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All Journal International Journal of Integrated Health Sciences
Triwedya Indra Dewi
Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Padjajaran/Dr. Hasan Sadikin General Hospital Bandung
Health Professions

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Culprit-Only Versus Complete Revascularization in STEMI Multi-Vessel Disease: A Case Report Mega Amanda Putri; Achmad Fauzi Yahya; Triwedya Indra Dewi
International Journal of Integrated Health Sciences Vol 9, No 2 (2021)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v9n2.2249

Abstract

Objective: To revisit data and highlight management of STEMI multi-vessel disease and explore culprit-only versus multi-vessel PCI and optimal timing to achieve complete revascularization.Methods: A 67 years old male with chest pain at rest 2 hours before admission with a history of smoking one pack of cigarette every day, was presented to the hospital. Physical examination was within normal limit with normal hemodynamically; however, elevated cardiac troponin was identified. Electrocardiogram showed STEMI anteroseptal wall with ischemic inferior wall, leading toSTEMI anteroseptal wall, Killip I diagnosis. Primary PCI was performed and multi-vessel disease was found. A complete revascularization single-staged procedure was performed due to his persistent chest pain. PCI of these coronary stenoses is beneficial to reduce risk of cardiac death and recurrent infarction. However, some issues related to PCI of non-culprit coronary arteries lesion and optimal timing to do complete revascularization is still a dilemma. Results: Related to data from some trials, e.g PRAMI, CvLPRIT, DANAM-3-PRIMULTI, COMPARE-ACUTE, COMPLETE, and some meta-analyses, showed benefit and safety of routine PCI of non-culprit lesions as a preventive strategy to reduce morbidity and mortality. Data showed reduce future morbidity and mortality in this setting. Meanwhile, the optimal timing of complete revascularization is still a matter of debate, although some data showed benefit of index procedural PCI.Conclusion: PCI of non-culprit lesions of myocardial infarction is consistently beneficial over culprit-only revascularization in patients with STEMI multi-vessel disease, despite the debate on the optimum timing for complete revascularization in this setting.
Congenital Complete Heart Block in Young Women Triwedya Indra Dewi; Giky Karwiky; Rekha Nova Iyos; Mega Febrianora
International Journal of Integrated Health Sciences Vol 9, No 1 (2021)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v9n1.2158

Abstract

Objectives: To present a rare case of Congenital Complete Heart Block (CCHB) in the setting of post-cesarean delivery of an asymptomatic young patient.Methods: A 30-year-old female patient complained of sudden weakness after C-section delivery with spinal anesthesia. She presented a slow heart rate and Complete Heart Block (CHB) on electrocardiogram (ECG). After one week of observation, the ECG still presented a CHB condition. A permanent pacemaker (PPM) with DDDR mode was then installed for this patient.Result: The etiology of CHB, especially at a young age, is unclear, hence challenging. A patient with a CCHB is difficult to diagnose, especially without any previously related symptoms. This abnormality is usually detected during routine screening not related to cardiovascular disease. The patient in this case study presented an ECG of persistent CHB from the time this patient was admitted until one week after observation. The echocardiography showed normal results. Other modalities to confirm diagnosis and evaluate the prognosis of a CCHB should be done.Conclusion: Establishing the etiology of CHB in young patients is challenging. The implantation of PPM is needed because the condition is permanent, regardless the etiology. However, implanting a permanent pacemaker is not always an easy decision, especially in young patients. 
Co-Authors Achmad Fauzi Yahya Giky Karwiky Mega Amanda Putri Mega Febrianora Rekha Nova Iyos