bluuebunny/crossref_metadata_2025 huggingface dataset:
C14. Benefit and Safety of Cardiac Rehabilitation Program in Pulmonary Hypertension Patient after Atrial Septal Defect Closure with Fenestration
Authors: Etami H V , Anggrahini D W , Arso I A
Published: April 2022

Background

ASD closure with surgical fenestration is purposed to reduce pulmonary hypertension (PH) crisis. PH is still found in patient conducting this procedure. Some issues told that PH patient should restrict activities due to complaints aggravation. Proper cardiac rehabilitation gives clinical improvements and safe for stable PH patient.

Case summary

A 20-year-old male, diagnosed as left to right shunt ASD with pulmonary hypertension (mPAP 41 mmHg, PVRI 4.86, and Qp/Qs 1.62), was conducted surgical closure with fenestration. Patient was given cardiac rehabilitation program from 6-minute walking test result. It was done twice a week for 1 month after surgery by walking on treadmill for 600 meters in 30 minutes and was increased 100 meters per meeting, the heart rate target was 107 – 125 beats per minute. The program evaluation by treadmill test on the last session showed increase of fitness capacity (9.33 METs from 2.34 METs) and decrease of symptoms. There was no incident during exercise. Education were given for PH evaluation and healthy lifestyle.

Discussion

Cardiac rehabilitation program was emphasized for PH management. Continuous and moderate intensity exercise is recommended than high intensity exercise. The cardiac rehabilitation program showed improvement of physical capacity, quality of life, and reduction of NT pro BNP by increasing peak oxygen uptake, anaerob threshold, pulmonary perfusion, muscle function and decreasing inflammatory response, oxidative stress, smooth muscle cell proliferation. It is save for stable PH patient under healthcare supervision.
C16. BRASH (Bradycardia, Renal Failure, AV Nodal Blocker, Shock, and Hyperkalemia) Syndrome: Lost in Plain Sight
Authors: Hazzy Fandy , Rohman M Saifur
Published: April 2022

Background

Bradycardia, Renal failure, AV-Nodal blockers, Shock, Hyperkalemia (BRASH) Syndrome new clinical entities due to a vicious cycle in which hyperkalemia from renal failure synergizes with AV-nodal blockers, consequently between the clinical condition of patients with the degree of hyperkalemia and bradycardia are inappropriate, Furthermore, the symptoms may be refractory to typical positive chronotropic interventions or overdose antidotes.

Case Illustration

A hypertensive 70-years old female with history of heart failure with routinely consume spironolactone, diltiazem, and beta blocker admitted with bradycardia and shock after watery diarrhea and vomit 3 days before. The electrocardiogram showed junctional rhythm 40 beats per minutes. Laboratory findings Hyperkalemia (6.8 mEq/L) and acute kidney injury (urea 58.6 mg/dL, creatinine 3.13 mg/dL, eGFR 16.23) was presented. Refractory hyperkalemia occured, but by using pacemaker, providing adequate fluids, and the return of renal perfusion, hyperkalemia can be overcome.

Discussion

BRASH syndrome usually triggered by hypotension in the elderly due to hypovolemia or an overdose of antihypertensive drugs. The natural compensation response for hypotension is to increase heart rate, but AV-nodal blockers blunt this response, which causes a decrease in renal perfusion. This ultimately results in hyperkalemia and accumulation of AV-nodal blockers which produce a synergistic effect causes bradycardia and decreased renal perfusion. Treatment involves supportive care including hemodynamic support with fluids and management of bradycardia, and also avoid trigger factor.
C27. CATASTROPHIC EVENT IN PERCUTANEOUS CORONARY INTERVENTION PROCEDURE: TYPE III LEFT MAIN CORONARY ARTERY DISSECTION
Authors: Suwarjana K I G B P , Aryadana W , Pradnyana D. S B A , Suwirya A P
Published: April 2022

Percutaneous coronary intervention (PCI) is an invasive revascularization method to improve coronary blood flow in patients with CHD. A male patient, 61 years old, came to the cardiac clinic at Sanglah General Hospital, complaining intermittent chest pain since one month earlier. Coronary angiography found a stenosis of 70% in the ostium left anterior descending coronary artery (LAD), 80-90% in the proximal to distal LAD and 70-80% in the ostium to the proximal right coronary artery (RCA).The patient was diagnosed with coronary artery disease 2 vessel disease (CAD 2VD) and was then prepared for the PCI procedure on LAD.

The 6F Optitorque TIG catheter was then replaced with a 3.5/6F BL guide catheter to the LMCA ostium. Angiographic evaluation at the time of re-canulation revealed aortic dissection at the LMCA to the ascending aorta (type III) and cessation of blood flow to the LAD. The patient then complained of severe chest pain accompanied by shock. Wiring to distal LAD was performed quickly afterward using a 0.014”/180 cm Runtrough NS Floppy, followed by a 2.0 x 15 mm balloon inflation on the LMCA ostium to the proximal LAD. Then, double wiring was performed to the LCx using 0.014 "/ 180 cm Runtrough NS Floppy wire to maintain coronary patency. At last, the a 3.5 x 12 mm Drug Eluting Stent (DES) on the LMCA to proximal to the LAD. Despite stenting at the dissection site, the patient fell into shock, developed a malignant arrhythmia and subsequently had cardiac arrest.
C32. Coarctation of the Abdominal Aorta, Disease Beyond the Arch; How do we identify and manage it?: A Case Report
Authors: Pamuna O S , Kurnianingsih N
Published: April 2022

Background

Coarctation of the abdominal aorta (AoA) is a rare case, approximately 0.5-2% of all stenosis aorta. We present an 11-years old boy, diagnosed with coarctation of the abdominal aorta.

