bluuebunny/crossref_metadata_2025_split huggingface dataset:
C24. Cardioembolic Stroke due to LV Thrombus : Very High Risk NSTEMI Complication
Authors: Valdy Gerry , Syafri Masrul , Syukri M 
Published: March 2023

Abstract

Background
Ischemic heart disease is the major cause to the high mortality rate. Ischemic heart disease was responsible for 7 million of the 53 million deaths reported in 2010. Left ventricle thrombus that complicates acute myocardial infarction (AMI) is a major cause of cardioembolic stroke.

Case Summary
A 69-year-old man presented with typical of infarction chest pain and shortness of breath since 2 days before admission to the hospital. The patient was diagnosed with NSTEMI TIMI 4/7 GS 177, PVC Frequent and history of VT and was planned for immediate PCI. After cannulation in the left coronary artery, the patient developed VT/VF and therefore CPR was performed. The patient was in ROSC then admitted to the CVCU and had improved. After two days of treatment, the patient experienced weakness in right limbs and difficulty of speaking, followed by decreased consciousness and suspected with ischemic stroke. The patient was then immediately treated for cardioembolic stroke. After 1 day of treatment the patient got worsened and was declared dead.

Discussion
Based on NSTEMI startification, patients was included in very high risk with a major cardiovascular event rate of 40.9%. During the treatment, patients experiencing cardioembolic stroke which causes increased mortality. Management of cardioembolic stroke as soon as possible increases the chances of success in therapy
C25. Cardiogenic shock in a 25-year-old male with tombstone ST-segment elevation pattern in emergency department, early hemodynamic assessment to guide the management: a case report of mixed cardiogenic shock phenotype
Authors: Tiyantara M S , Furqon M 
Published: March 2023

Abstract

Background
Cardiogenic shock (CS) is a lethal condition. There are several phenotypes, and classification based hemodynamic and/or clinical parameters for CS. We present CS with tombstone ST-segment elevation in emergency department (ED) with assessment of hemodynamic using bedside ultrasound to classify and guide the management.

Case Description
A 25-year-old-male complained sense of fatigue, fever, and myalgia for 2 days. The initial blood pressure and SpO2 were unrecordable, heart rate 112x/m, respiration rate 28x/m, temperature 36.8 °C. The patient was pale, anxious, with difficult jugular venous pressure assessment due to overweight appearance, diminished S1, and cold extremity. Electrocardiogram revealed tombstone ST-elevation in V2-V6, I, and aVL. After oxygenation management, initial dobutamine and norepinephrine, we performed bedside cardiac ultrasound revealed anterior left ventricular wall hypokinesis, mild pericardial effusion, ejection fraction 52%, mitral E/A ratio 2.7, E deceleration time 90.82ms, positive lung B-lines, inferior vena cava diameter 2.14cm with collapsibility &lt;50%. Tricuspid annular plane systolic excursion 19mm. Estimated cardiac index 1.88L/m/cm2, and systemic vascular resistance (SVR) 775dynes.sec/cm5. This pattern suggests mixed CS phenotype. Vasopressor was up titrated with improved blood pressure, SpO2, and urinary output. CXR revealed cardiomegaly, troponin T &gt; 10.000pg/ml. The patient was successfully stabilized in ED and transferred to ICCU.

Discussion
We classify our case as mixed CS. With hemodynamic assessment, we can determine the character of the shock with more objective parameters, guide the treatment, and avoiding over (increase oxygen demand, afterload, arrhythmia) and underused of vasopressor to bridging the treatment of causative factor.
C26. Case report: COVID-19 associated Takotsubo cardiomyopathy
Authors: Mulia E P B , Dewi I P , Subagjo A , Pikir B S 
Published: March 2023

Abstract

Background
COVID-19 infection can lead to several cardiovascular sequelae, including Takotsubo cardiomyopathy (TCM), which may portend worse clinical outcomes.

Case Description
A 56-years-old woman with history of hypertension presented to the emergency room for dyspnea and gradual decrease of consciousness for seven days. She was positive for COVID-19 and transferred to intensive care unit to receive mechanical ventilation due to respiratory failure. Electrocardiogram showed pathological Q wave and ST elevation in inferior and anterior. Troponin I was mildly elevated (5.52 ng/ml). Inflammatory marker CRP and procalcitonin were increased (3.6 mg/dl and 0.235 ng/ml, respectively). Serum cortisol level was 525.8 ng/ml. Echocardiography showed reduced left ventricular ejection fraction (LVEF 41%), with severe hypokinetic of the apical segments and preserved basal myocardial function consistent with visual signs of apical ballooning in TCM. Her follow-up echocardiography showed normal contractility of the apical myocardial segments, with normalization of the left ventricular systolic function, further supporting the reversibility of acute stress cardiomyopathy.

