions, long lesions, and heavily calcified arteries.
• Improve the precision, safety, and long-term success of coronary intervention.

Details of the Procedure

IVUS is performed during Coronary Angiography or Percutaneous Coronary Intervention (PCI) in the Cardiac Catheterization Laboratory (Cath Lab).

Before the procedure:

• Your cardiologist will review your medical history and medications.
• Blood tests, an electrocardiogram (ECG), and echocardiography may be performed.
• Coronary angiography will identify the location of the coronary blockage.
• You may be instructed to fast for several hours before the procedure.
• Inform your doctor if you have allergies to contrast dye, iodine, or medications.
• Certain medications may require temporary adjustment before the procedure.

IVUS generally adds only 10–20 minutes to the overall PCI procedure.

What Happens During the Procedure?

During the procedure:

1. Local anesthesia is administered to the wrist (radial artery) or groin (femoral artery).
2. A catheter is inserted and guided to the coronary arteries using real-time X-ray imaging.
3. A miniature IVUS catheter containing an ultrasound transducer is advanced into the coronary artery.
4. The ultrasound probe produces detailed cross-sectional images of the artery in real time.
5. Your cardiologist evaluates the vessel size, plaque characteristics, calcium distribution, and severity of narrowing.
6. If PCI is being performed, IVUS findings help determine the ideal stent size and treatment strategy.
7. After stent implantation, IVUS may be repeated to confirm complete stent expansion, proper apposition against the vessel wall, and adequate blood flow.

Throughout the procedure, your heart rhythm, blood pressure, oxygen level, and overall condition are continuously monitored.

What Should I Expect After the Procedure?

Because IVUS is performed as part of coronary angiography or PCI, recovery follows the primary procedure.

After the procedure:

• You will be monitored in the recovery area for several hours.
• Most patients can return home the same day or the following day, depending on their condition.
• Your doctor will provide instructions regarding medications, activity, wound care, and follow-up appointments.
• If a coronary stent has been implanted, you will receive antiplatelet medications to reduce the risk of blood clot formation.

Most patients can gradually resume normal daily activities within a few days.

What Are the Risks?

IVUS is considered a very safe diagnostic tool with a low risk of complications.

Potential risks include:

• Bleeding or bruising at the catheter insertion site.
• Minor injury to the coronary artery (rare).
• Temporary heart rhythm disturbances.
• Allergic reaction to the contrast dye used during angiography.
• Heart attack, stroke, or other serious complications (very rare).

Your healthcare team carefully monitors you throughout the procedure to ensure your safety.

Results and Follow-Up

IVUS provides highly detailed information about:

• Coronary artery diameter.
• Severity of arterial narrowing.
• Plaque composition and burden.
• Distribution and extent of calcium.
• Stent expansion and apposition.
• Causes of restenosis or previous stent failure.

This information enables your cardiologist to optimize treatment, reduce complications, and improve long-term outcomes following PCI.

When Will I Know the Results?

Because IVUS images are obtained in real time, your cardiologist can usually explain the findings immediately after the procedure.

Your doctor will discuss:

• The condition of your coronary arteries.
• The severity of the blockage.
• Plaque characteristics.
• Whether stent implantation was successful.
• Recommendations for ongoing treatment and follow-up.

If Abnormal Findings Are Detected, What Are the Next Steps?

If IVUS identifies significant disease or suboptimal stent results, your cardiologist may recommend:

• Further balloon optimization using high-pressure balloon dilation.
• Placement of an additional coronary stent, if necessary.
• Intravascular Lithotripsy (IVL) for severely calcified lesions.
• Optical Coherence Tomography (OCT) for additional intravascular assessment in selected cases.
• Coronary Artery Bypass Graft (CABG) surgery if PCI is not the most appropriate treatment.
• Medical therapy and lifestyle modification to reduce cardiovascular risk.

Treatment recommendations will be individualized based on your coronary anatomy, symptoms, and overall health.

When Should I Call My Doctor?

Contact your doctor immediately if you experience:

• Chest pain that returns or worsens.
• Shortness of breath.
• Persistent bleeding or swelling at the catheter insertion site.
• Fever.
• Severe pain, numbness, or discoloration of the arm or leg used during the procedure.
• Rapid or irregular heartbeat.
• Any new or worsening symptoms.

Seek emergency medical attention immediately if you develop severe chest pain, difficulty breathing, fainting, or symptoms suggestive of a heart attack or stroke.

Why Choose RS Abdi Waluyo for Intravascular Ultrasound (IVUS)?

At RS Abdi Waluyo, Intravascular Ultrasound (IVUS) is an integral part of our advanced interventional cardiology program, enabling more precise diagnosis and image-guided coronary intervention.

Our IVUS service offers:

• Advanced high-resolution IVUS technology for detailed evaluation of coronary artery disease from inside the vessel.
• State-of-the-art Hybrid Catheterization Laboratory (Hybrid Cath Lab) equipped with advanced imaging systems to support complex coronary interventions.
• Experienced interventional cardiologists specializing in image-guided PCI and the treatment of complex coronary artery disease.
• Comprehensive intravascular imaging, integrating IVUS with other advanced technologies such as Optical Coherence Tomography (OCT), Fractional Flow Reserve (FFR), and Intravascular Lithotripsy (IVL) when clinically indicated.
• A multidisciplinary Heart Team approach, involving interventional cardiologists, cardiac surgeons, cardiac imaging specialists, and anesthesiologists to provide individualized treatment for complex cases.
• Comprehensive cardiac care, from diagnosis and intervention to cardiac rehabilitation and long-term follow-up.
• Patient-centered care, focused on improving procedural precision, enhancing long-term stent performance, and achieving the best possible cardiovascular outcomes.

By combining advanced intravascular imaging, expert clinical care, and Hybrid Cath Lab technology, RS Abdi Waluyo delivers world-class image-guided coronary intervention, helping ensure safer procedures, more accurate treatment decisions, and improved long-term outcomes for patients with coronary artery disease.

The post Intravascular Ultrasound (IVUS) appeared first on Abdi Waluyo Hospital.

Overview

What is Intravascular Lithotripsy (IVL)?

Intravascular Lithotripsy (IVL) is an advanced, minimally invasive procedure used to treat severely calcified coronary arteries. Calcium deposits can make the arteries rigid and difficult to treat with conventional balloon angioplasty or stent placement. IVL uses acoustic pressure waves (shockwaves) to safely fracture calcium within the artery wall, allowing the artery to expand more easily and enabling optimal stent placement.

The technology is based on the same principle used for many years to treat kidney stones, but it has been specifically adapted for use inside blood vessels. Unlike traditional high-pressure balloons, IVL modifies hardened calcium while minimizing trauma to the surrounding healthy blood vessel.

At RS Abdi Waluyo, Intravascular Lithotripsy is performed by experienced interventional cardiologists using state-of-the-art technology in a Hybrid Catheterization Laboratory (Hybrid Cath Lab), providing safe and effective treatment for patients with complex coronary artery disease.

Why is Intravascular Lithotripsy Performed?

Your cardiologist may recommend IVL if you have:

• Severe calcification within the coronary arteries.
• Coronary artery disease that is difficult to treat with conventional balloon angioplasty.
• A blockage requiring optimal preparation before stent implantation.
• Previously unsuccessful balloon expansion due to hardened calcium.
• Complex coronary lesions requiring advanced interventional techniques.
• A high-risk coronary intervention where vessel preparation is critical for long-term success.

IVL helps improve the effectiveness and safety of coronary stent implantation by adequately preparing heavily calcified arteries.

Details of the Procedure

IVL is performed during a cardiac catheterization procedure and is often combined with coronary angioplasty and stent placement.

Before the procedure:

• Your cardiologist will review your medical history and current medications.
• Blood tests, ECG, echocardiography, and coronary angiography may be performed.
• You may be asked to fast for several hours before the procedure.
• Inform your doctor if you have allergies to contrast dye, iodine, or medications.
• Certain medications may need temporary adjustment before the procedure.

The procedure generally takes 60 to 120 minutes, depending on the complexity of the coronary artery disease.

What Happens During the Procedure?

During the procedure:

1. Local anesthesia is administered to the wrist or groin.
2. A catheter is inserted into the artery and guided to the coronary arteries using X-ray imaging.
3. Coronary angiography identifies the location and severity of the calcified blockage.
4. A specialized IVL balloon catheter is positioned across the calcified lesion.
5. The balloon is inflated at low pressure.
6. The IVL catheter delivers a series of acoustic pressure waves (shockwaves) that fracture calcium deposits within the artery wall.
7. Once the artery becomes more flexible, balloon angioplasty is performed if necessary.
8. A coronary stent is then implanted to keep the artery open.
9. Final imaging confirms optimal stent expansion and blood flow.

Throughout the procedure, your heart rhythm, blood pressure, and oxygen levels are continuously monitored.

What Should I Expect After the Procedure?

Following IVL:

• You will be monitored in the recovery area for several hours.
• Most patients are discharged on the same day or the following day.
• Mild soreness or bruising at the catheter insertion site is common.
• You will receive medications, including antiplatelet therapy, to reduce the risk of blood clots.
• Your doctor will provide instructions regarding physical activity, wound care, medications, and follow-up appointments.

