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All Journal Indonesian Journal of Cardiology Heart Science Journal Jurnal Klinik dan Riset Kesehatan
Martini, Heny
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Managing a Challenge Case: Transesophageal Echocardiography-Guided Transcatheter Closure of a Large Secundum Atrial Septal Defect in a Pregnant Woman Fathoni, Emil; Martini, Heny; Rahimah, Anna Fuji; Putri, Valerinna Yogibuana Swastika
Heart Science Journal Vol. 5 No. 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.12

Abstract

Background: The management of complex cardiovascular conditions during pregnancy poses unique challenges, and in the case of a large secundum atrial septal defect (ASD), achieving successful closure through a transcatheter approach guided by transesophageal echocardiography (TEE) requires careful navigation and expertise. This study sought to present a case that exemplifies the contemporary approach of using TEE guidance for the closure of an ASD in pregnant womenCase presentation: A 31-year-old woman with multigravida, diagnosed with secundum ASD and pulmonary hypertension, underwent TEE. The TEE examination revealed a significant ASD measuring 2.8-3.1 cm with inadequate surrounding rims. Subsequently, our intention was to employ a device to address this defect. TEE was utilized to guide the placement of a 14F delivery sheath into the left upper pulmonary vein and left atrium. Using a catheter, we successfully deployed a 40 mm ASD Occluder (MemoPart), concluding the intervention without any complications. Given the concerns regarding the potential risks of radiation exposure and teratogenic effects on fetal development, particularly in young patients and during pregnancy, it is crucial to prioritize TEE-guided closure of ASD for the safety of both the mother and the fetus.Conclusion: Closure of ASD with zero fluoroscopy proved to be a safe and effective procedure, demonstrating feasibility and significant benefits for pregnant women with ASD.
Successful Management of High-Risk Acute Pulmonary Embolism in Patients with Undetected Hepatocellular Carcinoma: A Case Report zunardi, Lutfi hafiz; Kurnianingsih, Novi; Martini, Heny
Heart Science Journal Vol. 4 No. 4 (2023): The Science and Art of Caring for Critically III Patients in Intensive Cardiac
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.04.6

Abstract

AbstractBackground: Acute pulmonary embolism (PE) as the earliest manifestation of hepatocellular carcinoma (also known as HCC) is an extremely uncommon discovery and a very uncommon illness. It is a serious condition that can be life-threatening and has high morbidity and mortality rates. Despite the high prevalence of PE, the diagnosis is still challenging, mainly due to the unpredictability of symptoms and physical signs and the unexplained cause. The stratification of acute pulmonary embolism is important because it determines the right steps in decision-making.Case Illustration: A 45-year-old man presented to the ER at a private hospital with complaints of sudden shortness of breath after taking a bath. His family brought him to the private hospital 30 minutes after the onset. He came with desaturation and shock conditions. He was assessed as having an acute coronary syndrome (ACS). He got loaded with dual antiplatelets and was referred to our hospital. Because the patient's complaint is not angina but sudden shortness of breath accompanied by desaturation, we rule out ACS. We considered the possibility of a pulmonary embolism, so we performed bedside TTE in the ER and found RV dysfunction and McConnell's sign leading to acute PE. We continued with the CT examination and found a thrombus in the pulmonary artery. We assessed patients with high-risk pulmonary embolism and performed thrombolysis with rTPA. The patient's complaints gradually improved. Initially, we suspected unprovoked PE because we did not find a clear trigger, such as malignancy, prolonged bedriddenness, recent surgery, or old age. We accidentally found HCC from the patient's CTPA evaluation, and HBSAG was reactive.Conclusion: Every case of dyspnea that shows up at an emergency room should have acute PE taken into consideration in the differential diagnosis. In patients with suspected PE without obvious risk factors, we can use CT to triple-rule out ACS, Aortic dissection, and pulmonary embolism. Patients treated with thrombolytic therapy show rapid improvement, which may lead to a lower rate of mortality and morbidity.
Management of Pregnant Women with Atrial Septal Defect and Pulmonary Hypertension: A Case Report Wicaksono, Arif; Martini, Heny; Rizal, Ardian; Rahimah, Anna Fuji
Heart Science Journal Vol. 5 No. 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.13