Case Description

An 11-years old boy complained about dizziness since 1.5 years ago with hypertension. He underwent hypertension treatment for 1.5 years with a pediatrician but there is no improvement in his blood pressure. His current blood pressure was 150/95 mmHg in upper extremities and 120/80 mmHg in lower extremities with three antihypertensives drugs. We found bruit in the abdomen and decreases pulse in lower extremities. An echocardiogram shows no congenital defect. The first was on suspicion of renal stenosis and underwent ultrasonography of the abdomen but not conclusive. Computed Tomography Angiographic (CTA) showed severe stenosis in the abdominal aorta on level thoracal 11-12. Aortogram shows significant stenosis in the abdominal aorta with a pressure gradient was 47 mmHg. He underwent percutaneous transluminal angioplasty with BMS self-stent implantation. At two month of follow up his blood pressure target was achieved with a minimal dose of oral antihypertensive drugs

Discussion

How to diagnosed coarctation of the abdominal aorta is still challenging and often underdiagnosed. Patients with young age and persistent hypertension should be more careful in diagnosis. A bruit in the abdomen with a weak pulse in the lower extremity raises suspicion of Coarctation of the Abdominal Aorta. The causal treatment is either percutaneous transluminal angioplasty with or without stent implantation or surgery.
C33. Complex ebstein anomaly in adult patient: a case report
Authors: Ratnasari A B , Fagi R A
Published: April 2022

Background

Ebstein’s anomaly is a rare form of congenital heart disease. In adult often present with arrhythmias, progressive cyanosis, and right heart failure. Management is complex and individualized.

Case Summary

A 24-year-old woman presented to the emergency room with heart failure presentation, palpitations and fainting. ECG examination shows abberant SVT with pulse, hemodinamically was stable with peripheral saturation 94% without oxygen supplementation. The patient then carried out cardioversion and got anti-arrhythmia amiodarone. Resting ECG obtained sinus rhythm right axis deviation with incomplete LBBB (splintered QRS). Echocardiography examination revealed displacement of the tricuspid valve, a large atrialized component of the right ventricle, the anterior leaflet of the tricuspid valve moves freely with bidirectional shunt ASD and moderate pericardial effusion, confirmed for Ebstein's anomaly type B .

Diuresis therapy was given and anti-arrhythmic therapy was continued. Echocardiographic evaluation showed reduced pericardial effusion to a minimum. Patients were scheduled for electrophysiological studies and angiographic evaluation and total corrections were planned.

Discussion

Ebstein anomaly is a characterized by abnormally formed and apically displaced leaflets of Tricuspid caused by is failure of proper delamination of the tricuspid valve, primarily of the septal and anterior leaflets from ventricular myocardium. The cardinal symptoms in Ebstein’s anomaly are cyanosis, right-sided heart failure, arrhythmias, and sudden cardiac death. Surgery is indicated in adults with symptoms of heart failure. Medical therapy is generally used only for temporary stabilization : diuretic therapy for volume overload, control of heart rhythm abnormalities, and standard medical therapy for left ventricular systolic dysfunction.
C35. Congenital Heart Disease in Neonatal Lupus: a case report
Authors: Pramono A , Abdullah L N
Published: April 2022

Background

Neonatal lupus (NL) is an autoimmune disease acquired in utero after exposure to antibodies produced by the maternal immune system against Ro and La antigens. It is considered as a syndrome since it can comprise manifestations including cardiac, cutaneous, and hematologic abnormalities. In many cases, mothers are clinically asymptomatic and only identified with serologic abnormalities when gestational surveillance reveals foetal bradycardia.

Case Summary

A term baby girl was born by c-section due to prolonged bradycardia, with one-minute APGAR score was five and five-minute APGAR was seven. She was the second baby from gemelli pregnancy of P4A0 mother. On further observation, the respiratory distress deteriorated, with the heart rate around 80-100 beats/minute on electrocardiogram showed total AV block. Laboratory examination showed anaemia, thrombocytopenia, hypoalbuminemia, and elevated C-reactive protein. The chest x-ray revealed pleural effusion, and from echocardiography, there was a small patent ductus arteriosus. ANA panel test showed positive 3+ for anti-Ro (SS-A) and Ro-32 recombinant. During treatment in NICU, this patient received dopamine, dobutamine, invasive mechanical ventilation, and chest tube thoracostomy installation. Later, she was referred to tertiary health care for pacemaker treatment.

Discussion

NL is an uncommon autoimmune disease that is present at birth. Affected infant develop various symptoms and complications, the most significant potential such as congenital heart block. Congenital heart block may manifest in various degrees. In this case, NL presented with a complete heart block which required a pacemaker for treatment.
C40. Early Repolarization Syndrome: The Dangerous One
Authors: Islami Z H , Hidayati F , Maharani E
Published: April 2022

Background

Early repolarization pattern (ERP) in electrocardiogram (ECG) was thought to be benign in nature. However, for the last 2 decades, several cases reported sudden cardiac deaths (SCD) in patient with ERP.

Case Summary

A 40-year-old male with a history of several syncope episodes. The latest episode in 2019 at 5 am, a brief convulsion happened before the patient went unconscious. In emergency room, he had another convulsion with a witnessed ventricular fibrillation. After resuscitation and defibrillation, the patient awoke, and ECG was recorded showing ST-segment elevation at V2-3 which suspected to be a Brugada syndrome (BrS).