Most patients can gradually return to normal daily activities within a few days.

What Are the Risks?

IVL is considered a safe and effective treatment for heavily calcified coronary arteries.

Possible risks include:

• Bleeding or bruising at the catheter insertion site.
• Blood vessel injury.
• Allergic reaction to contrast dye.
• Kidney injury related to contrast dye.
• Coronary artery dissection or perforation (rare).
• Blood clot formation within the stent.
• Heart attack, stroke, or abnormal heart rhythms (rare).
• Emergency cardiac surgery (very uncommon).

Your healthcare team carefully monitors you throughout the procedure to minimize these risks.

Results and Follow-Up

After the procedure, your cardiologist will evaluate:

• Successful fracture of coronary calcium.
• Adequate expansion of the coronary stent.
• Restoration of normal blood flow.
• Improvement of symptoms.
• Need for additional treatment or lifestyle modification.

Long-term follow-up may include:

• Regular cardiology consultations.
• Medication management.
• Cholesterol, blood pressure, and diabetes control.
• Lifestyle modification.
• Cardiac rehabilitation, when appropriate.

When Will I Know the Results?

Your cardiologist will usually explain the results immediately after the procedure.

You will receive information regarding:

• The severity of coronary calcification.
• The success of calcium modification using IVL.
• The success of stent implantation.
• Blood flow restoration.
• Recommendations for ongoing treatment and prevention.

If Additional Blockages Are Found, What Are the Next Steps?

If additional coronary disease is identified, your cardiologist may recommend:

• Additional PCI procedures.
• Coronary Artery Bypass Graft (CABG) surgery.
• Medical therapy.
• Lifestyle modification.
• Cardiac rehabilitation.
• Regular follow-up with your cardiologist.

Treatment recommendations will be individualized according to your coronary anatomy, symptoms, and overall cardiovascular health.

When Should I Call My Doctor?

Contact your doctor immediately if you experience:

• Chest pain that returns or worsens.
• Shortness of breath.
• Persistent bleeding or swelling at the catheter insertion site.
• Pain, numbness, or discoloration of the treated arm or leg.
• Irregular heartbeat.
• Any new or worsening symptoms.

Seek emergency medical attention immediately if you develop severe chest pain, difficulty breathing, fainting, or symptoms of a heart attack or stroke.

Why Choose RS Abdi Waluyo for Intravascular Lithotripsy?

At RS Abdi Waluyo, Intravascular Lithotripsy is offered as part of our comprehensive interventional cardiology services for patients with complex coronary artery disease.

Our IVL program offers:

• Advanced Shockwave Intravascular Lithotripsy technology for the treatment of severely calcified coronary arteries.
• State-of-the-art Hybrid Catheterization Laboratory (Hybrid Cath Lab) equipped with high-resolution imaging to support complex coronary interventions.
• Experienced interventional cardiologists trained in advanced coronary intervention techniques.
• Advanced intravascular imaging, including IVUS (Intravascular Ultrasound) and OCT (Optical Coherence Tomography), when clinically indicated, to assess calcium distribution and optimize stent placement.
• A multidisciplinary Heart Team approach, involving interventional cardiologists, cardiac surgeons, cardiac imaging specialists, and anesthesiologists for complex cases.
• Comprehensive cardiac care, from diagnosis and intervention to rehabilitation and long-term follow-up.
• Patient-centered care, focused on improving procedural safety, long-term stent performance, and overall cardiovascular outcomes.

By combining advanced calcium-modification technology, expert clinical care, and Hybrid Cath Lab capabilities, RS Abdi Waluyo provides one of the most advanced treatment options for patients with heavily calcified coronary artery disease, helping achieve safer procedures, better stent expansion, and improved long-term heart health.

The post Intravascular Lithotripsy (IVL) appeared first on Abdi Waluyo Hospital.

Overview

What is a Treadmill Stress Test (TMT)?

A Treadmill Stress Test (TMT), also known as an Exercise Stress Test or Exercise ECG, is a non-invasive test that evaluates how your heart responds to physical activity. During the test, your heart rate, blood pressure, and electrocardiogram (ECG) are continuously monitored while you walk on a treadmill with gradually increasing speed and incline.

Because the heart works harder during exercise, a Treadmill Stress Test can help identify heart conditions that may not be apparent when the body is at rest.

At RS Abdi Waluyo, Treadmill Stress Tests are performed by experienced healthcare professionals using advanced monitoring equipment to evaluate heart function safely and accurately.

Why is a Treadmill Stress Test Performed?

Your doctor may recommend a Treadmill Stress Test to:

• Evaluate chest pain or discomfort that may be related to coronary artery disease.
• Investigate symptoms such as shortness of breath, dizziness, or palpitations during physical activity.
• Assess blood flow to the heart during exercise.
• Detect coronary artery disease (CAD).
• Evaluate exercise tolerance and cardiovascular fitness.
• Assess the effectiveness of treatment for heart disease.
• Monitor recovery after a heart attack or cardiac procedure.
• Determine whether it is safe to begin or resume an exercise program.
• Evaluate heart rhythm abnormalities that occur during physical activity.

Details of the Test

A Treadmill Stress Test is a safe, outpatient procedure that usually takes 30 to 45 minutes, including preparation and recovery.

Before the test, you may be instructed to:

• Avoid eating heavy meals for 2–4 hours before the examination.
• Wear comfortable clothing and walking or athletic shoes.
• Avoid caffeine and smoking for several hours before the test, if advised by your doctor.
• Continue or temporarily stop certain medications according to your doctor’s instructions.

The test includes:

• Continuous ECG monitoring.
• Regular blood pressure measurements.
• Monitoring of your symptoms throughout the examination.

What Happens During the Test?

During the examination:

1. Small adhesive electrodes will be placed on your chest to monitor your heart’s electrical activity.
2. A blood pressure cuff will be placed on your arm.
3. You will begin walking on the treadmill at a slow pace.
4. Every few minutes, the treadmill’s speed and incline will gradually increase according to a standardized protocol.
5. Your heart rate, blood pressure, ECG, and symptoms will be continuously monitored.
6. The test will stop when you reach your target heart rate, develop significant symptoms, show specific ECG changes, or become too fatigued to continue.
7. After exercise, your heart rhythm and blood pressure will continue to be monitored during the recovery period.

The test is supervised throughout by trained healthcare professionals to ensure your safety.

What Should I Expect After the Test?

Most patients recover quickly after completing the test.

Following the examination:

• You will remain under observation for several minutes while your heart rate and blood pressure return to baseline.
• You may resume your normal daily activities unless your doctor advises otherwise.
• Drink plenty of fluids after exercising.
• If you experience any unusual symptoms after leaving the hospital, contact your doctor promptly.

What Are the Risks?

A Treadmill Stress Test is generally very safe when performed under medical supervision.

Although complications are uncommon, potential risks include:

• Temporary chest discomfort.
• Shortness of breath.
• Dizziness or lightheadedness.
• Temporary irregular heart rhythms (arrhythmias).
• Changes in blood pressure.
• Very rarely, heart attack or other serious cardiac events.

Your healthcare team is trained to manage any unexpected events, and emergency equipment is available throughout the procedure.

Results and Follow-Up

Your doctor will evaluate:

• Heart rate response to exercise.
• Blood pressure response.
• ECG changes during exercise and recovery.
• Exercise capacity.
• Symptoms experienced during the test.
• Evidence of reduced blood flow to the heart (exercise-induced ischemia).
• Exercise-induced heart rhythm abnormalities.

The results help determine whether additional testing or treatment is needed.

When Will I Receive My Results?

In many cases, your doctor can provide a preliminary interpretation shortly after the test.

A formal report is typically available the same day or within 24 hours, depending on your clinical evaluation.

Your doctor will review the findings and discuss any recommended next steps.

If the Results Are Abnormal, What Are the Next Steps?

If your Treadmill Stress Test suggests a heart abnormality, your doctor may recommend:

• Echocardiography.
• Stress Echocardiography.
• Nuclear Cardiac Stress Test.
• Cardiac CT or Coronary CT Angiography.
• Holter Monitoring.
• Coronary Angiography.
• Medication to manage heart disease.
• Lifestyle modifications to reduce cardiovascular risk.
• Referral to a cardiologist for further evaluation or treatment.

Your treatment plan will be based on your symptoms, medical history, and overall cardiovascular risk.

When Should I Call My Doctor?

Contact your doctor promptly if you experience after returning home:

• Chest pain or pressure.
• Persistent shortness of breath.
• Severe dizziness or fainting.
• Rapid or irregular heartbeat that does not resolve.
• Unusual fatigue lasting longer than expected.
• Any new or worsening symptoms.

Seek emergency medical attention immediately if you experience severe chest pain, difficulty breathing, loss of consciousness, or symptoms suggestive of a heart attack or stroke.

Why Choose RS Abdi Waluyo for a Treadmill Stress Test?

At RS Abdi Waluyo, we provide comprehensive cardiovascular diagnostic services supported by advanced technology and experienced cardiologists.

Our Treadmill Stress Test service offers:

• Comprehensive evaluation of heart function during exercise.
• Experienced cardiologists and cardiac technicians who ensure accurate testing and interpretation.
• Modern ECG monitoring systems for precise assessment.
• Integrated cardiac care, with access to advanced imaging and specialized heart treatments when needed.
• A patient-centered approach focused on safety, comfort, and personalized care.

