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Yudha, Ardi
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Dentistry Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health

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Acute Inferior ST-elevation Myocardial Infarction Arising from Wrap-Around Left Anterior Descending Artery Occlusion Nugraha, Daniel; Pesireron, David Jonathan; Dhani, Muhamad Sofan; Yudha, Ardi; Safir, Safir
Medica Hospitalia : Journal of Clinical Medicine Vol. 11 No. 2 (2024): Med Hosp
Publisher : RSUP Dr. Kariadi

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36408/mhjcm.v11i2.1114

Abstract

BACKGROUND: Acute myocardial infarction (AMI) remains a leading cause to global morbidity and mortality. Inferior MI predominantly stems from the right coronary artery (RCA) in more than 80% of instances, the left circumflex coronary artery (LCx) in fewer than 20% of cases, and infrequently from the left anterior descending artery (LAD) AIMS: This case report aims to highlight a rare occurrence of LAD occlusion initially manifested as inferior MI. CASE: A 56-year-old male presented with typical chest pain lasting for 6 hours. Vital signs were within normal range. Initial electrocardiogram (ECG) revealed ST-segment elevation in inferior leads (II, III, aVF). Laboratory tests indicated elevated troponin levels (>25ng/mL). Coronary angiography identified the culprit lesion as the LAD, which wrapped around the apex. DISCUSSION: While ECG alterations are valuable in identifying thrombosed vessels during AMI, the presence of simultaneous ST elevation in both inferior and anterior leads can hinder clinicians' ability to determine the specific artery affected by the infarction. Our case, depicting a scenario where both the right and left coronary arteries are co-dominant, showed complete occlusion at the mid-distal wrap-around LAD, resulting in ST-elevation observed in both inferior and anterior leads. CONCLUSION: The existence of inferior ST-segment elevation alongside alterations in anterior leads could imply occlusion of the wrapped LAD.
Successful ablation of double accessory pathways: a rare case of coexistence between right inferoseptal WPW and left lateral AVRT Yudha, Ardi; Ardhianto, Pipin
Heart Science Journal Vol. 5 No. 4 (2024): The Current Perspective About Cardiometabolic Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2024.005.04.18

Abstract

BACKGROUND: Managing double accessory pathways (APs) in the clinical setting presents significant challenges, primarily due to the rarity of this condition and the complexities involved in both diagnosis and treatment.CASE PRESENTATION: A 51-year-old male presented with recurrent episodes of palpitation. Electrocardiography (ECG) revealed sinus rhythm with a pre-excitation pattern characterized by a delta wave morphology showing a negative deflection in V1, a transitional zone in V2, and negativity in lead III and aVF, indicating an accessory pathway through the right infero-septal pathway. Further evaluation with electrophysiological study (EPS) confirmed the presence of accessory pathways, with the right infero-septal pathway exhibiting pre-excitation during sinus rhythm. Radiofrequency ablation (RFA) successfully eliminated the right infero-septal accessory pathway. Subsequently, coronary sinus propagation shifted from a concentric to an eccentric pattern, indicating another accessory pathway from the left lateral region. Another mapping was performed retrogradely at the mitral annulus, revealing ventriculoatrial (VA) fusion at the left lateral area and demonstrating inducible atrioventricular reentrant tachycardia (AVRT). RFA successfully eliminated the left lateral accessory pathway, with the final result showing retrograde block.CONCLUSION: This case highlights the importance of thorough diagnostics and tailored treatment strategies in managing dual APs, emphasizing the effectiveness of EPS-guided RFA for complex arrhythmias.
Co-Authors Dhani, Muhamad Sofan Nugraha, Daniel Pesireron, David Jonathan Pipin Ardhianto, Pipin Safir, Safir