bluuebunny/crossref_metadata_2025 huggingface dataset:
The Woolfes of Wine Street: Middling Culture and Community in Bristol, 1600–1620
Authors: Davies Callan
Published: April 2022

This article provides an in-depth cultural study of England’s urban middling sort—those in-between wage labourers and the gentry—at the beginning of the seventeenth century, concentrating on one community in a major street in Bristol. This demographic has long been of interest to historians seeking to understand the major social changes of the early modern period, but little is known about the total urban experience of such individuals prior to the Restoration. Wine Street was home to goldsmiths’ standings and shops, instrument-makers, inn-holding widows, aldermen, mayors, and one of the longest-running playhouses in early modern England outside of London—a venue run by Nicholas and Margaret Woolfe. This study seeks to understand more about the everyday lives of this crucial demographic through a holistic micro-history of one particular community—grounding them in a specific place and time and providing an earlier case-study than is generally available in existing literature. Doing so demonstrates how middling status was complicated and defined by neighbourhood, marriage, widowhood, and inheritance. More widely, this group of Wine Street tradespeople, artisans and proprietors lived in a location that was in large part distinguished by forms of ‘play’, the elastic early modern term used here to refer to various forms of commercial recreation, from drama to inn-going to luxury shopping. I establish how, in such urban environments, middling status can be distinctly recognised in the imbrication of play with cultural and commercial identity.
Apical root resorptions in girls with Turner syndrome: a controlled longitudinal study
Authors: Kjellberg Heidrun , Lundgren Ted , Barrenäs Marie Louise , Rizell Sara
Published: April 2022

Objectives

To study, longitudinally, the development of apical root resorptions (ARRs) in Turner syndrome (TS) and to correlate these to the karyotype and orthodontic treatment.

Materials and methods

Thirty girls with TS participated in the study, mean age 10.8 years (6.6–23.4) at the first registration (T1), and 14.3 years (9.2–25.2) at the second registration (T2). Forty girls without TS, orthodontically untreated, served as controls. ARR was diagnosed in panoramic radiographs, and root/crown ratios of the lower permanent first molar were measured at T1 and T2 with a mean follow-up period of 42 (11–89) months.

Results

During the follow-up period, ARR was seen in 40% of all TS patients and in 2.5% in the control group. The majority displayed ARR on the distal root of the mandibular first permanent molars (30%). ARR at T2 was seen in 56% of 45,X and isochromosome karyotype and 21% of every other TS karyotype patients. AAR was seen in 5 out of 12 TS patients with orthodontic treatment. No statistically significant differences in root/crown ratios between T1 and T2 were found.

Limitations

The number of patients studied is limited, thus possible differences might be disguised for this reason. Spatial projection errors in panoramic radiograph recordings might have influenced measurement, resulting in an underestimation of ARR.

Conclusions

There is a higher risk for ARR in girls with TS and probably the risk is therefore probably also higher during orthodontic treatment. Thus, if treated, frequent radiographic follow-ups should be taken during the treatment.

Protocol

The protocol was not published before trial commencement.
Careers in arm’s-length contracting: evidence from the Chilean wine-grape market
Authors: Jano Pilar , Hueth Brent
Published: April 2022

This paper investigates the presence of career and promotion-based incentives in the context of arm’s-length contracting between wineries and independent wine-grape farmers. We hypothesise that long-term contracts represent a stage in a farmer’s career after a series of short-term contracts. We develop a conceptual framework to frame the interaction between explicit performance incentives and implicit career incentives arising from the possibility of promotion to a long-term contract, conditional on wineries learning a farmer’s potential for superior-quality production. Based on data from Chilean wine-grape farmers, we find evidence suggesting that implicit market-based incentives, usually studied in the context of employment contracts, are also important in arm’s-length contracts used in procurement of farm output.
OR25. D-dimer characteristics in moderate to severe COVID-19 confirmed patients with fragmented QRS in Hermina Daan Mogot Hospital period August 2020-February 2021
Authors: Angelina A , Chandranegara A F
Published: April 2022

Aims

Fragmented QRS (fQRS) finding in ECG is one of the independent factors responsible for high mortality due to COVID-19. Other factor such as D-dimer is also worth noting as mortality risk increases in patients with higher values. In this study, we described D-dimer characteristics in COVID-19 patients with fQRS in Hermina Daan Mogot Hospital (HDMH).

Methods and Results

Cross-sectional descriptive study was performed in HDMH from May 1st to June 3rd 2021 in moderate to severe COVID-19 confirmed patients with fQRS finding.

Twenty six patients (100%) were included in this study, with 17 (65.4%) subjects are male and 9 (34.6%) being female. Average age of the subjects was 53.65 ± 9.69 years old. fQRS in inferior lead was found in 17 (65.4%) subjects and 1 (3.8%) subject with LBBB. Other leads include 7 (26.9%) in anterior, 1 (3.8%) in lateral, and 1 (3.8%) in infero-lateral lead.

Nineteen (73.1%) subjects were diagnosed with severe COVID-19, and 7 (26.9%) were moderate. Total of intubated patients were 17 (65.4%). Sixteen (61.5%) patients died.

D-dimer value was grouped into <230 ng/mL, 230-500 ng/mL, 501-2000 ng/mL and >2000 ng/mL. Each groups had 3 (11.5%), 3 (11.5%), 15 (57.7%) and 5 (19.2%) subjects. The number of deceased patients in each group was 0 (0%), 1 (33.3%), 10 (66.7%) and 5 (100%), respectively.