A Treadmill Stress Test at RS Abdi Waluyo helps detect heart disease, assess your cardiovascular fitness, and guide treatment decisions to support your long-term heart health.

The post Treadmill Stress Test (TMT) appeared first on Abdi Waluyo Hospital.

Overview

What is Transesophageal Echocardiography (TEE)?

Transesophageal Echocardiography (TEE) is a specialized ultrasound examination that produces highly detailed images of the heart and its surrounding structures. Unlike a standard transthoracic echocardiogram, where the ultrasound probe is placed on the chest, TEE uses a thin, flexible probe that is gently passed through the mouth into the esophagus (food pipe). Because the esophagus lies directly behind the heart, TEE provides exceptionally clear images without interference from the ribs, lungs, or chest wall.

At RS Abdi Waluyo, TEE is performed by experienced cardiologists using advanced imaging technology. The examination provides detailed visualization of the heart chambers, heart valves, blood vessels, and other cardiac structures, helping physicians diagnose complex heart conditions and guide treatment decisions.

Why is Transesophageal Echocardiography Performed?

Your doctor may recommend a TEE to:

• Evaluate heart valve diseases, such as valve narrowing (stenosis) or leakage (regurgitation).
• Detect blood clots within the heart, particularly in patients with atrial fibrillation.
• Diagnose infections involving the heart valves (infective endocarditis).
• Assess congenital heart defects.
• Evaluate abnormalities of the aorta and other major blood vessels.
• Identify the cause of a stroke or transient ischemic attack (TIA).
• Assess heart function when standard echocardiography does not provide sufficient detail.
• Guide catheter-based procedures, structural heart interventions, or cardiac surgery.

TEE provides highly detailed images that are often essential for accurate diagnosis and treatment planning.

Details of the Test

TEE is a minimally invasive procedure performed in a monitored clinical setting.

Before the examination:

• You will be asked not to eat or drink for approximately 6 hours before the procedure.
• Inform your doctor about any allergies, medications, bleeding disorders, or swallowing problems.
• Dentures, removable dental appliances, and oral prostheses should be removed before the examination.
• An intravenous (IV) line will be inserted to administer sedative medication if needed.
• Your throat will be sprayed with a local anesthetic to reduce discomfort during probe insertion.

Your healthcare team will explain the procedure, answer your questions, and ask you to sign a consent form before the examination.

What Happens During the Test?

During the procedure:

1. You will lie comfortably on your left side.
2. Your heart rate, blood pressure, and oxygen levels will be continuously monitored.
3. A local anesthetic spray will numb your throat, and a mild sedative may be administered to help you relax.
4. A bite guard will be placed to protect your teeth and the ultrasound probe.
5. The cardiologist will gently guide the flexible ultrasound probe through your mouth into your esophagus.
6. Detailed images of your heart will be obtained from multiple angles.
7. Once the examination is complete, the probe will be carefully removed.

The procedure usually takes 20 to 40 minutes, although your total visit may be longer to allow for preparation and recovery.

What Should I Expect After the Test?

Following the examination:

• You will remain under observation until the effects of the sedative have worn off.
• Your throat may feel mildly sore or numb for a few hours.
• You should not eat or drink until your swallowing reflex has fully returned, as instructed by your healthcare team.
• Because sedatives may affect your alertness, you should arrange for someone to drive you home.
• Most patients can resume their normal activities the following day, unless advised otherwise by their doctor.

What Are the Risks?

TEE is considered a safe procedure when performed by experienced healthcare professionals. However, as with any medical procedure, there are potential risks.

These may include:

• Temporary sore throat or hoarseness.
• Mild discomfort during swallowing.
• Reaction to sedative medication.
• Minor bleeding from the mouth or throat.
• Rare injury to the mouth, teeth, throat, esophagus, or stomach.
• Very rare complications such as aspiration or abnormal heart rhythm.

Your healthcare team will carefully monitor you throughout the procedure to minimize these risks.

Results and Follow-Up

The images obtained during TEE are carefully reviewed by your cardiologist to evaluate:

• Heart chamber size and function.
• Heart valve structure and function.
• Blood clots inside the heart.
• Congenital heart abnormalities.
• Infection of the heart valves.
• Abnormalities of the aorta and surrounding blood vessels.
• Other structural heart conditions.

The findings help your doctor determine the most appropriate treatment plan and whether additional testing or intervention is necessary.

When Will I Receive My Results?

Your cardiologist may discuss the preliminary findings immediately after the examination.

A comprehensive report is generally available within 24 to 48 hours, depending on the complexity of the study.

Your doctor will explain the results and discuss any recommended treatment or follow-up care.

If the Results Are Abnormal, What Are the Next Steps?

If TEE identifies a heart abnormality, your doctor may recommend:

• Additional cardiac imaging, such as Cardiac CT or Cardiac MRI.
• Cardiac catheterization or coronary angiography.
• Medication to manage heart disease or prevent complications.
• Structural heart intervention, such as valve repair or closure of congenital defects.
• Heart valve surgery or other cardiac surgery when indicated.
• Ongoing follow-up with a cardiologist.

Your treatment plan will be personalized based on your diagnosis, symptoms, and overall health.

When Should I Call My Doctor?

Contact your doctor promptly if you experience any of the following after returning home:

• Persistent or worsening sore throat lasting more than 48 hours.
• Difficulty swallowing or severe pain when swallowing.
• Fever or chills.
• Chest pain.
• Shortness of breath.
• Vomiting blood or coughing up blood.
• Persistent bleeding from the mouth.
• Severe abdominal pain.
• Any new or worsening symptoms that concern you.

Seek emergency medical attention immediately if you experience severe chest pain, difficulty breathing, or symptoms suggestive of a heart attack or stroke.

Why Choose RS Abdi Waluyo for Transesophageal Echocardiography?

At RS Abdi Waluyo, our cardiac imaging services combine advanced technology with the expertise of experienced cardiologists to deliver accurate diagnosis and comprehensive cardiovascular care.

Our TEE service offers:

• High-resolution cardiac imaging for detailed evaluation of heart structures.
• Experienced cardiologists skilled in advanced echocardiographic techniques.
• Comprehensive assessment of heart valves, chambers, blood flow, and structural abnormalities.
• State-of-the-art imaging technology to support accurate diagnosis and treatment planning.
• Integrated heart care, from diagnostic evaluation to advanced cardiac interventions.
• A patient-centered approach focused on safety, comfort, and clinical excellence.

With Transesophageal Echocardiography, RS Abdi Waluyo provides detailed cardiac imaging that helps diagnose complex heart conditions, guide treatment decisions, and improve patient outcomes.

The post Transesophageal Echocardiography (TEE) appeared first on Abdi Waluyo Hospital.

Overview

What is Cardiac Nuclear Imaging?

Cardiac Nuclear Imaging, also known as Nuclear Cardiology or Myocardial Perfusion Imaging (MPI), is a non-invasive diagnostic examination that evaluates blood flow to the heart muscle both at rest and during stress. The test uses a small amount of radioactive tracer (radiopharmaceutical) together with an advanced SPECT/CT gamma camera to produce high-resolution images of the heart and assess its function.

Unlike imaging tests that primarily show the anatomy of the heart, Cardiac Nuclear Imaging provides valuable functional and physiological information, allowing physicians to determine how well blood is reaching the heart muscle. It helps identify areas of reduced blood flow (ischemia), previous heart muscle damage (scar tissue), and abnormalities that may not be visible with conventional anatomical imaging.

The examination is performed using a highly sensitive gamma camera, which detects the radiation emitted by the tracer after it has been absorbed by the heart muscle. The gamma camera creates detailed images that enable physicians to accurately evaluate myocardial perfusion, heart function, and, in selected patients, quantify myocardial blood flow.

At RS Abdi Waluyo, Cardiac Nuclear Imaging is performed using advanced Nuclear Medicine technology with a state-of-the-art SPECT/CT gamma camera and interpreted by experienced Nuclear Medicine physicians and cardiologists to support accurate diagnosis, risk assessment, and personalized treatment planning.

Why is Cardiac Nuclear Imaging Performed?

Your doctor may recommend Cardiac Nuclear Imaging to:

• Evaluate chest pain or symptoms suggestive of coronary artery disease.
• Assess blood flow to the heart muscle.
• Detect narrowed or blocked coronary arteries.
• Evaluate damage caused by a previous heart attack.
• Determine whether heart muscle remains healthy and viable.
• Assess the effectiveness of previous treatments, such as coronary angioplasty, stent placement, or coronary artery bypass surgery.
• Evaluate patients with known or suspected coronary artery disease.
• Estimate the risk of future cardiac events.
• Guide treatment decisions before cardiac procedures.

Details of the Test

Cardiac Nuclear Imaging is a safe, outpatient procedure performed in two phases:

• Rest Imaging, performed while your heart is at rest.
• Stress Imaging, performed after exercise on a treadmill or after receiving medication that temporarily increases blood flow to the heart when exercise is not possible.