Abstract

Backgrounds:Pulmonary Hypertension (PH) is a condition where there is an increase in Pulmonary Vascular Resistance (PVR) and an increase in the mean Pulmonary Arterial Pressure (mPAP) to more than 20 mmHg. PH can occur in someone with Congenital Heart Disease (CHD). PH conditions can aggravate pregnancy in women with CHD. So that women with PH are recommended not to undergo pregnancy. However, it is possible for women with CHD with PH conditions to undergo pregnancy. In these conditions, optimizing PH therapy is important so that pregnant women with PH do not experience a worsening of the condition and can carry out their pregnancy well until delivery. Case Presentations:A 38-year-old female patient with a history of Atrial Septal Defect-Pulmonary Hypertension came for routine control to the cardiac clinic with the condition of pregnancy of her 4th child who was just discovered when she was 6 months pregnant. Since giving birth to her third child, the patient began to complain of being easily tired when doing activities accompanied by swollen legs that disappeared with rest. At that time, the patient went to a cardiologist for an echocardiography examination and was diagnosed as Atrial Septal Defect (ASD)-Pulmonary Hypertension (PH). Since then, the patient has been routinely treated at a cardiologist with Pulmonary Hypertension drugs, including Phospodiesterase5 (PDE5) inhibitors (Sildenafil) and Prostacyclin Analogue (Dorner). The patient had done Transesophageal Echocardiography (TEE) with the results of ASD secundum suitable for closure by device. Patients with Right Heart Catheterization (RHC) results, ASD secundum with PH High Flow High Resistance reactive to Vasoreactivity Test. Since the patient was found to be pregnant, the patient continued to use Sildenafil and discontinued the use of Dorner. The patient then continued treatment in a multidisciplinary team. Conclusion :Management of pregnant women with CHD and PH is important because the condition of PH itself further aggravates the condition of pregnancy. Medical management for PH in pregnant women follows the guidelines for the safety of drugs in pregnancy. So that the choice of therapy is crucial related to the goal of treatment to control the PH condition in the patient but still pay attention to safety in pregnancy conditions.
Clinical Features and Multimodality Diagnostic Tools of Pulmonary Hypertension Galuh, Lukitasari Ayu; Rahimah, Anna Fuji; Martini, Heny; Rizal, Ardian
Heart Science Journal Vol. 5 No. 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.4

Abstract

Pulmonary hypertension (PH) is characterized by an increase in mean pulmonary artery pressure (mPAP) above normal, which is > 20 mmHg and an increase in pulmonary vascular resistance (pulmonary vascular resistance / PVR) above normal, in resting conditions.The pathophysiology of PH involves remodeling of the pulmonary vessels, from the main pulmonary arteries, lobar arteries, segmental arteries, distal arteries, pulmonary arterioles, capillaries to the postcapillary pulmonary veins. In general, the epidemiological figures for PH are not known with certainty. The UK reported a PH prevalence of 97 cases/1,000,000 population with a female:male ratio of 1.8. The diagnostic approach to PH is mainly focused on two things. The primary goal is to raise the initial suspicion of PH and ensure fast-track referral to a PH center in patients with a high probability of PAH, CTEPH, or other forms of severe PH. The second aim is to identify the underlying disease, particularly left heart disease (Group 2 PH) and lung disease (Group 3 PH), as well as comorbidities, to ensure appropriate classification, risk assessment, and treatment. The Gold Standard diagnosis and classification of pulmonary hypertension is by examining the right heart catheterization (RHC). Clinical scoring in the form of shortness of breath without any obvious cause accompanied by physical examination, ECG and Thorax X-ray images which depict an enlarged right heart have good sensitivity and specificity for the diagnosis of pulmonary hypertension in patients with congenital heart disease. A high right ventricular pressure, mean PAP, and BNP values during observation, as well as heart size on chest X-ray can be predictors of a poorer prognosis in this population.
Successful Emergency Percutaneous Coronary Intervention of Challenging Unprotected Left Main Coronary Artery Disease Patient: How to Prepare and Optimize Suprayoga, Imam Mi'raj; Rohman, Mohammad Saifur; Martini, Heny; Satrijo, Budi
Heart Science Journal Vol. 5 No. 3 (2024): The Science and Art of Revascularization in Acute Coronary Syndrome
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.03.11

Abstract

Background: Myocardial infarction (MI) due to unprotected left main coronary artery disease (ULMCAD) is a relatively uncommon presentation. It represents as the anatomical subset of coronary artery disease (CAD) with the highest risk of atherosclerotic obstructive CAD. In the setting of acute MI, the treatment options are limited in this particular condition. Major advances in the field of PCI have made PCI as a viable option for patients with ULMCAD who are equally suited for CABG or PCI.Objective: This study aimed to describe the contemporary evidence PCI for ULMCADCase presentation: A man was admitted to our hospital with crescendo angina accompanied with dyspnea. Electrocardiogram (ECG) showed biphasic t wave on V2-V5 leads. He continued to experience symptoms of ischemia and had increased serial cardiac enzymes. Intra-aortic balloon pump (IABP) support was implemented before performing the PCI. After eight days of hospitalization, he was discharged with stable hemodynamics. Conclusion: PCI has risks and advantages when performed on patients with complex CAD, including ULMCAD. The prognosis for this high-risk patient group can be improved with thorough preparation and effective treatment strategies.
A young male patient with cardiomyopathy associated with human immunodeficiency virus infection in the era of highly active antiretroviral therapy Fathurohim, Zainal; Martini, Heny
Heart Science Journal Vol. 5 No. 4 (2024): The Current Perspective About Cardiometabolic Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2024.005.04.17

