bluuebunny/crossref_metadata_2025_split huggingface dataset:
C3. A case of extreme discrepancy between office and ambulatory blood pressure: is it true uncontrolled hypertension?
Authors: Tartila T S , Pujowaskito P , Jannah F D K , Tafriend N A 
Published: March 2023

Abstract

Background
White coat uncontrolled hypertension (WCUH), defined as drug-treated hypertension but with increased blood pressure in the office and normal ambulatory blood pressure, should be assessed in patients with uncontrolled hypertension to prevent overtreatment. We report a case of an extreme WCUH found by ambulatory blood pressure monitoring (ABPM).

Case Summary
A 66-year-old woman was a regular patient in Cardiology Outpatient Clinic, Indonesian Army Central Hospital Gatot Soebroto with uncontrolled hypertension, CAD post-PCI, and insulin-dependent type 2 diabetes mellitus. The patient was overweight (BMI was 24.56 kg/m2) with dyslipidemia and uncontrolled blood glucose. Despite aggressive treatment with ARB, CCB, beta-blockers, diuretic, and clonidine, the patient had persistent hypertension with mean office systolic blood pressure &gt;160/90 mmHg. Echocardiography showed concentric left ventricular hypertrophy. ABPM result found extreme variability of blood pressure with the average 24-hour blood pressure of 93.6/59 mmHg (mean daytime blood pressure was 90/55 mmHg and mean night-time blood pressure was 98.7/65.2 mmHg), intermittent hypotension, and reverse dipper pattern. The blood pressure once dropped to the lowest point of 69/44 mmHg, and the highest was 211/186 mmHg. Based on this result, we classified the patient’s condition as WCUH and adjusted the antihypertensive regiment.

Discussion
This case emphasizes the need to evaluate the presence of WCUH by ABPM in patients with uncontrolled hypertension so antihypertensive drugs could be adjusted accordingly and prevent hypotension.
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: March 2023

Abstract

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 &lt;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.
C12. Atrial Fibrillation post Sinovac-Coronavac Vaccine : A Case Report
Authors: Rismawanti R I , Lalitya W , Rachmanadi M B , Gumilang R A 
Published: March 2023

Abstract

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.
C23. CARDIAC REHABILITATION AFTER CONGENITAL HEART DISEASE SURGERY
Authors: Suryawan Willy , Ambari Ade Meidian 
Published: March 2023

Abstract

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.
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: March 2023

Abstract

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.
C35. Congenital Heart Disease in Neonatal Lupus: a case report
Authors: Pramono A , Abdullah L N 
Published: March 2023

Abstract

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.
C50. Obstructive hypertrophic cardiomyopathy in young adult man: a case report
Authors: Sinaga A , Ardini T W , Lubis A C , Hasan H 
Published: March 2023

Abstract

Background
Hypertrophic obstructive cardiomyopathy (obstructive HCM) is an autosomal dominant congenital disease characterized by obstruction of the left ventricular outflow tract with asymmetric septal hypertrophy. Obstructive HCM is predispose to the appearance of malignant ventricular arrhythmias, leading to syncope or sudden death.

Case Description
A 25-years-old male patient came to the hospital with chief complaint intolerance activity and previous syncope, without history of sudden cardiac death in his family member. ECG showed sinus rhytm with left axis deviation and left ventricular hypertrophy. Chest x ray showed cardiomegaly. The echocardiography showed asymmetric septal hypertrophy (septal/posterior wall thickness ratio 1.31), left atrium dilatation (LAVi 94.2 mL/m2), SAM and mild mitral regurgitation, mild aortic regurgitation, hyperdynamic ejection fraction (79%) with lower longitudinal strain values in basal and mid ventricular septal segment, grade I diastolic dysfunction, resting LVOT gradient 19.53 mmHg , provoked LVOT gradient 47.31 mmHg.