During the examination:

• A small amount of radioactive tracer is injected into a vein.
• After allowing time for the tracer to circulate, images of your heart are obtained using a specialized gamma camera.
• Depending on the protocol, both rest and stress images are compared.

Before the examination, you may be instructed to:

• Fast for several hours.
• Avoid caffeine for at least 24 hours before the test.
• Wear comfortable clothing and walking shoes if an exercise stress test is planned.
• Inform your doctor about pregnancy, breastfeeding, allergies, or medications you are taking.

The complete examination usually takes 2 to 4 hours, depending on the imaging protocol.

What Happens During the Test?

During the examination:

1. An intravenous (IV) line will be inserted into your arm.
2. The radioactive tracer will be injected.
3. You will wait for the tracer to circulate before imaging begins.
4. Images of your heart will be obtained while you lie comfortably under a gamma camera.
5. If stress imaging is required, you will exercise on a treadmill or receive a stress medication.
6. A second dose of tracer may be administered, followed by additional imaging.
7. The images from the rest and stress portions are compared to evaluate blood flow to the heart muscle.

Throughout the examination, your heart rate, ECG, blood pressure, and symptoms will be carefully monitored.

What Should I Expect After the Test?

After the examination:

• You may return to your normal daily activities unless instructed otherwise.
• Drink plenty of water to help eliminate the radioactive tracer from your body.
• The radioactive tracer naturally loses its activity and is eliminated through urine over the following hours.
• Most patients experience no side effects.

If stress medication was used, any temporary effects usually resolve quickly after the examination.

What Are the Risks?

Cardiac Nuclear Imaging is considered a safe and well-established diagnostic procedure.

Potential risks include:

• Exposure to a small amount of radiation from the radioactive tracer.
• Rare allergic reactions to the radiopharmaceutical.
• Temporary side effects from stress medication, such as flushing, headache, dizziness, or shortness of breath.
• Rare exercise-related complications, including abnormal heart rhythms or chest discomfort.

Your healthcare team carefully monitors you throughout the examination to ensure your safety.

Results and Follow-Up

A Nuclear Medicine physician and cardiologist will evaluate the images to assess:

• Blood flow to the heart muscle.
• Areas with reduced blood supply (ischemia).
• Areas of permanent heart muscle damage (scar tissue).
• Overall heart function.
• Left ventricular pumping function (ejection fraction), when applicable.
• Risk of future cardiovascular events.

The findings help your doctor determine whether additional treatment or testing is necessary.

When Will I Receive My Results?

A detailed report is generally available within 24 to 72 hours, depending on the complexity of the examination.

Your doctor will explain the results and discuss the most appropriate treatment or follow-up plan.

If the Results Are Abnormal, What Are the Next Steps?

If the examination identifies reduced blood flow or other abnormalities, your doctor may recommend:

• Lifestyle modifications to improve heart health.
• Medications to manage coronary artery disease.
• Cardiac CT or Coronary CT Angiography.
• Coronary Angiography (Cardiac Catheterization).
• Coronary angioplasty with stent placement.
• Coronary artery bypass graft (CABG) surgery.
• Regular follow-up with a cardiologist.

Treatment recommendations will depend on the severity of the findings, your symptoms, and your overall cardiovascular health.

When Should I Call My Doctor?

Contact your doctor promptly if you experience after the examination:

• Persistent chest pain.
• Shortness of breath.
• Severe dizziness or fainting.
• Palpitations that do not resolve.
• Swelling, redness, or pain at the injection site.
• Any new or worsening symptoms.

Seek emergency medical attention immediately if you experience severe chest pain, difficulty breathing, or symptoms suggestive of a heart attack or stroke.

Why Choose RS Abdi Waluyo for Cardiac Nuclear Imaging?

At RS Abdi Waluyo, we are committed to delivering advanced, evidence-based cardiovascular diagnostics through state-of-the-art Nuclear Cardiology technology and a multidisciplinary team of experienced Nuclear Medicine physicians and cardiologists.

Our Cardiac Nuclear Imaging service offers:

• Advanced Myocardial Perfusion Imaging (MPI) for accurate assessment of blood flow to the heart muscle.
• Stress Myocardial Blood Flow (MBF) quantification, enabling precise measurement of blood flow to the heart muscle during stress.
• Coronary Flow Reserve (CFR) / Myocardial Flow Reserve (MFR) assessment, providing quantitative evaluation of the coronary circulation to detect early coronary microvascular dysfunction and multivessel coronary artery disease that may not be apparent on conventional imaging.
• Exclusive advanced quantitative cardiac perfusion imaging, making RS Abdi Waluyo the first and currently the only hospital in Indonesia to offer comprehensive assessment of Stress Myocardial Blood Flow (MBF) and Coronary Flow Reserve (CFR/MFR) as part of routine Nuclear Cardiology services.
• Early detection of coronary artery disease, including balanced ischemia and coronary microvascular disease, allowing more accurate diagnosis and personalized treatment planning.
• Comprehensive cardiovascular evaluation, combining functional and physiological assessment rather than anatomical imaging alone.
• Integrated Heart Center services, with seamless collaboration between Nuclear Medicine specialists, cardiologists, interventional cardiologists, and cardiac surgeons.
• A patient-centered approach focused on safety, comfort, diagnostic accuracy, and clinical excellence.

By combining conventional myocardial perfusion imaging with advanced quantitative measurements of Stress Myocardial Blood Flow (MBF) and Coronary Flow Reserve (CFR/MFR), RS Abdi Waluyo provides one of the most comprehensive non-invasive evaluations of coronary circulation available today. This advanced technology enables earlier detection of heart disease, more precise risk assessment, and highly personalized treatment strategies to help patients achieve better cardiovascular outcomes.

The post Cardiac Nuclear Imaging (Nuclear Cardiology) appeared first on Abdi Waluyo Hospital.

Overview

What is Percutaneous Coronary Intervention (PCI)?

Percutaneous Coronary Intervention (PCI), also known as Percutaneous Transluminal Coronary Angioplasty & Stenting (PTCA) , is a minimally invasive procedure used to open narrowed or blocked coronary arteries and restore blood flow to the heart muscle.

During the procedure, a cardiologist inserts a thin, flexible catheter through an artery in the wrist (radial artery) or groin (femoral artery) and guides it to the affected coronary artery. A small balloon is inflated to widen the narrowed artery (angioplasty), and in most cases, a coronary stent—a small expandable wire mesh tube—is implanted to keep the artery open and reduce the risk of future narrowing.

PTCA is one of the most effective treatments for coronary artery disease (CAD) and is commonly performed to relieve chest pain (angina), improve blood flow to the heart, and restore circulation during an acute heart attack.

At RS Abdi Waluyo, PTCA is performed by experienced interventional cardiologists using advanced imaging technology in a state-of-the-art Hybrid Catheterization Laboratory (Hybrid Cath Lab). When clinically indicated, the procedure is further optimized using advanced technologies such as Intravascular Ultrasound (IVUS), Optical Coherence Tomography (OCT), Fractional Flow Reserve (FFR), and Intravascular Lithotripsy (IVL) to achieve the best possible outcomes.

Why is PCI Performed?

Your cardiologist may recommend PCI to:

• Treat narrowed or blocked coronary arteries caused by coronary artery disease.
• Relieve chest pain (angina) that does not improve with medication.
• Restore blood flow during an acute heart attack (STEMI or NSTEMI).
• Improve blood supply to the heart muscle.
• Reduce symptoms such as shortness of breath and fatigue during physical activity.
• Improve heart function in selected patients.
• Reduce the risk of future cardiovascular complications.
• Improve overall quality of life.

The decision to perform PCI is based on your symptoms, coronary angiography findings, heart function, and overall medical condition.

Details of the Procedure

PCI is performed in the Cardiac Catheterization Laboratory under local anesthesia with mild sedation when appropriate.

Before the procedure:

• Your cardiologist will review your medical history and current medications.
• Blood tests, an electrocardiogram (ECG), echocardiography, and coronary angiography may be performed.
• You may be instructed to fast for several hours before the procedure.
• Inform your doctor if you have allergies to contrast dye, iodine, or medications.
• Certain medications, particularly blood thinners, may require temporary adjustment before the procedure.

The procedure usually takes 30 minutes to 2 hours, depending on the number and complexity of the coronary blockages.

What Happens During the Procedure?

During the procedure:

1. Local anesthesia is administered to the wrist or groin.
2. A catheter is inserted into the artery and guided to the coronary arteries using real-time X-ray imaging.
3. Contrast dye is injected to identify the location and severity of the blockage.
4. A guidewire is advanced across the narrowed artery.
5. A balloon catheter is inflated to widen the narrowed segment.
6. When indicated, IVUS, OCT, or FFR may be used to evaluate the artery and guide treatment.
7. In heavily calcified arteries, Intravascular Lithotripsy (IVL) may be performed to prepare the vessel before stent implantation.
8. A coronary stent is implanted to keep the artery open.
9. Final imaging confirms optimal stent expansion and restoration of blood flow.
10. The catheter is removed, and the access site is closed using manual compression or a vascular closure device.

Throughout the procedure, your heart rhythm, blood pressure, oxygen level, and overall condition are continuously monitored.

