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Unprovoked transformation of saddle back to coved ST-segment elevation ECG pattern Firdaus, Muhammad; Ardian Rizal
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.2025.006.01.23

Background Brugada syndrome (BrS) is a heritable arrhythmia that is clinically characterized by spontaneous coved ST segment elevation and a negative T wave in the right precordial lead. Some psychotropic medications, anesthetics, cocaine, excessive alcohol consumption, and fever have been identified as potential causes of VF and SCA in BrS. Case Illustration A 35-year-old man was hospitalized after experiencing unexplained syncope. It was felt 3 times within an hour and was preceded by lightheadedness, nausea, and vomiting. He did not experience palpitations, chest pain, or shortness of breath prior to the syncope. Prior to syncope, he had no history of fever, dehydration, drinking, or taking any medications. There was no family member died suddenly because of heart disease. The physical examination, CXR, laboratorium, and echocardiography were all within the normal range, but the electrocardiogram showed a coved ST segment elevation with an inverted T wave at V1-V2, as well as a saddle back ECG pattern two weeks later with a J point of 2 millimeters at V2. The combination of symptoms and ECG findings led to the BrS diagnosis. He underwent ICD implantation at RSUD Dr Saiful Anwar Malang for secondary prevention. After several months of ICD check-ups, there were no VT/VF events or ICD shock therapy. Conclusion A change in the ecg of the brugada pattern from type 2 to 1 is often accompanied by known ethiologies. But an unprovoked conversion of the BrS type is possible in rare cases.

A follow-up approach to manage tachyarrhythmia and bradyarrhythmia in Ebstein’s anomaly patient Setyowati, Danti Utami; Ardian Rizal
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.2025.006.01.17

Background: Ebstein’s Anomaly (EA) is a rare heart defect that can cause a number of problems, including arrhythmias. They exhibit a greater rate of recurrence compared to those with normal hearts. High-definition (HD) mapping and three-dimensional (3D) ablation are new techniques that may be suboptimal, attributed to anatomical characteristics. The management tactics employed may necessitate modification in accordance with personal traits. Case Report: A 37-year-old male presented with intermittent palpitations over years. The electrocardiogram (ECG) is changing overtime such as supraventricular tachycardia (SVT), ventricular tachycardia (VT) and atrial fibrillation (AF). Echocardiography shown typical features of EA. During ablation, multiple atrial tachycardias were induced. Throughout the observation period, the patient exhibited complications related to several arrhythmia recurrence. In the end he suffered from total atrioventricular block (TAVB), leading to the decision to undergo a permanent pacemaker procedure. We postulated that specific characteristics of the right atrioventricular groove structure observed in pathological samples of EA could explain less than ideal results in ablation procedures. Conclusion: Managing arrhythmia in EA could be challenging. A prominent ridge alongside the lower atrioventricular groove is a typical characteristic in EA, and is associated with the clinical background of accessory pathways (AP). Understanding this anatomical aspect is important for electrophysiologists who work with this group of patients, since their management approaches may need to be adjusted.

Unprovoked transformation of saddle back to coved ST-segment elevation ECG pattern Firdaus, Muhammad; Ardian Rizal
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.2025.006.01.23

Background Brugada syndrome (BrS) is a heritable arrhythmia that is clinically characterized by spontaneous coved ST segment elevation and a negative T wave in the right precordial lead. Some psychotropic medications, anesthetics, cocaine, excessive alcohol consumption, and fever have been identified as potential causes of VF and SCA in BrS. Case Illustration A 35-year-old man was hospitalized after experiencing unexplained syncope. It was felt 3 times within an hour and was preceded by lightheadedness, nausea, and vomiting. He did not experience palpitations, chest pain, or shortness of breath prior to the syncope. Prior to syncope, he had no history of fever, dehydration, drinking, or taking any medications. There was no family member died suddenly because of heart disease. The physical examination, CXR, laboratorium, and echocardiography were all within the normal range, but the electrocardiogram showed a coved ST segment elevation with an inverted T wave at V1-V2, as well as a saddle back ECG pattern two weeks later with a J point of 2 millimeters at V2. The combination of symptoms and ECG findings led to the BrS diagnosis. He underwent ICD implantation at RSUD Dr Saiful Anwar Malang for secondary prevention. After several months of ICD check-ups, there were no VT/VF events or ICD shock therapy. Conclusion A change in the ecg of the brugada pattern from type 2 to 1 is often accompanied by known ethiologies. But an unprovoked conversion of the BrS type is possible in rare cases.

A follow-up approach to manage tachyarrhythmia and bradyarrhythmia in Ebstein’s anomaly patient Setyowati, Danti Utami; Ardian Rizal
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.2025.006.01.17

Background: Ebstein’s Anomaly (EA) is a rare heart defect that can cause a number of problems, including arrhythmias. They exhibit a greater rate of recurrence compared to those with normal hearts. High-definition (HD) mapping and three-dimensional (3D) ablation are new techniques that may be suboptimal, attributed to anatomical characteristics. The management tactics employed may necessitate modification in accordance with personal traits. Case Report: A 37-year-old male presented with intermittent palpitations over years. The electrocardiogram (ECG) is changing overtime such as supraventricular tachycardia (SVT), ventricular tachycardia (VT) and atrial fibrillation (AF). Echocardiography shown typical features of EA. During ablation, multiple atrial tachycardias were induced. Throughout the observation period, the patient exhibited complications related to several arrhythmia recurrence. In the end he suffered from total atrioventricular block (TAVB), leading to the decision to undergo a permanent pacemaker procedure. We postulated that specific characteristics of the right atrioventricular groove structure observed in pathological samples of EA could explain less than ideal results in ablation procedures. Conclusion: Managing arrhythmia in EA could be challenging. A prominent ridge alongside the lower atrioventricular groove is a typical characteristic in EA, and is associated with the clinical background of accessory pathways (AP). Understanding this anatomical aspect is important for electrophysiologists who work with this group of patients, since their management approaches may need to be adjusted.

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