Discussion
Non-invasive treatment was given due to LVOT gradient below 50 mmHg. The patient prescribed diltiazem 100mg once daily and recommended clinical evaluation follow-up every year or any worsening of symptoms. The other family member suggested for familial screening echocardiography.
C53. Infection of Coronavirus Disease 2019 Reveals Brugada Pattern
Authors: Patriya N A S , Yasa A 
Published: March 2023

Abstract

Background
Coronavirus Disease 2019 (COVID-19) resulted considerable morbidity and mortality worldwide since December 2019. In the other hand, Brugada syndrome had higher risk of sudden cardiac death. Although it was manifested with an electrocardiographic (EGC) abnormalities, the patients with Brugada syndrome were often healthy and unaware of their genetic predisposition.

Case Summary
A 59 years old man without significant medical history was reported a day of fever, productive cough, and shortness of breath. He did not complain any chest pain, palpitation, and episode of syncope. The patient had no family history of sudden cardiac death. On presentation, he was febrile (39,5°C), tachycardia (110 beats/ min), and tachypnea (28 breath/ min). Laboratory findings of the patient were elevated High-sensitivity C-reactive protein (hs-CRP), with normal electrolyte level, and troponin. The Polymerase chain reaction (PCR) test for COVID-19 performed with the positive result. The chest radiograph showed multifocal bilateral interstitial with a normal cardiac silhouette. The ECG revealed Brugada type 2 ECG pattern. A bedside echocardiogram demonstrated with the normal result. His condition continued to improve and the ECG demonstrated complete resolution of the initial Brugada ECG pattern.

Discussion
COVID-19 infection has been described as unmasking Brugada pattern. The most frequently reported symptoms of COVID-19 was fever. Brugada syndrome was a genetic disorder, that was most commonly involving SCN5A gene, which encoded the cardiac sodium channel. Fever caused blockade of sodium channel was being well described provocative trigger that might incite arrhythmia in patient with Brugada syndrome.
C64. New Onset PVC Bigeminy Post Covid-19 Infection: Another Covid-Cardiac Related Problem
Authors: Jeremiah B , Lubis A C , Hasan H 
Published: March 2023

Abstract

Background
Covid-19 is an infectious disease caused by a newly discovered coronavirus that caused acute severe respiratory syndrome and other complication. Many cardiac complication already occurred such as carditis and acute heart failure. PVC bigeminy is a new complication that we found in our post covid-19 patient.

Case Summary
A 31-years-old female patient admitted to the outpatient department with chief complaint palpitation with chest discomfort in the past 1 month with a history covid-19 infection 3 months ago with prolong covid infection for 2 months. ECG showed sinus rhythm and bigeminy PVC with PVC LBBB morphology left inferior axis and transition zone in V4. The patient planned to do Electrophysiology study and ablation. From the EP study we found 2 type of PVC, both of the PVC have LBBB morphology with left inferior axis and transitional zone in V4. The first PVC had 42ms earliest activation time and the second PVC had 48ms earliest activation. We do ablation with non irrigating catheter on the first PVC but the PVC still remain. Then try with irrigating catheter and do the ablation. After the ablation the PVC already vanished and the ablation was successful.

Discussion
PVC bigeminy post covid-19 infection is a rare complication in covid-19 patient. PVC bigeminy cause several complain from palpitation, chest discomfort, and shortness of breath. Ablation is one of the best way to treat PVC bigeminy patient with symptoms and in the patient the ablation was successful.
C65. Pace and Ablate as an Alternative Approach for Rate Control Strategy in Patient with Atrial Fibrillation
Authors: Hazzy Fandy , Rizal Ardian 
Published: March 2023

Abstract

Background
AF patient with refractory to optimal medical therapy for rate or rhythm control, atrioventricular (AV) nodal ablation with permanent pacemaker (PPM) implantation is an effective strategy for symptomatic relief. Maintenance of controlled ventricular rate helps to avoid frequent exacerbations of CHF and tachycardia-mediated cardiomyopathy, and is also associated with improved quality of life.

