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Recurrent Orthodromic SVT AVRT with Multiple Accessory Pathway in WPW syndrome: Ablate All or Not? Aziz, Indra Jabbar; Rizal, Ardian
Heart Science Journal Vol. 5 No. 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.16

Background: Patients diagnosed with Wolff-Parkinson-White syndrome (WPW) have a relatively low, nevertheless persistent risk of unexpected mortality. However, this risk can be effectively mitigated by applying radiofrequency catheter ablation targeting the accessory pathway. It is difficult to accurately study predictors because only a minority of patients develop potentially malignant arrhythmias (MA) or passed away, despite essential risk variables being relatively well-known.1 This study aimed to describe ablation in WPW syndrome.Case presentation: A 16-year-old male presents with symptoms characterized by palpitations during intense physical exertion, followed by chest pain episodes. The physical examination, CXR, laboratorium, and echocardiography were all within the normal range; his ECG showed shortened PR interval and a delta wave with a positive delta wave at V1 and mostly positive at the inferior lead. He also has recorded ECG when the patient has a tachycardia event with SVT AVRT orthodromic pattern. He underwent EP Study and had several accessory pathways at the posteroseptal mitral annulus and anteroseptal tricuspid. The decision was made to perform ablation on the posteroseptal accessory pathway located at the mitral annulus. An electrophysiology (EP) investigation was conducted at the anteroseptal tricuspid annulus, which did not induce tachyarrhythmia.Conclusion: Wolff-Parkinson-White syndrome is a congenital cardiac pathway formation, with not all accessory pathways causing tachyarrhythmias. Ablation therapy is necessary for patients with multiple pathways, with pathways with an ERP less than 250 being the only option.

Pengaruh Latihan Fisik terhadap Kadar Marker Inflamasi pada Pasien Hipertensi Pulmonal Aziz, Indra Jabbar; Martini, Heny
Jurnal Klinik dan Riset Kesehatan Vol 4 No 1 (2024): Edisi Oktober
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.1.7

Pulmonary hypertension (PH) is characterized by pulmonary vascular dysfunction, which can lead to right heart failure and death, as well as the accumulation of inflammatory cells in the perivascular area. Chronic inflammation plays an important role in the pathophysiology of pulmonary hypertension. Inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) are often elevated in patients with pulmonary hypertension. The accumulation of inflammatory cells accelerates the remodeling process of pulmonary blood vessels and pulmonary hypertension. Despite the current therapeutic approaches for pulmonary hypertension (PH), which aim to improve functional capacity and hemodynamics, pulmonary hypertension remains incurable but remains controllable. Inflammatory processes play a critical role in progressive pulmonary hypertension. Physical exercise can reduce the risk of chronic disease, and recent research has shown that it improves inflammatory marker profiles. This literature review aims to combine evidence on the influence of physical exercise on levels of inflammatory markers in patients with pulmonary hypertension.

Proper management of pulmonary hypertension crisis Aziz, Indra Jabbar; Martini, Heny
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.2025.006.01.4

A pulmonary hypertensive crisis is characterized by a sudden increase in the pressure in the pulmonary arteries, leading to an excessive workload on the right ventricle of the heart and a decrease in cardiac output. Typically, individuals with pulmonary hypertension (PH) have a greater mortality rate after surgical procedures, which can range from 4% to 24%. Early recognition of pulmonary hypertensive crisis is crucial. There are a limited number of comprehensive guidelines or review articles that focus on the evaluation and treatment of pulmonary hypertension crises. Hypoxia in pulmonary hypertension crisis leads to a vicious cycle of decreased cardiac output, elevated pulmonary vascular resistance, right ventricular enlargement, restricted left ventricular filling, reduced blood pumping, systemic hypotension, and metabolic and respiratory acidosis. It is crucial to monitor clinical parameters, including systemic hypotension, hypoxia, tachycardia, reduced urine output, and complete absence of urine production. The main characteristics of a pulmonary hypertension crisis are increasing pulmonary and right atrial pressures along with a decrease in cardiac output. Echocardiography can be a useful additional tool that shows the deterioration of the right ventricular (RV) function and enlargement. Confirmation of a pulmonary hypertensive crisis is achieved with the use of invasive hemodynamics. Our current review aims to discuss the proper management of Pulmonary Hypertension Crisis.

