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0:08 Brail TV, Brothers and sisters, may 0:38 Allah have mercy on you. Praise and 0:42 gratitude to Allah for the opportunity 0:45 to be in the health space of Radio 0:48 Silaturahim, which hopefully persuades 0:51 and motivates us all to move forward 0:54 much more comfortably, in good health, 0:57 inside and out. And for today, may we 1:03 all be abundantly fit, healthy, safe, 1:07 and sound. Let us not forget to send 1:10 peace and blessings to our leader and 1:12 beloved, Muhammad, the Messenger of 1:13 Allah, may peace and blessings be upon 1:15 him. May we one day receive his 1:18 intercession and be reunited with him 1:20 at the moment we long for in the 1:22 hereafter. Brothers and sisters, today 1:28 we are joined by Dr. Syarif Rohmi, who 1:34 is a pediatrician. He is an alumnus of 1:39 the University of Indonesia, and just 1:42 now, off-air, we spoke a little bit 1:44 about the heart. Is a congenital heart 1:49 condition different from a heart 1:52 condition caused by mistakes in our 1:55 life's journey? Well, this will be our 1:58 topic today. Let us listen with all our 2:01 hearts, with all our feelings, and with 2:04 our souls, okay. Now, let us welcome 2:06 him who is already here. Peace be upon 2:08 you, and Allah's mercy and blessings, 2:09 Doctor. 2:10 >> Peace be upon you too, and Allah's 2:11 mercy and blessings, Mbak Nuning. Are 2:12 you well? 2:13 >> Good morning. 2:14 >> Praise be to God. So, there are 2:16 congenital heart conditions, right? 2:20 Meaning, if it comes from our ancestors 2:22 , it can be hereditary, which is 2:24 something we must be aware of, right? 2:27 Because people think heart disease is 2:30 just caused by a wrong lifestyle and 2:33 such. 2:33 >> Yes, that's right. Correct. So, to be 2:35 precise, 2:36 >> Yes, actually, if we are talking about 2:38 heart disease, especially in children, 2:39 it is divided into two. 2:40 >> Heh. 2:41 >> Congenital heart disease and acquired 2:43 heart disease. 2:45 >> Now, the congenital one happens because 2:47 of an anomaly in the organogenesis 2:49 phase, as we call it. 2:51 >> During the formation of bodily organs 2:53 in the first trimester, Nuning. So, not 2:55 in the third or second trimester. So, 2:58 at that time, a defect occurs because 3:01 why? There are risk factors from the 3:02 mother. 3:03 >> Hm. Risk factors from the baby itself, 3:05 or fetal abnormalities. In research 3:07 abroad, there are also risk factors 3:08 from the father, but it is not as 3:10 significant. 3:11 >> Okay. So, brothers and sisters, these 3:14 are the factors that we will examine 3:17 closely, especially if you are planning 3:20 to get married and start a family. 3:23 Please, Doctor. 3:24 >> Yes. So, continuing from before, with 3:26 acquired heart disease, nothing happens 3:28 during birth. So, there are no risk 3:31 factors, but heart disease can occur 3:34 due to, for example, infections; for 3:37 instance, the well-known Kawasaki 3:39 disease, rheumatic heart disease, or 3:42 viral infections. Now, regarding this 3:45 acquired heart disease, why is it 3:48 currently—actually, congenital heart 3:51 disease is the most common, Ma'am. Heh. 3:56 >> Among congenital defects, 30%consist of 3:58 acquired heart disease. So, it is the 4:01 most frequent. Therefore, that is where 4:02 the focus lies. Besides being common, 4:05 the mortality rate is also high in 4:08 infants, right? In infants. 4:11 >> Third, besides the high mortality, 4:13 diagnoses are also sometimes delayed, 4:16 Mrs. Nunding. 4:17 >> Delayed. Why is it delayed? Yes, it's 4:19 delayed. Because as we know, during the 4:21 time inside the mother's womb or the 4:23 fetal phase, the blood circulation is 4:25 different, so sometimes it is not 4:27 always audible when we listen to heart 4:29 sounds based on murmurs, for example in 4:31 congenital heart disease in newborns 4:33 that isn't visible yet, Mrs. Nunding, 4:35 it's not really visible except for 4:37 severe congenital heart disease, yes. 4:39 >> It can be seen. So, how common is it? 4:45 If we read in books, out of 100 live 4:48 births, there is one baby with a 4:50 congenital heart defect. There is one 4:53 baby. 4:54 >> So the ratio is 10 to 1? 4:56 >> 100 to 1. 4:57 >> Oh, 100 to 1. Yes, if we multiply that 4:59 by the population in Indonesia, it's 5:00 quite a lot, isn't it? 5:02 >> If Indonesia's population is around 270 5:05 million and the birth rate is around 5 5:07 million, well, that's the same as the 5:09 population of Singapore. So, congenital 5:11 heart disease cases per year are around 5:13 50,000. 5:15 >> 50,000. Then, if we look at it, 5:17 unfortunately, we don't have, shall we 5:19 say, a registry yet. Registry means 5:22 accurate data. But if we refer to 5:24 developed countries, for example in 5:27 America, there are about 4 million 5:29 newborns there, and approximately 5:32 40,000 have congenital heart disease, 5:34 and 10%of them are critical congenital 5:37 heart disease. Now, that critical 5:39 congenital heart disease is 5:41 >> something that we sometimes cannot 5:43 diagnose early, but there are certain 5:45 techniques. 5:47 >> So, how can we actually diagnose 5:49 congenital heart disease early? Mrs. 5:52 Nunding, actually with the development 5:54 of knowledge, we can diagnose it even 5:56 while still in the mother's womb, yes. 5:58 >> In the first 3 months, we can diagnose 6:00 it. 6:01 >> Now, let's look at these figures when 6:03 we compare them, yes. In America, for 6:06 example, there are about 40,000 cases 6:07 of congenital heart disease there, yes. 6:09 Then, babies with critical congenital 6:11 heart disease, this is very dangerous, 6:13 about 10%of them, yes. 6:15 >> Then how about in Indonesia? If, for 6:17 example, the population in Indonesia is 6:18 around 6:19 >> 250 million. Million, yes, 6:22 approximately 5 million births, same as 6:24 the population of Singapore. 6:25 >> Then how many are CHD cases? It's about 6:28 1/100 as I said earlier, so 50,000, 6:30 right? Then the serious, critical 6:34 congenital heart disease is about 10%, 6:35 which is 5,000, and the mortality is 6:37 also high, yes. 6:39 >> The mortality is high. Therefore, our 6:42 task is to be able to detect congenital 6:45 heart disease earlier so that we can 6:48 reduce morbidity and mortality rates. 6:51 Because morbidity and mortality are 6:53 indeed indicators of a nation's or 6:56 society's well-being, right? So, as I 7:00 said earlier, congenital heart disease 7:02 can indeed be detected during the 7:04 intrauterine phase or while the baby is 7:07 in the mother's womb, especially, it is 7:10 said that the best time is at 18 to 22 7:12 weeks of gestation. 