The Role of the Hybrid Cath Lab

The Hybrid Cath Lab combines a fully equipped cardiac catheterization laboratory with the capabilities of a modern operating room, providing significant advantages for both routine and complex coronary interventions.

Benefits include:

• High-resolution real-time imaging for greater procedural accuracy.
• Image-guided coronary intervention using IVUS, OCT, and FFR to optimize stent selection and placement.
• Support for advanced procedures, including IVL for heavily calcified coronary arteries.
• Immediate availability of cardiac surgery should emergency surgical intervention become necessary.
• Hybrid procedures, combining catheter-based interventions and surgery in selected patients.
• Enhanced patient safety, eliminating the need to transfer patients between procedure rooms.
• A multidisciplinary Heart Team approach, bringing together interventional cardiologists, cardiac surgeons, cardiac imaging specialists, and anesthesiologists to deliver individualized care.

This integrated environment allows patients with complex coronary artery disease to receive comprehensive treatment in a single, highly specialized facility.

What Should I Expect After the Procedure?

After PCI:

• You will be monitored in the recovery area for several hours.
• Most patients can return home on the same day or the following day, depending on their condition.
• Mild bruising or discomfort at the catheter insertion site is common.
• Your doctor will prescribe medications, including dual antiplatelet therapy, to help prevent blood clots within the stent.
• You will receive instructions regarding medications, activity, wound care, and follow-up appointments.

Most patients can gradually return to normal daily activities within several days.

What Are the Risks?

PCI is a well-established procedure with a high success rate. However, potential risks include:

• Bleeding or bruising at the catheter insertion site.
• Blood vessel injury.
• Allergic reaction to contrast dye.
• Kidney injury related to contrast dye, particularly in patients with pre-existing kidney disease.
• Coronary artery dissection or perforation (rare).
• Blood clot formation within the stent (stent thrombosis).
• Re-narrowing of the artery (restenosis).
• Heart attack, stroke, or abnormal heart rhythms (rare).
• Emergency coronary artery bypass surgery (very uncommon).

Your healthcare team carefully monitors you throughout the procedure to minimize these risks.

Results and Follow-Up

Following PCI, your cardiologist will evaluate:

• Restoration of blood flow through the treated artery.
• Improvement in symptoms.
• Heart function.
• Stent expansion and positioning, when intravascular imaging is used.
• Need for additional treatment or lifestyle modification.

Long-term follow-up may include:

• Regular cardiology consultations.
• Medication review and adjustment.
• Blood pressure, cholesterol, and diabetes management.
• Smoking cessation support.
• Heart-healthy nutrition and exercise counseling.
• Cardiac rehabilitation when appropriate.

When Will I Know the Results?

Your cardiologist can usually explain the results immediately after the procedure.

You will receive information regarding:

• The severity of the coronary artery disease.
• The arteries treated.
• The number and type of stents implanted.
• The success of the procedure.
• Recommendations for recovery, medications, and long-term prevention.

If Additional Blockages Are Found, What Are the Next Steps?

If additional or more complex coronary artery disease is identified, your cardiologist may recommend:

• Additional PCI procedures.
• Coronary Artery Bypass Graft (CABG) surgery.
• Medical therapy.
• Lifestyle modification to reduce cardiovascular risk.
• Cardiac rehabilitation.
• Regular follow-up with your cardiologist.

Treatment recommendations will be individualized according to your coronary anatomy, symptoms, and overall health.

When Should I Call My Doctor?

Contact your doctor immediately if you experience:

• Chest pain that returns or worsens.
• Shortness of breath.
• Persistent bleeding or swelling at the catheter insertion site.
• Severe pain, numbness, or discoloration of the arm or leg used during the procedure.
• Rapid or irregular heartbeat.
• Any new or worsening symptoms.

Seek emergency medical attention immediately if you experience severe chest pain, difficulty breathing, fainting, or symptoms suggestive of a heart attack or stroke.

Why Choose RS Abdi Waluyo for PCI?

At RS Abdi Waluyo, PCI is performed using the latest interventional cardiology technology by a team of highly experienced specialists dedicated to providing safe, precise, and personalized cardiac care.

Our PCI program offers:

• Experienced interventional cardiologists specializing in the treatment of coronary artery disease, including high-risk and complex PCI.
• Comprehensive intravascular imaging, including IVUS (Intravascular Ultrasound) and OCT (Optical Coherence Tomography), to optimize stent selection and placement.
• Physiological assessment with Fractional Flow Reserve (FFR) to determine whether coronary narrowing requires intervention.
• Advanced calcium modification using Intravascular Lithotripsy (IVL) for patients with heavily calcified coronary arteries.
• 24-hour emergency Primary PCI service for patients experiencing acute heart attacks.
• A multidisciplinary Heart Team approach, involving interventional cardiologists, cardiac surgeons, cardiac imaging specialists, and anesthesiologists to provide individualized treatment for complex cases.
• Comprehensive cardiac care, from diagnosis and intervention to cardiac rehabilitation and long-term follow-up.
• Patient-centered care, focused on improving procedural safety, minimizing recovery time, and achieving the best possible long-term cardiovascular outcomes.

By combining advanced technology, expert clinical care, and comprehensive Heart Center services, RS Abdi Waluyo delivers world-class coronary intervention for patients with coronary artery disease, helping restore healthy blood flow, relieve symptoms, and improve quality of life.

The post Percutaneous Coronary Intervention (PCI) appeared first on Abdi Waluyo Hospital.

Overview

What is Cardiac Ablation?

Cardiac Ablation, also known as Catheter Ablation, is a minimally invasive procedure used to treat abnormal heart rhythms (cardiac arrhythmias) by eliminating or isolating small areas of heart tissue that generate or conduct abnormal electrical signals.

During the procedure, a cardiac electrophysiologist inserts thin, flexible catheters through blood vessels in the groin or neck and advances them into the heart. Using sophisticated three-dimensional (3D) mapping technology, the abnormal electrical pathways are precisely identified. Energy is then delivered through the catheter—most commonly radiofrequency (heat) or cryoablation (cold)—to create tiny scars that interrupt the abnormal electrical signals while preserving healthy heart tissue.

Cardiac Ablation can provide a long-term solution for many arrhythmias, reducing symptoms, improving quality of life, and in many cases eliminating the need for long-term antiarrhythmic medications.

At RS Abdi Waluyo, Cardiac Ablation is performed by experienced cardiac electrophysiologists using advanced electrophysiology systems and state-of-the-art technology in a Hybrid Catheterization Laboratory (Hybrid Cath Lab) to ensure precision, safety, and optimal patient outcomes.

Why is Cardiac Ablation Performed?

Your cardiologist or cardiac electrophysiologist may recommend Cardiac Ablation to treat:

• Atrial Fibrillation (AF)
• Atrial Flutter
• Supraventricular Tachycardia (SVT)
• Wolff-Parkinson-White (WPW) Syndrome
• Atrioventricular Nodal Reentrant Tachycardia (AVNRT)
• Atrioventricular Reentrant Tachycardia (AVRT)
• Certain types of Ventricular Tachycardia (VT)
• Premature Ventricular Contractions (PVCs) causing significant symptoms
• Arrhythmias that do not respond to medication
• Arrhythmias causing recurrent palpitations, dizziness, fainting, shortness of breath, or heart failure

The decision to perform ablation depends on the type of arrhythmia, symptom severity, underlying heart disease, and your overall health

Details of the Procedure

Cardiac Ablation is performed in the Electrophysiology (EP) Laboratory or Hybrid Cath Lab under local anesthesia with conscious sedation or general anesthesia, depending on the complexity of the procedure

Before the procedure:

• Your doctor will review your medical history and current medications
• Blood tests, an Electrocardiogram (ECG), echocardiography, Holter monitoring, cardiac CT, or cardiac MRI may be performed
• You may need to stop certain antiarrhythmic medications or blood thinners before the procedure, as instructed by your doctor
• You will usually be asked to fast for several hours before the procedure
• Inform your doctor if you have allergies, implanted cardiac devices, or kidney disease

The procedure generally lasts 2 to 6 hours, depending on the type and complexity of the arrhythmia

What Happens During the Procedure?

During the procedure:

1. Local anesthesia is administered at the catheter insertion site, usually in the groin
2. Thin catheters are inserted into blood vessels and guided to the heart using fluoroscopic and 3D mapping guidance
3. Detailed electrical mapping identifies the abnormal electrical circuits responsible for the arrhythmia
4. The abnormal heart rhythm may be temporarily induced to accurately identify its origin
5. Radiofrequency energy (heat) or cryoenergy (freezing) is delivered through the catheter to destroy or isolate the abnormal tissue
6. Additional electrical testing confirms that the abnormal rhythm has been successfully treated
7. The catheters are removed, and pressure is applied to prevent bleeding

Throughout the procedure, your heart rhythm, blood pressure, oxygen level, and overall condition are continuously monitored

The Role of the Hybrid Cath Lab

At RS Abdi Waluyo, Cardiac Ablation is supported by an advanced Hybrid Catheterization Laboratory (Hybrid Cath Lab), combining cutting-edge imaging technology with a fully equipped interventional and surgical environment

The Hybrid Cath Lab provides several important advantages:

• Advanced real-time imaging to improve procedural precision and safety
• Integration with sophisticated 3D electroanatomical mapping systems for accurate localization of abnormal electrical pathways
• Immediate access to cardiac surgery should complex situations require surgical intervention
• Enhanced patient safety, particularly for complex electrophysiology procedures
• Multidisciplinary Heart Team collaboration, involving electrophysiologists, cardiologists, cardiac surgeons, anesthesiologists, and imaging specialists
• Capability to manage complex structural heart and arrhythmia procedures in one integrated facility

What Should I Expect After the Procedure?