Conclusion

According to data collected, there is a connection between mortality of moderate to severe COVID-19 patients with fQRS finding which is increases as D-dimer value rises.
OR34. Evaluation of P wave abnormalities in newly diagnosed COVID-19
Authors: Mulawarman Rido , Ramadhan Muhammad Syahrul , Trifitriana Monica , Mulawarman Hisham , Nurmansyah Muhammad Ikhsan , Halim Rolando Agustian , Maulana Chandra Chandra Agung , Tondas Alexander Edo
Published: April 2022

Aims

The aim of the current study was to evaluate P wave abnormalities, including prolonged P wave duration, prolonged P wave dispersion (PWD) and abnormal P wave axis (PWA) in newly diagnosed COVID-19 patients.

Methods and Results

This is a cross-sectional, single center study with a total of 53 newly diagnosed COVID-19 patients (confirmed with polymerase chain reaction (PCR) test) and 63 age and sex-matched control subjects were included in the study. P wave dispersion, maximum P wave duration, and PWA were calculated manually from 12-lead ECG. Patients with COVID-19 more often had prolonged PWD, defined as PWD ≥ 36 ms compared to control group (37,7% vs 15,9%), (OR = 3,212; 95%CI 1,34 – 7,70; p = 0,007). There were no significant association between COVID-19 and prolonged P wave (defined as maximum P wave duration > 106 ms) (OR = 1,446; 95%CI 0,454 – 4,6; p = 0,531) and abnormal PWA (defined as any value of PWA outside 0 to 75°) (OR = 5,061; 95%CI 0,548 – 46,74; p = 0,115).

Conclusion

Our study showed that COVID-19 patients are more likely to have prolonged PWD compared to control patients. However, COVID-19 was not significantly associated with prolonged P wave and abnormal PWA. We believe that initial non-invasive evaluation of PWD may serve as a predictor of atrial arrhytmias often found in COVID-19 patients.
OR47. Index of Cardiac Electrophysiological Balance (iCEB) in Patients with COVID-19
Authors: Mulawarman Rido , Ramadhan Muhammad Syahrul , Trifitriana Monica , Mulawarman Hisham , Nurmansyah Muhammad Ikhsan , Maulana Chandra Agung , Tondas Alexander Edo
Published: April 2022

Aims

We aimed to examine whether there is abnormal value of index of cardiac electrophysiological balance (iCEB=QT/QRS) in patients with confirmed coronavirus disease 2019 (COVID-19), which can predict ventricular arrhythmias (VAs), including non-Torsades de Pointes-like ventricular tachycardia/ventricular fibrillation (non-TdPs-like VT/VF) in low iCEB and Torsades de Pointes (TdPs) in high iCEB. We also investigated low voltage ECG among COVID-19 group.

Methods and Results

This is a cross-sectional, single center study with a total of 53 newly diagnosed COVID-19 patients (confirmed with polymerase chain reaction (PCR) test) and 63 age and sex-matched control subjects were included in the study. Electrocardiographic marker of iCEB were calculated manually from 12-lead ECG. Low voltage ECG defined as peak-to-peak QRS voltage less than 5 mm in all limb leads and less than 10 mm in all precordial leads. Patients with COVID-19 more often had low iCEB, defined as iCEB below 3.24 compared to control group (56.6% vs 11.1%), (OR = 10.435; 95%CI 4.015 – 27.123; p = 0.000). There were no significant association between COVID-19 and high iCEB, defined as iCEB above 5.24 (OR = 1.041; 95%CI 0.485 – 2.235; p = 0.917). There were no significant difference of the number of low voltage ECG between COVID-19 and control groups (15.1% vs 6.3%), (OR = 2.622; 95%CI 0.743 - 9.257, p = 0.123).

Conclusion

In this study showed that patients with COVID-19 are more likely to have low iCEB, suggesting that patients with COVID-19 may be proarrhytmic (towards non-TdPs-like VT/VF event), due to the alleged myocardial involvement in SARS-CoV-2 infection.
OR57. Role of Copeptin as a Predictor of Major Adverse Cardiovascular Events (MACE) During Hospitalization on Acute Myocardial Infarction Patient
Authors: Wiratama I P R S , Wasyanto T
Published: April 2022

Aims

Copeptin has been considered as a potential biomarker for AMI which also give information regarding the prognostic of the Acute myocardial infarction (AMI). The aim of this study is to understand the role of copeptin as a predictor of major adverse cardiovascular events (MACE) during hospitalization in AMI patients.

Methods and Results

This was a cohort analytical study on AMI patient at Dr. Moewardi Hospital, whether with STEMI or NSTEMI. We observe the MACE during hospitalization and analyze the cut-off point value for optimal copeptin levels to predict the occurrence of MACE using the ROC curve. Linear multiple regression was conducted to predict determinants of MACE in hospitalization patients. 52 patients recruited in this research (44 males, 8 females). During hospitalization, MACE occurred in 52% of these subjects, with the respective proportions for acute heart failure, cardiogenic shock, arrhythmias, cardiopulmonary resuscitation, and mortality of 28%, 10%, 8%, 4%, and 2%. The ROC curve showed that the cut-off point of copeptin was 2,141.50 pg/mL and area under curve (AUC) value of 0.710 with sensitivity of 75.0%, specificity of 68.80% and accuracy of 71.15%. Hence, the AUC values and accuracy present fair results for predicting MACE during hospitalization in AMI patients.