7:15 >> It is indeed not 100%, but the accuracy 7:19 can reach 60 to 90%, yes. Why is the 7:22 accuracy range so wide? Because it 7:24 really depends on the equipment and 7:26 also the examiner's expertise. Then, it 7:29 also depends on the gestational age. 7:32 Yes, with more good equipment and 7:35 skilled experts, the chances of 7:37 detection will be even higher. Now, 7:43 when we talk about heart disease, 7:44 generally speaking, we have heard of 7:46 cyanotic and acyanotic congenital heart 7:48 disease. Actually, in terms of 7:51 management, there are major and minor 7:53 congenital heart diseases. 7:55 >> Now, "major" means that within the 7:57 first year, an operative procedure is 7:59 needed. However, for minor congenital 8:01 heart disease, we will look at the 8:03 classification later. It does not 8:05 require operative action, not at all. 8:07 So this explains to parents why my 8:08 child needs surgery and others do not, 8:10 for example. Explaining it like that. 8:12 Now, the heart disease I mentioned 8:14 earlier is further divided into two. 8:17 Cyanotic and acyanotic congenital heart 8:19 disease. Yes, let's look at the slide. 8:21 So, what is the difference? In cyanotic 8:24 congenital heart disease, simply put, 8:26 deoxygenated blood mixes with 8:28 oxygenated blood. If it is cyanotic, 8:30 deoxygenated blood mixes with 8:31 oxygenated blood. If it is acyanotic 8:33 congenital heart disease, oxygenated 8:35 blood mixes with deoxygenated blood. 8:37 What else is the difference? Cyanotic 8:39 congenital heart disease usually 8:40 involves more complex abnormalities. 8:42 >> Yes. 8:43 >> More complex. It's not just what we 8:45 might think, for example, just a hole, 8:47 but it's not just a hole. There can be 8:49 narrowing, blood vessels can be swapped 8:51 , or the valves may not be formed 8:53 properly. Whereas in acyanotic 8:56 congenital heart disease, it is usually 8:57 just a hole. Now, please try to show 9:01 another slide, or maybe another one. 9:05 Now, these are the names. So the 9:08 management of heart disease is also 9:09 slightly different, Mbak Nuni. 9:11 >> For acyanotic congenital heart disease, 9:13 if the hole is small, perhaps no 9:15 medication is needed at all. Then, if 9:17 the hole is disruptive enough to 9:19 interfere with blood flow, or causes 9:22 hemodynamic disturbance, it needs 9:24 medication. But if medication has been 9:27 given and there is still a hemodynamic 9:29 disturbance, which we can observe 9:32 through a physical examination. Then 9:35 with additional examinations, such as 9:37 X-rays or echocardiography, or if 9:39 symptoms persist despite medication, 9:41 surgery may be required. Now, if it is 9:43 cyanotic congenital heart disease, 9:45 surgery is needed, but the timing 9:46 varies. Some at 2 weeks, some at 1 9:49 month, some at 9 months, there are many 9:51 variations. 9:52 >> These are the names. Now, these are 9:55 acquired heart diseases; as mentioned 9:56 earlier, rheumatic heart disease is 9:58 quite common in Indonesia. Heart 10:01 disease is usually caused by a throat 10:04 infection, the tonsils, those red 10:07 tonsils, or caused by human 10:09 streptococcus. Then Kawasaki disease is 10:13 relatively new, relatively new. It was 10:17 indeed first widely discovered in the 10:19 Japanese population. But it turns out 10:21 it's also in Indonesia. 10:23 >> Yes. It's also in Indonesia. And 10:25 actually, this Kawasaki disease has 10:27 various symptoms, you know. The eyes 10:30 are red, the lips are also red, there's 10:32 lymph node enlargement, and the hands 10:34 can swell or have edema. Then there's 10:37 the rash I mentioned earlier. Now, the 10:39 problem is it can affect the heart's 10:42 blood vessels or what are called 10:43 coronaries. So, babies can also 10:46 experience coronary artery disease. Now 10:50 , in Kawasaki disease, all those 10:52 symptoms will disappear on their own, 10:53 but the coronary disease can persist, 10:55 so it needs to be treated with 10:57 medication. If not treated with 10:59 medication, it can lead to death or 11:01 even more dangerous coronary disease. 11:04 That's roughly it, Ms. Duni. 11:06 >> MashaAllah. So, brothers and sisters, 11:09 it's unimaginable that such things 11:12 could happen. And because this is live, 11:15 you can call the Silaturahim radio, and 11:18 as usual, you can also send a WhatsApp 11:21 message. We will discuss further 11:24 regarding, you know, how do we know if 11:28 there will be complications during 11:32 pregnancy? What is the first thing we 11:34 must do? 11:34 >> Yes. Thank you, Bunik. Actually, if we 11:37 read books, risk factors are indeed 11:39 mentioned, Ms. Nuni. So, if a mother 11:43 has risk factors, she has, what is it 11:45 called? The possibility of her baby 11:48 suffering from congenital heart disease 11:50 , for example, a well-known risk factor 11:52 is uncontrolled diabetes mellitus in 11:53 the mother. 11:55 >> Huh. 11:56 >> In literature, obesity is also 11:58 mentioned. Then theoretically, 12:01 theoretically, the mother is of 12:03 advanced age, over 35, although it's 12:05 not certain, it just needs to be 12:08 detected earlier. Then. 12:11 >> Having more than five children, 12:12 although other studies say it has no 12:14 effect. Then the mother has an 12:16 infection. Infections, for example, if 12:19 the mother has rubella during pregnancy 12:21 , that can also cause the possibility, 12:23 yes. 12:24 >> The mother takes medication. 12:26 >> Certain medications consumed can also, 12:28 yes, outside of heart disease, 12:29 theoretically that is the case. For 12:31 example, if the mother takes epilepsy 12:34 medication, theoretically that is the 12:36 case. 12:37 >> Then radiation can also be a factor. 12:41 >> If the mother has a disease, for 12:42 example, an autoimmune disease, that's 12:44 another example. Now, then what about 12:47 the risk to the baby? Actually, based 12:49 on research, all abnormalities that 12:51 occur in babies can be accompanied by 12:54 heart abnormalities, for instance, from 12:56 the head down to the abdomen, Nuning. 13:00 >> For example, a baby with a head 13:01 abnormality where the formation is not 13:03 perfect, right. 13:05 >> Then if you read the book again, oral 13:08 abnormalities can also lead to higher 13:10 risk factors compared to normal ones. 13:14 Then lung abnormalities, for example, 13:16 the lungs are not formed perfectly. One 13:19 doesn't form, whereas we know there are 13:21 two lungs. Then digestive abnormalities 13:24 , severe digestion, for example, the 13:27 stomach valve is not formed or the 13:29 valve is not perfect, then kidney 13:32 abnormalities. So, everything means 13:35 there are risk factors related to heart 13:37 abnormalities as well. So, if we later 13:41 encounter cases of other abnormalities, 13:43 we should really detect early whether 13:45 there is a heart condition or not, so 13:47 that morbidity and mortality rates can 13:49 decrease. We can help more. 13:52 >> And if it's known earlier, the 13:54 detection is better, right. 