bluuebunny/crossref_metadata_2025_split huggingface dataset:
C44. Electrocardiogram might failed identify acute coronary occlusion: When every minute counts
Authors: Habibi F N , Mangkoesoebroto A P , Pradityawati A , Ardhianto P 
Published: March 2023

Abstract

Backgrounds
Prompt diagnosis of acute coronary occlusion based on electrocardiogram (ECG) are essential to decide proper treatment. However, particular ECG such as Wellens syndrome have been higlighted without obvious ST-segmen elevation which is signifies critical stenosis or occlusion of the proximal left anterior descending (LAD) artery but unfortunately is often unrecognized by physicians.

Case Illustration
A 51-year old male patient referred from district hospital diagnosed as five day onset STEMI with recurrent chest pain. The first ECG in there emergency room was a deep inverted T wave in anterior and lateral lead that immediate intervention approach not choosen. The typical infarct evolution in anteroseptal lead appear one day after the onset. Troponin level was significantly increased. Urgent angiography was performed in our hospital, unfortunately it resulted critical stenosis in proximal LAD with triple vessels and left main coronary artery disease. Then we consider send to surgery due to high coronary complexity (Syntax score:62) and optimize antianginal agent.

Discussion
In current practice, ST-segment elevation at the J-point, ≥ 1 mm in ≥ 2 adjacent leads (other than leads V2 and V3, where elevation of ≥ 2 mm in men or ≥ 1.5 mm in women is considered significant) for STEMI diagnosis. However, these general ECG criteria fail to identify the STEMI equivalents. Wellens syndrome is one of them that suggesting severe stenosis of the proximal LAD artery, which will develop into an acute anterior wall MI within a few days to weeks in 75% of untreated patients.
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: March 2023

Abstract

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.
C48. How to handle VT storm in ICD patient : serial case report
Authors: Prismadani M , Julario R 
Published: March 2023

Abstract

Background
Ventricular tachycardia (VT) storm can cause sudden death in patients with trans-venous implantable cardioverter-defibrillator (ICD) and adversely affects prognosis in survivors. Patients with recurrent shocks have a poor quality of life and increased mortality rates. The purpose of this case series was to discuss the available treatment option for VT storm in ICD patients.

Case Summary
We reported two patients with VT storm on ICD. Both patients had palpitation, clinical heart failure, and recurrent shocks from ICD with appropriate rhythms. The first case had hypokalemia with ICD recording showed 45 episodes of VT, 45 antitachycardia pacing (ATP), and 5 shocks therapy. The second case had hypomagnesemia with ICD recording showed 195 episodes of VT, 42 ATP, and 3 shocks therapy. Management approaches to these patients include ICD reprogramming, correcting electrolyte abnormalities, treating heart failure and administering anti-arrhythmic drugs (AADs).

Discussion
VT storm on ICD refers to three or more appropriate therapies for ventricular tachyarrhythmias, including ATP or shocks, within 24 hours. The known triggers must be treated, such as electrolyte disturbance and worsened heart failure. AADs therapy could suppress VT and increased the tachycardia cycle length (TCL) so that the response to ATP is better. ICD reprogramming include higher heart rate treshold, longer detection period, and improving ATP programming. Catheter ablation and cardiac sympathetic denervation (CSD) may be an option if VT storm persists.
C54. Infective Endocarditis with Ventricular Septal Defect and Ruptured Sinus of Valsalva: A Case Report
Authors: Zebua J , Nasution A N , Siregar A A , Hasan H 
Published: March 2023

Abstract

Background
Ventricular Septal Defect (VSD) is the most common congenital heart defect with incidence rate about 50% of all case in children. VSD is often followed by weakness of the wall in the sinus of Valsalva causing aneurysms, where 30-50% of cases of aneurysms in the sinus of Valsalva is associated with VSD. Congenital heart defects also increased risk factors for infective endocarditis (IE) with the risk of infection 15-140 times greater than the general population.

