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All Journal Buletin Farmatera Indonesian Journal of Cardiology Sumatera Medical Journal Heart Science Journal Cardiovascular and Cardiometabolic Journal (CCJ) Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI) The Journal of Society Medicine (JSOCMED) Medistra Medical Journal (MMJ)
Sitepu, Andika
Departemen Jantung Dan Pembuluh Darah, Fakultas Kedokteran Universitas Sumatera Utara
Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience Public Health

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Journal : Medistra Medical Journal (MMJ)

 1 
Infark miokardium dengan arteri koroner non obstruktif (MINOCA) dengan komplikasi ventrikel takikardi : LAPORAN KASUS dr Nicholas Prananda Sembiring; dr. Andika Sitepu, Sp.JP(K), FIHA, FAsCC, FAPSC, M.H.(Kes); FIHA; FAsCC; FAPSC
Medistra Medical Journal (MMJ) Vol 1 No 2 (2024): Medistra Medical Journal (MMJ)
Publisher : Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35451/mmj.v1i2.2125

Abstract

Disini kami menyajikan seorang pasien dengan keluhan nyeri dada khas infark selama 2 hari dan menjalar ke punggung bagian belakang. Pada pemeriksaan saat ini, EKG awal menunjukkan elevasi segmen ST (>0,5 mm) di hampir semua sadapan. Pasien didiagnosis menderita STEMI anteroseptal akut dan syok kardiogenik. Pasien kemudian dilakukan pemeriksaan angiografi koroner yang dilaporkan hasilnya normal, tanpa lesi yang signifikan dan tidak ada tanda-tanda penyakit arteri koroner obstruktif, diseksi koroner, bridging atau emboli pada arteri koroner. Berdasarkan temuan di atas, kami menganggap pasien ini sebagai infark miokardium dengan arteri koroner non obstruktif (MINOCA). Kondisi pasien di perparah dengan adanya VT disertai dengan ketidakstabilan hemodinamik sehingga pasien harus di kardioversi. Pasien segera dirujuk setelah 2 hari pengobatan. Defibrilasi telah dilakukan dua kali pada pasien ini. MINOCA biasanya terjadi pada pasien yang lebih muda dan wanita, yang mungkin memiliki risiko kejadian kardiovaskular lebih rendah dibandingkan pasien dengan CAD obstruktif. Penyebab paling umum dari MINOCA diwakili oleh penyakit plak koroner, diseksi koroner, emboli pada arteri koroner, spasme mikrovaskuler koroner, kardiomiopati Takotsubo, miokarditis, tromboemboli koroner, bentuk lain dari infark miokard tipe 2 dan MINOCA dengan etiologi yang tidak pasti. Diperlukan pemeriksaan lebih lanjut seperti resonansi magnetik jantung (CMR) untuk menegakkan diagnosis lebih baik. Studi elektrofisiologi juga di pertimbangkan pada pasien ini dikarenakan pasien sudah berulang mengalami VT.
Wellens's Syndrome, Kenali karena setara dengan stemi: laporan kasus Br Ginting, Kristivani; Andika Sitepu; FIHA; FASCC; FAPSC
Medistra Medical Journal (MMJ) Vol 1 No 2 (2024): Medistra Medical Journal (MMJ)
Publisher : Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35451/mmj.v1i2.2110

