Indonesian Journal of Cardiology
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Examining the Specificity of Smartphone ECG Devices in Decision-Making for ST-Elevation Myocardial Infarction and Non-ST-Elevation Myocardial Infarction
Full text linkBackground & Objectives: Electrocardiography (ECG) stands as a cornerstone diagnostic tool for assessing cardiac health, particularly in ruling out abnormalities. The integration of smartphone devices presents a promising avenue for expedited detection of cardiac irregularities. This study aims to evaluate the diagnostic efficacy of smartphone ECG devices in subjects admitted to Cardiac Care Units (CCUs) and Cardiac Intensive Care Units (CICUs).
Methods: A retrospective analysis was conducted on a cohort comprising 62 patients presenting with cardiac symptoms. Utilizing smartphone ECG devices as the index, 12-lead ECG tests were administered alongside the Gold Standard ECG machine for comparison among patients in CCUs and CICUs. Diagnostic decisions concerning the presence of ST-Elevation Myocardial Infarction (STEMI) or Non-ST-Elevation Myocardial Infarction (NSTEMI) were made by a team of cardiologists following a meticulous review of both sets of ECG reports.
Results: Data analysis was conducted on 56 patients. The smartphone-based ECG device exhibited 100% specificity, 93% sensitivity, 80% Negative Predictive Value, and 100% Positive Predictive Value, yielding an F-score of 0.96 and a Mathew Correlation Coefficient value of 0.86.
Discussions: This study unequivocally underscores the significant potential of the Spandan ECG device in accurately identifying a range of cardiac abnormalities, including critical conditions such as STEMI and ischemia. Despite its portable nature, smartphone ECG technology demonstrates utility within Critical Care Units for timely monitoring and diagnosis
Cardiac involvement in Scorpion envenomation: A review of literature
Full text linkScorpion envenomation (SE) causes cardiac complications. Pubmed, Scielo, Embase and google scholar were searched using the keywords scorpion: cardiac, heart, arrhythmia, electrocardiograph and myocarditis in the abstract or text. 112 were selected. Cardiotoxicity can occur within 2 hours of SE and include hyper/hypotension, arrhythmias, myocarditis and heart failure. The postulated mechanisms are autonomic storm, inflammation, direct venom toxicity and metabolic derangement. Haematological and biochemical derangement suggests increased severity. Cardiac biomarkers, electrocardiography and transthoracic echocardiography helps detect cardiotoxicity and guide management. Early use of antivenom and/or alpha-adrenergic blockade may prevent or reverse cardiotoxicity. Hypertension is best managed alpha-adrenergic blockers. Arrhythmias are usually transient. Cardiovascular complications of SE are associated with morbidity and mortality. A clear consensus on the indication and utilization of antivenom administration in cardiac involvement SE are needed.
 
Hemodynamic impairment of double culprit ST-elevation myocardial infarction, double the trouble: a case report
Full text linkBackground: Multiple culprit artery involvement is rare (2.5%) among ST-segment elevation myocardial infarction (STEMI) patients undergoing primary coronary intervention (PCI). It can occur due to multiple factors and reflects a widespread pathophysiologic process. Most patients present with unstable hemodynamics and cardiogenic shock (CS), which results in a high mortality rate. Currently, there are no guidelines or consensuses on the management of multiple culprit arteries in STEMI patients.
Case Illustration: A 51-year-old man with chest pain in the past 16 hours was referred to the National Cardiovascular Center Harapan Kita. ECG at presentation revealed sinus rhythm with ST elevation in the inferior, posterior, and right leads. He was diagnosed with late-onset infero-posterior STEMI + right ventricle infarction, Killip IV, and thrombolysis in myocardial infarction 6/14, then was prepared for early PCI due to ongoing chest pain and CS. The patient underwent complete revascularization with drug-eluting stents and thrombus aspiration due to the high thrombus burden of the lesion in the right coronary artery and first obtuse marginal artery. After early PCI, his hemodynamic condition improved, and epigastric pain was his only complaint. However, on the following day, the patient experienced acute pulmonary edema and rhythm conversion to total AV block. He was managed conservatively with heparinization, inotropes, vasopressors, diuretics, and noninvasive ventilation. After 14 days of hospitalization, the patient was discharged without any complaints.
