Heart Science Journal
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Benefits of exercise training on pulmonary arterial pressure as measured by echocardiography in patients with pulmonary hypertension
Full text linkPulmonary hypertension (PH) is a substantial worldwide health concern that impacts around 1% of the population, in especially among the elderly. PH is defined by a mean pulmonary arterial pressure (mPAP) over 20 mmHg and is linked to significant morbidity and mortality. Optimal care depends on precise evaluation of mPAP, which acts as a crucial diagnostic and prognostic marker. Recent research emphasizes the significance of exercise training as a secure and economical intervention that can result in significant enhancements in hemodynamic parameters, such as decreased mPAP and increased cardiac output. Engaging in exercise training stimulates the expansion of blood vessels in the lungs, enhances the functioning of the right ventricle, and reduces persistent inflammation, therefore enhancing the overall ability to exercise and the quality of life for those with pulmonary hypertension. Echocardiography is crucial for monitoring mean pulmonary arterial pressure and evaluating right ventricular function. mPAP is a critical parameter in the evaluation and diagnostic testing for pulmonary hypertension (PH) due to its strong correlation with disease severity and prognosis. Exercise training confers a multitude of advantages to both the cardiovascular system and skeletal muscle systems. Exercise training is generally considered safe, yet, it is important to provide thorough supervision to reduce the occurrence of negative outcomes, especially in patients with advanced illness. In summary, including exercise training into the treatment plan for patients with pulmonary hypertension shows encouraging advantages, justifying more investigation and standardization of exercise procedures to enhance patient results
Effects of early ivabradine therapy in patients with acute heart failure: A meta-analysis and systematic review
No full textBACKGROUND: Although ivabradine is the agent of choice for reducing heart rate, its use in acute heart failure patients remains unclear.
OBJECTIVES: To evaluate the potential of in-hospital ivabradine administration in reducing heart rate, the risk of rehospitalization, mortality, and clinical profile in acute heart failure patients using a meta-analysis approach.
METHODS: The study was designed as a meta-analysis conducted from August to September 2024. We selected several database sources for the search strategy, including PubMed, Google Scholar, ProQuest, British Medical Journal, and American Journal of Cardiology. Data on the outcomes of ivabradine treatment compared to standard therapy were collected to determine cumulative point estimates. For statistical analysis, we used the Mantel–Haenszel test for categorical data or inverse variance for continuous data.
RESULTS:
We included 11 articles in the study. Our findings indicated that, in comparison to the standard therapy group, the ivabradine group was associated with improvements in resting heart rate, a reduction in the risk of rehospitalization, a decrease in cardiovascular mortality, a reduction in all-cause mortality, a shorter length of stay, improvements in New York Heart Association (NYHA) classification, better Left Ventricular Ejection Fraction (LVEF), and improved B-type Natriuretic Peptide (BNP) / N-terminal pro b-type Natriuretic Peptide (NT-proBNP) levels.
CONCLUSION: In conclusion, this study has revealed the beneficial effects of using ivabradine for the treatment of acute heart failure.
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Atrial myopathy: a pathogenic mechanism linking atrial fibrillation and ischemic stroke
Full text linkAtrial myopathy (AM) has become a topic of study for many years. Atrial Myopathy is characterized as "any variety of architectural, structural, electrophysiological, or contractile abnormalities altering the atria, which can result in clinically significant manifestations," and is associated with atrial dysfunction and dilatation. Evidence shows that atrial myopathy (AM) contributes to atrial fibrillation and embolic strokes of unknown origin. Atrial myopathy or disease provides a substrate leading to atrial fibrillation (AF) and contributes to a chance of atrial thrombus development and, finally, stroke. However, following clinical trials have opposed this point of view. Additionally, ischemic strokes are categorized as cryptogenic when an embolic stroke occurs without a known related etiology (embolic stroke of undetermined source, ESUS). This led to the concept of atrial myopathy, showing that a dysfunctional atrium may result in stroke without the incidence of atrial fibrillation. Atrial interstitial fibrosis, extracellular matrix deposition, and inflammation may trigger and perpetuate atrial myopathy, resulting in blood stasis inside the atria and potentially resulting in stroke without any intervening atrial fibrillation. This paper describes an overview of Atrial Myopathy in pathogenic mechanisms linking atrial fibrillation and ischemic stroke. Atrial myopathy is not only a substrate for atrial fibrillation and makes thrombus formation cause ischemic stroke, but also leads to blood stasis within the atria and makes ischemic stroke without intervening atrial fibrillation
Challenge case of ventricular arrhythmia in young women
Full text linkBackground: Torsade de pointes (TdP) and ventricular fibrillation can cause rapid mortality. The etiological cause the ventricular arrhythmia must be detected and treated early, especially in the ER.