13:56 >> Then it is also hoped that the 13:57 management will be more perfect. 14:00 >> Yes. So remaining vigilant and prepared 14:03 is something we cannot ignore, right. 14:05 This happens to be a question from Mrs. 14:08 Nani in Bekasi. Peace be upon you. I 14:10 want to join in and ask a question. Um, 14:13 Doc, yesterday we received a call from 14:16 a friend asking for help to find 14:18 authentic Yemeni honey in Indonesia. Oh 14:22 , they are in Malaysia. Because it was 14:25 suggested by a doctor there before the 14:27 heart surgery is performed. They said 14:30 there is a possibility the surgery 14:31 could be canceled. Could you please 14:34 give some input, Ms. Nuning, on the 14:36 addition of Yemeni honey to the doctor. 14:38 What is that? Yes, that's all, Doc. 14:43 >> So, so, regarding management and 14:45 treatment. So the treatment I mentioned 14:49 earlier depends on the type of disease, 14:51 Ms. Nuning. 14:53 >> If it is a cyanotic congenital heart 14:54 disease, 14:55 >> it usually requires operative action. 14:59 Although there are some cyanotic 15:01 congenital heart diseases that cannot 15:04 be treated, most of them can now be 15:06 managed well. Even intervention 15:09 procedures are done first to help 15:12 prevent early death. Meanwhile, for 15:15 acyanotic congenital heart disease with 15:17 small leaks, it usually can close on 15:18 its own. It could be, for example, ASD 15:21 or VSD, we say it can close. PDA can 15:24 also close spontaneously, unless the 15:26 leak is large. A large leak in terms of 15:30 symptoms usually means weight that 15:32 doesn't increase, frequent coughs and 15:34 colds, and also frequent infections. 15:38 Usually, if the leak is large, there is 15:40 a small possibility it can close on its 15:42 own. But if the leak is small, in daily 15:45 practice, it is very likely to close on 15:47 its own. So it's like that. Now, as for 15:51 the effect of honey, it might be 15:53 possible in the sense that the honey is 15:55 expected to increase and provide good 15:58 calories. 15:59 >> Good calories, because for operative 16:02 action, you need a good preoperative 16:05 condition, good body weight, and no 16:08 illness. Then it is also hoped that 16:11 because the preoperative condition is 16:13 good, the operative and postoperative 16:15 conditions will also be good. So that 16:18 is what is expected, perhaps it is like 16:20 that. So it is indeed expected to help 16:23 in increasing calories, right. As we 16:26 know, honey also has some studies 16:30 related to antibodies, right. 16:35 >> That might be it. 16:36 >> Yes, unfortunately, we cannot tell you 16:39 where to get that Yemeni honey here. 16:42 Alright, Ma'am, hopefully that at least 16:44 provided a picture, Doc. This is a 16:47 question from Yen Yeti. 16:51 >> I am almost 30 and have a family 16:52 history of diabetes. Well, if I get 16:57 married next year and want to have 17:00 children, what should I do, and what 17:02 will the impact of this diabetes 17:04 history be? Thank you. 17:08 >> Yes, it is true, to be certain whether 17:10 you will actually develop diabetes or 17:13 not, you should get checked. It’s 17:16 better to be prepared, 17:17 >> get checked first. Besides sugar, don't 17:19 forget about infections, okay. 17:20 Infections are quite common, right. 17:22 Like toxoplasma infection in the mother 17:24 . 17:25 >> Check your hormones too, so that when 17:27 you become pregnant, your preparation 17:29 will be more complete. 17:33 >> So, don't worry too much, but make sure 17:35 you don't have diabetes first, for 17:36 example. 17:37 >> Heredity doesn't always mean you'll 17:39 definitely get it, right, Doc? 17:40 >> Yes. Yes. Even though it just reflects 17:42 a slightly higher risk factor. But we 17:45 can catch it earlier, yes. Indeed, 17:48 mothers with diabetes mellitus are said 17:51 to have a risk factor for congenital 17:53 heart disease, such as a hole in the 17:56 ventricular septum or VSD, or Tetralogy 17:58 of Fallot, for instance. So, it can 18:02 indeed be detected earlier. Also, don't 18:05 forget to have it checked during the 18:07 first, second, or third trimester for 18:10 earlier intervention. Because if we 18:14 look at developing countries, if there 18:16 is a risk factor, they intervene 18:17 earlier. 18:19 >> Meaning it’s detected early so we can 18:22 identify the type of illness and then 18:24 provide proper therapy. Actually, what 18:27 is the goal of early intervention in 18:29 neonates? We can provide information to 18:32 the mother, the parents, and also the 18:34 obstetrician. Then, usually, in such 18:39 cases, we use a multidisciplinary 18:41 approach. There’s a pediatric 18:44 cardiologist, an obstetrician, and also 18:47 a fetomaternal specialist. It's 18:49 possible that perinatology colleagues 18:51 are also involved, so that by the time 18:53 of pregnancy, everything is very well 18:56 prepared to achieve the goal of 18:57 reducing morbidity and mortality rates. 19:02 >> Alright, next. There is no name here, 19:05 Doc. My husband smokes, and not just 19:08 outside the house, sometimes inside, 19:10 even in the bedroom. I am currently 19:13 pregnant, just a few weeks along. Is 19:18 there an effect of passive smoking on 19:20 our fetus's health? Thank you, oh men. 19:25 Smoking, yes. 19:27 >> Yes. Yes. 19:27 >> Yes, this might have been explained by 19:30 Dr. Darmawan previously, indeed 19:33 >> what is actually dangerous is passive 19:35 smoking; Dr. Darmawan even mentioned 19:36 that even if one smokes outside, the 19:38 residue still remains. 19:40 >> Yes. Yes. Yes. You might want to see 19:43 the explanation from Dr. Darmawan again 19:45 , as he is a pediatric pulmonologist. 19:49 His explanation is even better. 19:51 >> But indeed, there is a risk factor from 19:54 passive smoking. So, passive smokers 19:57 bear far more consequences than those 19:59 who enjoy the cigarettes. 20:01 >> Yes, that’s right. 20:02 >> Yeah. What do you think? We really want 20:05 to give some advice to the men, don't 20:06 we? But hearing this explanation, 20:08 especially if you have children at home 20:10 , Doctor. 20:11 >> Yes, that's correct. 20:12 >> Okay, while we wait for the next 20:16 questions. You can also call in since 20:18 this is live, and please, Doctor, feel 20:20 free to add anything. Regarding that 20:23 picture earlier, I would like to 20:25 explain blue and non-blue congenital 20:27 heart disease. 20:29 >> I saw it earlier, maybe that would make 20:32 it clearer. 