Conclusion

Copeptin has a role as a predictor of MACE during hospitalization in AMI patients.
OR66. The effect of combination bisoprolol therapy with quality of life in heart failure preserved ejection fraction (HFpEF)
Authors: Adityawati A D , Rohman M S , Rahimah A F , Sargowo D , Anjarwani S
Published: April 2022

Background and Aims

This study aimed to observe and evaluate the effect of bisoprolol in the improvement of HFpEF patient’s QoL. As we know, Global Public Health Burden of Heart Failure reported the growing prevalence of heart failure in 2020 and half of the case classified as HFpEF. It is well known that someone who have been diagnosed with heart failure will have a poorer quality of life/QoL. β-blocker is a heart rate lowering agent with a potency to improve the patient’s clinical outcome, such as QoL.

Methods and Results

This study is a retrospective cohort following HFpEF patients who received bisoprolol and who did not received bisoprolol. The study participant selected by purposive sampling method, who meet inclusion and exclusion criteria. This research was analysed by SPSS 25 version. It used comparasion test and regresion test to determine differences in the effects of using bisoprolol and which combination was good for lowering the MLHFQ score. The result of comparison between bisoprolol grup and non-bisoprolol grup showed a significance value of 0.000 (p < 0.05). Meanwhile, if bisoprolol are combined with other drugs, only the combination of 2.5 mg bisoprolol with ACE-Inhibitor has a significant effect on QoL (p total score 0.007)

Conclusion

We conclude that the use of bisoprolol as combination therapy is usefull for management HFpEF, because it showed improvement in the HFpEF patient’s QoL.
OR72. The relationship between diabetes mellitus and homocysteine level in peripheral arterial disease population in mataram city
Authors: Anthony L M , Yanna I , Deasy I , Catarina B , Herpan S H
Published: April 2022

Background

Peripheral Arterial Disease (PAD) is partial or total blockage of blood vessel caused by occlusive atherosclerosis especially in lower extremity. Hyperhomocysteinemia had been used as a biomarker of cardiovascular disease such atherosclerosis formation process. Previous study have reported higher incidence of homocysteine level in patient with Diabetes Mellitus (DM) type 2. However, data on homocysteine level in PAD patient with DM type 2 is limited. Therefore, this study aim to investigate the comparation between DM and homocysteine level in PAD patient in Mataram City.

Methods and Results

This study is a cross sectional study conducted at Siti Hajar Islamic Hospital in Mataram City. The sample was patients with PAD with an ankle brachial index score <0.90 and DM type 2. The outcome of this study was homocysteine level on DM PAD patient and non-DM PAD patient. Data analysis using the unpaired T test. fifty-two PAD patients in this study, with 75% female (39) and average age of 57.4 years old in this research. The average homocysteine level in PAD patient with DM (5.7±0.9 µmol/L) was significantly higher than those in non-DM PAD patient (4.8±1.0 µmol/L) (p = 0.001). We found that history of hypertension was significantly higher in non-DM PAD patient and ankle brachial index score was significantly lower in DM PAD patient (p = 0.049).

Conclusion

There is a significant differences of homocysteine level within DM patient compared to non-DM patient.
OR77. The Struggle of Improving Ejection Fraction in Heart Failure, Does Patient Adherence Has a Significant Role? A Single-Centre Pilot Study from CORE-HF Registry
Authors: Kusumastuti Irnizarifka F , Arifianto H , Ristiasah I H , Hafika A N , Myrtha R
Published: April 2022

Aim

Despite the development of its treatment, adherence is an important factor in reducing the mortality and morbidity of heart failure. This study aims to see the correlation between patient adherence and improvement of ejection fraction (EF) in a Heart Failure patients.

Method and Result

This is a retrospective cohort study held in HF Clinic UNS Hospital from CORE-HF (COmprehensive Registry and rEsearch on Heart Failure). The adherence was measured using MMAS-8. The total score was grouped into three categories; high = 8, moderate = 6 to < 8, and poor < 6. For HFrEF patient, the EF improvement within 12 months is grouped into; Recovery (EF evaluation > 50%), improved (EF evaluation > 40%), and none (EF evaluation < 40%). For HFmrEF and HFpEF, the change of EF is categorized into increased more than 10%, < 10%, and decreased. Among 130 patients, 47.7% have poor adherence, 58% moderate adherence, and 10% high adherence. The characteristics of the samples were 60.8% male, with a mean age of 57 years old, 10% with Atrial Fibrillation, 34.6% with CAD, 36% with HFrEF, 15% with HFmrEF, and 48% patients have HFpEF. Among HFrEF, the Kruskal-Wallis test showed a statistically significant difference in EF improvement between the adherence groups (χ2 (2) = 7.860; p = 0.02). This study also found a significant difference in EF improvement among adherence groups between HFmrEF and HFpEF (χ2 (2) = 9.159; p = 0.010)

Conclusion

Besides optimal medical therapy, patient adherence has an important role in improving EF.
M2. Cardiorenal anaemia syndrome vs left ventricular ejection fraction: which is a better mortality prognostic factor for heart failure? A systematic review and meta-analysis
Authors: Laurentius Andrea , Wiyono Lowilius , Subali Anita Dominique , Rossimarina Vienna
Published: April 2022

Aim

Cardiorenal anaemia syndrome (CRAS) involves a vicious interaction between heart failure (HF), chronic kidney disease, and anaemia. CRAS is associated with higher morbidity, mortality, and health care cost. This study investigated CRAS as a predicting factor of all-cause mortality compared to left ventricular ejection fraction (LVEF) in HF patients as one of the established classifications being linked to prognosis in HF.

