bluuebunny/crossref_metadata_2025_split huggingface dataset:
M16. The potential role of pentraxin-3 as prognostic factor to predict outcome in heart failure patients with reduced left ventricular ejection fraction: a meta-analysis study
Authors: Soemarno H W , Nursabur B M 
Published: April 2022

Abstract

Aims
This study was aimed to investigate the prognostic value of pentraxin-3 in predicting cardiac events in heart failure with reduced left ventricular ejection fraction (HFrEF) patients.

Methods and Results
A comprehensive search was conducted on Pubmed, Science Direct, Taylor-Francis and LILACS database with the date of publication ranging from inception until 20 July 2021. The identified articles were screened based on pre-specified eligibility criteria which resulted in four prospective cohort studies included in quantitative analysis. Their risk of biases have a mean score of 8.2 ± 0.4 according to the Newcastle-Ottawa Scale, equivalent to good quality rating based on the Agency for Healthcare Research and Quality. In these studies, 3,427 HFrEF patients were enrolled to measure their pentraxin-3 levels on admission and to observe cardiac events, defined as cardiac death or rehospitalization for worsening HF. The association between pentraxin-3 and cardiac events was summarized using forest plot and the heterogeneity was evaluated by I2 index. Higher concentrations of pentraxin-3 on admission were consistently associated with increased cardiac events in HFrEF patients (HR: 1.21, 95% CI: 1.14 - 1.29, I2: 12%). Unfortunately, most of the studies were conducted in Asia and had small sample sizes, which affects the external validity of this meta-analysis.

Conclusion
Elevated concentrations of pentraxin-3 on admission are associated with cardiac events in HFrEF patients. Further investigations with an emphasis on multi-centre studies, as well as the establishment of the standard cut-off value, are needed.
C2. A Case of Arrhythmogenic Right Ventricular Cardiomyopathy Presenting with Recurrent Ventricular Tachycardia : The Role of Imaging to Confirm Diagnosis
Authors: Permitasari D A , Habibi F N , Ardhianto P 
Published: April 2022

Abstract

Background
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited condition which predominantly affects young people, characterized by fibrofatty replacement of the right ventricle. It is also commonly being underdiagnosed, so that the role of imaging is imperative to confirm diagnosis of ARVC patient.

Case Summary
A 57-year-old man presented with palpitation, syncope and chest pain. The symptoms had begun since 3 month prior to hospital admission with no family history of premature sudden death. He had been hospitalized 3 times before due to palpitation. Electrocardiogram (ECG) revealed ventricular tachycardia with LBBB morphology and superior axis. Patient was undergoing 100 Joule cardioversion, and the ECG post-cardioversion showed sinus rhythm with inverted T-wave in inferior and anterior leads. Echocardiography revealed enlargement and reduced function of right ventricle (RV). Coroangiography revealed nonsignificant stenosis coronary artery disease. Cardiac MRI showed dyssynchrony RV contraction, reduced RV ejection fraction &lt;40%, hyperintensity in RV endocardium and posteroinferior aspect of endocardium to myocardium left ventricle, representing the fatty infiltration. Our patient had 2 major criteria which established the diagnosis of definite ARVC according to revised Task Force Criteria. Patient was planned to have an implantable cardiac defibrillator.

Discussion
Late clinical presentation of ARVC is rare, thus it should be included in the differential diagnosis when treating older patient with ventricular tachyarrhythmia. This case highlights the importance of imaging, either with echocardiography and cardiac MRI to confirm the diagnosis of ARVC as the potential cause sudden cardiac death.
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: April 2022

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.
C7. Air Traveling – Related Acute Decompensated Heart Failure, The Nightmare Begin in The Sky: A Case Report
Authors: Abdul G , Akhtar F M 
Published: April 2022

Abstract

Background
Patients with heart failure are prone to experience problem contributed air travel. The major cardiovascular problem with aviation is mainly as a result of dropping air pressure. During flight the cabin pressure will drop and be maintained at 8000 ft, bringing oxygen levels down to 15%.

Case Summary
A 50 yo woman presented with diaphoresis, acute worsening of dyspnea, and hypoperfused after air travel. In the first 10-15 minutes of 1-hour flying, she felt tachycardic and becoming increasingly short of breath that doesn’t relieve after debarking off. The previous history included chronic heart failure due to severe mitral regurgitation and hypertension. Echocardiography study revealed severe mitral regurgitation due to prolapse AML and dilated LA with preserved ejection fraction. Initial management with dobutamine and norepinephrine and then furosemide improved her clinical status. The patient was discharged with planning for surgical correction for mitral regurgitation.