20:33 >> Why is it called blue, Doctor? 20:34 >> Well, this one, go back, before this. 20:37 Before, even before that. 20:39 >> There, this one. If we look at it, a 20:42 normal heart is like this, right? 20:45 >> It consists of four chambers: left 20:47 atrium, right atrium, left ventricle, 20:49 and right ventricle. We also see there 20:53 are four valves, the blue ones signify 20:55 that the oxygen level has decreased, 20:57 reduced to about 70 or 80 percent. 21:00 While the red ones indicate high oxygen 21:02 levels. We live with high oxygen levels 21:05 . We see that congenital heart disease 21:09 occurs due to abnormalities during 21:11 formation. So the formation could be 21:15 anywhere, it could be due to an 21:17 incomplete septum or we see swapped 21:19 blood vessels or a leak, so it's more 21:21 complex. Now, for non-blue congenital 21:24 heart disease, please show it again. 21:27 For non-blue, we see that clean blood 21:30 mixes with dirty blood. 21:32 >> Yes. It has a leak, but the oxygen 21:35 level remains normal. If we look at it, 21:39 non-blue congenital heart disease is 21:42 indeed simpler; the leaks might be one 21:45 or two, but it is simpler compared to 21:48 the blue type. Try the other blue one. 21:55 Now, this one, next. Now, let's look at 21:59 this. This is blue congenital heart 22:02 disease. We see that on the right side 22:04 is the dirty blood. Dirty blood mixes 22:06 with clean blood. We see in this image 22:08 that for blue congenital heart disease, 22:11 besides the leak, there is also a 22:12 narrowing. 22:13 >> Towards the lungs, so it's more complex 22:15 and it won't close on its own. We have 22:17 to explain this to the parents. The 22:19 problem is sometimes when a baby is 22:22 just born. Sometimes they hope, "It's 22:27 okay, it will close by itself later." 22:29 Not necessarily. So we must first 22:31 ensure whether the congenital heart 22:32 disease is blue or non-blue to be safe. 22:35 If it turns out to be blue congenital 22:37 heart disease, it's a shame because 22:39 there is a timing, a golden period, 22:42 where surgical intervention would be 22:44 more perfect. If they are already 22:46 adults, it's usually a bit difficult. I 22:49 have several patients who are already 22:51 adults. And all this time, why did it 22:55 become adult? Because the parents might 22:57 have been hesitant, not having received 22:59 a proper explanation, so they waited 23:01 until adulthood. Then they took 23:03 medication, hoping it would close by 23:05 itself. Actually, I mentioned earlier 23:08 that non-blue congenital heart disease 23:10 cannot close on its own because it is 23:12 more complex. 23:15 >> There were two patients. So when 23:17 explaining to the patient, who is 23:18 already an adult and understands, fear 23:20 arises because it's already too late. 23:23 Now, regarding congenital heart disease 23:24 . If we look at "dirty blood," it 23:27 contains many germs; besides having low 23:30 oxygen levels that can affect other 23:32 body functions, such as reduced supply 23:35 to the brain or kidneys, that blood is 23:37 also full of bacteria. 23:40 >> The difficult part is when bacteria 23:42 develop there; a cavity in a tooth can 23:43 allow them to enter, making treatment 23:45 much longer. If a bacterial clump forms 23:48 and gets stuck, the treatment takes 23:50 much longer, up to 6 weeks, and the 23:52 costs incurred are quite substantial. 23:55 >> It is very substantial, so the costs 23:57 are quite high. Furthermore, the 23:58 success rate also becomes increasingly 24:00 slim. So, it is best if a heart disease 24:03 is suspected, to confirm whether it is 24:05 blue or non-blue congenital heart 24:07 disease. Then, how should the 24:09 management be planned? So don't just 24:11 hope, "Oh, this will close on its own 24:13 later, it's fine, my neighbor's closed 24:15 too," don't be like that. It is better 24:16 for us to just confirm it. Even though 24:20 there is blue congenital heart disease, 24:23 there is indeed one type in our country 24:26 that we have not yet been able to 24:28 manage well. But it must be explained 24:32 to the parents; if it isn't explained 24:34 or managed properly, what does it even 24:36 mean? If not managed, it will also lead 24:40 to death and suffering. We are also not 24:42 very successful with what is called 24:44 hypoplastic left heart syndrome, where 24:46 the left side of the heart is smaller; 24:48 we are usually not very successful yet. 24:52 >> Yes. 24:53 >> I 24:54 >> This is a question, but the name was 24:57 not mentioned, Doctor. I am a layperson 25:02 and don't know much, but I really want 25:05 to know the symptoms of a child who can 25:09 get this disease; could my 1.5-year-old 25:12 child have it? So far, I don't think 25:17 there's a problem, but hearing it can 25:19 happen makes me worried. May I have the 25:23 information, please? 25:24 >> Yes. 25:25 >> What are the symptoms like? Please go 25:27 to the first slide, sir. 25:29 >> Please. Keep going, keep going. Now, 25:30 this one is fine. This one is fine. 25:31 This, this one is fine. Uh, before, 25:34 before. Now, this one. Now, this one. 25:37 Previous, already previous. Now, this 25:38 one here, yes. So, we can see in the 25:40 picture here that actually 25:42 >> this is a severe congenital heart 25:44 disease, yes. Severe, in which 25:47 >> the aorta, the large artery, and the 25:50 pulmonary artery are swapped. However, 25:54 God is all-just, right. So, while 25:57 inside the mother's womb, the baby 26:00 still receives good oxygen from the 26:02 placenta, as we see in the red image, 26:04 meaning there is good oxygen, so at 26:06 birth, the baby appears to have a 26:09 normal birth weight. The Apgar score is 26:12 also good. When we take photos on the 26:14 first day, we make a video, the baby 26:16 doesn't show anything. But if we leave 26:20 it and fail to detect this, it will 26:22 cause death. We take it, bring it home, 26:26 the parents are explained to, but it 26:28 can actually cause death. 26:30 >> So, a baby born with a normal weight 26:32 and normal length who cries immediately 26:34 does not necessarily rule out 26:35 congenital heart disease. 26:38 >> That is actually already universal, 26:40 Mbak Nuning. Universal means how we can 26:42 diagnose this critical congenital heart 26:44 disease. Critical congenital heart 26:46 disease is a little different. The 26:47 critical congenital heart disease I 26:49 mentioned earlier has a very high 26:50 mortality rate because it is sometimes 26:51 detected too late. So, it has actually 26:53 become a Ministry of Health policy now 26:56 that newborns must have their oxygen 26:58 levels checked one day after birth. 