After Cardiac Ablation:

• You will remain in the recovery area for several hours for observation
• Most patients stay in the hospital overnight, although some may be discharged on the same day
• Mild soreness or bruising at the catheter insertion site is common
• You may experience occasional skipped heartbeats or brief palpitations during the healing period
• Your doctor may prescribe medications temporarily while the heart heals
• Most patients can return to normal daily activities within several days, although strenuous activity should be avoided for approximately one week

Follow-up appointments are important to evaluate treatment success and monitor heart rhythm.

What Are the Risks?

Cardiac Ablation is generally considered a safe procedure with a high success rate However, potential risks include:

• Bleeding or bruising at the catheter insertion site
• Blood vessel injury
• Infection
• Blood clots that could lead to stroke or pulmonary embolism
• Damage to the heart’s normal electrical conduction system, occasionally requiring a permanent pacemaker
• Cardiac perforation or pericardial effusion (rare)
• Damage to nearby structures, depending on the type of ablation performed
• Recurrence of the arrhythmia, which may require repeat ablation
• Heart attack or death (extremely rare)

Your healthcare team carefully monitors you throughout the procedure to minimize these risks

Results and Follow-Up

Following Cardiac Ablation, your electrophysiologist will evaluate:

• Elimination or reduction of the abnormal heart rhythm
• Improvement in symptoms
• Need for ongoing medications
• Recovery of heart function, when applicable
• Long-term rhythm control

Follow-up care may include:

• ECG examinations
• Holter or ambulatory ECG monitoring
• Echocardiography
• Medication review
• Lifestyle counseling and cardiovascular risk management

When Will I Know the Results?

Your electrophysiologist can usually explain the initial procedural results immediately after the ablation

However, it is important to understand that:

• Some arrhythmias require a healing period of approximately 2 to 3 months (known as the “blanking period”) before the final success of the procedure can be determined
• Temporary palpitations or irregular heartbeats may occur during this period and do not necessarily indicate treatment failure

Your doctor will evaluate your progress during scheduled follow-up visits

If the Results Are Abnormal, What Are the Next Steps?

If your arrhythmia persists or recurs, your doctor may recommend:

• Adjustment of antiarrhythmic medications
• Additional Holter monitoring or ECG testing
• Repeat Cardiac Ablation
• Implantation of a pacemaker or Implantable Cardioverter Defibrillator (ICD), when indicated
• Additional cardiac imaging or electrophysiology studies
• Ongoing follow-up with a cardiac electrophysiologist

Treatment recommendations will depend on the specific arrhythmia, your symptoms, and your overall heart condition

When Should I Call My Doctor?

Contact your doctor immediately if you experience:

• Chest pain
• Shortness of breath
• Persistent bleeding or swelling at the catheter insertion site
• Fever
• Fainting or severe dizziness
• Rapid or sustained palpitations
• Pain, numbness, or discoloration of the leg used for the procedure
• Any new or worsening symptoms

Seek emergency medical attention immediately if you experience severe chest pain, stroke symptoms, difficulty breathing, or loss of consciousness

Why Choose RS Abdi Waluyo for Cardiac Ablation?

At RS Abdi Waluyo, Cardiac Ablation is performed using advanced electrophysiology technology by highly experienced cardiac electrophysiologists dedicated to providing comprehensive arrhythmia care

Our Cardiac Ablation program offers:

• Advanced Electrophysiology (EP) Laboratory and Hybrid Catheterization Laboratory (Hybrid Cath Lab) equipped with state-of-the-art imaging and navigation systems
• Three-dimensional (3D) electroanatomical mapping technology for highly accurate identification of abnormal electrical pathways while minimizing radiation exposure
• Experienced cardiac electrophysiologists specializing in the treatment of both simple and complex cardiac arrhythmias
• Comprehensive management of atrial and ventricular arrhythmias, including atrial fibrillation, atrial flutter, SVT, ventricular tachycardia, and other complex rhythm disorders
• A multidisciplinary Heart Team approach, involving electrophysiologists, cardiologists, cardiac surgeons, anesthesiologists, and cardiac imaging specialists to provide individualized treatment
• Comprehensive cardiac care, from diagnosis and electrophysiological studies to catheter ablation, rhythm monitoring, and long-term follow-up
• Patient-centered care, focused on restoring normal heart rhythm, improving quality of life, reducing stroke risk, and minimizing the need for long-term medication whenever possible

With advanced electrophysiology expertise, Hybrid Cath Lab technology, and personalized cardiac care, RS Abdi Waluyo provides comprehensive treatment for heart rhythm disorders, helping patients achieve safer procedures, better long-term rhythm control, and an improved quality of life

The post Cardiac Ablation appeared first on Abdi Waluyo Hospital.

Overview

What is Echocardiography?

Echocardiography is a non-invasive diagnostic imaging test that uses high-frequency sound waves (ultrasound) to produce detailed, three-dimensional, real-time images of the heart. Compared with conventional two-dimensional (2D) echocardiography, 3D Echocardiography provides a more comprehensive view of the heart’s anatomy, allowing doctors to evaluate cardiac structures and function with greater accuracy.

At RS Abdi Waluyo, 3D Echocardiography is performed using advanced ultrasound technology by experienced cardiologists. The detailed images help assess the heart chambers, heart valves, heart muscle, and blood flow, supporting accurate diagnosis and personalized treatment planning.

Why is Echocardiography Performed?

Your doctor may recommend Echocardiography to:

• Evaluate the structure and function of your heart.
• Diagnose heart valve disease, including valve narrowing (stenosis) or leakage (regurgitation).
• Detect congenital heart defects.
• Measure the heart’s pumping function (ejection fraction).
• Assess the size and function of the heart chambers.
• Evaluate heart muscle abnormalities.
• Plan structural heart interventions or cardiac surgery.
• Monitor the progression of heart disease or response to treatment.
• Assess heart function after cardiac procedures or surgery.

The highly detailed three-dimensional images provide valuable clinical information to support accurate diagnosis and treatment decisions.

Details of the Test

Echocardiography is a safe, painless, and radiation-free examination.

The procedure involves:

• A handheld ultrasound transducer placed on the chest.
• A special ultrasound gel applied to the skin to improve image transmission.
• Advanced ultrasound technology that captures real-time, three-dimensional images of the heart.

Most patients do not require any special preparation.

If your doctor recommends a Transesophageal Echocardiography (TEE), you may be asked to fast for several hours before the examination. Your healthcare team will provide detailed preparation instructions if needed.

What Happens During the Test?

During the examination:

1. You will lie comfortably on an examination table.
2. Small electrodes may be placed on your chest to monitor your heart rhythm during the procedure.
3. Ultrasound gel will be applied to your chest.
4. The cardiologist or cardiac sonographer will move the ultrasound transducer over different areas of your chest to obtain images from multiple angles.
5. You may be asked to change your position or briefly hold your breath to improve image quality.
6. The images are displayed in real time and recorded for detailed evaluation.

The examination usually takes 30 to 60 minutes, depending on the purpose and complexity of the study.

What Should I Expect After the Test?

Following a standard transthoracic examination:

• The ultrasound gel will be removed from your chest.
• You may return to your normal daily activities immediately.
• There are no dietary or activity restrictions.

If you undergo a Transesophageal Echocardiography (TEE) with sedation, your doctor will provide specific instructions regarding recovery, eating, drinking, and when it is safe to resume your usual activities.

What Are the Risks?

Standard 3D Echocardiography performed through the chest (transthoracic echocardiography) is extremely safe and has virtually no known risks.

Some patients may experience mild pressure from the ultrasound transducer during the examination, but the procedure is generally comfortable.

If a Transesophageal Echocardiography (TEE) is performed, uncommon risks may include:

• Temporary sore throat
• Mild discomfort when swallowing
• Reaction to sedative medication
• Rare injury to the mouth, throat, or esophagus

Your doctor will explain the benefits and potential risks before the examination.

Results and Follow-Up

The images will be carefully reviewed by a cardiologist to evaluate:

• Heart chamber size and function
• Heart muscle performance
• Heart valve structure and function
• Blood flow through the heart
• Congenital or acquired structural abnormalities
• Blood clots, infections, or other cardiac conditions, when present

The results help your doctor diagnose heart conditions, determine the most appropriate treatment, and monitor your heart health over time.

When Will I Receive My Results?

In many cases, your doctor can discuss the preliminary findings shortly after the examination.

A comprehensive report is generally available within 24 to 48 hours, depending on the complexity of the study.

Your doctor will explain the results and discuss any recommended follow-up care or treatment.

If the Results Are Abnormal, What Are the Next Steps?

