bluuebunny/crossref_metadata_2025_split huggingface dataset:
C29. Chronic Pericardial effusion associated with Cytomegalovirus
Authors: Hutabarat H , Lukito A A , Chandra S , Fernandes R A P 
Published: April 2022

Abstract
Pericardial effusion is one of the most challenging clinical condition to determine the etiologies. A 60 yo woman presented with atypical sign of pericardial effusion. She visited several physicians and without any clinical improvement. Echocardiography revealed 133.5 ml pericardial effusion and pericardial thickness of 12,14 mm. Cardiac MRI was then performed and indicated, thickening of pericardium (4.8-5.1mm) at lateral right atrium, RV free wall and apical RV. The thickened part of the pericardium at apical RV has rigid, immobile appearance. Moderate amount of pericardial effusion prominently located at basal of heart. Pericardial effusion was at superior and lateral right atrium, apical RV and LV, and lateral, inferior, anterior left ventricle. Serology tests Anti CMV IgG reactive, anti CMV IgM non reactive and TB quantiferon negative. These results confirmed the pericarditis associated with CMV infection. The biggest challenge for the clinician is to find out an etiologic diagnosis. The common causes of pericarditis are infection (viral, bacterial), metabolic (renal failure, hypothyroidsism), cancer, myocardial infarction, and post traumatic. Among infectious causes, the enteroviruses, herpesviruses and mycobacterium tuberculosis are the most common causes. Cytomegalovirus belongs to the herpesviruses group. Clinician should be aware about the possible etiologies, as chronic pericarditis is a condition that requires comprehensive and multidisciplinary approaches.
C36. Deep Vein Thrombosis in A Patient with Thrombocytopenia : Case Report
Authors: Mirza Teuku , Ridwan Muhammad , Heriansyah Teuku 
Published: April 2022

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.
C37. Device Closure of Perimembranous Ventricle Septal Defect with Zero Fluoroscopy : The First case in Eastern region of Indonesia
Authors: Yoseph Hendry , Fitriani Aussie , Patimang Yulius , Alief Andi 
Published: April 2022

Abstract

Background
Ventricular septal defects (VSDs) are the most common Congenital Heart Defects (CHD) lesion in children. Transcatheter closure is considered as an alternative to surgery, for past few decades transcatheter closure were performed under fluoroscopy, recently guidance under Transesophageal Echocardiography (TEE) is increased. Transcatheter closure under TEE Guidance remains challenging but an alternative to overcome the radiation effect.

Case Summary
We reported 3-year-old female patient admitted to RSUP Dr. Wahidin Sudirohusodo with chief complaint was easily fatigue, Physical finding revealed regular heart sound with a grade 4/6 pansystolic murmur at the left lower sternal border, Transthoracal Echocardiography (TTE) has shown perimembranous VSD (pm-VSD) 6-7 mm L-R shunt with VSD Gradient 58 mmHg and aortic rim 4,5 mm. The patient was diagnosed with pm-VSD without Pulmonary hypertension and suitable for device closure under TEE Guidance. TEE Procedure was performed under general anesthesia and we found pm-VSD 3-4 mm, we decided to close the defect with Amplatzer Duct Occluder II (AGA) no 4/4 with delivery sheath amplatzer Torqvue LP 4F via retrograde approach with zero fluoroscopy, the device was well fixated with small central residual shunt 1,6 mm with hemodynamically unsignificant, The device was released and the procedure was finished without any significant problem.

Conclusion
We reported first case of VSD closure under TEE guidance in Eastern region of Indonesia, Transcatheter closure of pm-VSD under TEE Guidance are feasible and safe and can be an alternative to surgery and conventional technique under fluoroscopy to prevent radiation effect.
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: April 2022

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.
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: April 2022

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.
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: April 2022

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.
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: April 2022

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.
C71. Perimyocarditis related Corona Virus Disease: A Case Report
Authors: Budi D S , Anggrahini D W , Hartopo A B 
Published: April 2022

Abstract

Background
One of the ongoing outbreaks is the SARS-COV2 with clinical manifestations are dominated by pulmonary symptoms. However, some patients have reported mild to severe cardiovascular damage1.