27:01 >> Oxygen levels in the right hand and 27:03 left foot. 27:04 >> Yes. 27:05 >> Checking that is usually something 27:06 midwives already know, and our friends 27:08 in the ER know it has become a 27:09 procedure. So, when we were young, it 27:11 might not have existed. 27:13 >> Now it has advanced as well. So the 27:15 oxygen levels are checked; for example, 27:18 both must have oxygen saturation levels 27:21 above 95%. If it is below 90%, 27:24 follow-up action must be taken. Now, 27:28 >> what if the baby has just been born? We 27:30 checked the saturation earlier, second 27:32 one. Try another slide. Is there one? 27:35 Keep going, the one before, the other 27:37 one. Go back, please. Sorry, please go 27:40 back, back again, go back. Now, let's 27:43 look at the mother earlier. So, 27:45 actually, there is a leak. There is a 27:47 leak between the top parts, the right 27:49 atrium, the left atrium, and the bottom 27:50 parts, the ventricles. 27:52 >> Right and left ventricles. If the leak 27:53 is large, blood flows from the left 27:55 ventricle to the right ventricle. I 27:57 will explain later why symptoms arise. 28:00 From the left ventricle to the right 28:01 ventricle. From the right ventricle, 28:03 blood is pumped to the lungs, so the 28:05 lungs also receive excessive blood. If 28:08 there is excessive blood in the lungs, 28:10 it will cause the baby to tire easily. 28:13 Yes, babies get tired easily, not by 28:15 running fast, of course. They get tired 28:16 easily when breastfeeding. 28:18 >> So, if they breastfeed for a long time, 28:19 it is not good, and the weight does not 28:21 increase. 28:22 >> Because the lungs are flooded. Secondly 28:24 , they also often have coughs and colds 28:25 . So, if there is a baby whose weight 28:28 does not increase, who often has coughs 28:31 and colds, or gets tired easily when 28:33 moving or breastfeeding, we must 28:35 consider significant congenital heart 28:37 disease. Indeed, an echocardiography 28:40 must be performed. Now, for the blue 28:42 one, the next slide, this blue one is 28:44 the easy way. 28:45 >> The easy way is that when crying, the 28:48 tongue looks blue. Yes. 28:50 >> And their tongue is blue. Why is the 28:51 tongue the easiest place to see the 28:52 blue color? The tongue is not affected 28:54 by temperature or race, so it is more 28:56 visible. So, be careful if a baby is 28:58 blue, their tongue is blue, it could be 29:00 blue congenital heart disease. Now, for 29:02 older children, doctors usually have a 29:05 growth chart, so we also look at their 29:08 weight, whether they get tired quickly 29:11 during activity, if they have frequent 29:13 colds, those are also symptoms of 29:16 congenital heart disease. Also, it 29:19 often happens in older children that 29:21 they frequently have chest pain. 29:23 Frequently have chest pain. 29:24 >> Teenagers, for example. 29:24 >> There are teenagers too. 29:26 >> For teenagers, most of the time it’s 29:28 nothing serious; usually, it's what we 29:31 call non-cardiac chest pain, not due to 29:33 heart problems, but maybe due to their 29:35 muscles or their stomach. Perhaps that 29:37 is what I can explain. 29:39 >> Right, this is from Mr. Lukman in East 29:42 Jakarta. Doc, my teenage child has been 29:45 frequently participating in futsal 29:47 activities at school lately. I’ve 29:49 noticed that he gets tired more easily. 29:52 His breathing is also more labored 29:53 compared to his friends. Even though he 29:56 is physically healthy. Could getting 29:59 tired easily during physical activity 30:02 in adolescence be an alarm or an early 30:05 symptom of heart disease, Doc? Thank 30:09 you. 30:09 >> Yes, that is a question often 30:11 encountered in daily practice. Uh-huh. 30:14 >> One of the causes, firstly, is 30:17 lifestyle; poor sleep habits, poor 30:20 nutrition, and poor fluid intake can 30:23 all be contributing factors. Secondly, 30:28 not warming up before diving straight 30:30 into intense exercise. That usually has 30:34 an effect too. Thirdly, it could be a 30:36 heart condition, but usually with heart 30:38 conditions, their physical growth isn't 30:39 great. Uh-huh. 30:40 >> Not great. Although there are some 30:43 heart conditions that are not very 30:45 typical. Fourth, what I often find now 30:49 is that children nowadays easily 30:51 consume junk food. Junk food, yes. 30:55 >> And junk food is said to contain high 31:00 levels of sodium. So there are some 31:03 children who already have hypertension. 31:06 >> Hypertension. So, their intake really 31:08 needs to be monitored. Thirdly, there 31:11 are some children who are actually 31:14 healthy but get tired quickly; when we 31:17 check their vitamins, their vitamin D, 31:19 calcium, and magnesium are often low. 31:23 >> Hm. 31:23 >> So, we really need to pay attention to 31:25 their vitamin levels. They are also in 31:28 a growth phase; during adolescence, 31:29 growth is rapid, their cells are active 31:31 , and their needs might be higher. Also 31:34 , sometimes iron levels can be low 31:36 because of reduced calorie or animal 31:39 protein intake, sometimes we find their 31:41 iron is a bit low. Vitamin D is 31:44 actually the most common one. 31:46 >> vitamin D, especially for girls who 31:48 wear hijabs, sometimes there is an 31:51 effect, it is said that because they 31:54 are covered, the sun's rays are not 31:57 absorbed perfectly by our bodies. 32:02 Alright, this is from Mrs. Khadijah in 32:06 Depok. Doctor, I have a 15-year-old 32:10 daughter. Her chest often feels painful 32:14 or tight, especially when she is 32:16 overtired or stressed from having to 32:19 study for a long time. We thought it 32:23 was just catching a cold or something. 32:26 But Doctor, how do we as parents 32:29 distinguish between normal chest pain 32:32 and chest pain that points to heart 32:35 problems in teenagers? Please advise. 32:39 Thank you. 32:39 >> Yes, thank you. That is also a question 32:41 that is often encountered, Mrs. Nuling. 32:43 Yes. 32:43 >> So, indeed in daily practice, we ask 32:46 where the chest pain is located, 32:49 >> on the left side or the right side? 32:51 Usually it is on the left side, 32:53 >> the left side. 32:54 >> Then, when does it happen? 32:56 >> Whether it occurs during activity or 32:58 during rest, that also has an effect, 33:00 that is the easiest way. Then the best 33:02 thing to do is to have an EKG 33:04 examination performed, Nuning. 