When to consider takotsubo cardiomyopathy in menopausal elderly woman presenting chest pain Aziz, Indra Jabbar; Rohman, Mohammad Saifur
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.2025.006.01.21

Background: An elderly menopausal woman presenting with chest pain in the emergency department may have coronary artery disease (CAD), Takotsubo cardiomyopathy, or other conditions. It is crucial to conduct a thorough diagnostic evaluation in menopausal elderly woman. Case illustration: A 77-year-old postmenopausal woman presenting with first-onset chest pain after having familial issues and severe psychological stress was admitted to the emergency department. She had no identifiable risk factors for CAD, and her physical examination revealed no significant abnormalities. The electrocardiogram (ECG) indicated non-specific ST-segment elevation in leads V3-V6. Serial ECGs showed an evolution of ST-segment elevation that did not align with the typical pattern observed in STEMI. Despite the elevation in cardiac enzymes in the previous hospital, unfortunately, serial cardiac enzymes were inconsistently normal in our hospital. Therefore, these findings implied that the patient's condition might not be ACS, and we cannot rule out the possibility of Takotsubo syndrome. The patient underwent coronary angiography (DCA) and The DCA results revealed normal coronary with suspicion of apical ballooning of the left ventricle as observed from cine angiography. Subsequent echocardiography demonstrated apical akinesis with basal hyperkinesis, the large area of dysfunctional myocardium extending beyond the territory of a single coronary artery and characteristic apical ballooning resembling an octopus trap, consistent with the diagnosis of Takotsubo syndrome. The patient was managed conservatively with supportive care. Her symptoms improved, and she was discharged after five days. Conclusion: This case highlights the importance of considering takotsubo cardiomyopathy in menopausal elderly woman with no risk factor of CAD presenting with chest pain after having psychological stress.

Effects of exercise training on C-reactive protein (CRP) levels and 6-minute walk distance: A preliminary study Aziz, Indra Jabbar; Martini, Heny; Anna Fuji Rahimah; Valerinna Yogibuana; Cholid Tri Tjahjono
Heart Science Journal Vol. 6 No. 4 (2025): The Pursuit of Precision: Navigating Risks, Refining Diagnosis, and Securing Lo
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.04.11

Background Mortality rates increase among those with intermediate to high-risk pulmonary arterial hypertension, demonstrating the importance of improved diagnostic methods, treatment algorithms, and the development of new approaches to therapy for severely ill patients. Inflammation contributes to pulmonary hypertension progression, and exercise has been shown to suppress this process. Objective This study evaluated the relationship and differences between CRP levels and functional capacity after a 12-week exercise training program. Methods A clinical prospective cohort preliminary study was conducted with 26 consecutive patients who had already received pulmonary hypertension treatment and were enrolled in the LET-SHINE registry. Patients were divided into two groups: one control group (PH therapy only) and one treatment group (receiving adjuvant physical exercise). The study was conducted for 12 weeks, 6MWT and CRP tests were performed both before and after the study. Result This study found that the majority of cases were ASD, consistent with the fact that ASD is the most common congenital heart defect. The analysis of C-reactive protein levels showed non-significant changes in both groups after 12 weeks. The treatment group exhibited a modest reduction from 0.8 ± 2.4 mg/dl to 0.5 ± 1.0 mg/dl (p=0.514), while the control group maintained stable levels, ranging from 0.7 ± 1.0 mg/dl to 0.7 ± 0.8 mg/dl (p=0.166). An intergroup comparison revealed a non-significant greater mean decrease in the treatment group (-0.3 ± 1.5 mg/dl vs -0.1 ± 0.2 mg/dl, p=0.514). There was no significant correlation between the reduction in CRP levels and improvements in 6MWT distance in either the treatment group (correlation coefficient: -0.367, p=0.240) or the control group (correlation coefficient: 0.021, p=0.948). Conclusion This study showed that exercise training had no statistically significant impact on C-reactive protein levels, indicating a limited effect on systemic inflammation. No significant correlation was found between decreases in CRP levels and improvements in 6MWT distance in either the treatment or control groups.

