bluuebunny/crossref_metadata_2025_split huggingface dataset:
C40. Early Repolarization Syndrome: The Dangerous One
Authors: Islami Z H , Hidayati F , Maharani E 
Published: April 2022

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.
C47. Heparin Induced Thrombocytopenia (HIT) Associated with Multiple Deep Vein Thrombosis (DVT) and Intracardiac Thrombus Who Underwent Vena Cava Filter Prior to Surgical Thrombus Evacuation : a Case Report
Authors: Sihotang I M , Ryanti D , Haykal T B , Habib F , Ardini T W , Ketaren A P , Hasan H 
Published: April 2022

Abstract

Background
Heparin-induced thrombocytopenia (HIT) is a serious adverse drug reaction that increases patient’s risk of developing venous or arterial thromboembolism, which maybe life-threatening. The frequency varies from 0.5% to 5%, depending on population studies. This condition will worsen especially in patients with deep vein thrombosis.

Case
A 52 years old woman was reported swelling and decreased saturation of the lower extremities, with a history of Heparin therapy for 5 days before being referred to Haji Adam Malik Hospital Medan. Platelet count on admission day was 225.000/µl but dropped into 64.000/µl in the 7th post heparin treatment day. Doppler examination showed multiple thrombosis in deep femoral vein and and sign of stenosis peripheral artery. Echocardiography showed intracardiac thrombus without sign of acute pulmonary embolism. Two days after discontinuation of heparin, the platelet still tend to be low but in the next days, its count increases to within normal range. Due to the high risk of embolism, it was decided to place a vena cava filter prior to surgery for thrombus evacuation.

Discussion
This case demonstrates several interesting aspects of HIT, including thrombotic complication, limitation tools to support diagnosis of HIT, how to prepare this patient into surgical management, and the last is placing a IVCF prior to surgical thrombus evacuation and thrombectomy to reduce the risk of thromboemboli before surgical treatment. This is the first time procedure in Medan for placing a vena cava filter in a DVT patients who have contraindication to heparin administration.
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: April 2022

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: April 2022

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.
C72. Peripartum Cardiomyopathy: “Comparison in Management of Two Cases”
Authors: Widyastuti W , Krevani C K , Karani Y 
Published: April 2022

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.
C75. Premature Coronary Artery Disease in Young Male Patient with Strong Family History
Authors: Kurniawan A , Rohman M S 
Published: April 2022

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.
C77. Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction with Acute Kidney Injury caused by Cardiogenic Shock, Is it Really Safe?: A Case Report
Authors: Pamuna O S , Rohman M S 
Published: April 2022

Abstract

Background
ST-elevation myocardial infarction (STEMI) is a life-threatening condition. Timely treatment with Percutaneous Coronary Intervention (PCI) is a recommended management of STEMI. However, PCI in STEMI with Acute Kidney Injury (AKI) was a high-risk procedure with possibilities of worsening renal function.

Case Description
A 53 years old, woman, was referred from a private hospital with STEMI inferior Killip IV onset 5 hours with typical chest pain and azotemia. Creatinine serum was 3.4 mg/dl; eGFR 15 ml/m/1.73m2. Blood Gas Analyses show metabolic acidosis uncompensated. In the emergency room, she got hydration and inotropic drugs. After the PCI procedure, she was fallen into an altered mental status and shock condition. The laboratorium result in our hospital showed improvement of creatinine level to 1.6 mg/dl. We treated this patient for 9 days, with optimal medicaments and fluid therapy. On the last day of treatment, there is an improvement in clinical presentation and laboratorium results.

Discussion
STEMI is a life-threatening condition caused by acute occlusion in the coronary artery. The guideline strongly recommended Primary Percutaneous Coronary Intervention in a patient with STEMI and cardiogenic shock. AKI in STEMI patients was a consequence of acute cardiac condition and its treatment. PPCI in AKI condition can improve renal function due to improvement of renal flow. But on the other side, it can worsen renal function due to contrast-related acute kidney injury. Proper management to prevent worsening of renal function is very important.
C79. Pseudonormalisation ECG Pattern in Wellens’ Syndrome : A Pitfall in front of Our Eyes
Authors: Bahri Z , Lubis H A P , Haykal T B , Hasan H 
Published: April 2022

Abstract

Background
Wellens’ syndrome is a syndrome characterized by biphasic (type A) or deeply inverted T-wave (type B) in the anterior lead, without Q-waves and significant ST elevation, no loss of precordial R-wave progression, normal to minimally elevated cardiac enzymes, and a history of angina.