Patient then referred to Sardjito hospital for echocardiography and treadmill test, and the results were within normal limit. Coronary CT Scan showed a non-significant lesion at LAD. Holter examination showed during sleeping, J-wave elevation appeared at the rate of 50 bpm. Meanwhile, during exercise, J-wave disappeared at the rate of 135 bpm. The patient was diagnosed as early repolarization syndrome (ERS) and managed with implantable cardioverter-defibrillator (ICD) implantation.

Discussion

Patient with ERP who suffers syncope/cardiac arrest is classified as an ERS. Particular clinical findings such as history of cardiac arrest, convulsion, apnea, and ECG findings such as short coupled premature ventricular contraction, dynamic J-wave changes, widespread J-wave are associated with a higher chance for ventricular arrhythmia. Due to its similar nature in ECG morphology and its pathophysiology, ERS and BrS are classified into J-wave syndrome.
C47. Heparin Induced Thrombocytopenia (HIT) Associated with Multiple Deep Vein Thrombosis (DVT) and Intracardiac Thrombus Who Underwent Vena Cava Filter Prior to Surgical Thrombus Evacuation : a Case Report
Authors: Sihotang I M , Ryanti D , Haykal T B , Habib F , Ardini T W , Ketaren A P , Hasan H
Published: April 2022

Background

Heparin-induced thrombocytopenia (HIT) is a serious adverse drug reaction that increases patient’s risk of developing venous or arterial thromboembolism, which maybe life-threatening. The frequency varies from 0.5% to 5%, depending on population studies. This condition will worsen especially in patients with deep vein thrombosis.

Case

A 52 years old woman was reported swelling and decreased saturation of the lower extremities, with a history of Heparin therapy for 5 days before being referred to Haji Adam Malik Hospital Medan. Platelet count on admission day was 225.000/µl but dropped into 64.000/µl in the 7th post heparin treatment day. Doppler examination showed multiple thrombosis in deep femoral vein and and sign of stenosis peripheral artery. Echocardiography showed intracardiac thrombus without sign of acute pulmonary embolism. Two days after discontinuation of heparin, the platelet still tend to be low but in the next days, its count increases to within normal range. Due to the high risk of embolism, it was decided to place a vena cava filter prior to surgery for thrombus evacuation.

Discussion

This case demonstrates several interesting aspects of HIT, including thrombotic complication, limitation tools to support diagnosis of HIT, how to prepare this patient into surgical management, and the last is placing a IVCF prior to surgical thrombus evacuation and thrombectomy to reduce the risk of thromboemboli before surgical treatment. This is the first time procedure in Medan for placing a vena cava filter in a DVT patients who have contraindication to heparin administration.
C58. Management of Ellis Type V RV Branch Coronary Perforation Using Handmade Covered-stent: a case report
Authors: Wea Jeffry D D D , Rampengan S H , Pangemanan J A
Published: April 2022

Coronary perforation is a rare but life-threatening complication of percutaneous coronary intervention (PCI) requiring urgent management including balloon inflation, thrombin, microcoils, fat embolization, autologous blood clots administration, heparin-reversing agent, covered-stent implantation, or surgery. We report a case of Ellis type V RV branch coronary artery perforation during PCI treated with a handmade covered-stent.

A 69-year-old female presented with typical angina in three days. She was hemodynamically stable and no sign of congestion. Laboratory results showed leukocytosis, mild elevation of liver transaminase, elevated CK-MB level, mild hypoalbuminemia. ECG showed sinus rhythm with atrial bigeminy, late-onset inferoposterior and RV MI, and first-degree AV block. TTE revealed reduced LV systolic function (LVEF 45%), impaired LV relaxation, reduced RV function, marked LV hypokinetic in inferior, inferoseptal, apicoseptal, and inferolateral wall, and mild ischemic mitral regurgitation. DCA result showed 90 – 95% tubular stenosis in mid-LAD and total occlusion in proximal-RCA with grade V thrombus. She had an anomaly of RV branch angle that resembles the RCA so that the guidewire perforated the distal part of the RV branch artery. PCI was done using hydrophilic wire to distal RCA. Ellis type V perforation was found following multiple balloon inflation in RV branch. Perforation was managed with a handmade covered-stent using a Sirolimus-eluting stent with Tegaderm film. TIMI flow 3 was reached without thrombi or residual stenosis.

In medical centers that have limited resources, handmade covered-stents can be used as an option after unsuccessful balloon inflation trial.
C59. Management of Subacute Painless Aortic Dissection Stanford A Debakey II in Patient With Undiagnosed Marfan Syndrome During Pregnancy
Authors: Fadlan Muhamad Rizki , Kurnianingsih Novi , Widito Sasmojo , Sargowo Djanggan
Published: April 2022

Background

Pregnant women with Marfan’s syndrome needed multidisciplinary approach to evaluate pregnancy status, fetal and maternal outcome. Marfan’s syndrome was an inherited autosomal dominant with mutation of fibrillin-I (FBN1) gene. Pregnant woman with MFS can lead to aortic dissection. It’s increase 23% of maternal mortality and 35% of fetal death.