Methods and Results

A systematic review based on PRISMA guidelines was performed on 6 scientific databases (PubMed, ProQuest, Scopus, ScienceDirect, Springer) with search terms related to left ventricular ejection fraction, heart failure, and cardiorenal anaemia syndrome. Original English case-control and cohort studies in heart failure participants which analyzed hazard ratio (HR) of all-cause mortality were considered eligible. The quality assessment was evaluated with New Castle Ottawa Scale (NOS). A total of 17 studies comprising 90,092 participants from more than 14 countries were included in the qualitative analysis with eleven subjected to meta-analysis. The presence of CRAS aligns with a significantly higher mortality rate (HR 1.64 [95% CI 1.44 – 1.87]) as compared to current classification based on ejection fraction obtained insignificant clinical outcomes of reduced ejection fraction HF (HFrEF) (HR 1.06 [95% CI 0.98 – 1.15]) in the pooled analysis. 

Conclusion

CRAS is a significant death prognosticator and indicates a worse prognosis in HF patients as compared to HF patients with reduced ejection fraction. CRAS is a potential alternative prognostic factor for heart failure patients to predict mortality outcomes.
M18. Three-year cardiovascular outcome of SGLT-2 Inhibitor in patient with Type 2 Diabetes Mellitus: a Meta-Analysis of Randomized Control Trial
Authors: Mukhammad W W , Kembangsari C , Santoso Y A A J , Mukti I R , Putra H B P , Adiwinoto R P , Adiwinoto R D
Published: April 2022

Aims

SGLT-2 Inhibitor is an anti-diabetic drug. SGLT-2 Inhibitor has favourably effect in cardiovascular outcomes. However, the three-year cardiovascular outcomes of SGLT-2 Inhibitor in Type-2 Diabetes Mellitus remains unclear. We performed meta-analysis to evaluate cardiovascular outcomes in three-years of SGLT-2 Inhibitor therapy.

Methods

We performed a systematic literature search from various electronic databases. We used keywords “SGLT-2 Inhibitor”, “Type-2 Diabetes Mellitus”, and “Cardiovascular outcome”. Inclusion criteria for research is Randomized Control Trial and 3-year follow-up. Primary endpoint is Major Adverse Cardiovascular Event (MACE). Secondary endpoints are all-cause mortality, cardiovascular mortality and hospitalization of heart failure. Risk ratio (RR) with 95% confidence interval were used to report all outcomes.

Results

Total of two Randomized Control Trial was selected (EMPA-REG [Jardiance®] and VERTIS-CV [Steglatro®] trial) with 15.266 patients pooled in our analysis. Results of three-year primary outcome compared SGLT-2 Inhibitor with Placebo had no significant reduction in MACE (RR = 0.93 [95% CI, 0.81–1.07], p = 0.32; I2=56%). Result of secondary outcome showed no significant reduction in all-cause mortality (RR = 0.80 [95% CI, 0.60-1.08], p = 0.15; I2=85%) and cardiovascular mortality (RR = 0.77 [95% CI, 0.52–1.12], p = 0.17; I2=87%). However, there are significant reduction in hospitalization of heart failure (RR = 0.68 [95% CI, 0.57–0.82], p < 0.00001; I2=0%).

Conclusion

SGLT-2 Inhibitor in Type-2 Diabetes Mellitus has significant reduction in hospitalization of heart failure. However, no significant results were found in MACE, all-cause mortality, and cardiovascular mortality after 3-year follow-up.
C4. Acute Limb Ischemia in Covid-19 Patient : A Rare Case Report from Rural to Tertiary Hospital
Authors: Sekaringtyas E , Handari S D , Sembiring Y E
Published: April 2022

Background

Acute limb ischemia is defined as a decrease in blood perfusion to the limbs caused by blockages in peripheral arteries. Coronavirus disease 19 (COVID 19), declared as a pandemic by WHO, affects not only respiratory system but also other organs including cardiovascular system. Patients mainly manifests as venous thromboembolism, while peripheral arteries blockages is less common.

Case Summary

A 53 years old man came to emergency room complaining of pain in his left leg. It was felt since the third day of treatment at the previous hospital, in Tuban, as a covid patient one month ago. The first and third of his left toes were also blackish. There was no history of hypertension, diabetes or smoking. On laboratory result, D-dimer level was elevated by 745 ng/ml (normal range <500 ng/ml), while the others within normal limit. CT Angiography examination showed bilateral legs arterial thrombus which the left side was worse. A thrombectomy was performed, then heparin therapy intravenously was given. During observation at the 4th day after surgery, the sign of necrotic border in the 1st dan 3rd toes were seen clearer and we decided to do mutilation.

Discussion

The pathophysiology of acute limb ischemia in Covid-19 patients is known multifactorial, including endothelial damage, immobilization and hypercoagulable states that have a role in the occurrence of blockages. They may also have an acute thrombosis of non atherosclerotic native arteries. An immediate anticoagulants and vascular interventions are needed to reduce its morbidities.
C11. Aorto-Pulmonary Window in Tetralogy of Fallot with Absent Pulmonary Valve Syndrome : A Rare Case Report
Authors: Suryawan Willy , Sakidjan Indriwanto
Published: April 2022

Background

Aorto-pulmonary window and Tetralogy of Fallot with absent pulmonary valve syndrome (TOF-APVS) are very rare entities. The combination of the two defects in adolescence patient made the diagnosis based on standard imaging modalities challenging.

