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The Complexity of Premature Coronary Artery Disease Noverike, Nikhen; Rahimah, Anna Fuji; Rohman, Mohammad Saifur
Heart Science Journal Vol. 5 No. 3 (2024): The Science and Art of Revascularization in Acute Coronary Syndrome
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.03.2

Premature Coronary Artery Disease presents a significant health concern globally, characterized by the onset of coronary atherosclerosis at an early age, typically before the age of 55 in men and 65 in women. This review provides a comprehensive examination of the various aspects of premature CAD, ranging from its underlying pathophysiology to diagnostic modalities such as coronary angiography. Beginning with an overview of the risk factors contributing to premature CAD, including genetic predispositions, lifestyle factors, and metabolic disorders, the review delves into the intricate mechanisms involved in the initiation and progression of atherosclerosis. Furthermore, the review discusses the clinical manifestations and challenges associated with diagnosing premature CAD, particularly in asymptomatic individuals. It examines the utility of non-invasive imaging techniques, stress testing in identifying coronary artery stenosis, cardiovascular risk and the principles of coronary angiography. The review outlines the principles of coronary angiography, including patient preparation, procedural techniques, and interpretation of angiographic findings. In conclusion, this comprehensive review provides insights into the multifaceted nature of premature CAD, elucidating its pathogenesis, clinical presentation, and diagnostic evaluation, with a focus on the pivotal role of coronary angiography in guiding therapeutic interventions and optimizing patient outcomes.

Successful Management in Unprovoked Upper Extremity Deep Vein Thrombosis: Case Report Noverike, Nikhen; Kurnianingsih, Novi; Rizal, Ardian; Rahimah, Anna Fuji
Heart Science Journal Vol. 5 No. 3 (2024): The Science and Art of Revascularization in Acute Coronary Syndrome
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.03.14

BackgroundOne to four percent of all cases of deep vein thrombosis (DVT) occur in the upper extremities. Effective thrombolysis for upper extremity deep vein thrombosis (UEDVT) can be achieved with a combination of vascular interventions such as angioplasty, which is continued with catheter-directed thrombolysis (CDT) and anticoagulant therapy.Case IllustrationWe presented the case of a 40-year-old man who developed sudden pain and swelling in his right upper extremity. The thrombus was located in the right subclavian vein, confirmed by duplex ultrasonography. Laboratory results were normal. The patient was diagnosed with unprovoked UEDVT. He underwent venography, which showed an acute-on-chronic lesion at the right subclavian vein. We decided to use double access, tried to inflate the balloon to fragment the thrombus, several times of thrombo-suction, and then continued with Catheter-directed thrombolysis (CDT) using Alteplase. The patient continued oral anticoagulant therapy with Rivaroxaban. After 6 months of follow-up, there wasnâ€™t any complaint. Evaluation of Duplex ultrasonography showed normal results without any recurrent thrombusConclusionThis case revealed how to treat acute-on-chronic lesions of unprovoked UEDVT with a comprehensive management method not only with balloon fragmentation and CDT but also anticoagulant therapy and showed a good outcome and no signs of bleeding complication.

Impact of clinical features on in-hospital outcomes in premature coronary artery disease patients post percutaneous coronary intervention Noverike, Nikhen; Rohman, Mohammad Saifur; Rahimah, Anna Fuji; Rizal, Ardian; Prasetya, Indra
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.2024.005.04.11

Background: Premature coronary artery disease (PCAD) is a significant health concern globally, characterized by the onset of coronary atherosclerosis at an early age. The development of PCAD is influenced by a variety of risk factors and leading to substantial morbidity and mortality. Despite advancements in interventions, the clinical and angiographic characteristics influencing in-hospital outcomes for these patients remain underexplored.Objective: This study aims to investigate the relationship between clinical features and in-hospital outcomes in patients with premature CAD post-percutaneous coronary intervention (PCI) at Dr. Saiful Anwar Hospital.Method: A retrospective cohort study was conducted on 1279 patients who underwent PCI for premature CAD from January 2022 to December 2023. Clinical data, including risk factors and angiographic findings, were collected from medical records. Statistical analyses were conducted using SPSS 22, employing univariate, bivariate, and multivariate logistic regression analyses to determine correlations.Result: The study included 1279 patients, with 438 in the premature CAD group and 841 in the non-premature CAD group. Significant differences were observed in age, sex distribution, BMI, lipid profiles, smoking status, and family history between the groups. Premature CAD patients were younger (mean age 50 vs. 64.8, p<0.001) and had higher rates of smoking and dyslipidemia. Angiographic analysis showed significant differences in LAD and LCx involvement and occlusion rates. In-hospital outcomes indicated higher incidences of shock, cardiac complications, and in-hospital mortality in the non-premature CAD group.Conclusion: Clinical and angiographic characteristics significantly influence in-hospital outcomes for premature CAD patients. Younger age, smoking, and dyslipidemia were prevalent risk factors. Enhanced management strategies focusing on these factors could improve patient outcomes.Keywords: Premature coronary artery disease, percutaneous coronary intervention, clinical characteristics, angiographic findings, in-hospital outcomes.Â

