Heart Science Journal
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Giant left coronary artery with coronary cameral fistula in significant coronary artery disease : A case report
Full text linkBackground : Coronary Artery Fistula are coronary anomalies that affected populations with rare incidences. Concomitant disease such as coronary artery disease (CAD) may be occurred in CAF and causing complexity to its management.
Objective : This case presentation aimed to describe the characteristic, diagnosis and management of CAF with concomitant disease such as CAD.
Case Presentation : We will discuss A 56 year old male admitted as an outpatient with left sided chest pain as the chief complain. The chest pain was described as ischemic chest pain with supporting examination lead to the suspicion of coronary artery disease. Contrast enhanced CT Angiography examination was planned for diagnosing Coronary Artery Disease in this patient. 3D reconstruction of the coronary tree revealed giant LAD (Diameter 6.5 – 7mm) with normal size of LCx and Dominant RCA. The distal LAD was communicating with the LV cavity through big coronary fistulae. Impression of significant stenosis showed in the proximal RCA described as mixed plaque causing >70% Stenosis. PCI of the RCA and CAF Closure management was proposed but there was a disagreement of further coronary intervention from the patient.
Conclusion : CAF in concomitant CAD is a complex structural disease with challenging management. Combination of surgical procedure was the recommendation for the management of this case
Hypothermia theraphy in patients post cardiac arrest
Full text linkCardiovascular disease is the leading cause of death in several developing countries, and many of these deaths occur before reaching the hospital due to cardiac arrest. Most patients who return to spontaneous circulation (ROSC) and are brought to the hospital experience severe neurological damage during cardiac arrest, and this damage is the cause of in-hospital mortality. Improvements in survival and neurologic improvement of patients with CA have focused on two main therapy areas. The first area is improved education and skills of medical and paramedical personnel to improve perfusion post CA. The second area is a greater emphasis on post-resuscitation care which includes optimizing oxygenation and ventilation, avoiding hypotension, treating causes of CA such as acute coronary ischemia, and initiating hypothermia therapy if necessary, as in the 2020 guidelines and recommendations from the American Heart Association (AHA), International Liaison Committee of Resuscitation, and European Resuscitation Council covering the entire spectrum of post-resuscitation care. The AHA guidelines 2020 recommend optimizing hypothermia therapy for 24 hours with a target temperature between 320C - 360C in ROSC patients to improve clinical outcomes of neurological status after cardiac arrest. This is contrast to the study of Martinell et al in their research which concluded that there was no significant difference in survival rates within 30 days after cardiac arrest in patients who received either hypothermia therapy or those who did not. Hypothermia therapy, which is currently part of the post-resuscitation care recommendations, has varied variables and remains controversial in its implementation. Based on this, this referent will discuss the effects of hypothermia therapy on post-cardiac arrest patients, the stages, and the practical aspects of implementing hypothermia therapy
The role of GALNT and EGFR in vascular calcification: Study on pathophysiology and its implications in vascular therapy
Full text linkVascular calcification is a complex biomineralization process that occurs in arteries, primarily driven by the activity of vascular smooth muscle cells (VSMCs). This process involves the deposition of hydroxyapatite minerals in the arterial walls, particularly within the intima and media layers. Vascular calcification significantly increases the risk of cardiovascular diseases, including myocardial infarction, stroke, and heart failure. Understanding the role of GalNAc-transferase (GALNT) and the epidermal growth factor receptor (EGFR) in vascular calcification has advanced significantly. GALNT is involved in the regulation of glycosylation and affects various biochemical pathways, including insulin signaling and lipid metabolism. Variations in GALNT expression can influence the risk of vascular calcification, highlighting