33:06 >> Oh, an EKG. 33:07 >> An EKG, yes. 33:08 >> Actually, the heart is like a house, 33:10 Mrs. Nuneng. Like a house, yes. It has 33:13 walls, it has electricity. The 33:16 electricity, if it is related to 33:18 palpitations, it is related to the 33:19 electrical system, although the 33:21 electrical system is also related to 33:22 defects in the walls as well. So, if it 33:26 recurs, it is best to get an EKG for 33:28 this. 33:30 >> Yes. Mrs. Fanny is listening to this 33:33 and asks, "Doctor, I'm getting afraid 33:36 of having heart disease. What should I 33:38 do, how old are you, Mrs. Fi?" Yes. Yes 33:42 . If someone is worried because they 33:44 heard something and then starts 33:46 worrying themselves, should they just 33:48 check with a doctor, Doc, or how? 33:50 >> Yes. Actually, as we get older, we know 33:53 that many diseases often arise, 33:55 including heart disease, so let's just 33:57 reduce the risk factors. 33:58 >> Now, this is what must be noted. 34:00 >> Yes. Yes. Risk factors, yes. Yes. Good 34:02 exercise must be exercise, one 34:04 >> refreshing. Then also the diet 34:07 >> the diet shouldn't just be about tasty 34:08 food 34:09 >> it should be avoided, now things have 34:11 become very advanced if we look at 34:13 social media, there is a lot of 34:14 information there. 34:15 >> So don't forget to exercise and also 34:18 the muscles should be improved too, yes 34:21 . Then, for example, regarding blood 34:24 pressure and pulse, salt should also be 34:26 reduced because salt sometimes has an 34:28 effect too. 34:29 >> That is something we can possibly do. 34:32 But if one is pressured and stressed, 34:34 Doc, how? Is it difficult or not? 34:37 >> Releasing stress and pressure so as not 34:40 to get heart disease. Just be sincere, 34:43 like that 34:45 >> yes. For me, perhaps 34:51 >> alright, this is from Ms. Rian in 34:53 Tangerang. Doc, if a teenager is 34:57 detected to have congenital heart 34:59 disease, can it still be cured, Doc? 35:02 How should they go about their normal 35:04 daily activities? And does this have 35:08 any relation to the mother's health 35:10 during pregnancy? 35:13 >> Or is it purely just because of 35:15 lifestyle? 35:17 >> Thank you for the insight. Yes. 35:19 >> Yes. This is also frequently 35:22 encountered in daily practice. Yeah. 35:25 >> So for adolescents, we actually need to 35:26 confirm and reclassify whether it is 35:28 cyanotic or acyanotic congenital heart 35:29 disease, right? Blue or not. 35:31 >> There are signs of it being blue, as 35:32 mentioned earlier. 35:33 >> Yes. If we have an oxygen deficiency 35:36 for more than 6 months, usually this 35:38 will swell. 35:40 >> What I call clubbing fingers; clubbing 35:42 occurs because of long-term oxygen 35:44 deficiency, causing this swelling in 35:46 the fingers. Then, it will usually be 35:48 visible there. As they get older, the 35:52 need for oxygen increases, so they 35:54 actually look bluer compared to infants 35:57 . So in adolescents, it is easier to 35:59 see the blue tint. Now, regarding 36:01 adolescent cases, I usually explain to 36:04 parents, for example, if it's a complex 36:06 congenital heart disease, like having 36:09 both a hole and a narrowing. If we 36:11 imagine we have a house, if our exit is 36:14 blocked, we will surely find another 36:17 way out, right? 36:18 >> Yes. 36:19 >> Taking other routes. So there are "back 36:21 alleys" or shortcuts. 36:23 >> The danger is, if there are too many 36:25 shortcuts, surgery becomes quite 36:27 difficult, as far as I know. So indeed, 36:29 from the two infections earlier that... 36:32 >> Then, for acyanotic congenital heart 36:34 disease, we can see that things are 36:36 very advanced now. Very advanced. In 36:39 the past, most of the acyanotic ones 36:41 could be managed with surgery, right? 36:44 Although the surgeries varied. But now, 36:47 with the development of knowledge, 36:49 treatment can be done without 36:51 interventional surgery, although it 36:54 depends on... 36:56 >> The type as well, right? Yes, the type; 36:59 usually, before performing an 37:01 intervention or closing the hole 37:03 without surgery, the doctor will first 37:06 examine where it is located, how large 37:09 it is, and whether closing it would 37:11 interfere with other anatomical 37:13 structures or not, that's how it's done 37:16 now. Now, the problem is sometimes with 37:20 certain congenital heart diseases, even 37:22 if the hole is small, it interferes 37:25 with other structures. Usually, surgery 37:28 is still needed. As I said earlier, if 37:30 it's small, it's very likely to close 37:33 on its own, but it usually depends on 37:35 the age. 37:37 >> For PDA, if it's over 2 months, it 37:39 usually cannot close by itself. For ASD 37:43 , which is a hole in the atrial septum, 37:46 it's 5 to 8 years. VSD is also like 37:48 that. But it also depends on whether 37:50 the congenital heart disease interferes 37:53 with other anatomical structures or not 37:55 . 37:56 >> Yes. Umm, this is from...a question 38:02 related to early detection in 38:03 adolescents. Are there any examinations 38:08 that can be done independently at home 38:11 just to know? Through physical signs. 38:15 Uh, before we, uh, take them for CHD 38:18 detection, Doctor. When is the right 38:23 time to take a child to a cardiologist 38:26 after we see visible signs, and what 38:29 kind of signs? Thank you. Yes. 38:32 >> Yes. Well, at home, you could perhaps 38:35 do an examination. There are portable 38:37 ones now, like during the COVID era, 38:39 there were those, right? The oximeter, 38:41 you might be able to see that, right? 38:44 >> We can check the pulse, whether it's 38:46 too fast or too slow, that's possible 38:48 too. Then, from handheld devices, there 38:52 are also several applications that can 38:54 determine or provide information about 38:57 their heart rate and heart rhythm, 38:59 there are things like that now. Even 39:02 certain cell phones can also check the 39:04 ECG, right? 39:05 >> That ECG, or iPhone can do it. Well, if 39:08 not that way, usually go to your 39:09 regular doctor first, right. Or check 39:12 blood pressure; blood pressure can also 39:14 be done at home now, that's also good. 39:18 As I said earlier, it seems like these 39:19 days there are quite a lot of teenagers 39:21 with slightly elevated blood pressure, 39:22 right. Maybe because of junk food or 39:24 other factors, right. Yes, it's indeed 39:27 best to consult a pediatrician you 39:29 trust first, 39:30 >> then later go to a pediatric 39:31 cardiologist. 39:32 >> Yes, that's right. 39:34 >> Because the lifestyle of children 39:35 nowadays is indeed...Different. Yes. 39:37 High blood pressure, even if junk food 39:39 is fun, right, Doctor? Okay. This is 39:42 from Mr. Didin in Cileungsi. I am 35 39:46 years old, Doctor. Lately, my chest 39:50 often hurts suddenly on the left side. 39:54 Uh, but sometimes it's the whole chest, 39:56 and a few hours later it usually 39:57 disappears on its own. I once had an 40:00 ECG, Doctor. The results, thank God, 40:03 were just fine. Actually, why does my 40:06 chest keep hurting, Doctor? 