Troubleshooting for Kinked Coronary Catheter: How to Manage? ; A Case Series Noverike, Nikhen; Satrijo, Budi; Widito, Sasmojo; Kurnianingsih, Novi; Abusari, Muchamad
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.7

Background: Catheter entrapment and knotting are two problems that might arise during coronary angiography, regardless of the method used. It is not uncommon for the catheter shaft to become kinked during diagnostic or interventional procedures. Still, if the manipulation fails, an invasive retrieval method is usually necessary for cases with extensive catheter kinking.Case Illustration: We present two cases illustrating how different angiography approaches could lead to severe catheter kinking. Because of the significant tortuosity of the vasculature, even a gentle opposite rotation maneuver and the antegrade advancement of multiple guidewires failed to untwist the guide catheter. Once a twisted catheter has been identified via fluoroscopy, the twist can be eased by gently twisting the catheter in the opposite direction. It is not always easy. It could lead to using other interventional techniques such as snare, balloon, or surgical procedures. In our cases, we used a snare to snag the catheter's tip and untied the loop's knot. This prevented the need for unscheduled surgical intervention. We evaluated from angiography. There were no further complications. The patients were released from the hospital the following day.Conclusion: Although a kinked catheter could become entrapped, various approaches can be taken to deal with this difficulty and prevent the need for surgical intervention.

Valvular aspects from echocardiography in rheumatic heart disease Noverike, Nikhen; Anna Fuji Rahimah; Yogibuana, Valerinna; Karolina, Wella
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.5

Rheumatic Heart Disease is a result of an autoimmune response to group A streptococcal infection and is globally impacted and prevalent in low- and middle-income countries, especially among children and young adults. It primarily affects the heart valves, leading to damage and dysfunction. The progression of RHD can vary, with some individuals experiencing mild symptoms while others may develop severe valve damage leading to heart failure. Echocardiography plays a crucial role in the diagnosis and monitoring of RHD, as it allows to visualize and assess the structural and functional abnormalities of the heart valves. Early detection through echocardiography screening is essential for timely intervention and management of RHD. It provides valuable information about the severity of valve damage and helps determine the most appropriate treatment approach, whether it involves medication or surgical intervention. The ability of echocardiography to provide information about volumes, flows, and pressures, and to acquire quantitative hemodynamic data, highlights its importance in the assessment of patients with RHD. In conclusion, echocardiography has revolutionized the way we diagnose, monitor, and manage rheumatic heart disease, and its importance in the medical field cannot be overstated. The continued integration of echocardiography into clinical practice will undoubtedly lead to improved outcomes for patients with RHD.

Troubleshooting for Kinked Coronary Catheter: How to Manage? ; A Case Series Noverike, Nikhen; Satrijo, Budi; Widito, Sasmojo; Kurnianingsih, Novi; Abusari, Muchamad
Heart Science Journal Vol. 4 No. 3 (2023): The Essensial Role of the Metabolic Syndrome in the Development of Cardiovascul
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2023.004.03.7

Background: Catheter entrapment and knotting are two problems that might arise during coronary angiography, regardless of the method used. It is not uncommon for the catheter shaft to become kinked during diagnostic or interventional procedures. Still, if the manipulation fails, an invasive retrieval method is usually necessary for cases with extensive catheter kinking.Case Illustration: We present two cases illustrating how different angiography approaches could lead to severe catheter kinking. Because of the significant tortuosity of the vasculature, even a gentle opposite rotation maneuver and the antegrade advancement of multiple guidewires failed to untwist the guide catheter. Once a twisted catheter has been identified via fluoroscopy, the twist can be eased by gently twisting the catheter in the opposite direction. It is not always easy. It could lead to using other interventional techniques such as snare, balloon, or surgical procedures. In our cases, we used a snare to snag the catheter's tip and untied the loop's knot. This prevented the need for unscheduled surgical intervention. We evaluated from angiography. There were no further complications. The patients were released from the hospital the following day.Conclusion: Although a kinked catheter could become entrapped, various approaches can be taken to deal with this difficulty and prevent the need for surgical intervention.

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