If your examination identifies an abnormality, your doctor may recommend:

• Additional cardiac imaging, such as Cardiac CT or Cardiac MRI.
• Laboratory tests to investigate underlying conditions.
• Medications to improve heart function or manage heart disease.
• Follow-up echocardiograms to monitor changes over time.
• Cardiac catheterization or other interventional procedures.
• Heart valve repair or replacement, if indicated.
• Cardiac surgery for selected conditions.

Your treatment plan will be tailored to your diagnosis, symptoms, and overall health.

When Should I Call My Doctor?

Contact your doctor promptly if you experience:

• Severe or worsening chest pain.
• Shortness of breath.
• Fainting or persistent dizziness.
• A rapid or irregular heartbeat accompanied by other symptoms.
• Fever, persistent sore throat, or difficulty swallowing after a Transesophageal Echocardiography (TEE).
• Any new or concerning symptoms following the examination.

Seek emergency medical attention immediately if you experience symptoms suggestive of a heart attack or stroke.

Why Choose RS Abdi Waluyo for Echocardiography?

At RS Abdi Waluyo, we combine advanced cardiac imaging technology with the expertise of experienced cardiologists to provide precise diagnosis and comprehensive cardiovascular care.

Our 3D Echocardiography service offers:

• Advanced real-time 3D imaging for highly detailed visualization of the heart.
• Non-invasive, radiation-free assessment that is safe for most patients.
• Comprehensive evaluation of the heart chambers, valves, and cardiac function.
• Experienced cardiologists specializing in cardiovascular imaging and heart disease.
• Integrated heart care, from diagnosis and treatment planning to long-term follow-up.
• A patient-centered approach focused on safety, comfort, and clinical excellence.

With advanced 3D Echocardiography technology, RS Abdi Waluyo provides highly accurate cardiac imaging to support early diagnosis, guide personalized treatment, and improve outcomes for patients with cardiovascular disease.

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Overview

What is 24-Hour Ambulatory ECG (Holter) Monitoring?

A 24-hour Ambulatory ECG, commonly known as Holter Monitoring, is a portable heart rhythm test that continuously records your heart’s electrical activity while you go about your normal daily routine. Unlike a standard electrocardiogram (ECG), which records only a few seconds of heart activity, a Holter monitor captures your heart rhythm over an extended period—typically 24 hours, and sometimes longer if recommended by your doctor.

At RS Abdi Waluyo, Holter Monitoring is used to detect heart rhythm abnormalities that may not occur during a routine ECG. By continuously monitoring your heart throughout your daily activities and sleep, your cardiologist can gain valuable information to diagnose irregular heart rhythms (arrhythmias) and evaluate your heart’s overall electrical function.

Why is Holter Monitoring Performed?

Your doctor may recommend Holter Monitoring if you have symptoms or conditions that require prolonged heart rhythm assessment, including:

• Palpitations or the sensation of a racing, fluttering, or skipped heartbeat
• Dizziness or lightheadedness
• Fainting (syncope) or near-fainting episodes
• Unexplained chest discomfort
• Shortness of breath that may be related to heart rhythm problems
• Suspected irregular heart rhythms (arrhythmias)
• Evaluation after treatment for an arrhythmia
• Monitoring the effectiveness of heart medications
• Assessment after certain cardiac procedures or pacemaker implantation
• Evaluation of heart rhythm following a heart attack or other cardiac conditions

Because some rhythm abnormalities occur only occasionally, Holter Monitoring can help identify problems that may not be detected during a routine ECG performed in the clinic.

Details of the Test

Holter Monitoring is a safe, painless, and non-invasive test.

The test involves:

• Small adhesive electrodes placed on your chest.
• Thin wires connecting the electrodes to a portable recording device.
• Continuous recording of your heart’s electrical activity for 24 hours or longer, depending on your doctor’s recommendation.

To help ensure accurate results:

• Wear loose-fitting, comfortable clothing.
• Bathe or shower before your appointment, as you should avoid getting the monitor wet during the recording period.
• Continue taking your prescribed medications unless instructed otherwise by your doctor.
• Maintain your normal daily activities unless advised differently.
• Keep a diary of your activities, symptoms, and the time they occur so your doctor can correlate them with your heart rhythm recordings.

What Happens During the Test?

Your visit begins with preparation by a trained healthcare professional.

During the test:

1. The skin on your chest may be cleaned or shaved if necessary to improve electrode adhesion.
2. Several small electrodes are attached to your chest using adhesive patches.
3. The electrodes are connected to a lightweight portable recorder that can be worn around your neck, attached to your belt, or carried in a small pouch.
4. You will receive instructions on how to care for the monitor while wearing it.
5. You will go home and continue your normal daily routine while the device continuously records your heart rhythm.
6. After the monitoring period is complete, you will return to RS Abdi Waluyo to have the monitor removed and the recorded data downloaded for analysis.

The monitor records automatically, and you will not feel any electrical activity during the test.

What Should I Expect After the Test?

Once the monitoring period has ended:

• The electrodes and recorder will be removed.
• You may immediately return to your normal routine.
• There are no recovery restrictions.
• A cardiologist will analyze the recorded heart rhythm along with your activity and symptom diary.

If skin irritation develops where the electrodes were attached, it is usually mild and resolves within a few days.

What Are the Risks?

Holter Monitoring is considered extremely safe and carries very few risks.

Possible minor side effects include:

• Mild skin irritation or redness from the adhesive electrodes.
• Temporary discomfort when removing the adhesive patches.

The monitor itself does not emit electricity into your body and does not interfere with your heart’s normal function.

Results and Follow-Up

After the recording is complete, the data is carefully reviewed by a cardiologist to evaluate your heart rhythm throughout the monitoring period.

The analysis may identify:

• Normal heart rhythm
• Fast heart rhythms (tachycardia)
• Slow heart rhythms (bradycardia)
• Irregular heart rhythms (arrhythmias)
• Premature heartbeats
• Episodes of atrial fibrillation or other rhythm disorders
• Changes that correlate with your symptoms

Your doctor will discuss the findings with you and explain whether additional evaluation or treatment is needed.

When Will I Receive My Results?

Because the recording must be downloaded and carefully analyzed, results are generally available within a few days after you return the monitor.

Your doctor will review the findings during your follow-up appointment and answer any questions you may have.

If the Results Are Abnormal, What Are the Next Steps?

If Holter Monitoring detects an abnormal heart rhythm, your doctor may recommend:

• Additional heart rhythm monitoring with an extended event recorder or implantable loop recorder.
• An echocardiogram to evaluate heart structure and function.
• An exercise stress test.
• Blood tests to identify contributing conditions.
• Medications to control heart rate or rhythm.
• Referral to a cardiac electrophysiologist for specialized evaluation.
• Procedures such as catheter ablation or pacemaker implantation if indicated.

Your treatment plan will be tailored to your symptoms, diagnosis, and overall heart health.

When Should I Call My Doctor?

Contact your doctor promptly if you experience:

• Severe or worsening chest pain.
• Shortness of breath.
• Fainting or loss of consciousness.
• Persistent dizziness.
• A rapid or irregular heartbeat accompanied by weakness or discomfort.
• Significant skin irritation or signs of infection where the electrodes were attached.
• Any symptoms that are new, severe, or concerning.

Seek emergency medical care immediately if you experience symptoms suggestive of a heart attack or stroke.

Why Choose RS Abdi Waluyo for Holter Monitoring?

At RS Abdi Waluyo, our cardiac diagnostic services combine advanced technology with the expertise of experienced cardiologists to provide accurate and timely heart rhythm evaluation.

Our Holter Monitoring service offers:

• Continuous heart rhythm recording during your normal daily activities.
• Experienced cardiologists specializing in the diagnosis and management of heart rhythm disorders.
• Comprehensive cardiovascular evaluation, with access to advanced imaging and cardiac testing when needed.
• Personalized care and treatment recommendations based on your individual condition.
• A patient-centered approach focused on accurate diagnosis, comfort, and continuity of care.

By identifying heart rhythm abnormalities that may otherwise go undetected, Holter Monitoring helps your healthcare team diagnose cardiac conditions early and develop the most appropriate treatment plan for your long-term heart health.

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A Simple Test to Check Blood Flow to Your Heart

Your heart needs a constant supply of oxygen-rich blood to work properly. If the blood flow to the heart muscle is reduced, it may cause symptoms such as chest pain or shortness of breath.

Nuclear Myocardial Perfusion Imaging (MPI), also known as a Nuclear Stress Test, is a non-invasive imaging test that helps doctors evaluate how well blood flows to your heart muscle both during activity and at rest. The results help identify areas of the heart that may not be receiving enough blood and assist your doctor in planning the most appropriate treatment.

What Is Nuclear Myocardial Perfusion Imaging?

Nuclear Myocardial Perfusion Imaging is a specialized heart scan that uses a very small amount of radioactive tracer and a special camera to create detailed images of your heart.

After the tracer is injected into a vein, it travels through your bloodstream and is absorbed by healthy heart muscle. A gamma camera then captures images of your heart. Areas receiving good blood flow appear differently from areas with reduced blood supply or previous heart damage.

The test may be performed using one of two imaging technologies:

• Single Photon Emission Computed Tomography (SPECT)
• Positron Emission Tomography (PET)

Your cardiologist will determine which method is most suitable for your condition.

Why Might Your Doctor Recommend This Test?