Discussion
Mechanisms of TCM in viral infections include catecholamine-induced myocardial toxicity and inflammation related to sepsis. A presumptive diagnosis of TCM was made based on the characteristic echocardiogram findings of apical ballooning, normalization of left ventricular systolic function, unremarkable past cardiac history and spontaneous improvement in serum troponin-I levels in the setting of a severe systemic illness.

Conclusion
Clinicians should be aware of the diversity of cardiovascular complications of COVID-19, including Takotsubo cardiomyopathy and should strategize appropriately for diagnosing and managing them.
C27. CATASTROPHIC EVENT IN PERCUTANEOUS CORONARY INTERVENTION PROCEDURE: TYPE III LEFT MAIN CORONARY ARTERY DISSECTION
Authors: Suwarjana K I G B P , Aryadana W , Pradnyana D. S B A , Suwirya A P 
Published: March 2023

Abstract
Percutaneous coronary intervention (PCI) is an invasive revascularization method to improve coronary blood flow in patients with CHD. A male patient, 61 years old, came to the cardiac clinic at Sanglah General Hospital, complaining intermittent chest pain since one month earlier. Coronary angiography found a stenosis of 70% in the ostium left anterior descending coronary artery (LAD), 80-90% in the proximal to distal LAD and 70-80% in the ostium to the proximal right coronary artery (RCA).The patient was diagnosed with coronary artery disease 2 vessel disease (CAD 2VD) and was then prepared for the PCI procedure on LAD.
The 6F Optitorque TIG catheter was then replaced with a 3.5/6F BL guide catheter to the LMCA ostium. Angiographic evaluation at the time of re-canulation revealed aortic dissection at the LMCA to the ascending aorta (type III) and cessation of blood flow to the LAD. The patient then complained of severe chest pain accompanied by shock. Wiring to distal LAD was performed quickly afterward using a 0.014”/180 cm Runtrough NS Floppy, followed by a 2.0 x 15 mm balloon inflation on the LMCA ostium to the proximal LAD. Then, double wiring was performed to the LCx using 0.014 "/ 180 cm Runtrough NS Floppy wire to maintain coronary patency. At last, the a 3.5 x 12 mm Drug Eluting Stent (DES) on the LMCA to proximal to the LAD. Despite stenting at the dissection site, the patient fell into shock, developed a malignant arrhythmia and subsequently had cardiac arrest.
C30. Clinical Decision Making in Intermediate Coronary Stenosis: Role of Fractional Flow Reserve
Authors: Kusnadi S , Nugraha M T 
Published: March 2023

Abstract

Background
Coronary stenosis can be managed by percutaneous coronary intervention (PCI). However, it has limitation by producing only 2D images of the actual 3D vascular lumen. It is necessary to assess the functional significance of stenosis with fractional flow reserve (FFR).

Case Summary
There are two patients in this case. The first patient was a 52-year-old man with typical chest pain, with a history of PCI in LAD 2 years earlier. Echocardiography revealed regional wall motion abnormality (RWMA) with reduced left ventricular ejection fraction (LVEF) of 30-40%. PCI with FFR guidance was performed. Previous stent in osteal-distal LAD was patent. In the distal LAD, a stenosis of 60-70% was obtained with FFR of 0.81. In distal LCX, 50-60% stenosis was also obtained with FFR of 0.91. No stent was implanted then. The second patient was a 59-year-old man with typical chest pain. The patient had been stented in proximal-mid LAD and LCX-OM a year earlier. Echocardiography showed RWMA with LVEF of 51-54%. LAD and LCX stents were patent. A 70-80% stenosis was found in both mid and distal RCA. FFR was done in the mid-RCA with result of 0.57, so stent was placed in the mid RCA. FFR at distal RCA was 0.31 so that the stent was also placed in the distal RCA. Both showed good results.

Discussion
Physiologic assessment is important before deciding to revascularize. FFR-guided PCI is expected to better guide us in managing intermediate coronary stenosis.
C31. Closure of patent ductus arteriosus using intravenous paracetamol : a case series
Authors: Nursalim S , Setyawan D , Limbong M , Ahmad F 
Published: March 2023

Abstract

Background
Although patency of ductal arteriosus is essential for fetal circulation, postnatal ductal closure is critical for postnatal circulation adaptation in order to avoid pulmonary overcirculation with diminished circulation blood flow. Standard medical treatment for patent ductal arteriosus (PDA) consists of pharmacotheraphy and or surgical intervention.