Case Summary

a 30 year-old pregnant woman referred from secondary hospital care with valvular heart disease (severe aortic regurgitation due to dilatation of the aortic root and severe mitral regurgitation). Due to her severe myopia, history of aortic dissection in her family, enlarged of aortic root, pulnus excavatum, scoliosis and arachnodactyly, de novo MFS was suspected. She was diagnosed with marfan’s syndrome according her systemic score was 10 (posive >7), and calculated aortic z score was 6.2 (positive >2). Intimal tears and dilatation of the aortic root were considered to terminate the pregnancy. It’s can result bad neonatal outcome. For the management of a potential vascular catastrophe , monitoring of delivery and repairing the aortic root, we needed to multidisciplinary approach.

Discussion

Patient with marfan’s syndrome during pregnancy, may develop painless aortic dissection because massive dilatation of aortic arch prevent compression of pain sensitive structure. Less evidence to manage pregnant woman with MFS with aortic root dilatation more than 45 mm and or progressively dilatation of aortic root ( more than 0.5 mm/year). This patient was categorized as class IV modified WHO classification with high risk maternal mortality and severe morbidity.
C72. Peripartum Cardiomyopathy: “Comparison in Management of Two Cases”
Authors: Widyastuti W , Krevani C K , Karani Y
Published: April 2022

Background

Peripartum cardiomyopathy (PPCM) is a pregnancy related cardiomyopathy that associated with high morbidity, mortality, also high probability of partial and often full recovery. The management of PPCM remains challenging.

Case Summary

The first patient was 33 years old woman, diagnosed with PPCM 3 days after giving birth. The second patient was 30 years old woman with heart failure symptoms since 3 months after giving birth but only seek medical attention 10 months later. Both patients presented with heart failure and LVEF 37%. The difference was acute onset PPCM on the first patient and the second one was already fall to chronic heart failure condition due to untreated PPCM. Both patients were treated with heart failure drugs but no bromocriptine in second patient. Six months follow up showed increased LVEF to 65% in first patient with full recovery but no significant improvement on second patient with LVEF 40 %.

Discussion

The first patient was presented as acute PPCM. Diagnosis PPCM in the second patient was made after exclusion of other causes of heart failure. Both women presenting after delivery, so can generally be treated according to the ESC Guidelines for heart failure. BOARD scheme therapy (Bromocriptine, Oral heart failure therapies, Anticoagulants, vasoRelaxing agents, Diuretic) were used in first patient but we treated the second patient as common heart failure patient without including bromocriptine in therapy. Full recovery found in patient that was diagnosed and treated earlier. Long term management and counselling is essential for these patients.
C75. Premature Coronary Artery Disease in Young Male Patient with Strong Family History
Authors: Kurniawan A , Rohman M S
Published: April 2022

Background

Coronary artery disease (CAD) occurring in less than 45 years of age is termed as premature CAD (PCAD). Recent studies showed a prevalence of 4-10 % of PCAD. PCAD is associated with unfavorable outcomes for the patients and had a greater impact on the quality of life. Family History is the best method to explained complex interaction between shared risk factor.

Case Summary

A 37-years old male admitted to Saiful Anwar Hospital for further evaluation of anginal pain. The patient complains of recurrent chest pain since 5 months ago but still relieved by rest. The electrocardiogram showed Wellens Type B which is specific for critical stenosis of the left anterior descending artery (LAD). Then the patient undergoing DCA Ad Hoc. The implantation of a 46 mm DES at proximal until distal LAD was performed. The patient discharged after a day observation.

Discussion

The challenging point, in this case, was it happen at a young age with strong family history. There was positive family history of PCAD in 1st degree relative on her brother and mother, despite several risk factors were identified in this case consist of smoking, and dyslipidemia, which make CAD risk higher. Despite adequate control of risk factors, family screening is important to reveal subclinical atherosclerosis.
C77. Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction with Acute Kidney Injury caused by Cardiogenic Shock, Is it Really Safe?: A Case Report
Authors: Pamuna O S , Rohman M S
Published: April 2022

Background

ST-elevation myocardial infarction (STEMI) is a life-threatening condition. Timely treatment with Percutaneous Coronary Intervention (PCI) is a recommended management of STEMI. However, PCI in STEMI with Acute Kidney Injury (AKI) was a high-risk procedure with possibilities of worsening renal function.

Case Description

A 53 years old, woman, was referred from a private hospital with STEMI inferior Killip IV onset 5 hours with typical chest pain and azotemia. Creatinine serum was 3.4 mg/dl; eGFR 15 ml/m/1.73m2. Blood Gas Analyses show metabolic acidosis uncompensated. In the emergency room, she got hydration and inotropic drugs. After the PCI procedure, she was fallen into an altered mental status and shock condition. The laboratorium result in our hospital showed improvement of creatinine level to 1.6 mg/dl. We treated this patient for 9 days, with optimal medicaments and fluid therapy. On the last day of treatment, there is an improvement in clinical presentation and laboratorium results.

Discussion

STEMI is a life-threatening condition caused by acute occlusion in the coronary artery. The guideline strongly recommended Primary Percutaneous Coronary Intervention in a patient with STEMI and cardiogenic shock. AKI in STEMI patients was a consequence of acute cardiac condition and its treatment. PPCI in AKI condition can improve renal function due to improvement of renal flow. But on the other side, it can worsen renal function due to contrast-related acute kidney injury. Proper management to prevent worsening of renal function is very important.
C79. Pseudonormalisation ECG Pattern in Wellens’ Syndrome : A Pitfall in front of Our Eyes
Authors: Bahri Z , Lubis H A P , Haykal T B , Hasan H
Published: April 2022

Background

Wellens’ syndrome is a syndrome characterized by biphasic (type A) or deeply inverted T-wave (type B) in the anterior lead, without Q-waves and significant ST elevation, no loss of precordial R-wave progression, normal to minimally elevated cardiac enzymes, and a history of angina.