Discussion
The presentation of signs and symptoms denote clinical conditions termed acute decompensated heart failure wet and cold type. The onset of symptoms revealed that this situation related to air traveling. Drop in air pressure and oxygen levels that occur at the cabin during flight make physiological and psychological stress, hypoxia, and raised sympathetic tone. In the patient with preexisting chronic heart failure, these responses will lead to clinical decompensation and deterioration.
C9. An Extremely Rare Dual Congenital Disorder of The Heart: Aberrant Tendinous Chords with Tethering of The Tricuspid Leaflet Associated with Wolff-Parkinson-White Syndrome
Authors: Hartoko A , Nugraha M T 
Published: April 2022

Abstract

Background
Aberrant tendinous chords with tethering of the tricuspid leaflets is a rare congenital etiology of tricuspid regurgitation (TR), defined as abnormal insertion of tendinous cords at the clear zone of the tricuspid leaflet and connect to the endocardium instead of the papillary muscles. Wolff-Parkinson-White (WPW) syndrome defined as a congenital condition involving additional conductive cardiac tissue between the atria and the ventricles that provides a pathway for a reentrant tachycardia circuit. Ebstein's anomaly (EA) is the most commonly occurring congenital abnormality that caused TR associated with the WPW. Until now, there is no case report of aberrant tendinous chords with tethering of the tricuspid leaflets that associated with WPW.

Case Illustration
A 26-year-old female with history of recurrent palpitation she was given was referred to our hospital. Resting ECG revealed sinus rhythm with delta wave suggesting diagnostic of WPW. On physical examination we found loud systolic murmur on left lower sternal border. Echocardiography examination revealed dilated right atrial and right ventricle, severe tricuspid regurgitation with restricted septal TV caused by aberrant tendinous chords. No apical displacement of tricuspid leaflet &gt;8 mm/m2 excluding the diagnosis of EA.

Discussion
Both WPW and aberrant tendinous chords with tethering of the tricuspid leaflet are rare congenital disorder of the heart. EA is most common congenital TR associated with WPW, there are rarely reported other congenital TR associated with WPW. This case illustrates extremely rare case where we found both WPW and Aberrant Tendinous Chords.
C10. An ultra-rare case of Hutchinson–Gilford progeria syndrome with severe aortic regurgitation due to bicuspid aortic valve in a 9-year-old girl
Authors: Rasaki R , Novita  , Heriansyah T 
Published: April 2022

Abstract

Background
Hutchinson-Gilford progeria syndrome (HGPS) is an ultra-rare autosomal dominant that result in progressive premature aging syndrome. Cardiovascular diseases become the main cause of mortality including myocardial infarction, interstitial myocardial fibrosis, hypertension and calcification of the mitral and aortic valves. However, the relationship between HGPS and bicuspid aortic valve (BAV) has not been documented yet.

Case Summary
A 9-year-old girl with HGPS presented to the outpatient clinic with a complaint of shortness of breath since 5 years ago, especially when she did moderate physical activity. Chest pain and palpitation were denied. Her physical examination revealed short stature, thin, wrinkled skin, craniofacial disproportion with alopecia, shrunken facies and prominent scalp veins. There was failure to thrive and diastolic murmur grade 2/4 is heard on the aortic area. Laboratory test showed leukocytosis. Transthoracic echocardiogram showed severe aortic regurgitation due to calcified bicuspid aortic valve and mild mitral regurgitation. She was managed by conservative therapy because her parents were still considering the aortic valve repair procedure.

Discussion
The HGPS patient with severe aortic regurgitation due to BAV should be managed to reduce cardiovascular complications. Aortic valve repair is an interesting alternative to replacement managing aortic regurgitation due to BAV in young adults. Recently, advanced science about BAV disease and refinement of surgical techniques improved standardization of BAV repair procedure.
C13. Atropine Challenge: Bedside Diagnosis of Block Level
Authors: Akbar R R , Wasyanto T 
Published: April 2022

Abstract

Background
The concept of 2:1 AV block remains poorly understood by many physicians even after so many years of advancement in the field of electrophysiology. It cannot be classified into type I or type II second-degree AV block because there is only one PR interval to examine before the blocked P wave.

Case Illustration
Case 1 . A 78-year-old male with asymptomatic bradycardia was referred to our hospital. Resting ECG revealed 2:1 conduction AV block. In order to define the site of block we performed the atropine challenge test, revealed improvement of AV block to Mobitz I and then 1st degree AV block, suggesting the suprahissian block. Case 2. A 74-year-old male with inferoposterior and right ventricular STEMI was referred to our hospital. His resting ECG revealed 2:1 conduction of P wave. The atropine challenge test revealed improvement of block to 1st degree AV block, suggesting the suprahissian block.

Discussion
It is often difficult to distinguish intranodal and infranodal blocks when 2:1 conduction is present. Therefore, a careful search of a long ECG tracing for two consecutive P waves should be made. In addition, atropine can improve AV node conduction due to sympathetic and/or parasympatholytic stimulation. Therefore, it may increase AV node conduction but worsen infranodal block without affecting the refractory period of the infranodal. This case illustrates the importance of a noninvasive test for confirming the location of a 2:1 conduction AV block, as guide to diagnostic and therapeutic determinations.
C14. Benefit and Safety of Cardiac Rehabilitation Program in Pulmonary Hypertension Patient after Atrial Septal Defect Closure with Fenestration
Authors: Etami H V , Anggrahini D W , Arso I A 
Published: April 2022

Abstract

Background
ASD closure with surgical fenestration is purposed to reduce pulmonary hypertension (PH) crisis. PH is still found in patient conducting this procedure. Some issues told that PH patient should restrict activities due to complaints aggravation. Proper cardiac rehabilitation gives clinical improvements and safe for stable PH patient.