40:09 >> Yes, for adults, we indeed have to 40:11 think about and rule out heart problems 40:13 . The best thing is actually to get an 40:16 ECG while you're in pain, Ma'am. So, 40:19 when you're in pain, go straight for an 40:21 ECG. 40:22 >> So the data will be more accurate 40:24 because sometimes, although as I said 40:26 earlier, the heart is like electricity, 40:30 >> there are other pathways, those "rat 40:32 runs" that are sometimes used during an 40:34 attack. 40:35 >> If not during that time, 40:36 >> there's nothing there. So, it's best to 40:39 have an ECG during an attack, and to 40:41 determine it further, usually a 40:44 treadmill test is better, uh, I suggest 40:46 a treadmill test. It's more, more 40:49 thorough, right. So it's stressed to 40:52 see whether the treadmill test causes a 40:55 heart rhythm abnormality or not. The 40:58 best is a treadmill test. 40:59 >> Treadmill. 41:00 >> Yes, treadmill. 41:01 >> If you can walk outside, it's healthier 41:03 to get some sun, but if not, then just 41:05 do it at home. Treadmill. 41:07 >> Treadmill, treadmill in medical terms, 41:09 meaning that's what comes out when, 41:10 from what I know, I'm not an adult 41:12 cardiologist, though. They have a 41:15 treadmill test done. Later we will look 41:17 at the ECG. At what speed it’s paced 41:21 during the treadmill test, the best way 41:24 to see the ECG changes is during the 41:27 trip. 41:29 >> This is Ibu Ita. Uh, I happen to be 41:33 pregnant, even though I just started, I 41:36 want to check with the doctor to ask 41:38 what medications should not be consumed 41:42 during pregnancy regarding what is 41:44 being discussed here. Is there anything 41:49 that can be done so that the fetus can 41:51 be protected from those dangers? 41:54 >> Yes. Mm, actually, regarding congenital 41:56 abnormalities, it's folic acid, right? 41:59 But obstetricians nowadays are good and 42:01 surely know, 42:03 >> they are definitely doing the best for 42:04 their patients. They do provide iron 42:07 supplements because iron will affect 42:09 the baby's health later on, right? Then 42:12 sometimes folic acid too, and maybe 42:14 vitamin D as well. So it is best to 42:17 consult with an obstetrician. If there 42:21 is a suspicion, it is usually referred 42:23 to a fetomaternal specialist to perform 42:26 a fetal echocardiography, which is an 42:28 ultrasound inside the mother's womb. 42:31 >> Yes. Well, fetal echocardiography 42:34 actually doesn't just look at the 42:36 anatomy, but also, like us, the heart 42:38 has three parts. It looks at the 42:41 anatomy, the electrical system, and 42:44 also its function. Actually, inside the 42:47 mother's womb, we can get that 42:49 information if the equipment is 42:51 suitable. With good equipment, we can 42:54 actually detect anatomical 42:55 abnormalities, heart rhythm disorders, 42:57 and also functional abnormalities. If 43:00 it can be detected earlier, that would 43:02 be even better. 43:04 >> Yes. And there is someone asking, "Doc, 43:12 if I once had an ECG and there was a 43:17 disturbance, then I was given 43:21 medication some months ago." Do I have 43:25 to keep taking it or should I get 43:27 checked again, Doc? Yes, thank you. 43:29 >> Yes. As far as I know, it must be taken 43:30 . Don't, yes, do not stop it without 43:33 the doctor's knowledge. 43:36 >> And we should look for what the 43:38 underlying ECG abnormality is. Yes, 43:39 what the anatomical abnormality is. So, 43:43 actually, heart abnormalities will 43:45 cause hemodynamic or blood vessel 43:48 changes, right? 43:50 >> Those blood vessel changes will cause 43:51 changes in the heart's anatomy. Then 43:53 those changes in heart anatomy can be 43:56 seen on the ECG and echocardiography. 43:58 Therefore, it is necessary to ensure 44:01 the anatomy is clear so that the 44:03 management is more perfect. 44:07 >> So don't stop, just keep taking it. But 44:11 if I feel like, "I've been taking that 44:13 for months, should I continue or go to 44:15 the doctor again?" 44:17 >> Yes. It is better to go back to the 44:19 doctor or look at the risk factors and 44:21 eliminate them. The risk factors, 44:24 whether it's diabetes mellitus, whether 44:27 the body weight is too high or obese, 44:29 the risk factors should be eliminated 44:32 or reduced. 44:34 >> Yes. So keep checking and re-checking, 44:36 right? 44:37 >> Yes. It is better. 44:38 >> Because if you were once...what? 44:43 >> Exposed, right? Exposed and taking the 44:46 medication, don't stop before asking 44:48 the doctor again and getting checked. 44:52 >> That's how it is, such illnesses are 44:53 like that too. 44:54 >> Alright, there are no further questions 44:56 for now, Doc. You may add anything if 44:59 you wish to add something. Oh, here is 45:03 one more. Lately, my appetite has 45:05 decreased significantly. I am 49 years 45:08 old. Is there any connection to what is 45:09 being discussed? Decreased appetite. Oh 45:14 . 45:15 >> Yes, regarding appetite earlier, it is 45:17 generally related to infants, to babies 45:19 and children. But for adults, it might 45:21 be necessary to investigate other 45:23 causes. 45:23 >> Can stress also be a factor? He. 45:25 >> Yes. 45:27 >> Yes. As the doctor mentioned earlier, 45:29 brothers and sisters, he is a pediatric 45:31 cardiologist. Children, yes. So it is 45:33 indeed very important for us to find 45:35 out about our children's conditions. 45:38 How about this, Doc, someone asked 45:41 earlier and I missed it. If there is an 45:44 abnormal sound in my child's breathing 45:47 while sleeping, he is now 3 years old, 45:50 is there anything that should be 45:53 watched out for? Thank you. 3 years old 45:57 . 45:57 >> Yes, 3 years old. Well, actually, the 46:00 heart is neighbors with the lungs, with 46:03 the respiratory tract, right? Usually, 46:07 when it relates to the respiratory 46:09 tract, if it's normal, it will provide 46:12 good oxygen to the heart as well, right 46:14 ? In certain children, there is 46:17 congenital heart disease called 46:18 pulmonary hypertension which will also 46:20 cause respiratory disturbances, so it 46:22 must be confirmed first. 46:24 >> Let's make sure, we check if the 46:26 child's growth and development is good 46:28 or not, their weight, and then later 46:30 have them checked by a doctor for any 46:32 abnormal heart sounds. So just confirm 46:34 it first. The point is, the heart is 46:37 actually neighbors with the lungs. Lung 46:38 disorders can also cause heart 46:40 disorders. Yes. That is the point. 46:42 >> Problematic lungs can disturb the heart 46:44 . So they are true neighbors on the 46:46 left and right, right? Yes. Actually. 