Case Illustration

14-year-old boy was referred from Borneo Hospital with failure to thrive and shortness of breath symptoms. He was underwent multiple modalities procedure and it shows the presences of features of tetralogy of Fallot : right ventricular hypertrophy, sub-aortic ventricular septal defect and pulmonary infundibular stenosis. Pulmonary valve leaflets are not seen with mild dilatation of the main and left pulmonary artery (Absent PV syndrome) and a connection from Pulmonary Artery and Ascending Aorta (Aorta-Pulmonary Window)

Discussion

TOF-APVS is a relatively rare variant of TOF. Its co-existence with Aorto-Pulmonary Window make this case was very exceptional. There are only a few reported cases diagnosed with TOF-APVS in adult age in the literature as most of them are diagnosed at younger ages. The unique physiology due to the large connection of Ascending aorta and the main pulmonary artery resulting in L-R Shunt. The large connection from Ascending Aorta to Main Pulmonary artery (L-R Shunt) prompt this patient to pulmonary hypertension (before and after surgery) and heart failure, hence initial treatment of ACE-I and sildenafil was very necessary.
C12. Atrial Fibrillation post Sinovac-Coronavac Vaccine : A Case Report
Authors: Rismawanti R I , Lalitya W , Rachmanadi M B , Gumilang R A
Published: April 2022

Background

COVID-19 has become a global pandemic. Vaccines are currently used to reduce the morbidity and mortality of the disease. However, research regarding the use of the vaccine is still ongoing. Atrial fibrillation (AF) is one of the rare findings after receiving the COVID-19 vaccine.

Case Summary

A man, 64 years old, presented to the ER with palpitation an hour before admission. He refused to have any angina symptoms. Previously, he got a Sinovac-Coronavac injection one day before. On examination, BP 100/60, HR 114, RR 24, SpO2 99% room air, sub-febrile, other findings within normal limits. ECG showed AF with rapid ventricular response. A routine blood test showed no abnormality, rapid antigen SARS-COV2 negative, and hs Troponin I (hsTn-I) 2.5 ng/L. The patient was diagnosed with atrial fibrillation and given oxygen, amiodarone, aspirin, atorvastatin, and serial ECG post-therapy. ECG post therapy converted into sinus rhythm after 26 hours.

Discussion

Acute SARS-CoV-2 infection increases the susceptibility to new-onset atrial fibrillation (NOAF), but the pathophysiology is not well understood. After receiving the COVID-19 vaccine, the immune system will mimic primary infection. It was unclear why our patients developed NOAF. However, we found an observational zone hs-TnI value and a sub-febrile temperature. Troponin might be elevated in critically ill patients even without myocardial involvement, but this patient is in a good state. However, the correlation between atrial fibrillation and the COVID-19 vaccine is not well understood because of the lack of data.
C17. Can we improve the clinical manifestation of superior vena cava syndrome without treat the underlying disease?
Authors: Mappangara Idar , Syamsuddin Deni , Idul Hafiz
Published: April 2022

Background

Superior vena cava syndrome (SVCS) is a clinical manifestations from obstruction of superior vena cava that has thin wall. The main goals of SVCS management are to relieve the symptom and give therapy for the underlying disease. For now, there some additional therapies that connected to this disease such as steroid, diuretic, and anticoagulant. Flavonoid which a derivate from gamma benzopyrone has pharmacodynamics mechanism that appropriate with SVCS.

Case Summary

We reported a male 35 years old came with SVCS typical manifestations. Then, we done some additional examinations, and we establish the diagnose with SVCS et cause anterior mediastinum mass suspected thymoma. The patient was planned to done histology biopsy, but the patient was refused to done any examination or interventions. We already gave diuretic, Vit-K antagonist anticoagulant, and high dose in short period steroid, but there was no any clinical improvement. Then, we add flavonoid hesperidin-diosmin, and there was clinical improvement after 1 months.

Discussion

Based on the management algorithm of SVCS, we should done histology biopsy to this patient to establish the main cause of SVCS, so we can treat the patient by the cause. In literatures about SVCS, there was no any pharmacotherapies that believed can give clinical improvement, including steroid, diuretics, and anticoagulant. Flavonoid that has pharmacodynamics such as anti-inflammation, improve venous tone, increase lymphatic drainage appropriate with the clinical pathomechanism of SVCS. So it may has rational therapeutic effect to this patient.
C19. Cardiac Amyloidosis: A Great Pretender of Left Ventricular Hypertrophy with Systemic Manifestation
Authors: Tampi G G , Farissa I P , Nugroho M A , Dewi R A C K , Pangarsa E A , Hellmi R Y , Rahardjo S B , Puspasari D
Published: April 2022

Background

Systemic amyloidosis encompasses an underdiagnosed disorder characterized by the extracellular deposition of amyloid in one or more organs, including the heart. The therapeutic strategy depends on the characterization of amyloid protein type and the extent of the disease. When founding a pathological left ventricular hypertrophy, initial clues provided by electrocardiography and echocardiography combined with other clinical manifestations could support a suspicion of cardiac amyloidosis.

Case Summary

A 54-year-old male patient was repeatedly admitted to a local hospital for recurrent heart failure and refractory bilateral pleural effusions of unknown cause. There was intolerance of any heart failure medications and repeated thoracocentesis failed to control the pleural effusion. The echocardiogram revealed severely impaired left ventricular function with phenotypic overlap between hypertrophic and restrictive cardiomyopathy. In contrast, we found a low voltage electrocardiogram. After an extensive diagnostic workup, including speckle tracking echocardiography, cardiac magnetic resonance, serum immunofixation and free light chain, bone marrow biopsy, and also Congo Red staining for amyloid, the final diagnosis was light chain (AL) amyloidosis.