Case Summary
We report a 26-year-old male with confirmed Corona Virus Disease (COVID-19), who has manifestation of perimyocarditis. Diagnosis was built through clinical symptoms of fever, dyspnea, with ST elevation and PR depression on ECG, and an increase of hs-Troponin I and NT-Pro-BNP. There appeared to be a pericardial effusion on echocardiography, and an increase number of cardiothoracic ratio (CTR) during the infection. All of the perimyocarditis parameters improved when symptoms are decrease meanwhile laboratory showing improvement of inflammatory parameters (CRP, D-Dimer).

Discussion
Acute perimyocarditis is a reported cardiac complication of COVID-191. COVID-19 perimyocarditis associated with pericardial effusion and cardiac tamponade2. Electrocardiogram (ECG) abnormalities commonly seen with pericarditis, such as ST elevation and PR depression, may be observed in myocarditis3. Many COVID-19 patients were reported to have a detectable level of cardiac-Troponin-I as a result of oxygen supply–demand mismatch, which could precipitate ischemia that results in type 2 myocardial infarction. NT-pro-BNP level also could increase secondary to myocardial stress, a possible knock-on effect from severe respiratory illness4.
C73. Phlegmasia Cerulea Dolens "A Case of the Blue Leg": Act Properly, Avoid Morbidity and Mortality
Authors: Dewi I P , Wardhani L F K , Budiarto R M 
Published: April 2022

Abstract

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

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

Conclusion
Although uncommon, it is important to identify patients with PCD because they should be considered for more aggressive management. Intravenous anticoagulant is one of therapeutic strategy while a decision to pursue more aggressive therapy is being considered. Patients with extensive DVT but without signs of PCD do not routinely receive thrombolysis but should be anticoagulated and monitored closely for the development of PCD.
C88. Sick sinus syndrome in acute anterior myocardial infarction: when culprit strategy ended up jeopardy
Authors: Nadia  , Fitra M 
Published: April 2022

Abstract

Background
Atrial arrhythmias occur in 10% of acute myocardial infarctions and increases incidence of death. Altered heart rhythm with brady-tachy episodes indicates sinus node dysfunction ordinarily cause by inferior myocardial infarction.

Case Description
A 66-year-old-man, diagnosed with 2 days onset Acute Anterior Myocardial Infarction with history of syncope after chest pain, referred with sinus arrest and junctional rhythm that changed into atrial fibrillation. During hospitalization the heart rhythm changing periodically from bradycardia to tachycardia repeatedly with witnessed new ST elevation in inferior lead before an episode of cardiac arrest. After primary PCI to the RCA as the new culprit lesion, chest pain was relieved but hemodynamic condition was not stable and the rhythm remained continuously altered.

Discussion
Sick sinus syndrome is a cardiac conduction disorder characterized by symptomatic dysfunction of the sinoatrial node generally manifests as sinus bradycardia, sinus arrest, or sinoatrial block, and accompanied by supraventricular tachyarrhythmias (tachy-brady syndrome). This case of acute myocardial infarction with 3 vessel diseased lesion and total occlusion in RCA affected sinoatrial node causing sick sinus syndrome. Recently multi-vessels PCI strategy increasingly recommended at the time of primary PCI for patient with arrhythmia.

Conclusion
A man 66 years old with acute anterior MI compelling with sick sinus syndrome on presentation because apparently the culprit lesion was RCA. Unfortunately, at that time non-IRA lesion were not opened and TPM was not available, bradycardia continues and the patient ended up being jeopardy.
C89. Simultaneous Aortic Stenosis (AS) and Pulmonary Stenosis (PS) in A Middle-Aged Man: A Rare Case Report
Authors: Eliza B Suhuyanly , Sumantra I G 
Published: April 2022

Abstract

Background
Combined valvular lesions is very rare. Only 16 cases of combined valvular stenosis of the aortic and pulmonary valves have been reported. Failure to recognize and adequately correct both lesions may be catastrophic for the patient.

Case Illustration
A 38-year-old male came to the outpatient department with shortness of breath, fatigue, and swollen ankles. He had a short posture, broad forehead, bitemporal narrowing, broad nasal tip, long philtrum, wide mouth, and large earlobes. Cardiac examination revealed systolic murmurs over the pulmonary valve and at the aortic valve radiating to the apex (galliverdin phenomenon), rales in both lungs, and bilateral ankle edema. Electrocardiogram revealed sinus rhythm, extreme axis, RA enlargement, RBBB, and bifascicular block. Chest radiograph showed cardiomegaly, pulmonary edema, and left pleural effusion. Echocardiography demonstrated a dilated LA and concentric LVH with good LV function, HF/HG severe AS, a bicuspid aortic valve causing moderate aortic regurgitation, mild mitral regurgitation, mild tricuspid regurgitation, and severe valvular or supravalvular PS with RV hypertrophy. The patient was administered diuretics, a beta blocker, and an anti-platelet.