Case Summary

A 37-years-old male patient was admitted to the emergency department with the chief complaint of typical chest pain lasting for about 1 h. He had type 2 diabetes and a history of smoking. First ECG showed non-specific ST-T changes in the lateral lead. On ECG which was taken two hours later in the pain-free period, deeply inverted T waves were seen in the lead V2 and V3. Troponin I was found as 0.25 ng/mL. The patient was admitted to CVCU and brought to the angiography laboratory next day. A 90%-99% critical proximal LAD occlusion was observed. PCI was successfully performed with drug-eluting stent implantation and good restoration of LAD flow. He was discharged from the hospital on the following day without any complication after coronary intervention.

Discussion

Pseudonormalisation of T wave in pain period could be misinterpreted as normal ECG and could delay coronary angiography and revascularization. We should aware if a patient with typical chest pain came with normal or non-specific ECG changes. Evaluation of ECG in the pain-free period is crucial and leads to the best decision in managing the patient with this syndrome.
C80. Pulmonary Embolism in Congenital Heart Disease with Pulmonary Arterial Hypertension: a Case Series
Authors: Ibrahim M , Saboe A , Kartamihardja A H A , Cool C J
Published: April 2022

Background

Pulmonary arterial hypertension (PAH) is a frequent complication of congenital heart disease (CHD), notably in patients with left-to-right shunts. Patients with severe PAH due to CHD, Eisenmenger syndrome (ES), represent a high-risk group of pulmonary artery (PA) thrombosis patients. We present serial adult cases of CHD with PAH complicated by pulmonary embolism (PE).

Case Description

We found 3 cases of pulmonary embolism on adult congenital heart disease in our center. All of the patients were female, with an age range of 36 to 61 years old. The presenting symptoms were shortness of breath, WHO classification class II-III. All patients were hemodynamically stable. CHD and estimated RV systolic pressure were evaluated with echocardiography. CT-PA was performed in all patients, which findings were supporting PE. All patients were treated with anticoagulation. After three months, right heart catheterization was conducted in two patients, and one patient was refused.

Discussion

The prevalence of PE among adult patient with CHD and PAH range from 17 to 21%. PE was frequently found in older patients, women, and patients with lower oxygen saturation. To date, no uniformity regarding routine prophylaxis anticoagulation therapy in ES due to the high bleeding risk in this population despite being at risk of PA thrombosis. We conclude that risk stratification for PA thrombosis in adult CHD-PAH patients is essential, and further research is needed to prevent PE in this population.
C87. Serial Cases of Cardiovascular Manifestation on Leptospirosis: A Tales of Unfortunate Events
Authors: Ristiansah I H , Arifianto H , Irnizarifka  , Ahmad F , Kusumastuti F , Hafika A N , Myrtha R , Wulandari E L
Published: April 2022

Background

Leptospirosis is a zoonosis disease caused by Leptospira species. It's endemic and has become a major public health issue, especially in tropical regions. Clinical manifestation varies from mild or asymptomatic to severe multiple organ failure. We report cases of severe leptospirosis which complicates supraventricular tachycardia and myoperdicarditis from Universitas Sebelas Maret Academic Hospital.

Case Summary

The first case was a 44-year-old man referred from Internal Medicine Department with Leptospira infection with Weil’s disease. On 5th daycare, the patient was reporting had an episode of tachyarrhythmia, the ECG show SVT-AVNRT, there was no history of arrhythmic events before admitted to the hospital, the echocardiography was normal. The second case was a 67-year-old man who was referred from emergency department with shortness of breath, the ECG reveals diffuse ST-segment elevation in all limb and precordial leads with reciprocal ST-depression at aVR and V1, there was also downsloping of the PR and TP segment on precordial leads (Spodick’s sign), with normal ejection fraction on echocardiographic examination with pericardial thickening. Both patients have hsTroponin levels rose above the normal limit and serological testing found positive leptospira IgM.

Discussion

Severe leptospirosis can cause multi-organ dysfunction including cardiac involvement. The patients, in this case, suffered from leptospirosis with SVT-AVNRT and myopericarditis. The exact pathophysiology is still unclear, but there are several hypotheses, such as cytokine storms and direct damage from leptospira endotoxins. Arrhythmias and cardiac disturbance in leptospirosis patients are associated with poor outcomes and higher mortality rates.
C91. “Successful management of ventricular septal rupture after myocardial infarction in elderly: the role of intra-aortic balloon pump and timing for surgery”: A Case Report
Authors: Pradityawati A , Pradana S Y , Habibi F N , Sidiek A , Safir S
Published: April 2022

Background

Ventricular septal rupture (VSR) after myocardial infarction (MI) is a case with a high mortality rate, early diagnosis and appropriate treatment are essential. Surgical VSR closure though challenging and associated with high mortality, remains one of the main therapy in VSR closure.

Case Presentation

A 70-year-old woman had a complaint about the shortness of breath (SoB). From anamnesis, 17 days before admission, she complained of chest pain. 15 days before admission, she was taken to a local hospital and got hospitalized for 7 days in the intensive care unit. ECG showed anterior MI. During admission, patient developed SoB. From echocardiography, it showed VSR at apical. She was referred to dr. Kariadi hospital for further management.