Discussion

Cardiac involvement in systemic amyloidosis is the leading cause of morbidity and mortality. Frequently, myocardial wall thickening is incorrectly referred to as hypertrophy which may potentially lead to the wrong diagnosis and therapy. However, a need remains for improved awareness and expertise, while a multidisciplinary approach is important in making the correct diagnosis and management of this debilitating disease.
C20. Cardiac Arrest in COVID-19 Patient Presenting with Takotsubo Cardiomyopathy
Authors: Wardhani Louisa Fadjri Kusuma , Suwanto Denny , Sativa Oryza , Lefi Achmad
Published: April 2022

Background

Takotsubo cardiomyopathy (TC) presents as a result of catecholamine surge. There are increase of TC among COVID-19 patients, which is induced by cytokine storm. TC is previously known as a self-limiting and benign cardiac manifestation, but it has been uncovered that TC can be associated with fatal cardiac outcome due to cardiogenic shock and life-threatening arrhythmia.

Clinical Presentation

A 54-year-old woman presented to the emergency department with a fever since 9 days before admission accompanied by DOE, PND, and fatigue that worsened since 5 days before admission. Fifteen days before her complaints, she experience bereavement from his son death from motorcycle accident. She was referred from regional hospitals due to respiratory failure necessitating ventilator support. Physical examination revealed normal blood pressure and desaturation. ECG shows tachycardia with global ST-elevation. CXR shows cardiomegaly (CTR 62%) and pneumonia. The laboratory demonstrated increased Neutrophil to Lymphocyte Ratio (NLR), C-Reactive Protein, Troponin, and positive PCR COVID-19 swab. An echocardiography presented regional wall motion abnormality with apical ballooning appearance and reduced systolic function with LVEF of 51% resembling Takutsubo cardiomyopathy. Despite maximal ventilatory and pharmacology, she experienced malignant ventricular tachycardia not responding to defibrillation and expired in only 6 hours

Discussion

The presence of cardiac arrhythmia followed by cardiac arrest in COVID-19 patient complicated by TC can be a direct effect of catecholamine surge and myocardial injury or indirect effect from QT-prolongation and inflammatory process. Concurrent COVID-19 pneumonia and TC may progress with dismal prognosis, so that in need of prompt referral system.
C21. Cardiac Complications in Immunocompromised Patient : A Case Report
Authors: Hanafiah R , Candra V F K
Published: April 2022

Background

Cardiovascular diseases in human immunodeficiency virus (HIV)-positive patients are becoming increasingly detected in developing countries. Pericardial involvement may be manifested as acute pericarditis, constrictive pericarditis, symptomatic pericardial effusion and cardiac tamponade. The aim of this report is to present a patient with AIDS clinical stage IV who developed pericarditis and pericardial effusion.

Case Summary

A 27-year-old male came to our ER with 7-day fever and delirium syndrome. He has been diagnosed with AIDS clinical stage IV for the past 3 years with the latest CD4 count was 6/mm3. Serial Transthoracic Echocardiography (TTE) revealed small to moderate circumferential pericardial effusion, thickening of pericardium and reduced left ventricular ejection fraction without signs of cardiac tamponade from TTE. Upon hospitalization, he developed signs of hypotension without distended jugular veins nor muffled heart sounds. It was decided to initiate supportive treatment and NSAIDs without pericardiocentesis. The patient recovered uneventfully. As an outpatient, no other cardiovascular complications developed.

Discussion

Pericardial conditions are the most frequent cause of heart disease in patient with HIV infection. Most cases are mild and asymptomatic. Pericardial effusion may be marker of end-stage HIV infection because it is associated with low CD4 cell count and is often caused by opportunistic infections and malignant neoplasms. Treatment of pericarditis in HIV patients is no different from that in general population. Asymptomatic patients with small pericardial effusion without tamponade require no intervention.
C23. CARDIAC REHABILITATION AFTER CONGENITAL HEART DISEASE SURGERY
Authors: Suryawan Willy , Ambari Ade Meidian
Published: April 2022

Background

The survival rates of children with congenital heart disease (CHD) have dramatically increased due to the contribution of advance in medical and surgical care. Nonetheless, patients often have decreased exercise capacity and health-related issues that affect their quality of life. Cardiac rehabilitation programs in patients after CHD surgery have shown improvement in peak-VO2 and cardio respiratory fitness . Paradoxically, only a minority of CHD patients receives formal cardiac rehabilitation and are often encouraged towards a sedentary lifestyle as a result of overprotection and uncertainty as to which physical activities and with what intensity should be recommended. We therefore present case report about cardiac rehabilitation after CHD surgery based on current evidence to show the importance and benefit in CHD patient

Case Illustration

A 17 years old female patient came to Rehab clinic after Valve replacement and ASD surgical closure for severe mitral and tricuspid regurgitation, ASD secundum and Cor triatiatum. Her last stay in hospital was prolonged due to several complications. Her appearance was frail and she even was not able to walk. After a thorough examination and 6 minutes walk test, she went phase II rehabilitation. After Cardiac rehabilitation, she got better and her cardio respiratory fitness was improved. Based on her result in 6 minutes walk test and calculation, She was capable to do daily activity life on her own and ready to continue phase III rehabilitation.