Discussion
Most patients with combined aortic and pulmonary obstruction at sub-valvular level have hypertrophic cardiomyopathy. Cases with both aortic and pulmonary valve stenoses are exceedingly rare. The age of presentation ranges from neonate to 55 years. It is more common in males. Most patients present with murmur since birth, dyspnea, and fatigue. Our patient is suspected to have Williams syndrome based on the physical appearance and cardiac examination findings.
C90. Successful Procedure of Ductus Arteriosus Stenting: Promising Choice for Pulmonary Atresia Survival
Authors: Andini R , Permitasari D A , Priyatno A 
Published: April 2022

Abstract

Background
Duct-dependant circulation in a baby presents as a life threatening emergency. Maintain the duct patency is crucial for patient survival before they have an cardiac surgery. We describe a case of a baby with pulmonary atresia who underwent succesful procedure of patent ductus arteriosus (PDA) stenting.

Case Summary
a female baby was born in peripheral hospital with birth weight of 3 kg by normal delivery, noticed to have cyanosis sixteen hours after birth. At our centre, the baby look cyanosed. Saturation by pulse oximetry was 84%. In physical examination appears, a continuous murmur was heard below clavicle at linea parasternal. Echocardiography confirmed the diagnosis of pulmonary atresia. Faint flow of PDA observed with duct size less than 1 mm. Prostaglandin E1 Infusion was start immediately at the rate of 1 µg/Kg/min. Within 6 hours of infusion the baby had an episode of apnoea. The baby then taken up for ductal stenting to keep the duct patent for few months before staged cardiac surgery.

Discussion
Pulmonary atresia is an critical case of congenital heart disease. The systemic or pulmonary circulation are mantained through flow in patent ductus arteriosus. Before cardiac surgical repair these patient can survive only if duct patency is reliably maintained. PDA stenting has been shown to be as an acceptable and less invasive approach to maintain ductal patency.
C95. The electrocardiographic changes in a hypertensive COVID-19 patient who received beta-blocker and favipiravir: a case report
Authors: Fatimah V A N , Istiqomah N S , Fadjri M 
Published: April 2022

Abstract

Background
Various electrocardiographic manifestations have been reported in COVID-19 which either result from myocarditis or insult-induced re-emerging of pre-existing condition. Some antiviruses used off-labelly for COVID-19, including favipiravir, are considered to be proarrhythmic. Meanwhile, anti-hypertensive drugs such as beta-blocker may induce bradyarrhythmia.

Case Summary
A 69-year-old male with confirmed COVID-19 and a history of uncontrolled hypertension presented with blood pressure of 216/111mmHg at admission. No sign and symptom of acute target organ damage had been reported. His electrocardiography showed normal sinus rhythm (heart rate [HR] 60bpm). The echocardiographic finding revealed normal heart function. He received favipiravir for 5 days, intravenous nicardipine (0.5mcg/kgBW/hour), and peroral amlodipine (1x10mg), candesartan (1x16mg), and bisoprolol (1x2.5mg). During hospitalization, the HR fluctuated between 52-109. On the sixth day, a total atrioventricular (AV) block with junctional escape rhythm (HR 66bpm) was present. Both favipiravir and bisoprolol were ceased simultaneously. The AV block persisted for 4 days then transformed into a junctional rhythm for the next 3 days and sinus bradycardia (HR 48bpm) thereafter. No pacing was performed.

Discussion
The possible differential diagnoses in this case include sick sinus syndrome (SSS), COVID-19-induced myocarditis, and drug-induced. The SSS might explain the wide variability of the HR. There were some reports presenting the sinus node dysfunction as a manifestation of SARS-CoV-2 infection. Further evaluation using Holter and/or electrophysiological study is warranted. Drug-induced cause may be excluded because the bradyarrhythmia remained after the cessation of both beta-blocker and favipiravir.