Case Description
A 7-year-old boy was reported with fever and shortness of breath, echocardiography examination showed subaortic VSD, ruptured sinus of Valsalva, multiple vegetation on left ventricular outflow tract, right coronary cusp, and right ventricle, moderate aortic, pulmonal and tricuspid regurgitation with mild pulmonal hypertension. Although there was no growth of bacteria from blood culture but result from kidney ultrasound showed sign of glomerulonephritis, suggesting additional findings in Duke criteria. The patient was treated with broad spectrum antibiotic and heart failure drugs. Then, Heart Team decided to refer the patient to Cardiac Center Harapan Kita for evacuating vegetations and repairing congenital heart defect.

Discussion
Infective endocarditis is one of the most arduous complication that must be treated immediately in patients with VSD. Besides reducing the symptoms that arise from heart defects, the clinicians also have to stop the process of infection. Adequate antibiotics and immediate surgery are the best strategy to evacuate the focus of infection as well as to repair congenital defects.
C55. Intramyocardial dissecting hematoma, a rare complication after myocardial infarction : a case report
Authors: Kaputrin N , Rahimah A F , Rizal A 
Published: March 2023

Abstract

Background
Intramyocardial dissecting hematoma (IDH) is a rare complication of myocardial infarction (MI) that contribute to high morbidity and mortality rate. There is scarce information in literature and hence management uncertainties. Additionally, coronary reperfusion results on the occurrence of IDH is still poorly understood.

Case Summary
A 49-year-old man with a previous anterior wall MI 3 months before without revascularization, presented with a recent onset of New York Heart Association (NYHA) functional class IV heart failure. Echocardiographic diagnosis of IDH was based on the presence of a neocavity with an endomyocardial border extending from the LV mid inferoseptal wall to the apical segments, corroborated with cardiac magnetic resonance (CMR). Coronary angiography showed severe three-vessel disease. The patient underwent staged complete revascularization and kept on optimal medical management. With non-surgical treatment, the patient remained clinically stable and showed a gradual improvement. Repeated echocardiography up to one year after the initial diagnosis demonstrated regression of the haematoma.

Discussion
An unusual form of myocardial rupture that can complicate acute myocardial infarction is IDH. The diagnosis can be missed in some cases. Transthoracic echocardiography may allow diagnosing and evaluating IDH at the bedside. Controversy exists regarding whether surgical repair or conservative treatment is the best option for this condition. The appropriate management should be individualized. Conservative treatment in clinically stable patients suffering from IDH following MI and coronary intervention can be a feasible option.
C56. Isolated Right Ventricular Non-Compaction Cardiomyopathy (IRVNC) in Adolescence: A Case Report
Authors: Fernandes R , Lukito A A , Chandra S , Hutabarat H 
Published: March 2023

Abstract

Background
Non-compaction ventricular myocardium (NCVM) is a rare genetic cause of cardiomyopathy which mostly affects the left ventricle. A limited case of IRVNC was reported which render a limited knowledge for clinician.

Case Summary
A 16-y.o male presented to our emergency unit with recurrent syncope, chest discomfort, palpitation which exaggerated by strenuous exercise. There was no familial history of sudden death. On admission, BP of 102/64 mmHg and bradycardia of 49 bpm were remarkable. Electrocardiography revealed sinus arrhythmia, 49 bpm with early repolarization on precordial leads and LVH. Laboratory tests were in normal limits. Echocardiography revealed hyper-trabeculated RV with no LV-dysfunction. CMR was performed and showed normal LV dimension and function. Right atrium and RV were dilated with RV-dysfunction. RV trabeculae were indicative for IRVNC (NC/C ratio of 4.3). Holter ECG monitoring was done and remarkable for sinus arrhythmia without sinus pause nor ventricular arrhythmia.
Anticoagulant was given for embolic prevention in the non-compacted area. ACEi, β-blockers, and diuretic were not given due to hypotension, bradycardia and no signs of congestion. The patient showed clinical improvement and discharged after 5 days of hospitalization.