Your doctor may suggest Nuclear Myocardial Perfusion Imaging if you:

• Experience chest pain or chest discomfort
• Feel short of breath during physical activity
• Have symptoms that may indicate coronary artery disease
• Have had a previous heart attack
• Need evaluation before or after heart procedures such as angioplasty or bypass surgery

The test helps your doctor:

• Detect narrowed or blocked coronary arteries
• Assess blood flow to different parts of the heart
• Evaluate damage from a previous heart attack
• Determine how well your heart functions during exercise
• Monitor the effectiveness of previous heart treatments
• Decide whether further testing or procedures are needed

How Accurate Is the Test?

Nuclear Myocardial Perfusion Imaging is one of the most reliable non-invasive tests for detecting coronary artery disease. Studies have shown an accuracy of approximately 83% to 94% for identifying significant coronary artery disease. However, your doctor will interpret the results together with your symptoms, medical history, and other test findings.

How Should I Prepare?

To ensure accurate results, your healthcare provider may advise you to:

• Avoid coffee, tea, chocolate, energy drinks, and other caffeine-containing products for at least 12 hours before the test.
• Avoid smoking for at least 6 hours before your appointment.
• Avoid eating a heavy meal before the examination.
• Temporarily stop certain heart medications if instructed by your doctor. Never stop your medications without medical advice.

Before the test, inform your healthcare team if you:

• Are pregnant or think you may be pregnant
• Are breastfeeding
• Have medication allergies
• Have other medical conditions
• Are taking prescription medications, vitamins, or supplements

What Happens During the Test?

The examination usually includes two sets of images:

Stress Images

Your heart is evaluated while working harder.

Depending on your condition, this may be done by:

• Walking on a treadmill, or
• Receiving medication that temporarily increases blood flow to the heart if you are unable to exercise.

Once your heart reaches the desired level of stress, the tracer is injected, and images of your heart are taken.

Rest Images

After a resting period—either later the same day or on another day—you will receive another tracer injection, followed by another set of heart images.

Your doctor compares the stress and rest images to identify areas with reduced blood flow.

Is the Test Safe?

Yes. Nuclear Myocardial Perfusion Imaging is considered very safe.

The amount of radioactive tracer used is very small and is generally considered safe for most patients. Side effects are uncommon, and the radiation exposure is low. However, because radiation is involved, this test is generally not recommended during pregnancy unless absolutely necessary.

What Should I Do After the Test?

Most people can return to their normal daily activities immediately after the examination.

Your healthcare provider may recommend that you:

• Drink plenty of water over the next 24–48 hours to help eliminate the tracer from your body.
• Avoid prolonged close contact with pregnant women and infants for about 24 hours.
• If you are breastfeeding, follow your doctor’s instructions regarding when it is safe to resume breastfeeding.

When Will I Receive My Results?

A cardiologist will carefully review your images and prepare a report. Your doctor will discuss the findings with you during your follow-up appointment and explain whether additional tests or treatment are recommended.

If the test identifies a significant abnormality requiring urgent attention, your healthcare team may contact you sooner.

Frequently Asked Questions

Does the injection hurt?

You may feel a brief needle prick when the intravenous (IV) line is inserted. Most patients tolerate the procedure well.

How long does the test take?

The complete examination typically takes 2 to 4 hours, depending on the testing protocol and whether both stress and rest images are performed on the same day.

Can I drive home afterward?

In most cases, yes. Unless your doctor advises otherwise, you can usually drive and resume your normal routine after the test.

Key Takeaway

Nuclear Myocardial Perfusion Imaging is a safe, non-invasive, and highly effective test for evaluating blood flow to the heart. It helps doctors diagnose coronary artery disease, assess heart function, and determine the most appropriate treatment plan. If your doctor recommends this test, following the preparation instructions carefully will help ensure the most accurate results.

The post Understanding Nuclear Myocardial Perfusion Imaging (MPI) appeared first on Abdi Waluyo Hospital.

Coronary CT Angiography (CCTA): A Modern Cardiac Imaging Technology and Its Future Direction

Coronary CT Angiography (CCTA) is one of the latest innovations in cardiac imaging, capable of providing highly detailed visualization of the coronary arteries. This technology allows clinicians to assess very small blood vessels—approximately 2–5 mm in diameter—even while the heart is continuously beating and in motion.

With advancements in technology, the integration of artificial intelligence (AI) has further enhanced CCTA’s ability to analyze coronary plaque with greater precision. This opens significant opportunities for early detection and more accurate cardiovascular risk assessment.

However, like any medical procedure, the use of CCTA requires careful clinical consideration tailored to each individual. Not every patient will be advised to undergo this test, despite the growing perception that it should be performed universally.

The Role of CCTA in Evaluating Coronary Artery Disease

CCTA is a non-invasive modality used to evaluate coronary artery anatomy. Beyond simply detecting blockages, it provides comprehensive insights, including:

• Severity of atherosclerosis (total plaque burden)
• Plaque composition and characteristics, including high-risk plaque features
• Degree of luminal narrowing
• Whether a lesion impairs blood flow to the heart

In clinical practice, CCTA has both current and emerging applications, such as:

• Diagnosis in patients with chest pain or acute coronary syndrome
• Evaluation of patients with prior stent placement or coronary artery bypass grafting (CABG)
• Early detection of coronary artery disease
• Monitoring disease progression
• Enhanced plaque analysis using AI to identify high-risk patients

Clinical Applications Based on Patient Presentation

1. Symptomatic Patients

Currently, the primary use of CCTA is in patients presenting with symptoms, such as chest pain. It helps to:

• Determine whether symptoms are cardiac in origin
• Identify obstructive coronary artery disease (>70% stenosis)
• Guide decisions regarding stent placement or bypass surgery
• Serve as an alternative to exercise or stress testing

A major clinical trial, SCOT-HEART, demonstrated that the use of CCTA in patients with chest pain significantly reduced cardiac mortality and heart attack rates compared to standard stress testing. Additionally, CCTA enabled earlier detection of subclinical disease, leading to increased use of preventive therapies such as aspirin and statins.

Notably, approximately 50% of heart attacks occur in individuals without previously diagnosed heart disease. CCTA helps identify these patients earlier, allowing for more effective long-term prevention.

2. Asymptomatic Patients

In asymptomatic individuals, the role of CCTA remains an area of ongoing discussion. Currently:

• It is not yet widely included in clinical guidelines
• It is generally not covered by insurance for this population

However, CCTA holds significant potential for:

• Early detection of silent coronary artery disease
• Improving future cardiovascular risk assessment
• Initiating preventive therapy earlier
• Monitoring plaque progression or regression
• Helping determine the timing of intervention in high-risk lesions (e.g., left main or multivessel disease)

3. Monitoring Disease Progression and Therapy Response

In research settings, CCTA is used to monitor disease progression and evaluate response to therapy. However, in routine clinical practice, its role in this area has not yet become standard.

Identification of High-Risk Plaque

One of the key strengths of CCTA is its ability to identify high-risk plaque features associated with future cardiac events. Important parameters include:

• Total Plaque Volume (TPV): the strongest predictor of cardiovascular events
• Non-calcified plaque volume: more predictive than luminal stenosis
• Low Attenuation Plaque (LAP): associated with up to a 5-fold increased risk of heart attack

Other high-risk features include:

• Positive remodeling (arterial wall expansion)
• Spotty calcifications
• Napkin-ring sign
• Thin fibrous cap with a large necrotic core

Evaluation of Coronary Inflammation

CCTA is also increasingly used to assess coronary artery inflammation, a key factor in atherosclerosis progression.

A novel approach involves measuring the perivascular fat attenuation index (FAI), an imaging biomarker that evaluates changes in the fat surrounding blood vessels. This parameter can:

• Predict cardiovascular risk independently of traditional risk factors
• Provide additional information beyond calcium scoring
• Detect coronary artery disease even when the calcium score is zero

In the future, personalized cardiovascular risk assessment is likely to integrate coronary CT imaging and vascular inflammation analysis into standard evaluation protocols.

Limitations of CCTA

Despite its advantages, CCTA has several limitations:

1. Radiation Exposure

CCTA involves radiation exposure, which should be carefully considered, especially in younger patients (particularly women under 50). The radiation dose varies depending on the procedure:

• Chest X-ray: 0.1 mSv
• Mammogram: 0.5 mSv
• Calcium scan: 1.0 mSv
• Coronary CT: 3–5 mSv
• Nuclear stress test: 7 mSv
• Cardiac catheterization: 7–14 mSv

Factors such as obesity and elevated heart rate can increase radiation exposure.

2. Accessibility

Not all healthcare facilities have access to advanced CT scanners capable of performing CCTA, which may limit its availability.

Conclusion

CCTA is an evolving cardiac imaging modality with a significant role in diagnosing and managing coronary artery disease, particularly in symptomatic patients. With the integration of AI, its diagnostic capabilities continue to improve in both accuracy and detail.

However, its use in asymptomatic individuals remains under investigation. Current clinical guidelines do not yet recommend routine use in this population. Ongoing studies, such as the TRANSFORM trial, aim to further clarify its benefits.

In the future, CCTA is expected to play a central role in personalized medicine, particularly in cardiovascular risk assessment and early prevention strategies.

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