Discussion

Patient who have underwent cardiac rehabilitation after congenital heart disease surgery have been presented. Systematic Examination should be performed prior cardiac rehabilitation in order to give an individualized exercise prescription.
C29. Chronic Pericardial effusion associated with Cytomegalovirus
Authors: Hutabarat H , Lukito A A , Chandra S , Fernandes R A P
Published: April 2022

Pericardial effusion is one of the most challenging clinical condition to determine the etiologies. A 60 yo woman presented with atypical sign of pericardial effusion. She visited several physicians and without any clinical improvement. Echocardiography revealed 133.5 ml pericardial effusion and pericardial thickness of 12,14 mm. Cardiac MRI was then performed and indicated, thickening of pericardium (4.8-5.1mm) at lateral right atrium, RV free wall and apical RV. The thickened part of the pericardium at apical RV has rigid, immobile appearance. Moderate amount of pericardial effusion prominently located at basal of heart. Pericardial effusion was at superior and lateral right atrium, apical RV and LV, and lateral, inferior, anterior left ventricle. Serology tests Anti CMV IgG reactive, anti CMV IgM non reactive and TB quantiferon negative. These results confirmed the pericarditis associated with CMV infection. The biggest challenge for the clinician is to find out an etiologic diagnosis. The common causes of pericarditis are infection (viral, bacterial), metabolic (renal failure, hypothyroidsism), cancer, myocardial infarction, and post traumatic. Among infectious causes, the enteroviruses, herpesviruses and mycobacterium tuberculosis are the most common causes. Cytomegalovirus belongs to the herpesviruses group. Clinician should be aware about the possible etiologies, as chronic pericarditis is a condition that requires comprehensive and multidisciplinary approaches.
C36. Deep Vein Thrombosis in A Patient with Thrombocytopenia : Case Report
Authors: Mirza Teuku , Ridwan Muhammad , Heriansyah Teuku
Published: April 2022

Background

Deep vein thrombosis (DVT) is a common but elusive illness that can result in suffering and death if not recognized and treated effectively. Overall, 43% of patients with thrombocytopenia were hospitalized, but just 2% of patients had DVT.

Case Summary

A 48-year-old male patient presented with a complaint left leg pain accompanied by edema leg 8 days before admission. The patient is a smoker, the patient has a history of diabetes since one year ago, In the laboratory results showed platelet count 23,000/mm3, D-dimer above 4000 ng/ml. Anti-dengue IgM and IgG were negative. Doppler examination revealed a thrombus in the common femoral and popliteal veins of the left leg. Patient was treated with low molecular weight heparin (LMWH) Subcutan fondaparinux 5 mg once daily for up to 7 days without bleeding and continued with Rivaroxaban 20 mg once daily, The patient was discharged on day 14.

Discussion

Platelet count below 50 x109/L significantly reduces the risk of DVT. Some known risk factors for DVT still appear to apply in patients with thrombocytopenia, and therefore patients with thrombocytopenia would benefit from DVT risk stratification based on platelet count and comorbidity. Patients having thrombocytopenia with DVT were treated safely with anticoagulants without increased occurrence of bleeding. The majority of cases were given therapeutic doses of LMWH.
C37. Device Closure of Perimembranous Ventricle Septal Defect with Zero Fluoroscopy : The First case in Eastern region of Indonesia
Authors: Yoseph Hendry , Fitriani Aussie , Patimang Yulius , Alief Andi
Published: April 2022

Background

Ventricular septal defects (VSDs) are the most common Congenital Heart Defects (CHD) lesion in children. Transcatheter closure is considered as an alternative to surgery, for past few decades transcatheter closure were performed under fluoroscopy, recently guidance under Transesophageal Echocardiography (TEE) is increased. Transcatheter closure under TEE Guidance remains challenging but an alternative to overcome the radiation effect.

Case Summary

We reported 3-year-old female patient admitted to RSUP Dr. Wahidin Sudirohusodo with chief complaint was easily fatigue, Physical finding revealed regular heart sound with a grade 4/6 pansystolic murmur at the left lower sternal border, Transthoracal Echocardiography (TTE) has shown perimembranous VSD (pm-VSD) 6-7 mm L-R shunt with VSD Gradient 58 mmHg and aortic rim 4,5 mm. The patient was diagnosed with pm-VSD without Pulmonary hypertension and suitable for device closure under TEE Guidance. TEE Procedure was performed under general anesthesia and we found pm-VSD 3-4 mm, we decided to close the defect with Amplatzer Duct Occluder II (AGA) no 4/4 with delivery sheath amplatzer Torqvue LP 4F via retrograde approach with zero fluoroscopy, the device was well fixated with small central residual shunt 1,6 mm with hemodynamically unsignificant, The device was released and the procedure was finished without any significant problem.

Conclusion

We reported first case of VSD closure under TEE guidance in Eastern region of Indonesia, Transcatheter closure of pm-VSD under TEE Guidance are feasible and safe and can be an alternative to surgery and conventional technique under fluoroscopy to prevent radiation effect.
C41. Echocardiography Assessment of Aortic Native Valve Infective Endocarditis Complicated with Anterior Mitral Leaflet Abscess
Authors: Yudistira K A , Sari N M A W , Saraswati L P O , Wibhuti I B R
Published: April 2022

Background

Infective endocarditis (IE) presents a major therapeutic challenges due to difficulties in diagnosis and a high risk of morbidity. Despite numerous complications of IE, reported cases complicated by abscesses on the heart valve leaflets were extremely rare as illustrated in this case report

Case Summary

A 46-year-old man was admitted with severe shortness of breath since August 14, 2020. The patient also had cough and fever, emerging since 1 month before hospitalized. A history of PND, orthophnea, and DOE was experienced since the 1 month ago. Upon physical examination, abnormal findings include: tachycardia, tachypnea, visible and diastolic murmur at the right second intercostal alongside the parasternal line and systolic murmur at apex, respectively, as well as ronchi at 2/3 of the lung bases. Electrocardiogram revealed both sinus tachycardia and anteroseptal ischemia. An echocardiography was performed; thereby generating a vegetation at RCC and NCC of aortic valve, pocket-shaped echodense structure on anterior mitral leaflet with suspected abscess.