Pengaruh Latihan Fisik terhadap Kadar Marker Inflamasi pada Pasien Hipertensi Pulmonal Aziz, Indra Jabbar; Martini, Heny
Jurnal Klinik dan Riset Kesehatan Vol 4 No 1 (2024): Edisi Oktober
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.1.7

Pulmonary hypertension (PH) is characterized by pulmonary vascular dysfunction, which can lead to right heart failure and death, as well as the accumulation of inflammatory cells in the perivascular area. Chronic inflammation plays an important role in the pathophysiology of pulmonary hypertension. Inflammatory markers such as C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) are often elevated in patients with pulmonary hypertension. The accumulation of inflammatory cells accelerates the remodeling process of pulmonary blood vessels and pulmonary hypertension. Despite the current therapeutic approaches for pulmonary hypertension (PH), which aim to improve functional capacity and hemodynamics, pulmonary hypertension remains incurable but remains controllable. Inflammatory processes play a critical role in progressive pulmonary hypertension. Physical exercise can reduce the risk of chronic disease, and recent research has shown that it improves inflammatory marker profiles. This literature review aims to combine evidence on the influence of physical exercise on levels of inflammatory markers in patients with pulmonary hypertension.

Proper management of pulmonary hypertension crisis Aziz, Indra Jabbar; Martini, Heny
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.2025.006.01.4

A pulmonary hypertensive crisis is characterized by a sudden increase in the pressure in the pulmonary arteries, leading to an excessive workload on the right ventricle of the heart and a decrease in cardiac output. Typically, individuals with pulmonary hypertension (PH) have a greater mortality rate after surgical procedures, which can range from 4% to 24%. Early recognition of pulmonary hypertensive crisis is crucial. There are a limited number of comprehensive guidelines or review articles that focus on the evaluation and treatment of pulmonary hypertension crises. Hypoxia in pulmonary hypertension crisis leads to a vicious cycle of decreased cardiac output, elevated pulmonary vascular resistance, right ventricular enlargement, restricted left ventricular filling, reduced blood pumping, systemic hypotension, and metabolic and respiratory acidosis. It is crucial to monitor clinical parameters, including systemic hypotension, hypoxia, tachycardia, reduced urine output, and complete absence of urine production. The main characteristics of a pulmonary hypertension crisis are increasing pulmonary and right atrial pressures along with a decrease in cardiac output. Echocardiography can be a useful additional tool that shows the deterioration of the right ventricular (RV) function and enlargement. Confirmation of a pulmonary hypertensive crisis is achieved with the use of invasive hemodynamics. Our current review aims to discuss the proper management of Pulmonary Hypertension Crisis.

When to consider takotsubo cardiomyopathy in menopausal elderly woman presenting chest pain Aziz, Indra Jabbar; Rohman, Mohammad Saifur
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.2025.006.01.21

Background: An elderly menopausal woman presenting with chest pain in the emergency department may have coronary artery disease (CAD), Takotsubo cardiomyopathy, or other conditions. It is crucial to conduct a thorough diagnostic evaluation in menopausal elderly woman. Case illustration: A 77-year-old postmenopausal woman presenting with first-onset chest pain after having familial issues and severe psychological stress was admitted to the emergency department. She had no identifiable risk factors for CAD, and her physical examination revealed no significant abnormalities. The electrocardiogram (ECG) indicated non-specific ST-segment elevation in leads V3-V6. Serial ECGs showed an evolution of ST-segment elevation that did not align with the typical pattern observed in STEMI. Despite the elevation in cardiac enzymes in the previous hospital, unfortunately, serial cardiac enzymes were inconsistently normal in our hospital. Therefore, these findings implied that the patient's condition might not be ACS, and we cannot rule out the possibility of Takotsubo syndrome. The patient underwent coronary angiography (DCA) and The DCA results revealed normal coronary with suspicion of apical ballooning of the left ventricle as observed from cine angiography. Subsequent echocardiography demonstrated apical akinesis with basal hyperkinesis, the large area of dysfunctional myocardium extending beyond the territory of a single coronary artery and characteristic apical ballooning resembling an octopus trap, consistent with the diagnosis of Takotsubo syndrome. The patient was managed conservatively with supportive care. Her symptoms improved, and she was discharged after five days. Conclusion: This case highlights the importance of considering takotsubo cardiomyopathy in menopausal elderly woman with no risk factor of CAD presenting with chest pain after having psychological stress.

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