Discussions
Recently, there has been no specific criteria and cut off for IRNVC. Earlier studies mentioned that ILVNC criteria could be used for diagnosing IRNVC, as we used in our case. In the future, it’s necessary to determine new cut off points dedicated for IRVNC. Furthermore, close follow-up is needed as complications such as arrhythmia, embolic events and heart failure might occurred.
C57. Left Main Coronary Artery Compression by A Dilatated Pulmonary Artery in Patients with Pulmonary Arterial Hypertension: What Should We Do?
Authors: Jauhari H , Anggrahini D W , Hartopo A B 
Published: March 2023

Abstract

Background
Pulmonary artery hypertension (PAH) is often associated with angina and extrinsic compression of left main coronary artery (LMCA) by a dilatated pulmonary artery is recognized as the cause. The optimal management for pulmonary arterial hypertension with extrinsic LMCA compression has not been clearly established.

Case Summary
We report on 31-year-old female with secundum atrial septal defect and 44 -year-old female with incomplete atrioventricular septal defect complain of progressive typical angina that aggravated with exertion. The electrocardiogram showed right heart strain and chest radiograph showed cardiomegaly involving the right cavities with enlargement of the pulmonary arch. Right heart catheterization showed pulmonary arterial hypertension with the mean pulmonary artery pressure of 61 mmHg and 65 mmHg respectively. Cardiac CT demonstrated compression of proximal LMCA by dilatated pulmonary artery. Although with optimal phosphodiesterase-5 (PDE5) inhibitor and prostacyclin analog therapy, patients still complain of angina.

Discussion
LMCA compression may be associated with additional complications of severe myocardial ischemia, including myocardial infarction, left ventricle dysfunction, arrhythmia, and eventually, sudden death. It may occur in patients with PAH with severely dilated PA and can be identified with either computed tomographic coronary angiography or selective coronary angiography. Furthermore, there are no guidelines recommending optimal management of this disease entity. Optimalization of pharmacologic treatment of PAH may reduce compression-related symptoms. A stent implantation is a promising alternative option for the treatment of LMCA compression and provides an optimal risk-to-benefit ratio, both for symptom relief and for long-term outcomes.
C58. Management of Ellis Type V RV Branch Coronary Perforation Using Handmade Covered-stent: a case report
Authors: Wea Jeffry D D D , Rampengan S H , Pangemanan J A 
Published: March 2023

Abstract
Coronary perforation is a rare but life-threatening complication of percutaneous coronary intervention (PCI) requiring urgent management including balloon inflation, thrombin, microcoils, fat embolization, autologous blood clots administration, heparin-reversing agent, covered-stent implantation, or surgery. We report a case of Ellis type V RV branch coronary artery perforation during PCI treated with a handmade covered-stent.
A 69-year-old female presented with typical angina in three days. She was hemodynamically stable and no sign of congestion. Laboratory results showed leukocytosis, mild elevation of liver transaminase, elevated CK-MB level, mild hypoalbuminemia. ECG showed sinus rhythm with atrial bigeminy, late-onset inferoposterior and RV MI, and first-degree AV block. TTE revealed reduced LV systolic function (LVEF 45%), impaired LV relaxation, reduced RV function, marked LV hypokinetic in inferior, inferoseptal, apicoseptal, and inferolateral wall, and mild ischemic mitral regurgitation. DCA result showed 90 – 95% tubular stenosis in mid-LAD and total occlusion in proximal-RCA with grade V thrombus. She had an anomaly of RV branch angle that resembles the RCA so that the guidewire perforated the distal part of the RV branch artery. PCI was done using hydrophilic wire to distal RCA. Ellis type V perforation was found following multiple balloon inflation in RV branch. Perforation was managed with a handmade covered-stent using a Sirolimus-eluting stent with Tegaderm film. TIMI flow 3 was reached without thrombi or residual stenosis.
In medical centers that have limited resources, handmade covered-stents can be used as an option after unsuccessful balloon inflation trial.
C59. Management of Subacute Painless Aortic Dissection Stanford A Debakey II in Patient With Undiagnosed Marfan Syndrome During Pregnancy
Authors: Fadlan Muhamad Rizki , Kurnianingsih Novi , Widito Sasmojo , Sargowo Djanggan 
Published: March 2023

