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Echocardiography Features in Patient Rheumatic Mitral Stenosis Dwigustiningrum, Nur Kaputrin; Rahimah, Anna Fuji; Karolina, Wella; Martini, Henny
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.2024.005.02.5

Rheumatic mitral stenosis (RMS) is a progressive valvular heart disease that can lead to significant morbidity and mortality, especially in developing countries. Echocardiography plays a crucial role in the diagnosis, assessment, and management of patients with RMS. This study aims to review the utility echocardiography feature in patient RMS. We discuss the key echocardiographic parameters used for assessment and severity of RMS, and associated valvular abnormalities. Additionally, we explore the role of multimodality imaging, such as transesophageal echocardiography in enhancing the diagnostic accuracy and therapeutic decision-making in RMS. A thorough understanding of echocardiographic findings in RMS is essential for clinicians involved in the care of these patients, as it aids in risk stratification, treatment planning, and monitoring of disease progression. Integrating echocardiography is a widely used non-invasive method for comprehensive assessment, monitoring disease progression and evaluating treatment efficacy, ensuring optimal management for patient with RMS.

Challenge case of ventricular arrhythmia in young women Kaputrin, Nur; Rizal, Ardian; Karolina, Wella; Widito, Sasmojo
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.16

Background: 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't 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.

Transcatheter atrial septal defect closure: Focus on tips and tricks for interventional procedure in challenging cases Setiawan, Dion; Putri, Valerinna Yogibuana Swastika; Martini, Heny; Karolina, Wella
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.6

The 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.

Unveiling strategies in acute cardiac care for ventricular septal rupture following acute myocardial infarction: Lessons from cases Nurudinulloh, Akhmad Isna; Anjarwani, Setyasih; Prasetya, Indra; Yogibuana, Valerinna; Rahimah, Anna Fuji; Karolina, Wella
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.17

Background: Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is drastically decreasing in the reperfusion era but mortality remains high. VSR correction is the definitive treatment and using mechanical support to delay closure is an attractive option despite data on success being limited. Case Illustration: A 60-year-old man presented with late presentation of anterior STEMI complicating hemodynamic deterioration. Echocardiography showed apical VSR 11-14 mm L-R shunt. Patient was given adequate fluids, multiple inotropic agents, and IABP insertion, then a successful PPCI procedure was performed immediately. IABP was maintained for hemodynamic stabilization and patient was scheduled for interventional closure. Unfortunately, the patient worsened due to cardiogenic shock and passed away on the 5th day of admission. In another case, a 61-year-old man came to our hospital also with a late presentation of anterior STEMI but stable in hemodynamics. Echocardiography showed apical VSR 9-11 mm L-R shunt. Coronary angiography showed CAD three vessel disease with critical stenosis at LAD. In hospital’s heart team discussion, patient was planned to be performed VSR closure percutaneously and continue with PCI procedure. Both procedures were performed successfully. Patient was improved and discharged on 20th day of admission. Conclusion: Rapid diagnosis and prompt treatment are the keys to optimal management of VSR complicating late presentation STEMI. Mechanical circulatory support and correction of VSR are required to optimize patient outcomes despite VSR is still a challenging case.

Valvular aspects from echocardiography in rheumatic heart disease Noverike, Nikhen; Anna Fuji Rahimah; Yogibuana, Valerinna; Karolina, Wella
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.5

Rheumatic Heart Disease is a result of an autoimmune response to group A streptococcal infection and is globally impacted and prevalent in low- and middle-income countries, especially among children and young adults. It primarily affects the heart valves, leading to damage and dysfunction. The progression of RHD can vary, with some individuals experiencing mild symptoms while others may develop severe valve damage leading to heart failure. Echocardiography plays a crucial role in the diagnosis and monitoring of RHD, as it allows to visualize and assess the structural and functional abnormalities of the heart valves. Early detection through echocardiography screening is essential for timely intervention and management of RHD. It provides valuable information about the severity of valve damage and helps determine the most appropriate treatment approach, whether it involves medication or surgical intervention. The ability of echocardiography to provide information about volumes, flows, and pressures, and to acquire quantitative hemodynamic data, highlights its importance in the assessment of patients with RHD. In conclusion, echocardiography has revolutionized the way we diagnose, monitor, and manage rheumatic heart disease, and its importance in the medical field cannot be overstated. The continued integration of echocardiography into clinical practice will undoubtedly lead to improved outcomes for patients with RHD.

Diagnosis and differentiation of pathological concentric left ventricular hypertrophy Millisani, Hayla Iqda; Karolina, Wella
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.6

Identifying the diagnosis and differentiation of concentric left ventricular hypertrophy (LVH) can be crucial, as the various etiology ofter similar characteristics and morphology. Concentric left ventricular hypertrophy (LVH) is the term used to describe the enlargement of the left ventricle (LV), the increase in the mass and thickness of the LV wall which can occur in response to pressure overload. The most common etiology of concentric hypertrophy include the systemic hypertension, aortic stenosis and hypertrophic cardiomyopathy (associated with sarcomere mutations, infiltrative cardiac diseases, and storage disorders). Cardiac imaging is the predominant modality for visualizing and quantifying LVH in clinical practice and often collaborates with an established diagnosis. Echocardiography, the primary imaging modality, enables a thorough evaluation of left ventricular systolic and diastolic function. Cardiovascular magnetic resonance offers further benefits by correctly measuring left ventricular and right ventricular sizes and mass, as well as characterizing myocardial tissue properties. These measurements can provide valuable insights for making a final diagnosis.

