bluuebunny/crossref_metadata_2025_split huggingface dataset:
C68. Patient with Zero Coronary Calcium Score and Significant Stenosis in Left Anterior Descending Coronary Artery: a case report
Authors: Dylan R , Suratna K S K , Rampengan S H , Pangemanan J A 
Published: March 2023

Abstract

Background
Coronary heart disease is pathological process characterized by the accumulation of atherosclerotic plaque in the epicardial artery, either obstructive or non-obstructive. Coronary calcium score (CCS) detects and calculates coronary artery calcification (CAC) and CT coronary angiography (CTCA) allows evaluation of the coronary arteries anatomy for luminal stenosis due to atherosclerotic plaque with or without calcification.

Case Description
A 70 years-old man, admitted to the emergency department with a chief complain of chest pain. Physical examination was within normal limits. His treadmill stress testing was positive ischemic response one month prior. Then patient undergoing CTCA, the result was zero calcium score with 90-99% stenosis at proximal left anterior descending (LAD) due to soft plaque. Invasive coronary angiography (ICA) confirmed the CT findings and showed total occlusion with grade V thrombus in osteal LAD.

Discussion
A study showed that 1-2% of symptomatic patients with zero CAC potentially had obstructive CAD. It is supported with this report that the patient had typical chest pain with zero calcium score. CCTA has high sensitivity and negative predictive value for the detection of CAD but has a relatively low positive predictive value, especially for moderate severity coronary. In this report CTCA showed 90% -99% stenosis at the proximal LAD and correlate with ICA findings.
C69. Percutaneous Balloon Pulmonary Valvuloplasty for Critical Pulmonary Stenosis Baby as A Challenging Management in Resource-Limited Hospital: A Case Report
Authors: Sitio M , Santoso A S , Iskandar  , Widasmara S , Koentartiwi D , Yogibuana V , Martini H 
Published: March 2023

Abstract

Background
Severe or critical right ventricular outflow tract obstructions are life-threatening conditions. Percutaneous balloon pulmonary valvuloplasty is the preferred therapy for pulmonary valve stenosis.

Case Summary
A-50-day-old cyanotic baby girl, weighing 4.4 kg, was admitted to hospital with a bluish appearance insidiously progressing over the preceding 2 weeks. Transthoracic echocardiogram (TTE) revealed critical pulmonary valvular stenosis with pulmonary valve annulus diameter 7 mm, severe tricuspid regurgitation (TR), restrictive intraatrial mixing physiology, and an almost spontaneously closed Patent Ductus Arteriosus. The patient underwent percutaneous balloon pulmonary valvuloplasty (BPV). The available balloon, Tyshak mini balloon 9.0 mm x 20 mm, failed to across stenotic lession. It was replaced with coronary balloon 2 mm x 10 mm and inflated several times with a maximum pressure of 10 mmHg within 10 seconds. After the valve was adequately opened, the coronary balloon was replaced by previous Tyshak mini balloon. It was inflated once with pressure of 3 mmHg for 5 seconds. Successful dilatation is indicated by the disappearance of the waist around the balloon under cineangiography. RV-PA gradient decreased from 67 mmHg to 38 mmHg, a 43% reduction. After the procedure, the patient was no longer cyanotic. TTE after BPV demonstrated no pulmonary stenosis, TR TVG decreased from 100 mmHg to 20 mmHg, and no pulmonary regurgitation.

Discussion
Our successful results suggest that percutaneous balloon pulmonary valvuloplasty is a potential and safe intervention for babies with critical Pulmonal Stenosis that was conducted in resource-limited hospital.
C71. Perimyocarditis related Corona Virus Disease: A Case Report
Authors: Budi D S , Anggrahini D W , Hartopo A B 
Published: March 2023

Abstract

Background
One of the ongoing outbreaks is the SARS-COV2 with clinical manifestations are dominated by pulmonary symptoms. However, some patients have reported mild to severe cardiovascular damage1.

Case Summary
We report a 26-year-old male with confirmed Corona Virus Disease (COVID-19), who has manifestation of perimyocarditis. Diagnosis was built through clinical symptoms of fever, dyspnea, with ST elevation and PR depression on ECG, and an increase of hs-Troponin I and NT-Pro-BNP. There appeared to be a pericardial effusion on echocardiography, and an increase number of cardiothoracic ratio (CTR) during the infection. All of the perimyocarditis parameters improved when symptoms are decrease meanwhile laboratory showing improvement of inflammatory parameters (CRP, D-Dimer).