the crucial role of glycosylation in the pathogenesis of vascular calcification. On the other hand, EGFR contributes to vascular calcification by modulating the activity of tissue-nonspecific alkaline phosphatase (TNAP) and the formation of calcifying extracellular vesicles, as well as through the proliferation and migration of VSMCs. A deeper understanding of the roles of GALNT and EGFR provides new insights into the pathophysiological mechanisms of vascular calcification and opens up opportunities for the development of more effective therapies. This review aims to enhance scientific knowledge and provide a foundation for further research and the development of more targeted and personalized therapies in the prevention and treatment of vascular calcification
Time components contributing to door-to-balloon time of patients with ST-elevation myocardial infarction
Full text linkTimely percutaneous coronary intervention (PCI) for patients experiencing ST-segment elevation myocardial infarction (STEMI) can greatly decrease mortality and morbidity. However, delays can hinder its effectiveness. The interval from hospital admission to reperfusion with PCI, known as door-to-balloon time (D2B), is closely linked to patient outcomes and is a key indicator of hospital quality. European guidelines suggest a D2B time of 90 minutes or less. Furthermore, some registries break down the D2B time into component times. These components include the time needed to identify a STEMI and activate the catheterization lab (door-to-activation time), the time for lab preparation and patient transport (activation-to-laboratory time), and the time from lab arrival to the initial use of devices to open the blocked artery (laboratory-to-balloon time). In Indonesia, factors such as population diversity, cultural beliefs, health literacy, and national insurance processes may affect D2B times. Understanding these components can help develop strategies to reduce delays. Understanding each component of D2B time and its contributing factors can aid physicians in developing effective strategies to reduce D2B delays
Determinants of cost discrepancies in inpatients with acute decompensated heart failure
Full text linkBACKGROUND: Acute decompensated heart failure (ADHF) is a prevalent and complex condition that significantly burdens healthcare systems, requiring intensive care and leading to high treatment costs.
OBJECTIVES: This study aims to identify factors influencing cost discrepancies in hospitalized ADHF patients.
METHODS: This retrospective study was conducted at Universitas Brawijaya Hospital from July to August 2024. Data were collected from 86 ADHF patients who were hospitalized between January 2021 and December 2023. Information regarding the patients\u27 clinical conditions, comorbidities, and medical procedures was extracted from their case histories. Statistical analyses included t-tests and Mann-Whitney tests.
RESULTS: In this study of 86 individuals with ADHF, 58.1% were over 65 years old, 31.4% were between 45 and 64 years old, and 10.5% were between 18 and 44 years old. By classification of care, 58.1% were admitted for Class 1 care, 30.2% for Class 2, and 11.6% for Class 3. Our findings indicated that the costs of treatment for patients with moderate and severe diseases were higher as compared to those of mild severity. Patients who had a length of stay over 7 days had higher costs than the ones whose length of stay was 1 to 3 days. Furthermore, Class 2 care was associated with higher costs than Class 3 care. The analysis also revealed that an increase in the number of comorbidities and medical procedures corresponded with higher treatment costs.
CONCLUSION: This study identified factors that increase the cost of treatment for patients with ADHF
Optimal treatment resolves total atrioventricular block in patient with myocardial infarction non-obstructive coronary artery: A case report
Full text linkBackground: Total atrioventricular block (TAVB) cause of myocardial infarction non-obstructive coronary artery (MINOCA) in the anteroseptal segment is an uncommon case. Appropriate treatment can prevent worsening and give the best outcome to the patient.
Case Presentation: We present a TAVB patient with unstable hemodynamics and complains of severe chest pain. Narrowing in the LAD segment was found in the coronary angiography without any sign of atherosclerosis. The patient improved with optimal reperfusion, and TAVB resolved within 24 hours.