Case summary
A 20-year-old male, diagnosed as left to right shunt ASD with pulmonary hypertension (mPAP 41 mmHg, PVRI 4.86, and Qp/Qs 1.62), was conducted surgical closure with fenestration. Patient was given cardiac rehabilitation program from 6-minute walking test result. It was done twice a week for 1 month after surgery by walking on treadmill for 600 meters in 30 minutes and was increased 100 meters per meeting, the heart rate target was 107 – 125 beats per minute. The program evaluation by treadmill test on the last session showed increase of fitness capacity (9.33 METs from 2.34 METs) and decrease of symptoms. There was no incident during exercise. Education were given for PH evaluation and healthy lifestyle.

Discussion
Cardiac rehabilitation program was emphasized for PH management. Continuous and moderate intensity exercise is recommended than high intensity exercise. The cardiac rehabilitation program showed improvement of physical capacity, quality of life, and reduction of NT pro BNP by increasing peak oxygen uptake, anaerob threshold, pulmonary perfusion, muscle function and decreasing inflammatory response, oxidative stress, smooth muscle cell proliferation. It is save for stable PH patient under healthcare supervision.
C16. BRASH (Bradycardia, Renal Failure, AV Nodal Blocker, Shock, and Hyperkalemia) Syndrome: Lost in Plain Sight
Authors: Hazzy Fandy , Rohman M Saifur 
Published: April 2022

Abstract

Background
Bradycardia, Renal failure, AV-Nodal blockers, Shock, Hyperkalemia (BRASH) Syndrome new clinical entities due to a vicious cycle in which hyperkalemia from renal failure synergizes with AV-nodal blockers, consequently between the clinical condition of patients with the degree of hyperkalemia and bradycardia are inappropriate, Furthermore, the symptoms may be refractory to typical positive chronotropic interventions or overdose antidotes.

Case Illustration
A hypertensive 70-years old female with history of heart failure with routinely consume spironolactone, diltiazem, and beta blocker admitted with bradycardia and shock after watery diarrhea and vomit 3 days before. The electrocardiogram showed junctional rhythm 40 beats per minutes. Laboratory findings Hyperkalemia (6.8 mEq/L) and acute kidney injury (urea 58.6 mg/dL, creatinine 3.13 mg/dL, eGFR 16.23) was presented. Refractory hyperkalemia occured, but by using pacemaker, providing adequate fluids, and the return of renal perfusion, hyperkalemia can be overcome.

Discussion
BRASH syndrome usually triggered by hypotension in the elderly due to hypovolemia or an overdose of antihypertensive drugs. The natural compensation response for hypotension is to increase heart rate, but AV-nodal blockers blunt this response, which causes a decrease in renal perfusion. This ultimately results in hyperkalemia and accumulation of AV-nodal blockers which produce a synergistic effect causes bradycardia and decreased renal perfusion. Treatment involves supportive care including hemodynamic support with fluids and management of bradycardia, and also avoid trigger factor.
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: April 2022

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.
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: April 2022

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.
C33. Complex ebstein anomaly in adult patient: a case report
Authors: Ratnasari A B , Fagi R A 
Published: April 2022

Abstract

Background
Ebstein’s anomaly is a rare form of congenital heart disease. In adult often present with arrhythmias, progressive cyanosis, and right heart failure. Management is complex and individualized.

Case Summary
A 24-year-old woman presented to the emergency room with heart failure presentation, palpitations and fainting. ECG examination shows abberant SVT with pulse, hemodinamically was stable with peripheral saturation 94% without oxygen supplementation. The patient then carried out cardioversion and got anti-arrhythmia amiodarone. Resting ECG obtained sinus rhythm right axis deviation with incomplete LBBB (splintered QRS). Echocardiography examination revealed displacement of the tricuspid valve, a large atrialized component of the right ventricle, the anterior leaflet of the tricuspid valve moves freely with bidirectional shunt ASD and moderate pericardial effusion, confirmed for Ebstein's anomaly type B .
Diuresis therapy was given and anti-arrhythmic therapy was continued. Echocardiographic evaluation showed reduced pericardial effusion to a minimum. Patients were scheduled for electrophysiological studies and angiographic evaluation and total corrections were planned.

Discussion
Ebstein anomaly is a characterized by abnormally formed and apically displaced leaflets of Tricuspid caused by is failure of proper delamination of the tricuspid valve, primarily of the septal and anterior leaflets from ventricular myocardium. The cardinal symptoms in Ebstein’s anomaly are cyanosis, right-sided heart failure, arrhythmias, and sudden cardiac death. Surgery is indicated in adults with symptoms of heart failure. Medical therapy is generally used only for temporary stabilization : diuretic therapy for volume overload, control of heart rhythm abnormalities, and standard medical therapy for left ventricular systolic dysfunction.
C35. Congenital Heart Disease in Neonatal Lupus: a case report
Authors: Pramono A , Abdullah L N 
Published: April 2022

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.