Objective: We report a patient with severe hypokalemia and TdP following the administration of Amiodarone in QT-interval prolongation
Case Report: A 32-year-old girl with diarrhea and vomiting for two days arrived to the ED with a seizure with her hand flexed and leg straight down. Her family reported she didn\u27t take prescriptions regularly. She was GCS 224, hemodynamically stable, typical ECG showed extended QTc and her head CT was normal. During observation at the ED, she had seizure and the monitor revealed a Torsade de Pointes (TdP) ) with a pulse rate of 160-180 bpm. She was given Amiodarone and peroral Bisoprolol 5 mg. She returned to sinus rhythm with PVC bigeminy and was admitted to the ICU Laboratory data showed hypokalemia (1.9) improved (2.9) after treatment. Eight hours later, she experienced a TdP without pulse palpability for less than 1 minute, then Ventricular Fibrillation, began CPR, and the doctor in charge gave her a defibrillation operation once. She returned with sinus tachycardia 110-130 bpm. The next day, she was having recurring TdP episodes without a pulse. The doctor conducted CPR and defibrillation and returned with 120-130 bpm sinus tachycardia. The patient consulted a cardiologist and was prescribed lidocaine 1 mg/hour and continued Bisoprolol 5 mg for long QT problem. Observation The seizure ended 12 hours later, the patient was alert, GCS 456, and the ECG showed sinus rhythm with extended QTc. Over the days before discharge, electrocardiography demonstrated reduced QT-interval prolongation.
Conclusion: Life-threatening ventricular arrhythmia in a young female can be caused by QT-interval prolongation. It must be diagnosed and treated immediately to avoid mortality
Technical procedure of endovenous laser ablation for chronic venous insufficiency
Full text linkVenous insufficiency is an often-encountered medical issue. In recent years, a number of procedures have been developed for the treatment of venous insufficiency within the context of minimally invasive surgery. Endovenous laser ablation (EVLA) is a commonly used contemporary method. The ultimate outcome is the formation of fibrotic tissue that seals the lumen of the treated vein. Vein ablation procedures are often performed with local-tumescent anaesthesia, allowing patients to be treated in an office environment and resume full activity immediately afterwards. The use of EVLA is strongly recommended above surgical intervention or foam sclerotherapy, as indicated by a 1A class recommendation. The approach seems to possess significant attributes and benefits in terms of safety and efficacy. This article provides an overview of the technical technique involved in EVLA for the treatment of venous insufficiency. Additionally, it emphasises the significance of EVLA in managing venous insufficiency
Transcatheter atrial septal defect closure: Focus on tips and tricks for interventional procedure in challenging cases
Full text linkThe ostium secundum defect is the most prevalent form of atrial septal defect (ASD). The development and refinement of devices and techniques for transcatheter ASD closure have led to its acceptance as the preferred management for most patients with secundum ASD. Meticulous planning and execution constitute the key to achieving success in a procedure. It entails a thorough assessment of the patient, beginning with selecting suitable cases, as well as detailed pre- and intraprocedural imaging, knowledge of various device deployment techniques, anticipation of potential complications, and appropriate management strategies. This review article will discuss tips and tricks to overcome the technical intricacies of achieving a successful transcatheter ASD closure and address some challenging cases associated with its use
Navigating backward, healing forward: The impact of retrograde EVLT in venous ulcer management: A case report
Full text linkBackground: Chronic venous insufficiency (CVI) is a condition caused by venous reflux (backward flow) or obstruction, leading to significant morbidity and negatively impacting patients\u27 quality of life (QoL). One recognized treatment for CVI is Endovenous Laser Treatment (EVLT). The antegrade conventional approach of EVLT is typically straightforward, but distal vein access can sometimes be difficult to achieve.
Case Illustration: A 50-year-old man presented with bilateral lower extremity swelling and a chronic ulcer on his left leg that had persisted for one year without improvement. Doppler ultrasonography confirmed CVI in both lower extremities, with a great saphenous vein (GSV) reflux time exceeding 1500 ms. The patient was diagnosed with CVI C6EpAsPr and underwent EVLT. However, the small diameter of the distal GSV and vasospasm made antegrade access challenging. A retrograde approach was employed for EVLT on his left lower extremity, resulting in a successful outcome.
Conclusion: This case highlights the use of the retrograde approach in EVLT as a viable alternative for accessing distal lesions when antegrade access is difficult, leading to successful wound healing. The retrograde technique can be considered a valuable option for CVI patients facing such challenges
Association of clinical manifestations, disease activity, and medications on premature atherosclerosis in systemic lupus erythematosus
Full text linkBackground
SLE is distinguished by the development of multiple autoantibodies that lead to chronic inflammation and increased risk of cardiovascular diseases, especially atherosclerosis.
Objective
This examination sought to explore the association between the disease activity, clinical manifestations, and medication with the atherosclerotic lesion from SLE patients.