Discussion

Definite infective endocarditis was navigated depicting the suspicion of: a vegetation in the aortic valve of NCC and RCC diagnosis, an abscess of the anterior mitral valve and ADHF of B profile with a potential of VHD and CAD with severe aortic valve regurgitation.
C46. Gastrointestinal-related Symptoms Leading to Acute ST Elevation Myocardial Infarction in a Young Woman without Cardiovascular Risk Factor in Rural Area: A case report
Authors: Kusnadi A , Jambormias E F , Meudi T M K A , Aurora R G
Published: April 2022

Background

Acute Coronary Syndrome (ACS) has been regarded as man’s disease, for many years, women have been underdiagnosed and undertreated. Women commonly present with atypical right-sided chest pain, neck or shoulder pain, and gastrointestinal symptoms.

Case Presentation

A 31-year-old woman presented to the ER with worsening epigastric pain accompanied with nausea, vomiting and diaphoresis since 30 minutes before admission. She had similar complaints before and only took dyspepsia medication repeatedly. She denied any history of smoking, hypertension, T2DM, dyslipidemia, and family history of ACS. Physical examination was within normal limits except for epigastric tenderness. The electrocardiogram showed ST-elevation in leads II, III, AVF, V7-V9, and ST depression in leads V2-V4. Laboratory results were within normal limits. She was diagnosed with acute inferoposterior STEMI and RV infarction. Loading dose of dual-antiplatelets was given, followed by fibrinolysis therapy using Streptokinase. After 60 minutes, the epigastric pain subsided and she had no other complaints, and successful fibrinolysis was achieved, she was transferred to the ICU for further treatment.

Discussion

Although females in reproductive age have cardio-protective effects of endogenous estrogen, ACS is still possible. They can present with non-specific gastrointestinal symptoms, a 12-lead-ECG can confirm the diagnosis of STEMI in young women with non-specific symptoms. Possible etiologies including plaque rupture or erosions, microvascular dysfunction, and spontaneous coronary artery dissection (SCAD) can be determined by coronary angiography. Since catheterization laboratory services are unavailable in our province, this patient is planned to undergo coronary angiography after hospital discharge.
C61. Managing Acute Decompensated Heart Failure with Exacerbation of Chronic Obstructive Pulmonary Disease in Rural Area: A Case Report
Authors: Irfon R , Jusram  , Anggriana E
Published: April 2022

Background

COPD is one of the comorbidities in heart failure patients with a prevalence of around 10-41%. The mortality and morbidity increase in patients with concomitant HF and COPD.

Case Description

A-54-year-old man, smoker, complained dyspnea that worsen for 48 hours, orthopnea, worsening productive cough with thick phlegm for 1 week, diaphoresis, and fatigue. History of untreated COPD since 2014, dyslipidemia, heart attack, and hypertension since 2018. Examination: Obesity, HR 54x/min, RR 30 x/min, BP 140/90 mmHg, SpO2 96% on O2 4 lpm. JVP was increased, gallops, bilateral crackles, wheezing, and pre-tibial edema. WBC count was 15.000, Inferior OMI and LVH on ECG. Signs of pulmonary congestion, cardiomegaly, and increased Broncho-vascular pattern on chest X-ray. Echocardiography and cardiac marker testing were unavailable. The patient was diagnosed with ADHF and AECOPD. The patient was initially given furosemide IV, ramipril, spironolactone but didn’t improve. SABA-anticholinergic nebulization was added then and improved the symptoms. These medications were continued and added corticosteroid IV, antibiotics, aspirin in inward room. After 5 days of treatment, the patient improved, considered as outpatient and advised to control after 3 days.

Discussion

In the limited setting, manages patients with heart disease is challenging. History of untreated COPD, heart attack, hypertension, and dyslipidemia led the patient to this condition. There was no consensus in managing HF in the COPD population. Clinical consideration based on the dominant patient condition was suggested by some studies. This patient had significant improvement after combining diuretic, nebulization, and corticosteroid.
C67. Patent Ductus Arteriosus Closure with Transthoracic Echocardiography Guidance, Small Changes with a Big Impact: a case report
Authors: Nurawita R , Laode M , Andi A U , Yulius P , Aussie F G
Published: April 2022

Background

Patent Ductus Arteriosus (PDA) is one of the most common congenital heart diseases with a left to right shunt. PDA occurs in 5-10% of all congenital heart disease, excluding premature infants. It is more frequently occurs in women compared to men. Patients could be asymptomatic depending on the size of the PDA, systemic and pulmonary vascular resistance, and the size of the left-to-right shunt.

Case Description

We report a case of an 18-year-old girl presenting with PDA and left-to-right shunt. The patient underwent a PDA closure with a transthoracic echocardiography (TTE) guidance and used an occluder device. The procedure was performed without any complication, the patient was stable, and from the TTE control, we found no residual shunt and device in situ.

Discussion

Several adverse effects of PDA closure using fluoroscopy guidance had been highlighted due to its radiation exposure. The necessity of using a contrast agent is also confirmed to increase the patient risk. To this end, the closure of PDA using TTE guidance was developed to prevent the side effect of fluoroscopy for both doctors and patients. This method required a well-developed collaboration between the pediatric interventional cardiologist and echo-cardiologist. In conclusion, PDA Closure using a device and TTE guidance is as effective as fluoroscopy guidance. Closure of the PDA using TTE guidance may prevent patients and doctors from the adverse effects of radiation and minimize the risk of contrast agents.