Case Summary
A 37-years-old male patient was admitted to the emergency department with the chief complaint of typical chest pain lasting for about 1 h. He had type 2 diabetes and a history of smoking. First ECG showed non-specific ST-T changes in the lateral lead. On ECG which was taken two hours later in the pain-free period, deeply inverted T waves were seen in the lead V2 and V3. Troponin I was found as 0.25 ng/mL. The patient was admitted to CVCU and brought to the angiography laboratory next day. A 90%-99% critical proximal LAD occlusion was observed. PCI was successfully performed with drug-eluting stent implantation and good restoration of LAD flow. He was discharged from the hospital on the following day without any complication after coronary intervention.

Discussion
Pseudonormalisation of T wave in pain period could be misinterpreted as normal ECG and could delay coronary angiography and revascularization. We should aware if a patient with typical chest pain came with normal or non-specific ECG changes. Evaluation of ECG in the pain-free period is crucial and leads to the best decision in managing the patient with this syndrome.
C80. Pulmonary Embolism in Congenital Heart Disease with Pulmonary Arterial Hypertension: a Case Series
Authors: Ibrahim M , Saboe A , Kartamihardja A H A , Cool C J 
Published: April 2022

Abstract

Background
Pulmonary arterial hypertension (PAH) is a frequent complication of congenital heart disease (CHD), notably in patients with left-to-right shunts. Patients with severe PAH due to CHD, Eisenmenger syndrome (ES), represent a high-risk group of pulmonary artery (PA) thrombosis patients. We present serial adult cases of CHD with PAH complicated by pulmonary embolism (PE).

Case Description
We found 3 cases of pulmonary embolism on adult congenital heart disease in our center. All of the patients were female, with an age range of 36 to 61 years old. The presenting symptoms were shortness of breath, WHO classification class II-III. All patients were hemodynamically stable. CHD and estimated RV systolic pressure were evaluated with echocardiography. CT-PA was performed in all patients, which findings were supporting PE. All patients were treated with anticoagulation. After three months, right heart catheterization was conducted in two patients, and one patient was refused.

Discussion
The prevalence of PE among adult patient with CHD and PAH range from 17 to 21%. PE was frequently found in older patients, women, and patients with lower oxygen saturation. To date, no uniformity regarding routine prophylaxis anticoagulation therapy in ES due to the high bleeding risk in this population despite being at risk of PA thrombosis. We conclude that risk stratification for PA thrombosis in adult CHD-PAH patients is essential, and further research is needed to prevent PE in this population.
C87. Serial Cases of Cardiovascular Manifestation on Leptospirosis: A Tales of Unfortunate Events
Authors: Ristiansah I H , Arifianto H , Irnizarifka  , Ahmad F , Kusumastuti F , Hafika A N , Myrtha R , Wulandari E L 
Published: April 2022

Abstract

Background
Leptospirosis is a zoonosis disease caused by Leptospira species. It's endemic and has become a major public health issue, especially in tropical regions. Clinical manifestation varies from mild or asymptomatic to severe multiple organ failure. We report cases of severe leptospirosis which complicates supraventricular tachycardia and myoperdicarditis from Universitas Sebelas Maret Academic Hospital.

Case Summary
The first case was a 44-year-old man referred from Internal Medicine Department with Leptospira infection with Weil’s disease. On 5th daycare, the patient was reporting had an episode of tachyarrhythmia, the ECG show SVT-AVNRT, there was no history of arrhythmic events before admitted to the hospital, the echocardiography was normal. The second case was a 67-year-old man who was referred from emergency department with shortness of breath, the ECG reveals diffuse ST-segment elevation in all limb and precordial leads with reciprocal ST-depression at aVR and V1, there was also downsloping of the PR and TP segment on precordial leads (Spodick’s sign), with normal ejection fraction on echocardiographic examination with pericardial thickening. Both patients have hsTroponin levels rose above the normal limit and serological testing found positive leptospira IgM.

Discussion
Severe leptospirosis can cause multi-organ dysfunction including cardiac involvement. The patients, in this case, suffered from leptospirosis with SVT-AVNRT and myopericarditis. The exact pathophysiology is still unclear, but there are several hypotheses, such as cytokine storms and direct damage from leptospira endotoxins. Arrhythmias and cardiac disturbance in leptospirosis patients are associated with poor outcomes and higher mortality rates.
C91. “Successful management of ventricular septal rupture after myocardial infarction in elderly: the role of intra-aortic balloon pump and timing for surgery”: A Case Report
Authors: Pradityawati A , Pradana S Y , Habibi F N , Sidiek A , Safir S 
Published: April 2022

Abstract

Background
Ventricular septal rupture (VSR) after myocardial infarction (MI) is a case with a high mortality rate, early diagnosis and appropriate treatment are essential. Surgical VSR closure though challenging and associated with high mortality, remains one of the main therapy in VSR closure.