Coronary angiography showed total occlusion in mid LAD. An intra-aortic balloon pump (IABP) was inserted for stabilized hemodynamic and as bridging. Inotropic support was given and afterload reduction was also administered. Surgical VSR closure and coronary artery bypass grafting (CABG) was successfully performed on the 22nd day after the onset of MI. The patient was discharged 10 days after surgery in a good condition.

Discussion

The mortality of VSR varied significantly depending on the timing of surgery. Patients who underwent surgery within 7 days of presentation had a 54.1% mortality compared with 10 % mortality if the repair was delayed until after 21 days. The cornerstone of preoperative management of VSR is afterload reduction. IABP provides mechanical afterload reduction and augmentation of cardiac output.
C92. Successful Percutaneous Coronary Intervention (PCI) in Rare Case of Anomalous Aortic Origin of the Right Coronary Artery from the Opposite Sinus (AAORCA) Presenting as Inferior ST Elevation Myocardial Infarction (STEMI)
Authors: GK Ahimsa , N Taufiq , BY Setianto
Published: April 2022

Background

AAORCA from opposite sinus is a rare congenital anomaly that can present with symptoms similar to coronary artery disease, even sudden cardiac death. AAORCA with Inferior STEMI is a rare combination situation. Management of acute myocardial infarction with AAORCA is not well established and still debatable.

Case Summary

We presented a case 61 years old aged male with STEMI and AAORCA. He admitted to our hospital with complaint of retrosternal chest pain with ST segment elevation in inferior lead thus we diagnosed as Inferior STEMI. He underwent an emergency coronary angiography (CAG) that showed anomalous of right coronary artery (RCA) and total occlusion of the proximal RCA with atherosclerotic lesion. Stent then implanted at proximal of RCA. Further work-up by Computed Tomography Angiography (CTA) revealed an AAORCA with interarterial course.

Discussion

AAORCA with interarterial course that presents as inferior STEMI is a rare case. Diagnosis requires CAG and coronary CTA to identify anatomy and physiology so revascularization can be carried out appropriately. It is still arguable whether atherosclerosis or the interarterial course of AAORCA that caused acute MI. There is evidence that anomalous coronary arteries doesn’t increase atherosclerosis risk than normal. Total occlusion located at the distal to interarterial course reinforce that atherosclerosis may be the possible cause of acute MI. PCI could be the preferred choice in patients with inferior STEMI accompanied by AAORCA with evidence of atherosclerotic lesion, because may result in complete reperfusion and good clinical outcome.
C99. Torsade de pointes in coronavirus disease 2019 patient: hypopotassemia, cardiac injury, and drug-induced arrhythmia
Authors: Shandy C A , Jayantika I G A B K
Published: April 2022

Background

Coronavirus disease 2019 (COVID-19) is a viral disease with wide spectrum of clinical manifestation. Malignant arrhythmia had been reported, however the exact mechanism remains unclear. We present a case of Torsade de Pointes (TdP) in COVID-19 patient.

Case Description

A 28 years old female, post caesarean section, confirmed COVID-19, was consulted to cardiology department due to acute lung oedema and premature ventricular complex (PVC) bigeminy. Oxygen saturation dropped to 78% with non-rebreathing mask, so she was intubated. She got furosemide and amiodarone drip. Later on, she developed pulseless ventricular tachycardia, TdP. Defibrillation 200 J was done and MgSO4 2 gram intravenous bolus was delivered. The rhythm converted to normal sinus rhythm, with prolonged QT Interval (503 ms). Potassium level was 2.7, hs-troponin I level was 510.6, and IL-6 level was 33.95. Echocardiogram showed global normokinetic with EF 64% on dobutamin. Amiodarone was stopped. She got MgSO4 drip and potassium chloride drip.

Discussion

Cardiac involvement in COVID-19 are common. Possible mechanisms are systemic inflammation and cytokine storm, as shown by increased IL-6. Cardiac injury, marked by increased hs-troponin I, causes abnormal conduction and prolonged repolarization due to interstitial edema and cardiac fibrosis, with abnormal Ca2+ handling and down regulation of K+ channels. These, together with QT-prolonging effect of amiodarone and hypokalemia, hypoxia, or neurohormonal stress, can induce TdP. Early treatment, ECG monitoring, and correcting electrolyte imbalance are very crucial in COVID-19. Once lethal arrhythmia ensues, proper anti-arrhythmia administration and withdrawal of contributing medications can prevent mortality.
C100. Torsades de Pointes (Polymorphic VT) as a Manifestation in Hypothyroid Patient’s: A Case Report
Authors: Akina M T , Muzakkir A
Published: April 2022

Background

Hypothyroidism is a common endocrine disorder with varying abnormalities including cardiac manifestations consisting of structural, functional, and electrical conduction problems especially in severe cases. Torsades de pointes (TdP) is a very rare initial presentation in a patient with hypothyroidism. We report a patient with severe hypothyroidism manifest with life-threatening arrhythmias.

Case Description

A 48-year-old man who underwent emergency resuscitation suffering from cardiac arrest. On admission, the patient collapsed and was unresponsive. Electrocardiography (ECG) showed QT interval prolongation, and polymorphic ventricular tachycardia (TdP). Laboratory test revealed marked hypokalemia (potassium concentration of 2.6 mmol per liter) and unexpected severe hypothyroid (Free T4 (FT4) was <0.07 [normal 0.93-1.71] μg/dl; thyroid-stimulating hormone (TSH) was >60.0 [normal 0.27-4.20] mIU/mL). Temporary cardiac pacing was placed for managing specific arrhythmias. The patient was also treated with levothyroxine 100 μg per day, and the underlying electrolyte disturbance was corrected. Treatment with levothyroxine was continued in outpatient clinic. ECG and thyroid tests were returned to normal limit within six weeks.