Case Summary
Female 66-year-old suffered from Heart Failure exacerbations caused by paroxysmal AF with rapid ventricular response (RVR) with underlying hypertensive cardiovascular disease. Rhythm control strategy with drip Amiodarone induce sinus bradycardia with unstable hemodynamic, when drugs was stopped then AF RVR reappeared, we tried to rate control strategy with Digoxin but, she experienced same condition as before. She underwent a pragmatical technique AV nodal ablation with cardiac pacing for rate control and she had drastic improvement of symptoms within the next 24 h. Complete AV block was achieved after application of 2 radiofrequency energies over the anatomic AV node. A permanent pacemaker (PPM) was programmed to VVIR at the rate of 70 bpm.

Discussion
Conventional medical therapies, including beta-blockers, non-dihydropyridine calcium channel blockers, digoxin, and anti-arrhythmic drugs, may fail to control the ventricular rate. Atrioventricular junction ablation and pacing (AVJAP) can be applied for patients whom medication is inadequate or associated with side effects (Recommendation IIA). According to our case, AVJAP is possible but an attractive choice for some elderly patients who are not compliant with treatment or associated with dangerous side effect for patients.
C70. Performing Percutaneous Coronary Intervention in Dextrocardia: A Case Report
Authors: Syafar R H , Khairat M , Syukri M 
Published: March 2023

Abstract

Background
Dextrocardia is defined as the heart location in the right hemithorax with the apex pointing inferiorly and to the right. Performing percutaneous coronary intervention (PCI) in patient with dextrocardia can be difficult and requires some modification.

Case Summary
A 55-years old male with chest pain 3 hours before admission, apex in right side, a chest X-ray confirm the heart in the right hemithorax, electrocardiogram (ECG) was consistent with dextrocardia and showed inferior ST-segment elevation myocardial infarction (STEMI). We performed primary PCI with femoral access. During coronary angiography, it was a challenge to engage the diagnostic catheter to both of ostium right and left coronary artery. Coronary angiography showed total occlusion in the proximal of right coronary artery (RCA). We inversed the engagement technique and radiological angles for RCA from the left anterior oblique 35º to the right anterior oblique 30º and finally revascularization could be done easier.

Discussion
Performing PCI in patient with dextrocardia can be challenging. Inversion the engagement technique and radiological angles and views will give an advantage to the operator for imaging and doing intervention. Using image reversal technology is also help to get the image like a normal position.
C72. Peripartum Cardiomyopathy: “Comparison in Management of Two Cases”
Authors: Widyastuti W , Krevani C K , Karani Y 
Published: March 2023

Abstract

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.
C73. Phlegmasia Cerulea Dolens "A Case of the Blue Leg": Act Properly, Avoid Morbidity and Mortality
Authors: Dewi I P , Wardhani L F K , Budiarto R M 
Published: March 2023

Abstract

Background
Deep vein thrombosis (DVT) may compromise venous outflow from a limb, causing significant swelling. Phlegmasia cerulea dolens (PCD) is a severe presentation of massive DVT. PCD is a medical emergency that can lead to venous gangrene of the lower extremity. Early diagnosis and prompt treatment are crucial for limb salvage.

Case Presentation
We report 65-year-old woman presented with acute onset edema and pain in left leg. Left lower limb examination found edema from the left groin to the distal left extremity, marmorata, and bullae with cold palpation. Sensoric and motoric function of left leg were decrease. Duplex ultrasonography showed thrombus and non compressible in left common femoral vein (CFV). We have done systemic thrombolytic using streptokinase 250.000 IU. However, the condition of the patient didn’t improve. The patient then underwent surgical thrombectomy procedure with a forgaty catheter. There was a ± 20 cm of thrombus. Her left lower limb became warm after thrombectomy and her symptoms improved. Finally, after 12 days hospitalization the patient was discharged and give anticoagulant therapy.

Conclusion
Although uncommon, it is important to identify patients with PCD because they should be considered for more aggressive management. Intravenous anticoagulant is one of therapeutic strategy while a decision to pursue more aggressive therapy is being considered. Patients with extensive DVT but without signs of PCD do not routinely receive thrombolysis but should be anticoagulated and monitored closely for the development of PCD.
C75. Premature Coronary Artery Disease in Young Male Patient with Strong Family History
Authors: Kurniawan A , Rohman M S 
Published: March 2023

Abstract

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.