Case Presentation
A 70-year-old woman had a complaint about the shortness of breath (SoB). From anamnesis, 17 days before admission, she complained of chest pain. 15 days before admission, she was taken to a local hospital and got hospitalized for 7 days in the intensive care unit. ECG showed anterior MI. During admission, patient developed SoB. From echocardiography, it showed VSR at apical. She was referred to dr. Kariadi hospital for further management.
Coronary angiography showed total occlusion in mid LAD. An intra-aortic balloon pump (IABP) was inserted for stabilized hemodynamic and as bridging. Inotropic support was given and afterload reduction was also administered. Surgical VSR closure and coronary artery bypass grafting (CABG) was successfully performed on the 22nd day after the onset of MI. The patient was discharged 10 days after surgery in a good condition.

Discussion
The mortality of VSR varied significantly depending on the timing of surgery. Patients who underwent surgery within 7 days of presentation had a 54.1% mortality compared with 10 % mortality if the repair was delayed until after 21 days. The cornerstone of preoperative management of VSR is afterload reduction. IABP provides mechanical afterload reduction and augmentation of cardiac output.
C92. Successful Percutaneous Coronary Intervention (PCI) in Rare Case of Anomalous Aortic Origin of the Right Coronary Artery from the Opposite Sinus (AAORCA) Presenting as Inferior ST Elevation Myocardial Infarction (STEMI)
Authors: GK Ahimsa , N Taufiq , BY Setianto 
Published: April 2022

Abstract

Background
AAORCA from opposite sinus is a rare congenital anomaly that can present with symptoms similar to coronary artery disease, even sudden cardiac death. AAORCA with Inferior STEMI is a rare combination situation. Management of acute myocardial infarction with AAORCA is not well established and still debatable.

Case Summary
We presented a case 61 years old aged male with STEMI and AAORCA. He admitted to our hospital with complaint of retrosternal chest pain with ST segment elevation in inferior lead thus we diagnosed as Inferior STEMI. He underwent an emergency coronary angiography (CAG) that showed anomalous of right coronary artery (RCA) and total occlusion of the proximal RCA with atherosclerotic lesion. Stent then implanted at proximal of RCA. Further work-up by Computed Tomography Angiography (CTA) revealed an AAORCA with interarterial course.

Discussion
AAORCA with interarterial course that presents as inferior STEMI is a rare case. Diagnosis requires CAG and coronary CTA to identify anatomy and physiology so revascularization can be carried out appropriately. It is still arguable whether atherosclerosis or the interarterial course of AAORCA that caused acute MI. There is evidence that anomalous coronary arteries doesn’t increase atherosclerosis risk than normal. Total occlusion located at the distal to interarterial course reinforce that atherosclerosis may be the possible cause of acute MI. PCI could be the preferred choice in patients with inferior STEMI accompanied by AAORCA with evidence of atherosclerotic lesion, because may result in complete reperfusion and good clinical outcome.
C99. Torsade de pointes in coronavirus disease 2019 patient: hypopotassemia, cardiac injury, and drug-induced arrhythmia
Authors: Shandy C A , Jayantika I G A B K 
Published: April 2022

Abstract

Background
Coronavirus disease 2019 (COVID-19) is a viral disease with wide spectrum of clinical manifestation. Malignant arrhythmia had been reported, however the exact mechanism remains unclear. We present a case of Torsade de Pointes (TdP) in COVID-19 patient.

Case Description
A 28 years old female, post caesarean section, confirmed COVID-19, was consulted to cardiology department due to acute lung oedema and premature ventricular complex (PVC) bigeminy. Oxygen saturation dropped to 78% with non-rebreathing mask, so she was intubated. She got furosemide and amiodarone drip. Later on, she developed pulseless ventricular tachycardia, TdP. Defibrillation 200 J was done and MgSO4 2 gram intravenous bolus was delivered. The rhythm converted to normal sinus rhythm, with prolonged QT Interval (503 ms). Potassium level was 2.7, hs-troponin I level was 510.6, and IL-6 level was 33.95. Echocardiogram showed global normokinetic with EF 64% on dobutamin. Amiodarone was stopped. She got MgSO4 drip and potassium chloride drip.

Discussion
Cardiac involvement in COVID-19 are common. Possible mechanisms are systemic inflammation and cytokine storm, as shown by increased IL-6. Cardiac injury, marked by increased hs-troponin I, causes abnormal conduction and prolonged repolarization due to interstitial edema and cardiac fibrosis, with abnormal Ca2+ handling and down regulation of K+ channels. These, together with QT-prolonging effect of amiodarone and hypokalemia, hypoxia, or neurohormonal stress, can induce TdP. Early treatment, ECG monitoring, and correcting electrolyte imbalance are very crucial in COVID-19. Once lethal arrhythmia ensues, proper anti-arrhythmia administration and withdrawal of contributing medications can prevent mortality.