Indonesian Journal of Cardiology
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Get PDFAbstracts of the 10th Annual Scientific Meeting of the Indonesian Heart Rhythm Society (InaHRS) 2023: Revie
Hyperkalemia Mimicking Anteroseptal Myocardial Infarction
Get PDFBackground: Hyperkalemia often results in cardiac emergency associated with fatal cardiac arrhythmias. However, the presence of ST segment elevation in hyperkalemia is rare and could potentially subject the patients to unnecessary risk of intervention. Most commonly, ST elevation in hyperkalemia presents in a down-sloping fashion compared to the typical convex or upsloping pattern in myocardial infarction. However, in some cases, the ST elevation morphology can be very identical and difficult to distinguish. Herein, we describe a hyperkalemic patient presenting with non-ischemic ST segment elevation that resolved spontaneously following therapy.
Case illustration: A 77-year-old, bed-ridden, inarticulate woman was admitted to emergency department with acute dyspnea perceived for 1.5 hours. The patient’s past clinical history included craniotomy for subdural hematoma, poorly controlled hypertension, hypertensive heart disease, rheumatoid arthritis, and dementia and was under candesartan, amlodipine, nebivolol, spironolactone, and atorvastatin treatment. The 12-lead electrocardiography (ECG) recording showed wide QRS complex with left bundle branch block pattern, slow atrial fibrillation with total atrioventricular block, ST segment elevation and Q wave in anteroseptal leads, and peaked T wave (Figure 1A). The pattern of ST elevation was indistinguishable from that of myocardial infarction which necessitated further laboratory confirmation. Laboratory results showed severe hyperkalemia (K+ 7.93 mmol/L) and normal troponin level (45.0 ng/L). The patient was given serial insulin-based therapy and calcium gluconate immediately. The follow-up ECG pictured normal sinus rhythm with no sign of bundle branch block, resolution of ST segment elevation, and reduction in T wave amplitude (Figure 1B). However, the reduction in potassium level was not significant and the patient also experienced an acute kidney injury. The patient was transferred to intensive care unit and was prepared for hemodialysis.
Conclusion: ST segment elevation is a rare feature of hyperkalemia that could mislead the patient’s treatment. Thorough ECG evaluation is the key to narrow down the differential diagnosis. Every deviant feature should not be interpreted separately. Laboratory tests could help confirm the diagnosis, particularly in patients with atypical presentation and could help avoid unnecessary risk of intervention.This article has a related Erratum
Research
Get PDFAbstracts of the 10th Annual Scientific Meeting of the Indonesian Heart Rhythm Society (InaHRS) 2023: Researc
Original Research
Get PDFAbstracts of the 32nd Annual Scientific Meeting of the Indonesian Heart Association (ASMIHA) 202
Case Reports
Get PDFAbstracts of the 32nd Annual Scientific Meeting of the Indonesian Heart Association (ASMIHA) 202
Case Reports
Get PDFIndonesian Society of Interventional Cardiology Annual Meeting 2021
Abstracts: Case Report
Traumatic Coronary Artery Dissection as A Potential Cause of Acute Myocardial Infraction in Motorcycle Accident
Get PDFBackground: Chest pain in blunt chest trauma can be caused by various intrathoracic injuries. Pneumothorax, hemothorax, and rib fractures are commonly seen in the emergency department. Although cardiac involvement is very rare, the probability should not be excluded.
Case Illustration: A-31-years-old male who complained of chest pain and diaphoresis was brought to the emergency department after a high-speed motorcycle collision. Chest X-ray revealed no abnormality but a 12-lead Electrocardiogram (ECG) demonstrated ST-segment elevation in lead I, AvL, V2-6, and atrial fibrillation. Because of the unusual presentation, the decision was to proceed with percutaneous coronary intervention (PCI). Coronary Angiography detected a thrombus at proximal LAD and spiral dissection at mid LAD (TIMI 2 Flow). After the procedure, he was transferred to the High Care Unit.
Conclusion: Following blunt chest trauma, chest pain in the setting of a vehicle collision can be caused by dissection of the coronary artery. Prompt cardiac workup (ECG, cardiac enzyme, and echocardiography) must be done in a highly suspected patient
Evaluation of Cardiometabolic Factors Affecting Chronotropic Incompetence: A Cross-Sectional Retrospective Study in Sanglah General Hospital, Bali
Get PDFBackground: Recent studies have identified that chronotropic incompetence is correlated with poor cardiometabolic health and systemic inflammation that results in exercise intolerance, impaired quality of life and death due to cardiovascular disease (CVD). Unfortunately, there’s still paucity of data regarding cardiometabolic factors associated with chronotropic incompetence. The purpose of this study was to identify the cardiometabolic factors associated with chronotropic incompetence.
Methods: This study was a cross-sectional retrospective study using cardiac treadmill stress test data at Sanglah General Hospital from May 2018 - May 2020 and 136 patients were enrolled. Data analysis used SPSS version 21. Pearson chi-square test was used to compare categorical variables based on cardiometabolic risk factors in chronotropic incompetence.
Results: Patients were divided based on the characteristics of age, gender, smoking status, body mass index, coronary artery disease, heart failure, hypertension, dyslipidemia, type 2 diabetes mellitus (T2DM), the levels of HbA1C, total cholesterol, LDL, HDL, and triglyceride. In this study, it was found that T2DM (PR 2.29; 95%CI 1.16–3.37), HbA1C (PR 3.13; 95%CI 2.31-4.22), dyslipidemia (PR 1.773; 95%CI 1.170–2.687), high total cholesterol (PR 2.396; 95%CI 1.650-3;481), and high LDL level (PR 1.853, 95%CI 1.229-2.794) were significantly associated with chronotropic incompetence (all p-value <0.05), while other factors were not significantly related.
Conclusion: Chronotropic incompetence can impair quality of life and contribute to cardiovascular mortality. However, T2DM, high HbA1C, dyslipidemia, high total cholesterol and LDL levels were found to be associated with chronotropic incompetence. This may contribute to higher cardiovascular risk attributed to those factors
Research Abstracts
No full text8th Annual Scientific Meeting of the Indonesian Heart Rhythm Society 2021
Abstracts: Research