Abstract

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

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

Discussion
Patient with marfan’s syndrome during pregnancy, may develop painless aortic dissection because massive dilatation of aortic arch prevent compression of pain sensitive structure. Less evidence to manage pregnant woman with MFS with aortic root dilatation more than 45 mm and or progressively dilatation of aortic root ( more than 0.5 mm/year). This patient was categorized as class IV modified WHO classification with high risk maternal mortality and severe morbidity.
C60. Management of Symptomatic Wolff-Parkinson-White (WPW) Syndrome: A Case Report
Authors: Lestari Puspa , Rizal Ardian , A Yudi Putra , Fadlan M R , Ardhi R A Lukitasari Ayu Galuh 
Published: March 2023

Abstract

Background
Atrioventricular reentrant tachycardia (AVRT) could be the reentrant tachyarrhythmia that occurs in Wolff-Parkinson-White (WPW) syndrome. In AVRT, the existence of normal AV node and accessory pathway (AP) along with the atria and ventricles establish the electrical circuit that permits impulse re-entry. The incidence of multiple accessory pathways (MAP) is reported 3-15% and incidence of sudden cardiac death (SCD) in WPW syndrome is about 0.25% per year or 3% to 4% over a lifetime.

Case Description
We presented a case of Wolff-Parkinson-White Syndrome. A 28-year old man was admitted for evaluation of frequent episodes of palpitation. The diagnosis of WPW syndrome was established based on the 12 lead surface electrocardiogram (ECG). Echocardiography showed normal resting echocardiography then we performed electrophysiology study (EPS). We conducted the radiofrequency ablation (RFA) to the accessory pathway (AP). The challenging point of this case was multiple accessory pathways (APs) located at right posteroseptal and left lateral.

Discussion
Ablation of multiple accessory pathways (MAP) had a longer fluoroscopic time and large number of unsuccessful attempts than those with a single accessory pathway. We performed RFA at right posteroseptal and left lateral accessory pathway. The radiofrequency ablation has successfully eliminated both accessory pathways. In summary, we conclude that anatomical consideration, EP study, and the ablation strategy was important to improve the safety and success rate of RFA procedure.
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: March 2023

Abstract

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.
C62. May-Thurner syndrome, a diagnosis and endovascular treatment in adult women with no risk factor: a case report and literature review
Authors: Hidayatullah F N , Pasciolly R M R J 
Published: March 2023

Abstract
May-Thurner syndrome (MTS) is a venous compression syndrome in which the left common iliac vein (LCIV) is compressed between the lower lumbar spine and the right common iliac artery (RCIA). This syndrome is suspected when a patient presents with recurrent or chronic venous insufficiency (CVI) or deep vein thrombosis (DVT) on his/her left lower extremity; although MTS’ clinical presentation varies. A history of recurrent left lower extremity DVT and symptoms associated with chronic venous hypertension, including varicosities, venous ulcers, lower limb swelling, and pain in the inguinal, calf, or upper leg regions suggests MTS diagnosis. We present a case report and conduct a literature review on a patient presenting with painful, numb, and swollen left leg since three months before admission. Intermittent claudication was found. Doppler ultrasonography confirmed no thrombus, yet suggested that the RCIA compressed the LCIV. Doppler’s finding was confirmed using computed tomography (CT) scan, and RCIA compression seemed to cause an obstruction. MTS diagnosis is often missed in patients with lower limb pain because the block is not caused by a thrombus and a clinician often misses to conduct Doppler examination on the iliac artery/vein. This study highlights the importance of considering MTS in a patient with left lower limb pain, and chronic DVT which is unresponsive to pharmacological treatment, hence, endovascular treatment may be warranted.
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: March 2023

Abstract

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.