46:48 >> Not in front and behind, right? 46:49 >> Yes. 46:50 >> Okay. 46:50 >> Yes. Even in fact, what I mentioned 46:53 earlier, there is also acquired heart 46:55 disease, there is acquired heart 46:56 disease called myocarditis. Usually, 46:59 what is encountered in daily practice 47:01 is caused by a virus that previously 47:03 attacked lung disorders as well, 47:04 respiratory issues too, 47:06 >> but it also affects the heart. There 47:09 are disorders like that. 47:12 >> Yes. If the doctor mentioned earlier 47:15 about, what do you call it? 47:19 >> The blue color on the tongue, on the 47:21 lips, is it visibly blue or just faint, 47:24 Doc? Because. 47:26 >> But it depends on the oxygen, which one 47:27 . 47:28 >> The oxygen, so actually that is 47:31 something that must be carefully 47:33 observed, right? It is best to check 47:38 the saturation. 47:41 >> What was mentioned earlier, sometimes 47:43 that blue color. 47:44 >> It appears depending on the oxygen 47:47 level as well, right? The intensity of 47:50 the color depends on that. Normal is 47:53 above 95%, but if it's below 90%—well 47:55 , around 90%, it might not be visible 47:58 —it's called silent cyanosis. So 48:01 actually, they are blue but it’s not 48:03 visible, so we have to be careful. 48:05 >> Be careful, but the characteristic is 48:07 if they really 48:09 >> have a drop in oxygen levels, they will 48:11 get tired faster; they get tired 48:13 quickly if they run a little, for 48:15 example, in Tetralogy of Fallot 48:16 patients, they squat down first to rest 48:18 . Well, that is usually how it is. 48:21 >> So, fatigue that comes on faster is 48:23 also a sign that must 48:25 >> sometimes they will, what is it called? 48:28 Their body will regulate, like 48:30 self-regulate, right. 48:32 >> Tired from running, tired from activity 48:34 , they 48:35 >> they stop for a moment, that's possible 48:37 . 48:38 >> They do that because they need to lower 48:40 , to raise their oxygen levels again. 48:43 >> That is if the child tires easily. What 48:46 if it seems like they aren't hot, but 48:48 they are sweating so much, just soaked, 48:50 that also exists. 48:51 >> We also look at these other symptoms. 48:54 If I look at it, for example, we must 48:56 ensure whether their weight is good or 48:58 not, 48:58 >> then whether their weight is good or 49:00 not, whether they often have a cough or 49:01 cold, then whether they often have 49:03 infections or not. Then we look at the 49:06 physical examination; not everyone who 49:08 sweats has a heart condition. Indeed, 49:11 one of the symptoms of heart disease is 49:13 sweating 49:14 >> excessively, yes. Remember, that 49:17 leakage actually causes the blood level 49:20 to the aorta, the large artery, to 49:23 decrease, right. But because it 49:26 decreases, there is a compensation, it 49:28 will beat faster too. Now, that fast 49:31 pulse in the aorta will cause them to 49:34 sweat like that. One of the symptoms. 49:38 But not all, normal sweating is not a 49:41 symptom of heart disease. 49:45 >> Alright, Mrs. Sinta. Here, Doc. I don't 49:49 happen to be sick, but when I check, my 49:53 cholesterol is high, I was given 49:57 simvastatin. 49:59 >> If I then go through a pregnancy 50:02 process, should it be stopped or what 50:05 should happen? As far as I know, it's 50:08 safe. 50:09 >> Simvastatin is safe, okay for 50:10 cholesterol. Yes. 50:13 >> But it must also be ensured, what's it 50:14 called, reduced, what's it called, 50:15 controlled too, why the high 50:17 cholesterol happens, right? 50:18 >> It can be reduced by eating right, 50:20 right. 50:22 >> Keep up the activity or improve the 50:24 diet again. 50:26 >> Yes. So indeed, we really need to 50:28 understand the side effects of 50:30 medications. Especially if it relates 50:34 to us being pregnant, where there is a 50:37 next generation inside our womb, Doc. 50:41 Okay, Doc. Maybe you could summarize 50:43 our discussion related to, um, today. 50:47 >> Yes. Thank you, Ms. Nuning. So, today 50:51 we are talking about congenital heart 50:53 disease. Congenital heart disease is 50:55 the most common birth defect, 50:58 >> even among children. Then, besides 51:00 being common, what is the problem? The 51:02 mortality rate is also quite high. Then 51:04 sometimes the diagnosis is late. 51:06 Therefore, early detection is very 51:08 important. When can early detection be 51:10 done? First, during the intrauterine 51:14 period, although the detection rate 51:16 isn't 100%, it is quite helpful. 51:20 >> Then, for a baby one day after birth. 51:23 >> It is better to perform a pulse 51:24 oximetry test. We can just ask the 51:26 midwife. Please check what their oxygen 51:29 saturation is. Next, in the childhood 51:32 phase, we look at whether their weight 51:34 is appropriate for their age, if they 51:36 often have coughs or colds, if they 51:38 have frequent infections, or if they 51:40 get tired easily. If such symptoms are 51:44 present, it is certainly better to 51:46 perform early detection. Also, don't 51:49 forget that a baby born normal— 51:51 meaning normal birth weight, normal 51:54 birth length, and a normal Apgar score 51:56 —does not rule out congenital heart 51:59 disease. Because in the infant phase, 52:02 the first two months are a transition 52:05 phase for every human, and sometimes it 52:07 is not clearly visible. Therefore, the 52:10 consensus is that early, easy detection 52:13 must be done. Easy in the sense that it 52:16 can be done by a midwife, nurse, or 52:19 other medical personnel without high 52:21 costs, using pulse oximetry screening, 52:24 which has become the agreed-upon 52:26 universal screening for congenital 52:28 heart disease. Perhaps that is all, Sir 52:31 . Alright, brothers and sisters. 52:34 Hopefully, this helps us understand 52:37 better, especially for expectant 52:40 mothers or mothers who have children 52:44 under five. Everything that was 52:49 conveyed by Dr. Syarif hopefully makes 52:49 us more prepared. To be clear, out of 52:53 1,000 births, what is the likelihood of 52:55 being affected? 52:56 >> 1,000 uh 10. 52:57 >> 10. 52:58 >> 10. Okay. 53:00 >> But that is calculated based on live 53:02 births. If those that don't survive are 53:03 included, it would be even higher. 53:04 >> Oh, I see, only that. Alright, 53:06 hopefully, this is beneficial once 53:09 again for our friends at Rasil in the 53:11 regions who are also rebroadcasting 53:13 today's program. Thank you very much. 53:17 Hopefully, once again, we can persuade 53:20 those listening, whether for themselves 53:22 or their families. Thank you once again 53:26 , Doctor. Billahi taufik wal hidayah. 53:27 Wasalamualaikum warahmatullahi 53:29 wabarakatuh. 