Discussion

Clinicians need to highlight that TdP is relatively rare in hypothyroidism. Early diagnosis and prompt management were needed due to potential fatal cardiac manifestation if left untreated. All patients with overt hypothyroidism with TSH >10 mIU/L should be treated. Administration of levothyroxine is a mandatory treatment and should be monitored carefully and safely to eliminate arrhythmias.
C103. Viral Myocarditis Mimicking Acute Myocardial Infarction: A Case Report
Authors: Seriulina R A , Martanto E
Published: April 2022

Background

Acute myocarditis still challenging diagnosis in cardiology. Its entity is rarely recognized and its pathophysiology defectively understood. Viral infection remains the most commonly identified cause for myocarditis, but bacteria, fungi, protozoa, and helminths have also been implicated.

Case Summary

A 61 years old female was admitted to emergency department, complaining typical angina since 12 hours prior to admission. She also complains nausea, vomit, flu like syndrome, and low grade fever since 1 weeks prior to admission. She was a former smoker and had hypertension. ECG in 6 hours on admission ECG revealed sinus rhythm, ST-elevation anteroseptal, ischemic lateral-high lateral and there is no evolution compare to previous ECG which taken in other hospital. Laboratory findings showed increased of troponin enzyme. Coronary angiography was performed with result normal coroner. Echocardiography revealed normal all chambers, concentric LV remodelling, normal LV systolic function with ejection fraction 51% without regional wall motion abnormalities. On the next day, troponin levels decrease and the ECG remain abnormal without any changes. In order to get more data, CMR was planned, but she refused. Patients was discharged uneventful.

Discussion

Myocarditis is challenging diagnosis due to the heterogenicity clinical presentation. It presents in many different ways, ranging from mild “flu-like” symptoms, mild symptoms of chest pain and palpitations associated with transient ECG changes. Chest pain in acute myocarditis may mimic typical angina and be associated with electrocardiographic changes, including ST-segment elevation and often misdiagnosed as ACS until coronary angiography demonstrates normal or non-obstructive coronary arteries.
Integrative multi-omics database (iMOMdb) of Asian pregnant women
Authors: Pan Hong , Tan Pei Fang , Lim Ives Y , Huan Jason , Teh Ai Ling , Chen Li , Gong Min , Tin Felicia , Mir Sartaj Ahmad , Narasimhan Kothandaraman , Chan Jerry K Y , Tan Kok Hian , Kobor Michael S , Meikle Peter J , Wenk Markus R , Chong Yap Seng , Eriksson Johan G , Gluckman Peter D , Karnani Neerja
Published: April 2022

Asians are underrepresented across many omics databases, thereby limiting the potential of precision medicine in nearly 60% of the global population. As such, there is a pressing need for multi-omics derived quantitative trait loci (QTLs) to fill the knowledge gap of complex traits in populations of Asian ancestry. Here, we provide the first blood-based multi-omics analysis of Asian pregnant women, constituting high-resolution genotyping (N = 1079), DNA methylation (N = 915) and transcriptome profiling (N = 238). Integrative omics analysis identified 219 154 CpGs associated with cis-DNA methylation QTLs (meQTLs) and 3703 RNAs associated with cis-RNA expression QTLs (eQTLs). Ethnicity was the largest contributor of inter-individual variation across all omics datasets, with 2561 genes identified as hotspots of this variation; 395 of these hotspot genes also contained both ethnicity-specific eQTLs and meQTLs. Gene set enrichment analysis of these ethnicity QTL hotspots showed pathways involved in lipid metabolism, adaptive immune system and carbohydrate metabolism. Pathway validation by profiling the lipidome (~480 lipids) of antenatal plasma (N = 752) and placenta (N = 1042) in the same cohort showed significant lipid differences among Chinese, Malay and Indian women, validating ethnicity-QTL gene effects across different tissue types. To develop deeper insights into the complex traits and benefit future precision medicine research in Asian pregnant women, we developed iMOMdb, an open-access database.
Activity of fosfomycin/colistin combinations against planktonic and biofilm Gram-negative pathogens
Authors: Boncompagni Selene Rebecca , Micieli Maria , Di Maggio Tiziana , Aiezza Noemi , Antonelli Alberto , Giani Tommaso , Padoani Gloria , Vailati Silvia , Pallecchi Lucia , Rossolini Gian Maria
Published: April 2022

Objectives

To investigate the in vitro activity of fosfomycin, colistin and combinations thereof against planktonic and biofilm cultures of Gram-negative pathogens, mostly showing MDR phenotypes, at concentrations achievable via inhalation of aerosolized drugs.

Methods

Activity against planktonic cultures was tested by the chequerboard assay with 130 strains, including 52 Pseudomonas aeruginosa, 47 Klebsiella pneumoniae, 19 Escherichia coli, 7 Stenotrophomonas maltophilia and 5 Acinetobacter baumannii. Activity against biofilm cultures was tested by biofilm chequerboard and quantitative antibiofilm assays with a subset of 20 strains. In addition, 10 of these strains were tested in mutant prevention concentration (MPC) assays.