Abstract

Background: Cardiomyopathy in young people, especially those associated with HIV infection, has been reduced since the era of Highly Active Antiretroviral Therapy (HAART). In the era of post-HAART, manifestations of human immunodeficiency virus (HIV)-associated cardiomyopathy with impaired left ventricular (LV) systolic function are approximately about 1-3% of HIV-infected people. In this case, we presented how to diagnose and appropriately manage such a patient.Case Illustration: A 27-year-old male patient who works as a health worker came to the emergency room with complaints of shortness of breath; it worsened in the last 2 weeks. He got vital signs: blood pressure 97/60 mmHg, heart rate 118 bpm, respiratory rate 23 tpm, and oxygen saturation 99 % with oxygen supplementation of 8 lpm. Risk factors in patients such as smoking, family history, hypertension, diabetes mellitus, and dyslipidemia were denied. He was diagnosed with HIV on (antiretroviral therapy) ART 3 years ago with risk factors for free sex without protection. The last CD4 value was 796 cells/ul (normal value 637 – 1485). The echocardiography showed all chamber dilatation, global hypokinetic, and a significant decrease in LV systolic function (LVEF 16%). Laboratory examination showed an increase of N-terminal prohormone of brain natriuretic peptide (NT-proBNP) into 6824 pg/mL (normal value <85.8). It was then treated by optimizing HF therapy continue HIV therapy.Conclusion: In HIV patients who have fallen into heart failure, a proper diagnosis using relevant tools could be a reference for clinicians to make the right decision. Prompt treatment combination of optimal HF therapy and HIV therapy are becoming the keys to the treatment.
How to Recognize and Overcome Pulmonary Hypertension Crisis During Patent Ductus Arteriosus Closure by Device in Adult Galuh, Lukitasari Ayu; Martini, Heny
Heart Science Journal Vol. 5 No. 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.11

Abstract

BACKGROUND: Managing a patent ductus arteriosus (PDA) with severe pulmonary hypertension (PH) is challenging since closing the PDA can result in reduced cardiac output and right ventricular (RV) failure. The latest guideline for Adult Congenital Heart Disease (ACHD) stated it is harmful to close the defect in patients with pulmonary vascular resistance (PVR) ≤5 WU and flow ratio (FR) <1.5.  CASE ILLUSTRATION: A 37-year-old female was referred with cough, fever, low saturation, and murmur findings. After serial examination, she was diagnosed with large PDA and severe PH her peripheral saturation (SaO2) was 88%-89% and non-responder to acute vasoreactivity test. After a year of PH therapy, vasoreactivity showed a response to the vasoreactivity test and improved on clinical presentation with SaO2 91%-92%. Patient fell in to PH crisis condition during the procedure of device closure, prostacyclin analogue intravenous (IV) and phosphodiesterase inhibitors inhalation was administered, and the procedure was carried on. The device was successfully implanted, and the patient had SaO2 97% in all four extremities before discharge.CONCLUSION: With established PH therapy, PDA with severe PH can underwent PDA closure by device with satisfying outcome. 
Scoring system for early detection in pulmonary hypertension type I based on clinical presentation, electrocardiography, and chest X-ray at RSUD dr. Saiful Anwar Galuh, Lukitasari Ayu; Martini, Heny; Rahimah, Anna Fuji
Heart Science Journal Vol. 5 No. 4 (2024): The Current Perspective About Cardiometabolic Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2024.005.04.12