Case Summary
We present 17 cases of PDA confirmed by echocardiography and was observed for ductal closure after 3 days of intravenous paracetamol intervention (10-15 mg/kg) given every 8 hours. The echocardiography evaluation of PDA status was conducted after those pharmacological intervention and divided based on the gestational age group. In the preterm groups (&lt;36 weeks), 3 cases remained open, 3 cases were closed, and 1 case with reduced flow. In the aterm groups (36-42 weeks), 5 out of 8 cases were closed, while the other 3 showed reduced flow. In the postterm groups (&gt;42 weeks), 1 case was closed and 1 case with reduced flow. Successful rate for PDA closure of each groups were 43%, 62,5% and 50%.

Discussion
Indomethacin and ibuprofen are standard treaments for PDA closure. However, they have some side effects such as acute renal failure and gastrointestinal complications. From this case series, paracetamol has a promising effect similar to indomethacin and ibuprofen in conducting PDA closure with less side effects. Paracetamol inhibits prostaglandin synthetase activity eventhough its precise mechanism of action remains controversial.
C34. Concomitant Finding of Hemorrhagic Cardiac Tamponade and Venous Thromboembolism as the First Manifestation of Occult Malignancy – A Case Report
Authors: Sitorus Sondang Jasmine , Alsagaff Mochamad Yusuf , Kusumastuti Etty 
Published: March 2023

Abstract

Background
Venous thromboembolism (VTE) encompasses pulmonary embolism (PE), and deep vein thrombosis (DVT) is a common complication of cancer. Cancer manifestation in cardiac often secondary from the metastatic process, mostly in the pericardium. These concomitant findings of PE, DVT, and hemorrhagic cardiac tamponade as the first signs of cancer in a young patient is rare.

Case Summary
A 39-years-old man was referred to the emergency department from secondary hospital with the main complaint of dyspnea that onset abruptly two days before admission and swollen of the entire right leg since one week before. We report concomitant finding of hemorrhagic cardiac tamponade, deep vein thrombosis, and acute pulmonary embolism as initial presentations of occult malignancy. Starting anticoagulant in the hemorrhagic state and finding the primary cancer were problematic and challenging.

Discussion
The challenge in management, posed by hemorrhagic versus thrombosis state in cancer, prompted us to cautiously deliver the treatment with consideration of benefit over the risk. Primary cancer is not always easy to identify. Comprehensive (re-)evaluation is mandatory.
C36. Deep Vein Thrombosis in A Patient with Thrombocytopenia : Case Report
Authors: Mirza Teuku , Ridwan Muhammad , Heriansyah Teuku 
Published: March 2023

Abstract

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.
C38. Diagnosis and Management of Atrial Septal Defects (ASD) and Pulmonary Hypertension (PH) in Pregnancy
Authors: Sari Anna P , Krevani C K , Karani Y , Kino  
Published: March 2023

Abstract

Background
Atrial Septal Defect (ASD) is a congenital heart disease that is often found in adulthood, including women in pregnancy. Women with ASD are at greater risk for cardiovascular complications during pregnancy especially with Pulmonary Hypertension (PH), so comprehensive management is essential for this case.

Case Summary
A 31-year-old woman with gravida 32-33 weeks complaint of shortness of breath increasing since 3 days before entering the hospital with central cyanosis, clubbing finger, peripheral oxygen saturation 74%, from auscultation showed hardened P2 sound, indistinct wide fixed split, grade 3/6 systolic murmur. Echocardiography showed ASD with High Probability PH (Pulmonary Hypertension). The patient treated with furosemide 2x20 mg, sildenafil 3x12.5 mg, 3x20 mcg berraprost. The pregnancy was electively terminated with cesarean delivery and also got tubectomy. After 18 days of treatment in hospital, patient was discharged with stable and good condition. The patient was planned for right heart catheterization from outpatient clinic.

Discussion
Based on Guidline ESC on the management of Cardiovascular disease during Pregnancy in 2011, patients with ASD-PH are included in class IV WHO classification, where are contraindicated for pregnancy. If the pregnancy continues, recommended for patients to control regularly to the cardiologists and obstetricians during pregnancy, delivery and the puerperium.
From literature, cesarean delivery is recommended for pregnant women with Pulmonary Hypertension (including Eisenmenger's Syndrome). Special attention and comprehensive management are required for pregnant patients with ASD-PH. The choice of intervention method and some medical therapy in this patient must also be considered.
C39. Ductus Arteriosus Stenting: A Promising and Life Saving Procedure for Ductal-Dependent Pulmonary Blood Flow
Authors: Permitasari D A , Priyatno A , Ayukusuma A R , Andini A R , Christina M , Susilawati M 
Published: March 2023

Abstract

Background
Duct-dependant congenital heart disease in newborn presents as a life-threatening emergency and the survival depends on patency of the ductus arteriosus. Stent implantation into ductus arteriosus has been proposed as non-surgical management for critical congenital heart disease with duct-dependent.