Discussion
Acute perimyocarditis is a reported cardiac complication of COVID-191. COVID-19 perimyocarditis associated with pericardial effusion and cardiac tamponade2. Electrocardiogram (ECG) abnormalities commonly seen with pericarditis, such as ST elevation and PR depression, may be observed in myocarditis3. Many COVID-19 patients were reported to have a detectable level of cardiac-Troponin-I as a result of oxygen supply–demand mismatch, which could precipitate ischemia that results in type 2 myocardial infarction. NT-pro-BNP level also could increase secondary to myocardial stress, a possible knock-on effect from severe respiratory illness4.
C74. Post covid-19 cardiomyopathy in an adolescent patient: a case report
Authors: Pujowaskito P , Tartila T S , Tafriend N A , Jannah F D K 
Published: March 2023

Abstract

Background
Myocardial injury caused by viral myocarditis may occur during COVID-19 infections. This condition may lead to cardiomyopathy as the chronic sequela. We report a case of an adolescent COVID-19 survivor without underlying heart disease presented with dilated cardiomyopathy.

Case Summary
A 16-year-old male patient was referred to Cardiology Outpatient Clinic, Indonesian Army Central Hospital Gatot Soebroto. The patient presented with a chief complaint of fatigue and just recovered from mild to moderate COVID-19 one month before the visit. There was no prior history of heart disease. Physical examination was within normal limit, but laboratory findings showed highly elevated NT-proBNP (7705 pg/mL) and D-dimer (1850 ng/mL). ECG revealed normal sinus rhythm with poor R wave progression. Echocardiography detected all chamber dilatation, eccentric left ventricular hypertrophy, global hypokinetic, moderate mitral regurgitation, and reduced ejection fraction (22%). The patient was diagnosed with new-onset dilated cardiomyopathy as a COVID-19 sequela and we initiated treatment with ARB (candesartan), beta-blocker (bisoprolol), diuretics (furosemide and spironolactone), rivaroxaban, and trimetazidine. During a follow-up visit three months later, the patient’s recovery was stable.

Discussion
The occurrence of new-onset cardiomyopathy in our previously healthy young patient highlights the possible mechanism of COVID-19 as a single cause of myocardial injury without underlying heart disease. Comprehensive evaluation and optimal treatment should be taken during hospitalization and post-discharge period to prevent further complications. Additional examinations such as cardiac magnetic resonance and endomyocardial biopsy should be done to provide definitive confirmation.
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: March 2023

Abstract

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: March 2023

Abstract

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.
C81. Pulse Dose Corticosteroid Improves Clinical Outcome in Pulmonary Hypertension Patient: A Potential of Immense Affordability and Availability Medication in Suburban Area
Authors: Sudirman A R , Sitompul S I 
Published: March 2023

Abstract

Background
Pulmonary hypertension (PH) in adolescence is a devastating diagnosis with significant morbidity and mortality. Despite limited literature exists on treating PH with anti-inflammatory medications in humans, hereby we present the case of prednisolone induced clinical outcomes improvement in PH patient.

Case Summary
A 20-year-old woman presented with exertional dyspnea. Her past-two-years medical history was remarkable for tricuspid regurgitation with multiple readmission. Upon arrival, her saturation-75% and BP-110/60. She was in respiratory distress with JVP increased and high-pitched-holosystolic murmur. Laboratory studies was unremarkable. The x-ray revealed cardiomegaly and ECG showing RVH-RAE. Initial echocardiography demonstrated TR-Vmax 4.55m/s and PR-Vmax 3.62m/s. The RVSP estimated around 107mmHg, which was highly suggestive for PH. Due to the aggressive nature of the disease, her condition deteriorated despite management with IV-furosemide-(40mg/d), beta-blocker-(2.5mg/d), and sodium beraprost-(60µg/d). Following days, a 5-days pulse-dose-steroid (methylprednisolone) at 2mg/kg/day was administered. Her condition improved with saturation from 50% to 90% and significant reduced in dyspnea. The steroid was tapering down for another 7 days and she was discharged for further referral.