Abstract

Acute coronary syndrome (ACS) is one of the leading causes of acute chest pain, requiring emergency care and eventual hospitalization. Wellens’ syndrome is one such example, which in ACS patients is a catastrophic event often accompanied by extensive anterior myocardial infarction and high mortality rates. Wellens’ syndrome is a pattern of T-wave changes seen in the anterior (V2-V3) leads on critical stenosis of the left anterior descending (LAD) coronary artery. We reported a 65-year-old man admitted to our emergency facility because of intermittent chest pain that had been experienced for the past 2 days. An initial ECG performed in the emergency room while pain free showed sinus rhythm with biphasic T waves in V2–4 which is typical of Wellen's Syndrome. Chest x-ray shows cardiomegaly. Cardiac enzyme examination showed an increase in CKMB and Troponin T levels of 18.40 U/L and 560 ng/L respectively. The echocardiography (ECHO) demonstrated a hypokinesis of the anteroseptal with left ventricular ejection fraction (LVEF) of 47 %. Cardiac catheterization showed total occlusion in the mid-LAD and other coronary arteries had non-significant lesions. He then underwent balloon angioplasty and placement of a stent in the proximal and mid LAD with a good result. Wellen’s syndrome often represents a pre-infarction state of myocardial infarction. Early recognition of these ECG features is crucial to identify these high-risk clients, and the definitive evaluation and treatment is cardiac catheterization with intervention to relieve the LAD obstruction.
High-Degree AV Block in STEMI with Metabolic Disorders: Who is the Prime Suspect? Sinulingga, Brigitta Olivia; Sitepu, Andika
Medistra Medical Journal (MMJ) Vol 3 No 1 (2025): Medistra Medical Journal (MMJ)
Publisher : Institut Kesehatan Medistra Lubuk Pakam

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.35451/az5zac60

Abstract

Background: ST-elevation myocardial infarction (STEMI) is typically associated with a single culprit lesion. However, cases involving dynamic progression or multiple simultaneous infarct-related arteries are rare but carry significantly higher risks, particularly when accompanied by malignant arrhythmias and electrical instability. Case Illustration: A 33-year-old male, active smoker and casual drinker, presented with acute chest pain, dyspnea, and nausea. He was initially diagnosed with inferior STEMI and transient ventricular tachycardia at the referring hospital. Upon transfer, his ECG evolved to show inferior-anterior STEMI with complete atrioventricular block. Shortly after arrival, he experienced cardiac arrest and was successfully resuscitated. Coronary angiography revealed dual culprit lesions: total occlusion of both the right coronary artery (RCA) and the left anterior descending artery (LAD). PCI was performed with drug-eluting stent placement in the RCA, and balloon angioplasty with thrombus aspiration and intracoronary eptifibatide in the LAD. Revascularization achieved TIMI III flow.Discussion: Despite successful PCI, the patient suffered recurrent cardiac arrests in the catheterization lab and ICU, ultimately dying from cardiac arrest. This case illustrates the rare but catastrophic progression of STEMI into a dual-vessel event with severe electrical and hemodynamic complications in a young patient. Conclusion: Dual culprit lesions in STEMI can evolve rapidly and unpredictably, particularly in the presence of malignant arrhythmias. Early recognition, rapid intervention, and aggressive hemodynamic support are essential to improve survival in these high-risk cases.
Co-Authors Abdullah Afif Siregar Abdullah Afif Siregar Abimanyu, Roni Ahmad Handayani Aldino Satria Adhitya Alfuadi, T. Rifki Mirza Ali Nafiah Nasution Andra, Cut Aryfa Andra, Cut Aryfa Br Ginting, Kristivani Chan, Muhammad Ikhsan Cut Aryfa Andra Dhilion, Har Rawishwar Singh dr Nicholas Prananda Sembiring Faisal Habib FAPSC FASCC FIHA Habib, Faisal Harris Hasan Harris Hasan Hasan, Harris Hasan, Refli Haykal, T. Bob Ilyas, Kamal Kharrazi Intan, Tengku Kemala Jaya Suganti Ketaren, Andre Pasha Lubis, Ainil Wardah Lubis, Anggia Chairuddin Lubis, Hilfan Ade Putra Muhammad Azmi, Muhammad Mukhtar, Zulfikri Nasution, Ali Nafiah Putra, Muhammad Hafiz Mahruzza Ratna Mariana Tamba Raynaldo, Abdul Halim Sarastri, Yuke Setia Putra Tarigan Shafira Pramesi Putri Sinulingga, Brigitta Olivia Siregar, Abdullah Afif Steven Winardi Syarifuddin, Fairuz Tamba, Ratna Mariana Tanjung, Ika Citra Dewi Teuku Bob Haykal Wirtanto, Ardy Putra Yuke Sarastri Zulfikri Mukhtar