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Cokorda Istri Padmi Suwari
Warmadewa University
Health Professions

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Junctional Bradikardia pada Pasien Hiperkalemia Cokorda Istri Padmi Suwari; Bayu Puradipa; Ni Luh Eka Sriayu Wulandari
Jurnal Kesehatan Andalas Vol 10, No 2 (2021): Online July 2021
Publisher : Fakultas Kedokteran, 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
Mitral Stenosis Berat pada Penyakit Jantung Rematik Cokorda Istri Padmi Suwari; Widyawati Desak Gede
Jurnal Kesehatan Andalas Vol 12, No 2 (2023): Online July 2023
Publisher : Fakultas Kedokteran, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jka.v12i2.2245

Abstract

Rheumatic Heart Disease (RHD) has high morbidity and mortality. Cardiac valve disorders after rheumatic fever are the leading cause of heart failure in children and young adults. A comprehensive understanding of RHD can help early diagnosis and provide optimal management in the future. It has been reported that a 55-year-old man came to the heart clinic of Bhayangkara Hospital Denpasar for routine control of heart disease. The patient has been diagnosed with rheumatic heart disease since 2018. The patient complains of shortness of breath when walking long distances and doing strenuous activities. The patient was diagnosed with CHF FC II ec RHD + MS moderate-severe (Wilkins score 8) + AF NVR (CHA2DS2VASc 3) and treated with heart failure and antiplatelet medication. Mitral stenosis due to RHD produces the typical pathological features seen in Transthoracic echocardiography (TTE), including fibrous thickening and calcification of the valve leaflets, fusion of the commissures, and thickening and shortening of chordae tendineae. Chronic stress overload on the LA due to MS can cause LA dilatation and trigger AF. RHD patients with AF are recommended for anticoagulation for stroke prevention. Patients with acute rheumatic fever clinical features should be evaluated further and given long-term therapy to prevent more severe heart problems.Keywords:  atrial fibrillation, mitral stenosis, rheumatic  heart  disease
Co-Authors Bayu Puradipa Ni Luh Eka Sriayu Wulandari Widyawati Desak Gede