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All Journal Jurnal Kesehatan Andalas Cardiovascular and Cardiometabolic Journal (CCJ) The Journal of Society Medicine (JSOCMED)
Wulandari, Ni Luh Eka Sriayu
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Neuroscience

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Dilated Cardiomyopathy Related to Hyperthyroidism in Young Adults Sudarmika, Kadek Adi; Wulandari, Ni Luh Eka Sriayu
Journal of Society Medicine Vol. 3 No. 8 (2024): August
Publisher : CoinReads Media Prima

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.47353/jsocmed.v3i8.162

Abstract

Introduction: DCM is characterised by myocardial structural and functional abnormalities not caused by ischemia. One cause is hyperthyroidism. Hyperthyroidism can lead to a hyperdynamic circulatory state, increasing cardiac output and metabolic demands, which can ultimately result in heart failure. Case: A 35-year-old woman presented with complaints of acute shortness of breath that worsened at night, accompanied by bilateral lower limb oedema and palpitations. Her medical history revealed hyperthyroidism diagnosed in 2021, but the patient was not compliant with treatment. Physical examination showed low blood pressure (84/60 mmHg), tachycardia 110 Beats Per Minute (BPM), and elevated Jugular Venous Pressure (JVP). Auscultation detected fine bilateral crackles and mitral regurgitation. Bilateral lower limb oedema. Echocardiography showed global hypokinesia with an Ejection Fraction (EF) of 30%, consistent with DCM. Laboratory tests revealed hyponatremia, elevated creatinine, and significantly increased liver enzymes. Initial management included intravenous saline infusion, continuous dobutamine infusion, and high-dose furosemide drip, which did not respond to furosemide. Acetazolamide was introduced as an additional diuretic. The patient also received ramipril, spironolactone, and enoxaparin for comprehensive cardiovascular and electrolyte imbalance management. This case highlights the importance of recognising the multifactorial nature of heart failure, particularly in patients with hyperthyroidism. Conclusion: This case illustrates the complexity of treating DCM with hyperthyroidism and the need for individualized therapy to optimize patient outcomes. The addition of acetazolamide proved effective in addressing the inadequate response to furosemide, emphasizing its role in enhancing diuretic response.
The Dilated Cardiomyopathy Related to Hyperthyroidism with Cardiogenic Shock and Inadequate Diuretic Therapy: A Case Report Sudarmika, Kadek Adi; Bagiari, Ketut Erna; Pratama, I Gede Bagus Gita; Wulandari, Ni Luh Eka Sriayu
Cardiovascular and Cardiometabolic Journal (CCJ) Vol. 5 No. 2 (2024): Cardiovascular and Cardiometabolic Journal
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ccj.v5i02.2024.125-133

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Highlights: 1. This article highlights the complexity of thyroid dysfunction and how individual assessments are crucial in determining the effective management of it. - Background: Dilated Cardiomyopathy (DCM) is a non-ischemic heart muscle disease characterized by structural and functional myocardial abnormalities. One of its causes is hyperthyroidism. Hyperthyroidism can lead to a hyperdynamic circulatory state, increasing cardiac output and metabolic demands, which can ultimately result in heart failure. Case Presentation: A 35-year-old woman presented with complaints of acute shortness of breath that worsened at night, accompanied by bilateral lower limb edema and palpitations. Physical examination showed low BP (84/60 mmHg), tachycardia 110 BPM, and elevated JVP. Auscultation detected fine bilateral crackles and mitral regurgitation. Echocardiography showed consistent with DCM. Conclusion: Effective management of heart failure in the context of thyroid dysfunction requires a multidisciplinary approach that encompasses the disease's cardiac and endocrine components. This case illustrates the complexity of treating DCM with hyperthyroidism and the need for individualized therapy to optimize patient outcomes. Managing cardiomyopathy related to hyperthyroidism presents unique challenges, as it requires treatment for both hyperthyroidism and heart failure, especially when cardiogenic shock is present with an inadequate response to diuretics. This case highlights the complex interaction between thyroid dysfunction and heart failure, as well as the therapeutic strategies used to manage this condition.
Junctional Bradikardia pada Pasien Hiperkalemia Suwari, Cokorda Istri Padmi; Puradipa, Bayu; Wulandari, Ni Luh Eka Sriayu
Jurnal Kesehatan Andalas Vol. 10 No. 2 (2021): Online July 2021
Publisher : Faculty of Medicine, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jka.v10i2.1772

Abstract

Hyperkalemia is a life-threatening electrolyte abnormality resulting in cardiac arrhythmia. Hyperkalemia may also cause bradycardia with junctional rhythm. However, the prevalence of hyperkalemia accompanying symptomatic bradycardia has only been explored in a few case reports. Thus we present a case of hyperkalemia with uncommon ECG findings. It has been reported that a 76 years old woman with type 2 diabetes mellitus, hyperkalemia and suspected coronary artery disease complaining about palpitation. Electrocardiography (ECG) showed junctional bradycardia with tall T wave and laboratory examination showed mild hyperkalemia (5.8 mmol/L). After one day of observation, severe hypotension was detected. Unexpectedly the cardiac rhythm was returned into the sinus after correction of hyperkalemia using calcium gluconate, insulin, dextrose, and salbutamol. As serum potassium level rises, sinoatrial and atrioventricular conduction was blocked, causing escape rhythm (junctional escape rhythm). In hyperkalemia, cardiotoxicity can be caused by an increase in resting membrane potential, decreased depolarization and duration of depolarization. When detected on ECG, hyperkalemia should be treated urgently and important to identify underlying causes or precipitating factors of hyperkalemia. Sinus node dysfunction is not excluded in this case.  Hyperkalemia can present a bradycardia junctional rhythm. Although the increasing serum potassium levels were low, hyperkalemia may have affected the conduction system leading to the ECG changes.Keywords:  hyperkalemia, junctional bradycardia, symptomatic bradycardia
Co-Authors Ketut Erna Bagiari, Ketut Erna Pratama, I Gede Bagus Gita Puradipa, Bayu Sudarmika, Kadek Adi Suwari, Cokorda Istri Padmi