Methods
This inquiry investigated forty-two female SLE patients (18-45 years old) who met the 2019 EULAR/ACR assortment decency with matched healthy individuals as control A cross-sectional study was sanctioned at the Rheumatology Clinic of Saiful Anwar General Hospital Malang between July and November 2023. Demographic data, clinical manifestations, and medication history was documented in the medical records. Disease activity was stelled by the SLEDAI-2K score. Carotid Intima-Media Thickness (cIMT) and Flow-Mediated Dilation (FMD) (after brachial BP cuff inflation up to 200 mmHg for five minutes) examinations were used as atherosclerosis marker.
Results
Markedly higher of cIMT mean was demonstrated in SLE patients compared to healthy individual (0.51±0.11 vs 0.40±0.11 mm, p<0.001). FMD was subtancially curtailed in SLE patients set side to side to control (0.00 (0.00-0.10) vs 0.10 (0.00-0.28) mm, p=0.022). There was no statistical distinctness of the cIMT and FMD among SLE patients according to the presence of clinical manifestations. Neither cIMT nor FMD showed a statistically correlated with the disease activity. Patients who received hydroxychloroquine (0.57±0.02 vs. 0.50±0.09 mm, p=0.043) and cyclophosphamide (0.55±0.09 vs. 0.48 ± 0.10 mm, p=0.031) had higher cIMT. Higher cIMT was demonstrated in subjects who received steroid (p=0.045) and the dosage of steroid was essentially enforced to cIMT (R=0.418, p=0.034).
Conclusion
Our study unveil that early atherosclerosis was evidenced in patients with SLE and several medications might affect the progressivity of atherosclerosis
Precision in practice, save the limb, save the life: Early detection of grade IIA acute limb ischemia and management using catheter-directed thrombolysis - A case report
Full text linkBackground: Acute limb ischemia is an emergency condition that causes high morbidity and mortality. Endovascular revascularization in acute limb ischemia showed better in-hospital clinical outcomes than surgical revascularization.
Case illustration: A 67-year-old man was referred by internal medicine at the rural area hospital with a diagnosis of acute limb ischemia. He complained of sudden left leg pain and numbness of the left leg 2 days prior to hospital admission. He was a heavy smoker and had a predisposition for atrial fibrillation. He received heparinization at the previous hospital. Upon arriving at Saiful Anwar Hospital, a physical examination showed severe left leg pain and was difficult to move. His left leg was pulseless, paresthesia and poikilothermia. Duplex ultrasound revealed a thrombus in the left popliteal artery with no flow downwards. We diagnosed the patient with Acute Limb Ischemia Rutherford IIA left inferior extremity. We decided to perform catheter-directed thrombolysis with the Alteplase regiment. Post catheter-directed thrombolysis angiography evaluation showed TIMI flow II at the left leg after 24-hour catheter-directed thrombolysis. The patient did not complain of leg pain or numbness anymore.
Conclusion: Good outcomes in this patient were obtained through the ability to make correct initial diagnosis, early administration of heparin, and immediate referral to a cardiovascular center that can provide endovascular treatment. Catheter-directed thrombolysis is the right choice for grade IIA acute limb ischemi
The relationship between atrial myopathy with and without atrial fibrillation to cryptogenic stroke
Full text linkBackground: Ischemic stroke is the second most common cause of mortality globally, with some cases classified as cryptogenic strokes (CS) where the cause is unknown. Traditionally, atrial fibrillation (AF) has been considered the primary cause of ischemic stroke, but recent clinical trials and the occurrence of CS have led to the concept of atrial myopathy (AM). AM not only serves as a substrate for AF, promoting thrombus formation, but also causes blood stasis in the atrium, resulting in stroke without AF.
Objective: The relationship between AM with and without AF to CS incidences at Saiful Anwar Hospital, Malang was evaluated in this study.
Methods: Retrospectively analyzed medical records of patients from January 2023 to December 2024. Univariate analysis for baseline characteristic, bivariate analysis with Chi square, t-test and Mann Whitney u-test and multivariate analysis for predictive model using logistic regression were used for determine the relationship among variable in this study.
Result: 112 patients were included in this study. AM has a statistically significant (OR 31.762, 95% CI: 3.965-254.427, p=0.001) as a predictor of CS, but AF did not (OR: 1.666, 95% CI: 0.414-6.707, p=0.473). A better predictive value was achieved with CHA2DS2-VASC ≥2 combined with AM (OR 7.948, 95% CI: 2.628-24.034, p<0.001), compared with CHA2DS2-VASC ≥2 alone (OR 1.909, 95% CI: 0.651-5.598, p=0.239) or CHA2DS2-VASC ≥2 combined with AF and AM (OR 3.600, 95% CI: 0.985-13.159, p=0.050).
Conclusion: Atrial myopathy with and without atrial fibrillation had association to increasing the risk of cryptogenic stroke. Combining AM with the CHA2DS2-VASC score can improve stroke cryptogenic risk predictio