Discussion
Inflammation plays unequivocal role in the pathogenesis of PH, which was involved in the development of pulmonary vascular remodeling. The possible mechanism of prednisolone were related with the inhibition of platelet-derived growth factor (PDGF)-induced accelerated proliferation and migration of pulmonary artery smooth muscle cell, and prevented the activation of NF-κB, key transcription factor that controls inflammation, cell-proliferation, and apoptosis. Thus, given the ready availability and features of this medication compared with other PH-medication, we decided to utilize steroid in this patient.
C82. Rare electrocardiography findings of Wellen’s Type A evolving into Type B on late onset Myocardial Infarction: A Case Report
Authors: Achmad R M P , Madiastuti Septi , Nadia Ina , Widyantoro Bambang 
Published: March 2023

Abstract

Background
Wellens' Syndrome is a left anterior descending (LAD) coronary artery disease which first described in 1982 by de Zwaan et al. A byphasic T or deeply inverted T are the typical Wellen's electrocardiogram (ECG) changes which represent a critical stenosis. It may be presented without any typical symptoms, and normal or mildly elevated enzymes depends on its onset.

Case Summary
A 56-years-old male, admitted to ER with typical chest pain within 1 day. The first ECG showed byphasic T wave on V2 and V3, and an hour serial ECG showed a deeply inverted T wave on V2 and V3. Cardiac marker showed an elevated Troponin I levels of 1,590.6 ng/L. The patient was diagnosed with acute NSTEMI and underwent an early invasive strategy on the next day. Coronary angiography revealed total occlusion of the proximal LAD, and implantation of drug eluting stent was done accordingly. The patient remained symptoms-free after the procedure and discharged in stable condition.

Discussion
This patient suffering a left coronary total occlusion with no appearance of any ST-elevation on ECG. Therefore, a critical stenosis does not always came up with a typical ST-segment changes. Wellen’s type ECG showed how the T waves evolution would represent a critical stenosis. Early recognition of Wellen's typical ECG in this patient lead to early invasive strategy decision and later resulted a good outcome.
C83. Recurrent Syncope in Isolated Right Ventricular Non-Compaction Cardiomyopathy: A Case Report
Authors: Chandra S , Lukito A A , Hutabarat H , Fernandes R A P 
Published: March 2023

Abstract
Isolated right ventricular non-compaction cardiomyopathy (iRVNC) is a rare disease, and often under diagnosed. The patients might come with right heart failure, ventricular arrhythmias and systemic embolism. A 64 –yo female presented with episodes of recurrent syncope. There is thickened trabecular on apical right ventricular (RV), moderate tricuspid regurgitation and moderate probability of pulmonary hypertension on echocardiography. Furthermore, cardiac MRI on this patient confirned hypertrabeculated and dilatation of RV, spongiform appearance of the RV apical, non-compacted (NC) thickness of the RV was 23.5 mm at the apical level with compacted thickness (C) of 2 mm (NC to C ratio 11,7), hypertrophic moderator band, and dilatation RA and global hypokinetic and decreased function of RV. Hence, the diagnosis was an isolated right ventricular non-compaction cardiomyopathy, without LV involvement. The medication given including sildenafil, nebivolol, spironolactone, digoxin and edoxaban. Lesson learned from this case, syncope might be one of iRVNC symptoms. Multiple modalities could be needed for diagnostic confirmation for patients with syncope. Echocardiography as a diagnostic tool is useful to find prominent trabeculations and when NC/C ratio &gt;2. If the echocardiographic findings were inconclusive, cardiac MRI was could be performed for better discrimination between compact and non-compact inner and outer layers of myocardium with NC/C ratio &gt; 2,3.
C84. Resistent Hypertension in Young Patient, what has Been Missed? A Case Report of Coartation of the Aorta
Authors: Hartoko A , Sulastomo H 
Published: March 2023

Abstract

Background
In children and adolescent patient the most common cause hypertension is secondary due to renal disease. There are other cause of secondary hypertension including Coartation of the Aorta (CoA). Early diagnosis and prompt treatment are important for CoA, if left untreated CoA can causes ventricular hypertrophy, premature coronary artery disease and eventually heart failure.

