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All Journal Medical Journal of Indonesia Indonesian Journal of Cardiology Jurnal Ilmu Kedokteran dan Kesehatan
Muliawan, Hary Sakti
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Biochemistry, Genetics & Molecular Biology Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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Hyperkalemia Mimicking Anteroseptal Myocardial Infarction Nugraha, Raka Aldy; Husen, Auliya; Muliawan, Hary Sakti; Zamroni, Dian
Jurnal Kardiologi Indonesia Vol 44 No 1 (2023): Indonesian Journal of Cardiology: January - March 2023
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1297

Abstract

Background: Hyperkalemia often results in cardiac emergency associated with fatal cardiac arrhythmias. However, the presence of ST segment elevation in hyperkalemia is rare and could potentially subject the patients to unnecessary risk of intervention. Most commonly, ST elevation in hyperkalemia presents in a down-sloping fashion compared to the typical convex or upsloping pattern in myocardial infarction. However, in some cases, the ST elevation morphology can be very identical and difficult to distinguish. Herein, we describe a hyperkalemic patient presenting with non-ischemic ST segment elevation that resolved spontaneously following therapy. Case illustration: A 77-year-old, bed-ridden, inarticulate woman was admitted to emergency department with acute dyspnea perceived for 1.5 hours. The patient’s past clinical history included craniotomy for subdural hematoma, poorly controlled hypertension, hypertensive heart disease, rheumatoid arthritis, and dementia and was under candesartan, amlodipine, nebivolol, spironolactone, and atorvastatin treatment. The 12-lead electrocardiography (ECG) recording showed wide QRS complex with left bundle branch block pattern, slow atrial fibrillation with total atrioventricular block, ST segment elevation and Q wave in anteroseptal leads, and peaked T wave (Figure 1A). The pattern of ST elevation was indistinguishable from that of myocardial infarction which necessitated further laboratory confirmation. Laboratory results showed severe hyperkalemia (K+ 7.93 mmol/L) and normal troponin level (45.0 ng/L). The patient was given serial insulin-based therapy and calcium gluconate immediately. The follow-up ECG pictured normal sinus rhythm with no sign of bundle branch block, resolution of ST segment elevation, and reduction in T wave amplitude (Figure 1B). However, the reduction in potassium level was not significant and the patient also experienced an acute kidney injury. The patient was transferred to intensive care unit and was prepared for hemodialysis. Conclusion: ST segment elevation is a rare feature of hyperkalemia that could mislead the patient’s treatment. Thorough ECG evaluation is the key to narrow down the differential diagnosis. Every deviant feature should not be interpreted separately. Laboratory tests could help confirm the diagnosis, particularly in patients with atypical presentation and could help avoid unnecessary risk of intervention.
Literature Review: Cardiac Complication Of Idiopathic Pulmonary Fibrosis Dharmawan, Ibrahim N.I.P.; Muliawan, Hary Sakti; Nurwidya, Fariz
Jurnal Ilmu Kedokteran dan Kesehatan Vol 11, No 12 (2024): Volume 11 Nomor 12
Publisher : Prodi Kedokteran Fakultas Kedokteran Universitas Malahayati

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.33024/jikk.v11i12.17722

Abstract

Idiopathic pulmonary fibrosis (IPF) is a chronic, fibrosing interstitial pneumonia of unknown cause that is associated with radiological and histologic features of usual interstitial pneumonia (UIP). Idiopathic pulmonary fibrosis occurs primarily in adult and associated with poor prognosis with patients typically survive 2-3 years after diagnosis, although some cases progress much faster than others. Symptoms of IPF include cough and shortness of breath, especially during activity. In severe cases, respiratory failure may occur. IPF is often linked to several health problems, including lung cancer, sleep apnea, heart disease, and digestive issues like acid reflux.  The cardiovascular problem related to IPF are pulmonary hypertension, coronary artery disease, arrythmia, and iatrogenic disease caused by IPF pharmacological treatment. This literature review will explain the link between IPF and its pathogenesis in causing cardiac complications based on available literature.
Role of regulatory T cells and T helper 17 cells in the pathogenesis of hypertension: a review Muliawan, Hary Sakti; Dwi Putra, Swastya; Amin, Hilman Zulkifli; Widyantoro, Bambang
Medical Journal of Indonesia Vol. 33 No. 4 (2024): December
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.13181/mji.rev.247521

Abstract

The discovery of autoantibodies in artery samples from cadavers with hypertension over 50 years ago suggested a potential link between the immune system and hypertension. Since then, research exploring the role of the immune system in hypertension has emerged. Animal studies have demonstrated a strong correlation between regulatory T cells (Tregs) and T helper 17 (Th17) cells in hypertension development, yet studies on human hypertension remain limited. Tregs produce inhibitory cytokines such as interleukin (IL)-10 and transforming growth factor-β to act as anti-inflammatory cells that protect against hypertension. In contrast, Th17 cells, by producing IL-17A, function as pro-inflammatory cells that promote hypertension. Recently, a subset of cells known as IL-17A+FOXP3+Treg cells have been identified, which can produce IL-17 and act as inflammatory cells under certain conditions. Understanding the basic mechanisms by which the immune system influences hypertension could lead to targeted immunotherapies for hypertension in the future. Thus, we highlighted the role of Tregs and Th17 cells in the development of hypertension and their potential as targets for therapy. Our findings confirmed the role of Tregs and Th17 cells in the pathogenesis of hypertension.
Co-Authors Auliya Husen, Auliya Bambang Widyantoro Dharmawan, Ibrahim N.I.P. Dwi Putra, Swastya Fariz, Nurwidya Hilman Zulkifli Amin, Hilman Zulkifli Nugraha, Raka Aldy Zamroni, Dian