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All Journal Indonesian Journal of Cardiology
Rido Mulawarman
Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
Health Professions Medicine & Pharmacology

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Myocarditis Mimicking STEMI Complicated by Complete Atrioventricular Block: Diagnostic and Therapeutic Insights Rido Mulawarman; Hiradipta Ardining; Celly Anantaria Atmadikoesoemah; Dony Yugo Hermanto; Bambang Widyantoro; Rarsari Soerarso
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1921

Abstract

Background: Myocarditis, or myocardial inflammation, may share similar characteristics to Acute Coronary Syndrome (ACS), particularly ST-Elevation Myocardial Infarction (STEMI). This condition is further augmented when a Complete Atrioventricular Block (CAVB) is present. Despite being rare, this condition may pose additional diagnostic and therapeutic challenges. Case Illustration: We report a 54-year-old woman with fatigue, dyspnea, fever, nausea, and watery diarrhea for three days. Upon admission, she experienced hypotension, pulmonary congestion, and a complete Atrioventricular (AV) block, with ST-segment elevation seen on the lateral leads. Initial laboratory results revealed markedly elevated high-sensitivity troponin T and C-reactive Protein (CRP). Bedside echocardiography showed a prominently reduced Ejection Fraction (EF) (40%) alongside the presence of regional wall motion abnormalities. Urgent coronary angiography revealed only non-obstructive coronary disease and no obstructive coronary disease. A temporary pacemaker and inotropic support were initiated. Given the presence of systemic prodromal symptoms and the absence of coronary obstruction, myocarditis was strongly suspected. High‑dose intravenous methylprednisolone was given as an anti‑inflammatory treatment in suspected fulminant myocarditis with cardiogenic shock and complete AV block. Recognizing that immunosuppressive therapy is not routinely recommended for all myocarditis cases, especially without biopsy confirmation. Cardiac magnetic resonance imaging subsequently confirmed myocarditis, demonstrating myocardial edema and subepicardial late gadolinium enhancement. The patient was discharged after receiving guideline-directed medical therapy and tapering corticosteroids, with preserved ventricular function on follow-up 1 month after discharge. Conclusions: This report illustrates the importance of a stepwise diagnostic approach to differentiate myocarditis from STEMI, particularly when complicated by conduction disturbances such as CAVB. Early recognition and timely initiation of immunosuppressive therapy can lead to favorable outcomes.
Reviving the Atrial Switch: A Case Report of Successful Senning Procedure in a 13-Year-Old with Late-Presenting d-Transposition of the Great Arteries Rido Mulawarman; Sonya Aprelladiva; Indira Kalyana Makes; Adnan Rhafif; Ahmad Yani Mansur; Ericko Ongko Joyo; Della Fergina; Ruth Sabathani Ayuningtyas; Hiradipta Ardining; Muhammad Adrin Aefiansyah; Sisca Natalia Siagian
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1922

Abstract

Background: d-Transposition of the Great Arteries with an Intact Ventricular Septum (d-TGA-IVS) is a severe congenital cardiac anomaly typically necessitating an Arterial Switch Operation (ASO) during the neonatal stage. In late presenters with a regressed Left Ventricle (LV), ASO becomes high-risk or infeasible, making atrial switch procedures such as the Senning procedure a potential salvage option, particularly in resource-limited settings. Case Illustration: We report a 13-year-old boy with lifelong cyanosis who developed progressive exertional dyspnea. Echocardiography and cardiac catheterization confirmed d-TGA-IVS with secundum atrial septal defect, severe Right Ventricular Hypertrophy (RVH), and preserved Pulmonary Vascular Resistance (PVR) (1.93 WU). Due to LV regression and the limited feasibility of late ASO, a Senning atrial switch was performed. Postoperative recovery was clinically stable, with oxygen saturation improving from 73% to 91%. Early postoperative echocardiography showed reduced systemic Right Ventricular (RV) function (Tricuspid Annular Plane Systolic Excursion [TAPSE] 7 mm), which subsequently improved on follow-up. Conclusion: The Senning procedure remains a valuable salvage option for very-late presenting d-TGA-IVS with favorable pulmonary hemodynamics when ASO is not feasible. This case underscores the importance of periodic reassessment of operability in patients initially deemed inoperable and highlights the need for lifelong follow-up to monitor systemic RV function, arrhythmia risk, and baffle integrity.
Co-Authors Adnan Rhafif Ahmad Yani Mansur Bambang Widyantoro Celly Anantaria Atmadikoesoemah Della Fergina Dony Yugo Hermanto Ericko Ongko Joyo Hiradipta Ardining Hiradipta Ardining Indira Kalyana Makes Muhammad Adrin Aefiansyah Rarsari Soerarso Ruth Sabathani Ayuningtyas Sisca Natalia Siagian Sonya Aprelladiva