Case Illustration
A 17 Years old patient with history of hypertension since the age of 12. He was suspected secondary hypertension due to renal disease and referred to pediatric nephrologist. Laboratory examination and CT angiography renal artery showed normal result. He was treated with multiple antihypertensive drugs, but remains hypertensive despite of medical therapy for 5 years.
He was referred to our hospital due to resistant hypertension. At physical examination this patient revealed blood pressure at upper 150/90 and lower extremities 100/60. Echocardiography examination and CT angiography showed Left Ventricle Hypertrophic (LVH) with coartation aorta located distal to left subclavian artery. Thoracic Endovascular Repair (TEVAR) was performed to dilated the coartation in this patient. Post TEVAR procedure peak systolic gradient reduced from 51 mmHg to 4 mmHg.

Discussion
CoA are one of the causes of secondary hypertension. Uncommonly resistant hypertension can occur in CoA. Early diagnosis and prompt treatment are important for CoA. In this patient the CoA already caused LVH, and if left untreated it can lead more severe complication such as heart failure, and premature coronary artery disease and death.
C85. Right heart failure due to chronic thromboembolic pulmonary hypertension in systemic lupus erythematosus patient: a case report
Authors: Saputra B M I , Darma K S S 
Published: March 2023

Abstract

Background
Systemic lupus erythematosus (SLE) is a chronic inflammatory disease with varying clinical manifestations and high risk of thrombosis. Chronic Thromboembolic Pulmonary Hypertension (CTEPH) as late complication of acute pulmonary embolic sometimes occured in SLE patients and in advanced condition it can manifest as right heart failure.

Case Summary
A female, 29 years old with complaints of bilateral ankle oedema and bloated stomach, as well as dyspneu on effort occurred progressively since approximately 4 months. These complaints were also accompanied by hair loss and redness on both cheeks. Physical examination revealed increased jugular venous pressure, systolic murmur in left lower sternal border, ascites, hepatomegaly, and bilateral ankle oedema. Echocardiography revealed dilated right atrium and right ventricle (RV), decreased RV systolic function, severe tricuspid regurgitation, and distended inferior vena cava. Computed tomography (CT) pulmonary angiography showed filling defect in the left pulmonary artery. Lab examination showed an increase in D-dimer, ANA titer &gt;1: 1000, and lupus anticoagulant ratio 1.59. Diuretics therapy, anticoagulant, corticosteroid, and immunosuppressant were given to this patient. Right heart function was improved following the treatment.

Discussion
The increased risk of thrombosis in this case is related to several factors, including: antiphospholipid antibodies, inflammation and disease activity. CTEPH is formed as a result of poor resolution of the thrombus in the pulmonary arteries, resulting in fibrosis of residual thrombotic material that can impede blood flow. Increased intrapulmonary pressure due to pulmonary vascular obstruction causes RV remodeling and dysfunction.
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: March 2023

Abstract

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.
C88. Sick sinus syndrome in acute anterior myocardial infarction: when culprit strategy ended up jeopardy
Authors: Nadia  , Fitra M 
Published: March 2023

Abstract

Background
Atrial arrhythmias occur in 10% of acute myocardial infarctions and increases incidence of death. Altered heart rhythm with brady-tachy episodes indicates sinus node dysfunction ordinarily cause by inferior myocardial infarction.

Case Description
A 66-year-old-man, diagnosed with 2 days onset Acute Anterior Myocardial Infarction with history of syncope after chest pain, referred with sinus arrest and junctional rhythm that changed into atrial fibrillation. During hospitalization the heart rhythm changing periodically from bradycardia to tachycardia repeatedly with witnessed new ST elevation in inferior lead before an episode of cardiac arrest. After primary PCI to the RCA as the new culprit lesion, chest pain was relieved but hemodynamic condition was not stable and the rhythm remained continuously altered.

Discussion
Sick sinus syndrome is a cardiac conduction disorder characterized by symptomatic dysfunction of the sinoatrial node generally manifests as sinus bradycardia, sinus arrest, or sinoatrial block, and accompanied by supraventricular tachyarrhythmias (tachy-brady syndrome). This case of acute myocardial infarction with 3 vessel diseased lesion and total occlusion in RCA affected sinoatrial node causing sick sinus syndrome. Recently multi-vessels PCI strategy increasingly recommended at the time of primary PCI for patient with arrhythmia.

Conclusion
A man 66 years old with acute anterior MI compelling with sick sinus syndrome on presentation because apparently the culprit lesion was RCA. Unfortunately, at that time non-IRA lesion were not opened and TPM was not available, bradycardia continues and the patient ended up being jeopardy.