Conclusion: Double culprit STEMI is rare and associated with catastrophic hemodynamic impairment, including CS, at presentation. Individualized treatment with early and aggressive revascularization yields relatively good results
Hemodynamic conundrum of thyroid storm induced acute heart failure: a challenging case in remote area.
Full text linkBackground Thyroid storm (TS) is an acute and critical presentation of hyperthyroidism. It can lead to multiple organ dysfunction and has high rate of mortality. Heart failure is one of grave complication of hyperthyroidism and thyroid storm. Rapid progression of TS can lead to hypoperfusion and shock even with normotensive blood pressure and normal hemodynamic parameter. Unfortunately, prevalence of hyperthyroidism majority in developing area who lack of advanced medical facility.1 This case presentation aims to present the rare condition of acute high output failure secondary due to thyroid storm with hypoperfusion and normotensive shock.
Case Illustration A 28-year-old man came to the emergency department of private hospital in East Borneo with worsening dyspnea on effort since three days before admission. His blood pressure was 169/103 mmHg with irregular heart rate at 135-148 bpm. His axillary temperature was 37.9° C. ECG showed rapid atrial fibrillation with Ashman phenomenon. Chest x-ray revealed cardiomegaly with flattened cardiac waist and lung infiltrate. His echocardiogram has hyperdynamic LV with LVEF 70%, normal RV function, concentric LV hypertrophy, and increased LAVi (51.19 mL/m2). From initial echocardiogram hemodynamic assessment, eRAP was 15 mmHg, CO was 6.5 to 7.4 L/min, SVR was 1167 to 1329 dyne/sec/cm-5. His peak E wave velocity was 92-95 cm/s, His fT4 was increased (100 ng/dL) while TSH was reduced (0.007 mU/L). H2FPEF score estimated 38.7% probability of heart failure with preserved ejection fraction (HFpEF). Burch-Wartofsky score was 60, suggesting thyroid storm. He was diagnosed with acute high output heart failure secondary to thyroid storm due to uncontrolled Grave’s Disease, and AF rapid ventricular respond. During follow up in intensive care unit (ICU), patients underwent hypoperfusion with normotensive blood pressure (normotensive shock). norepinephrine was initiated. Patient keep deteriorating, and then passed away in our critical care unit at day of 7th
Conclusion Thyroid storm induced acute heart failure might have conundrum presentation due normotensive and good cardiac output, give false impression of hemodynamic condition. Clinical presentation was very important to identify hypoperfusion and aggressive treatment was needed to stabilize patient condition
Revisiting Subspecialty Training in Cardiology in Indonesia: Structural, Regulatory, and Global Perspectives
Full text linkThe rapid expansion of cardiology as a discipline has prompted the emergence of numerous subspecialties that require structured, competency-based training. In Indonesia, however, the development of subspecialty education remains inconsistent, divided between university-based programs known as Spesialis-2 (Sp-2) and hospital-based fellowships. The interchangeable use of the terms “fellowship” and “subspecialty” has generated conceptual ambiguity and regulatory uncertainty. Globally, subspecialty training in cardiology follows a hospital-based apprenticeship model, led by accredited teaching hospitals and closely regulated by professional boards such as ACGME, ACC, or ESC. Indonesia’s deviation from these international norms has implications not only for the quality of advanced cardiovascular training but also for the nation’s ability to attract international fellows—a marker of global academic recognition. This review examines the current landscape of cardiology subspecialty education in Indonesia, contrasting it with global frameworks, and discusses structural, academic, and legal challenges, including those concerning foreign trainees. The article concludes by proposing a policy framework to harmonize Indonesia’s subspecialty education with global standards, thereby strengthening both national capacity and international credibility
Simplified Selvester QRS Score as an Infarct Size Parameter in STEMI Patients Undergoing Pharmacoinvasive or Primary Percutaneous Coronary Intervention
Full text linkIn “Simplified Selvester QRS Score as an Infarct Size Parameter in STEMI Patients Undergoing Pharmacoinvasive or Primary Percutaneous Coronary Intervention” (Indonesian Journal of Cardiology, 43(4), 150-8. https://doi.org/10.30701/ijc.1186), there is an error noted.
An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1186. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.
The publisher apologizes for any inconvenience caused by this error
Correlation between Peak Left Atrial Longitudinal Strain and The Severity of Mitral Valve Disease at Haji Adam Malik General Hospital Medan
Full text linkIn “Correlation between Peak Left Atrial Longitudinal Strain and The Severity of Mitral Valve Disease at Haji Adam Malik General Hospital Medan” (Indonesian Journal of Cardiology, 44(2), 68-74. https://doi.org/10.30701/ijc.1541), there is an error noted.