Results

Against planktonic cultures, synergism between fosfomycin and colistin was detected with a minority (10%) of strains (eight K. pneumoniae and five P. aeruginosa), while antagonism was never observed. Synergism between fosfomycin and colistin against biofilms was observed with the majority of tested strains (16/20 in biofilm chequerboard assays, and 18/20 in the quantitative antibiofilm assays), including representatives of each species and regardless of their resistance genotype or phenotype. Furthermore, combination of fosfomycin and colistin was found to significantly reduce the MPC of individual drugs.

Conclusions

Fosfomycin and colistin in combination, at concentrations achievable via inhalation of nebulized drugs, showed notable synergy against MDR Gram-negative pathogens grown in biofilm, and were able to reduce the emergence of fosfomycin- and colistin-resistant subpopulations.
Medium-run local economic effects of a major earthquake
Authors: Aguirre Paula , Asahi Kenzo , Diaz-Rioseco Diego , Riveros Ignacio , Valdés Rodrigo O
Published: April 2022

Existing research is inconclusive regarding the longer-term economic effects of earthquakes. We examine the medium-run impacts of the 2010 earthquake in Chile, the sixth-largest ever recorded, using value-added tax collection as a proxy for economic activity at the municipal level and a measure of local ground-shaking intensity. We find that the affected municipalities suffered a relevant and persistent drop in their economic activity of about 10%, 8–9 years after the event. We discuss the plausibility of the assumption of conditional parallel trends and show that the overall results are robust to using alternative estimation methods.
Dark secrets of phytomelatonin
Authors: Chen Qi , Hou Suying , Pu Xiaojun , Li Xiaomin , Li Rongrong , Yang Qian , Wang Xinjia , Guan Miao , Rengel Zed
Published: April 2022

Phytomelatonin is a newly identified plant hormone, and its primary functions in plant growth and development remain relatively poorly appraised. Phytomelatonin is a master regulator of reactive oxygen species (ROS) signaling and acts as a darkness signal in circadian stomatal closure. Plants exhibit at least three interrelated patterns of interaction between phytomelatonin and ROS production. Exogenous melatonin can induce flavonoid biosynthesis, which might be required for maintenance of antioxidant capacity under stress, after harvest, and in leaf senescence conditions. However, several genetic studies have provided direct evidence that phytomelatonin plays a negative role in the biosynthesis of flavonoids under non-stress conditions. Phytomelatonin delays flowering time in both dicot and monocot plants, probably via its receptor PMTR1 and interactions with the gibberellin, strigolactone, and ROS signaling pathways. Furthermore, phytomelatonin signaling also functions in hypocotyl and shoot growth in skotomorphogenesis and ultraviolet B (UV-B) exposure; the G protein α-subunit (Arabidopsis GPA1 and rice RGA1) and constitutive photomorphogenic1 (COP1) are important signal components during this process. Taken together, these findings indicate that phytomelatonin acts as a darkness signal with important regulatory roles in circadian stomatal closure, flavonoid biosynthesis, flowering, and hypocotyl and shoot growth.
DeepLoc 2.0: multi-label subcellular localization prediction using protein language models
Authors: Thumuluri Vineet , Almagro Armenteros José Juan , Johansen Alexander Rosenberg , Nielsen Henrik , Winther Ole
Published: April 2022

The prediction of protein subcellular localization is of great relevance for proteomics research. Here, we propose an update to the popular tool DeepLoc with multi-localization prediction and improvements in both performance and interpretability. For training and validation, we curate eukaryotic and human multi-location protein datasets with stringent homology partitioning and enriched with sorting signal information compiled from the literature. We achieve state-of-the-art performance in DeepLoc 2.0 by using a pre-trained protein language model. It has the further advantage that it uses sequence input rather than relying on slower protein profiles. We provide two means of better interpretability: an attention output along the sequence and highly accurate prediction of nine different types of protein sorting signals. We find that the attention output correlates well with the position of sorting signals. The webserver is available at services.healthtech.dtu.dk/service.php?DeepLoc-2.0.
Phosphorylation of the FACT histone chaperone subunit SPT16 affects chromatin at RNA polymerase II transcriptional start sites in Arabidopsis
Authors: Michl-Holzinger Philipp , Obermeyer Simon , Markusch Hanna , Pfab Alexander , Ettner Andreas , Bruckmann Astrid , Babl Sabrina , Längst Gernot , Schwartz Uwe , Tvardovskiy Andrey , Jensen Ole N , Osakabe Akihisa , Berger Frédéric , Grasser Klaus D
Published: April 2022

The heterodimeric histone chaperone FACT, consisting of SSRP1 and SPT16, contributes to dynamic nucleosome rearrangements during various DNA-dependent processes including transcription. In search of post-translational modifications that may regulate the activity of FACT, SSRP1 and SPT16 were isolated from Arabidopsis cells and analysed by mass spectrometry. Four acetylated lysine residues could be mapped within the basic C-terminal region of SSRP1, while three phosphorylated serine/threonine residues were identified in the acidic C-terminal region of SPT16. Mutational analysis of the SSRP1 acetylation sites revealed only mild effects. However, phosphorylation of SPT16 that is catalysed by protein kinase CK2, modulates histone interactions. A non-phosphorylatable version of SPT16 displayed reduced histone binding and proved inactive in complementing the growth and developmental phenotypes of spt16 mutant plants. In plants expressing the non-phosphorylatable SPT16 version we detected at a subset of genes enrichment of histone H3 directly upstream of RNA polymerase II transcriptional start sites (TSSs) in a region that usually is nucleosome-depleted. This suggests that some genes require phosphorylation of the SPT16 acidic region for establishing the correct nucleosome occupancy at the TSS of active genes.