Case Summary
We present full-term newborn babies who had critical congenital heart disease with ductal-dependent pulmonary blood blow and successfully managed with ductal stenting. Patient A, a 13-days-old male had Tetralogy of Fallot-Pulmonary Atresia and restrictive Ventricular Septal Defect (VSD). Patient B, a 3-days-old male had Pulmonary Atresia-Intact Ventricular Septum (PA-IVS) with Patent Foramen Ovale (PFO). Patient C, a 5-days-old female had Tricuspid Atresia with restrictive VSD and multiple congenital anomaly. Patient D, a 2-days-old female had PA-IVS with PFO stretch. Prostaglandin-E1 infusion was started at first and stop 6 hours prior to the procedure. Ductus arteriosus stenting using drug-eluting stent and femoral artery approach was successful in all 4 patients. All patient had improvement of oxygen saturation and good post-procedure outcome.

Discussion
Ductal stenting in patient with duct-dependent pulmonary circulation appears to be an alternative to surgery. It provides a bridging palliation in cyanotic congenital heart disease until the time of definitive surgery. Stenting of ductus arteriosus is feasible and safe with good result, thus early recognition and timely management are important to save the life.
C40. Early Repolarization Syndrome: The Dangerous One
Authors: Islami Z H , Hidayati F , Maharani E 
Published: March 2023

Abstract

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

Case Summary
A 40-year-old male with a history of several syncope episodes. The latest episode in 2019 at 5 am, a brief convulsion happened before the patient went unconscious. In emergency room, he had another convulsion with a witnessed ventricular fibrillation. After resuscitation and defibrillation, the patient awoke, and ECG was recorded showing ST-segment elevation at V2-3 which suspected to be a Brugada syndrome (BrS).
Patient then referred to Sardjito hospital for echocardiography and treadmill test, and the results were within normal limit. Coronary CT Scan showed a non-significant lesion at LAD. Holter examination showed during sleeping, J-wave elevation appeared at the rate of 50 bpm. Meanwhile, during exercise, J-wave disappeared at the rate of 135 bpm. The patient was diagnosed as early repolarization syndrome (ERS) and managed with implantable cardioverter-defibrillator (ICD) implantation.

Discussion
Patient with ERP who suffers syncope/cardiac arrest is classified as an ERS. Particular clinical findings such as history of cardiac arrest, convulsion, apnea, and ECG findings such as short coupled premature ventricular contraction, dynamic J-wave changes, widespread J-wave are associated with a higher chance for ventricular arrhythmia. Due to its similar nature in ECG morphology and its pathophysiology, ERS and BrS are classified into J-wave syndrome.
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: March 2023

Abstract

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.
C42. Eisenmenger Syndrome, Could Its Pathophysiological Changes Serve as Protective Factors Against Severe COVID-19 Infection?
Authors: Gunawan R Y , Medishita H 
Published: March 2023

Abstract

Background
Congenital heart disease (CHD) and pulmonary artery hypertension (PAH) are comorbidities to severe COVID-19 infection. We reported a case of adult congenital heart disease (ACHD) with Eisenmenger Syndrome (ES) who survived COVID-19 without progression to severe infection.

Case Description
A 39 years old male with history of uncorrected ACHD complained of low-grade fever and cough for 3 days. Initial oxygen saturation was 85%, no tachypnoea, no tachycardia, and blood pressure was normal. SARS-CoV2 RT-PCR results was positive. Thorax CT showed lung fibrosis, minimal GGO, and prominent pulmonary notch. Notable laboratory result was haemoglobin: 20.4g/dL. Echocardiography showed a large secundum ASD with bidirectional shunt, dilated RA and RV, normal ventricular systolic functions, mild TR with increased tricuspid gradient (TR V max 4.27m/s) which concluded the diagnosis of ES. The patient was treated according to moderate COVID-19 guidelines and ES management. His response to treatment was favourable and was discharged in 3 weeks uneventfully.

Discussion
Studies have documented CHD and PAH as comorbid to severe COVID-19 infection, but our patient had moderate COVID-19 infection and recovered without progression to severe disease. We proposed several pathophysiological characteristics of ES which could serve as protective factors against severe COVID-19, which are: 1) Pre-existing PAH, where pulmonary vasculopathy and remodelling lessened endothelial response to inflammation, and reduced expression of ACE2 receptors, 2) Chronic hypoxia, which prepared cells and tissues against hypoxic environment, and 3) Polycythaemia, might be beneficial in haemoglobinopathy directly caused by SARS-CoV2.