An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1541. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.
The publisher apologizes for any inconvenience caused by this error.
DOI of original article: https://doi.org/10.30701/ijc.154
Hemodynamic and Clinical Outcomes of Milrinone Compared to Dobutamine in Cardiogenic Shock: A-Systematic Review and Meta-Analysis
Full text linkIn “Hemodynamic and Clinical Outcomes of Milrinone Compared to Dobutamine in Cardiogenic Shock: A-Systematic Review and Meta-Analysis” (Indonesian Journal of Cardiology, 43(3), 108-15. https://doi.org/10.30701/ijc.1296), there is an error noted.
An error has been found in the PDF version of this article. The DOI printed in the PDF is incorrect. The correct DOI is https://doi.org/10.30701/ijc.1296. The error occurs only in the PDF; the DOI listed in the article metadata is already correct.The publisher apologizes for any inconvenience caused by this error.DOI of original article: https://doi.org/10.30701/ijc.129
Arrhythmic Mitral Valve Prolapse with Features of Mitral Annular Disjunction and Myocardial Tissue Changes as Assessed with Cardiac Magnetic Resonance
Full text linkBackground. Mitral valve prolapse (MVP) is a rare disorder linked to abrupt cardiac mortality and malignant ventricular arrhythmias. Beyond conventional prognostic indicators, risk stratification may have a promising function in MVP patients, as cardiac magnetic resonance imaging (CMR) can identify tissue alterations in these patients.
Case Illustration. A 36-year-old female with palpitation, dyspnea on effort, and episode of near syncope had multifocal premature ventricular complex (PVC) with right bundle branch block patern. Bileaflet MVP with multifocal benign infrequent PVC from posteromedial papillary muscle was diagnosed in this patient based on echocardiography and holter monitoring. Mitral annular disjuction (MAD), mitral regurgitation (MR), tricuspid regurgitation (TR) were also noticed. CMR examination confirmed moderate MR ec AML-PML prolapse with MAD at PML (P1, P2, P3), moderate TR ec anterior tricuspid leaflet prolapse, myocardial inflammation and myocardial fibrosis.
Conclusion. We present case report of a young woman diagnosed with PVC predominant from posteromedial papillary muscle and bileaflet with features of MAD, myocardial inflammation and fibrosis. The arrhythmogenesis in MVP involves the development of a substrate for arrhythmias combined with a trigger for arrhythmias. Future prospective research is needed to further delineate optimal methods for risk stratification and treatmen
Novel Echocardiographic Parameter Assessing Pulmonary Vascular Resistance in Patient with Acyanotic Congenital Heart Disease
Full text linkBackground
Pulmonary vascular resistance (PVR) is an important variable in management of acyanotic congenital heart disease. Right heart catheterization (RHC) using impedance catheter remains gold standard for pulmonary vascular resistance (PVR) measurement. The ratio of peak tricuspid regurgitant velocity to the right ventricular outflow tract time-velocity integral (TRVmax/RVOTVTI) was presented as a reliable non-invasive method of estimating PVR. Recently, right ventricular 2-dimensional speckle tracking strain (RVGLS) was proven as a new promising parameter to evaluate PVR. This study performed to examine whether this new non-invasive variable ratio (TRVmax/RVGLS) provides clinically reliable method to determine pulmonary vascular resistance (PVR) obtained by echocardiography.
Methods
Right-heart catheterization and echocardiographic examination were performed in 56 patients with congenital heart disease. The ratio of TRVmax/RVOTVTI and TRVmax/RVGLS analysis performed using receiver-operating characteristic curve analysis, a cutoff value for the ratio was generated to determine PVR more than 5 WU.
Results
A TRVmax/RVOTVTI cutoff value of 0.21 provided a sensitivity of 77.1% and a specificity of 81% (CI 81% to 97.5%) and TRVmax/RVGLS cutoff value of -23.16 provided sensitivity of 74.3% and a specificity of 90.5% to determine PVR > 5 WU (CI 79.6% to 98.2%).
Conclusions
The echocardiography parameter (TRVmax/RVGLS) could serve as a dependable noninvasive method to predict PVR greater than 5 WU in acyanotic congenital heart disease patients