Abstract

Background: In Indonesia, pulmonary hypertension prevalence is 1:10.000 population. Due to its atypical symptoms, often PH patients come as a late presenters thus they have a worse prognosis. The golden standard to diagnose is Right Heart Catheterization (RHC) which is not widely available.Objectives: To generate a scoring system based on clinical presentation, electrocardiogram, and chest x-ray for early detection.Methods: A hospital-based cross-sectional survey was conducted in RSUD dr. Saiful Anwar, East Java from July 2020 – November 2023 with data from the medical record in which all variables are obtained at one period. Data were analyzed using bivariate analysis, multiple logistic regression, and Area Under Curve (AUC) from Receiver Operating Characteristic (ROC).Results: A total of 244 patients who were above 18 years old were conducted RHC at RSUD dr. Saiful Anwar East Java. We found a total score of 12 consisting of Dyspnea on Effort (DOE) score 2, Palpitation score 1, Increasaed P2 score 2, Increased JVP (Jugular vein pressure) score 2, RV (Right Ventricular) Heaves score 2, Right bundle branch block (RBBB) score 1, and Cardiomegaly (CTR >50%) score 2. With a 2 x 2 table, we found that a score of ⩾5 is likely for pulmonary hypertension diagnosis.Conclusion: Our study is a predictive model with a scoring system that has good sensitivity and specificity in selected populations where one of its limitations is sampling bias thus cannot yet be applied to the general population and needs further research for validation.
Pengaruh Latihan Fisik terhadap Kadar Marker Inflamasi pada Pasien Hipertensi Pulmonal Aziz, Indra Jabbar; Martini, Heny
Jurnal Klinik dan Riset Kesehatan Vol 4 No 1 (2024): Edisi Oktober
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.1.7

Abstract

Pulmonary hypertension (PH) is characterized by pulmonary vascular dysfunction, which can lead to right heart failure and death, as well as the accumulation of inflammatory cells in the perivascular area. Chronic inflammation plays an important role in the pathophysiology of pulmonary hypertension. Inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) are often elevated in patients with pulmonary hypertension. The accumulation of inflammatory cells accelerates the remodeling process of pulmonary blood vessels and pulmonary hypertension. Despite the current therapeutic approaches for pulmonary hypertension (PH), which aim to improve functional capacity and hemodynamics, pulmonary hypertension remains incurable but remains controllable. Inflammatory processes play a critical role in progressive pulmonary hypertension. Physical exercise can reduce the risk of chronic disease, and recent research has shown that it improves inflammatory marker profiles. This literature review aims to combine evidence on the influence of physical exercise on levels of inflammatory markers in patients with pulmonary hypertension.
Effect Of Combination Decafeinated Green Tea and Green Coffee In Reducing Cholesterol Levels In Patients With Metabolic Syndrome Alfata, Fandy Hazzy; Rohman, Mohammad Saifur; Astiawati, Tri; Tjahjono, Cholid Tri; Martini, Heny
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.4

Abstract

Background: Green tea and green coffee are natural ingredients that improve cholesterol levels. Combining the two in experimental animal studies provides more significant benefits when compared to single administration in reducing cholesterol levels.Objective: This study aimed to determine the effect of decaffeinated green tea and green coffee as adjuvant treatments in reducing blood cholesterol levels.Methods: This randomized controlled trial included 90 metabolic syndrome patients determined according to the IDF criteria for Asian people aged 50–70. All subjects received atorvastatin 20 mg and were divided into three groups. Participants in Group 1 received decaffeinated green tea and green coffee 2.5 grams twice daily, Group 2 received 5 grams daily, and Group 3 received a placebo. The total cholesterol, low-density lipoprotein cholesterol (LDL), high-density lipoprotein cholesterol (HDL), and triglyceride levels were measured at the beginning and the end of the study.Results: At 90 days, after administration of the extract of decaffeinated green tea and green coffee, we found that the concentration of total cholesterol in Group 1 and Group 2 was significantly reduced compared to the placebo (-50 ± 6.1 vs. -62.8 ± 5.9 vs. -22.5 ± 5.8 mg/dL; p= <0.05). But there was no significant difference in reduction of total cholesterol levels between the first and second groups. The other parameters also decreased, but not significantly compared to the placebo group.Conclusion: Administration of a combination of decaffeinated green tea extract and green coffee as an adjunctive therapy can reduce the average total  cholesterol, LDL, HDL, and triglyceride levels more than placebo, but only total cholesterol has a significant difference compared to other cholesterol  components.
Co-Authors Alfata, Fandy Hazzy Anjarwani, Setyasih Anna Fuji Rahimah Arif Wicaksono Astiawati, Tri Aziz, Indra Jabbar Cholid Tri Tjahjono Cholid Tri Tjahjono Emil Fathoni, Emil Fathurohim, Zainal Galuh, Lukitasari Ayu Gultom, Yosafat Hasiholan Marthin Indra Prasetya Karolina, Wella Kurnianingsih, Novi Lestari, Puspa Mohammad Saifur Rohman Muhammad Firdaus Nugraha, Yudha Tria Pratiwi, Irma Kamelia Putri, Valerinna Yogibuana Swastika Rahimah, Anna Fuji Rizal, Ardian Saskia Dyah Handari Satrijo, Budi Setiawan, Dion Setyowati, Danti Utami Suprayoga, Imam Mi'raj Valerinna Yogibuana Yogibuana, Valerinna zunardi, Lutfi hafiz