Hype or hope: The role of alcohol septal ablation in improving outcomes for young patients with obstructive hypertrophic cardiomyopathy: A case series Saputri, Vemmy Lian; Rizal, Ardian; Rahimah, Anna Fuji; Karolina, Wella; Yogibuana, Valerinna; Prasetya, Indra
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.19

Background: Hypertrophic cardiomyopathy (HCM) is a disease that has a poor prognosis and a higher likelihood of death in young people. Alcohol septal ablation (ASA) is a minimally invasive procedure that involves the injection of ethanol through a septal perforator to lead to infarction of the hypertrophied septum. This case series aims to present data on the beneficial effects of ASA in promoting hope for enhanced outcomes in young patients with HCM. Case: Patient 1: A 32-year-old male with HCM has been suffering from chest discomfort and atrial fibrillation since 2020. Echocardiography detected an increased obstruction in the left ventricular outflow tract (LVOT), resulting in a gradient of 104 mmHg. The patient underwent ASA to decrease the gradient to 37 mmHg, reducing hospitalizations throughout a 12-month follow-up period. Patient 2: A 27-year-old female diagnosed with HCM has been frequently suffering episodes of near syncope and shortness of breath with light activity over the past 6 months. The echocardiography findings showed a significant increase in the resting gradient in the LVOT. Following ASA, the resting gradient decreased to 54 mmHg during a 3-month follow-up. The patient did not suffer further near syncope events, and her NYHA functional class improved throughout a 9-month follow-up period. Conclusion: The effectiveness of ASA as a treatment option is hope for young patients with obstructive HCM, which is demonstrated in this case series, leading to relieving symptoms, reduced repeated hospitalization, and improved functional capacity.

Athlete's heart: how echocardiography can unveil the heart's hidden secrets in athletes? Abadi, Sahlan; Karolina, Wella
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.7

Massive saddle embolism in chronic thromboembolic pulmonary hypertension: The unresolved tale Firdaus, Achmad Jauhar; Karolina, Wella
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.18

BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) represents a rare and severe variant of pulmonary hypertension (PH), leading to progressive damage to the cardiopulmonary system. The obstruction could happen anywhere from the small branches to the main pulmonary artery. A saddle-type emboli, a particularly severe type of pulmonary embolism that occurs in the main pulmonary artery and blocks both the right and left branches, has the highest potential to cause death. This article presents a case of progressive CTEPH with inoperable conditions that underwent catheter-directed thrombolysis (CDT) as a last resort given the limitations of other treatment modalities. CASE: A 53-year-old woman with worsening shortness of breath was diagnosed with CTEPH, but despite anticoagulant treatment, imaging evaluation showed a progressive saddle-type pulmonary embolism along with findings of interstitial lung disease (ILD). Multidisciplinary team discussions were conducted, and the decision to proceed with pulmonary endarterectomy (PEA) was influenced by various factors. CDT was then performed, however, there was no notable clinical improvement. The patient ultimately succumbed to the disease following 31 days of treatment. CONCLUSION: CTEPH is a rare type of pulmonary hypertension caused by pulmonary embolism. The treatment algorithm employs a multimodal strategy that addresses the different anatomical lesions. In proximal obstruction, surgical PEA remains the treatment of choice in operable patients. An experienced multidisciplinary team is mandatory. Without these requirements, other strategies can continue to be studied for their role in inoperable CTEPH.

When coronary anomalies induce arrhytmias: A case of ventricular tachycardia due to left coronary artery-pulmonary artery fistula Saerang, Gebryel Dennis; Rizal, Ardian; Karolina, Wella
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.20

Background: Coronary artery fistula (CAF) is a rare vascular anomaly involving an abnormal connection between a coronary artery and another cardiac or vascular structure. Although often asymptomatic, CAF can cause myocardial ischemia, presenting as angina, dyspnea, or ventricular arrhythmias, due to flow diversion, leading to a coronary stealing phenomenon that poses a serious clinical challenge. Case: An 81-year-old female presented with chest pain, palpitations, and syncope. Electrocardiography (ECG) showed monomorphic VT, successfully cardioverted and managed with amiodarone. Following initial stabilization, she experienced recurrent episodes of VT that were terminated with lidocaine. Physical examination revealed a continuous machinery murmur at the left upper sternal border. Transthoracic echocardiography showed left coronary artery dilation with turbulent flow into the pulmonary artery. Aortography and coronary angiography confirmed a dilated left main coronary artery with an aneurysmal segment and a tortuous fistulous tract to the pulmonary artery. Computed tomography coronary angiography (CTCA) with 3D reconstruction confirmed a left coronary artery fistula to the pulmonary artery. Conclusion: This case highlights CAF as an uncommon yet clinically important etiology of recurrent VT, likely attributable to the coronary stealing phenomenon. Multimodal imaging, especially CTCA, is crucial for diagnosis and treatment planning. In addition to immediate management with cardioversion/defibrillation and antiarrhythmic drugs, treatment of ischemia as the underlying cause is important in the management of ischemia-induced VT. CAF closure is recommended in symptomatic or hemodynamically significant CAF to alleviate ischemic symptoms and prevent complication.

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