Conclusion: Optimal treatment focused on rapid reperfusion due to vasospasm can resolve TAVB and improve clinical conditions in the patients
Hemodialysis prophylaxis and renal replacement therapy in contrast associated acute kidney injury (CA-AKI): literature study
Full text linkContrast associated acute kidney injury (CA-AKI) had been the main focus along the development of percutaneous invasive procedure. Contrast associated acute kidney injury (CA-AKI) increase risk of dead among hospitalized patient. The use of iodine based contrast along percutaneous procedure potentially induce contrast associated acute kidney injury (CA-AKI). Many potential hazardous effect may effect individual with CA-AKI such as myocardial re-infarction, stent thrombosis, dead, and major adverse cardiac event (MACE). Many strategies had been developed to prevent and treat CA-AKI such as risk stratification, hydration with normal saline, avoid nephrotoxic drug, use of statin, and N-acetilcystein but when all strategies failed, hemodialysis prophylaxis and renal replacement therapy had potential benefit in CA-AKI
Continous renal replacement therapy: revisited
Full text linkPatients in condition of acute kidney injury (AKI) and critically ill often benefit from renal replacement therapy (RRT). Patient with hemodynamically unstable in cardiac intensive care, such as those with congestive heart failure, acute myocardial dysfunction, or excessive hemodilution during cardiac surgery, continuous renal replacement therapy (CRRT) is considered to be the suitable renal replacement therapy modality. This paper discusses indications, techniques, and CRRT in cardiac critical care
When to consider takotsubo cardiomyopathy in menopausal elderly woman presenting chest pain
Full text linkBackground: An elderly menopausal woman presenting with chest pain in the emergency department may have coronary artery disease (CAD), Takotsubo cardiomyopathy, or other conditions. It is crucial to conduct a thorough diagnostic evaluation in menopausal elderly woman.
Case illustration: A 77-year-old postmenopausal woman presenting with first-onset chest pain after having familial issues and severe psychological stress was admitted to the emergency department. She had no identifiable risk factors for CAD, and her physical examination revealed no significant abnormalities. The electrocardiogram (ECG) indicated non-specific ST-segment elevation in leads V3-V6. Serial ECGs showed an evolution of ST-segment elevation that did not align with the typical pattern observed in STEMI. Despite the elevation in cardiac enzymes in the previous hospital, unfortunately, serial cardiac enzymes were inconsistently normal in our hospital. Therefore, these findings implied that the patient\u27s condition might not be ACS, and we cannot rule out the possibility of Takotsubo syndrome. The patient underwent coronary angiography (DCA) and The DCA results revealed normal coronary with suspicion of apical ballooning of the left ventricle as observed from cine angiography. Subsequent echocardiography demonstrated apical akinesis with basal hyperkinesis, the large area of dysfunctional myocardium extending beyond the territory of a single coronary artery and characteristic apical ballooning resembling an octopus trap, consistent with the diagnosis of Takotsubo syndrome. The patient was managed conservatively with supportive care. Her symptoms improved, and she was discharged after five days.
Conclusion: This case highlights the importance of considering takotsubo cardiomyopathy in menopausal elderly woman with no risk factor of CAD presenting with chest pain after having psychological stress
Periodontitis and venous thromboembolism risk: Investigating the connection through a systematic review and meta-analysis
Full text linkBACKGROUND: The relationship between periodontitis and venous thromboembolism (VTE) remains controversial. Some studies show an association, while others do not show an association between periodontitis and VTE.
OBJECTIVES: This study aims to determine the relationship between periodontitis and the risk of VTE using a meta-analysis approach.
METHODS: A meta-analysis study, registered in PROSPERO, was conducted from August to September 2024. The sources for article searches in this study were Scopus, Embase, and PubMed. Data on the proportion of VTE occurrences in the periodontitis and non-periodontitis groups were collected from each article, and pooled point estimates were calculated using the Mantel-Haenszel test.
RESULTS: We identified 40,397 VTE cases and 2,215,063 controls from six articles. Among these six articles, three showed an association between periodontitis and an increased risk of VTE. Additionally, we identified one article reporting that periodontitis was associated with a decreased risk of VTE. Furthermore, two articles revealed that periodontitis had no association with VTE occurrence. Our calculations using the Mantel-Haenszel test showed that, overall, an increased risk of VTE was found in individuals with periodontitis compared to those without (RR: 1.61; 95% CI: 1.09 – 2.39; Egger\u27s p: 0.7917; Heterogeneity p: <0.0001; p: 0.0200).
CONCLUSION: We have identified that periodontitis is an important factor in the occurrence of VTE