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All Journal Heart Science Journal CRJIM (Clinical and Research Journal in Internal Medicine) Deka in Medicine
Afifuddin, Mokhammad
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Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Medicine & Pharmacology Nursing Public Health Other

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Compartment syndrome as reperfusion injury following thrombectomy in acute limb ischemia: A case report Afifuddin, Mokhammad; Kurnianingsih, Novi; Kurniawan, Dea
Deka in Medicine Vol. 1 No. 2 (2024): August 2024
Publisher : PT. DEKA RESEARCH INSTITUTE

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69863/dim.2024.e209

Abstract

BACKGROUND: Compartment syndrome following reperfusion in acute limb ischemia represents a rare but serious complication. Thus, documenting such cases is essential to enhance comprehension and management of this condition. CASE PRESENTATION: A 51-year-old man was referred from an urban hospital presenting with severe right leg pain persisting for 5 days prior to admission, accompanied by pulselessness, paresthesia, poikilothermia, and paralysis. The patient had underlying risk factors including uncontrolled diabetes mellitus and active smoking. Duplex ultrasound confirmed the diagnosis of acute limb ischemia, which was further supported by CT angiography revealing total occlusion from the right common iliac artery to the distal region. Intravenous heparin was administered, and the patient underwent emergency surgical thrombectomy. Following the intervention, the patient developed clinical signs of compartment syndrome as a manifestation of reperfusion injury, necessitating fasciotomy. Subsequent evaluation of the wound post-fasciotomy indicated it was not suitable for closure, and unfortunately, the patient passed away a few days later. CONCLUSION: This case illustrates acute limb ischemia necessitating thrombectomy and surgical fasciotomy due to compartment syndrome resulting from reperfusion injury, emphasizing the importance of rigorous monitoring.
Optimizing Cardiac Rehabilitation for Patients with Complex Coronary Disease without Revascularization Afifuddin, Mokhammad; Tjahjono, Cholid Tri; Mayangsari, Veny
Clinical and Research Journal in Internal Medicine Vol. 6 No. 2 (2025): Volume 6 No 2, November 2025
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.crjim.2025.006.02.10

Abstract

Patients with complex coronary artery disease (CAD) ineligible for revascularization present considerable management challenges and a high ischemic burden. Cardiac rehabilitation (CR), a comprehensive, multidisciplinary intervention, emerges as an essential non-pharmacological therapy. This review synthesizes the principles of CR, focusing on its profound pathophysiological benefits in this specific cohort. Mechanistically, CR confers pleiotropic effects: it enhances endothelial function via the eNOS/NO pathway, mitigates systemic inflammation through myokine regulation, promotes coronary collateralization (HIF-1α/VEGF pathway), and restores autonomic balance (HRV). Furthermore, CR integrates essential psychosocial support to address the high prevalence of depression and anxiety, which are independent risk factors. A primary objective, the improvement of quality of life (QoL), is consistently achieved through reduced anginal symptoms and enhanced functional status. Despite robust clinical and economic evidence demonstrating CR's efficacy in reducing MACE, mortality, and healthcare utilization, significant barriers to referral and adherence persist. Vigilant supervision and protocol adaptations are mandated for high-risk anatomical subsets, such as those with chronic total occlusions or severe left ventricular dysfunction
Tailoring risks and benefits of invasive strategy in patient with non ST elevation myocardial infarction coexist anemia gravis due to active gastrointestinal bleeding Afifuddin, Mokhammad; Mohammad Saifur Rohman
Heart Science Journal Vol. 7 No. 2 (2026): The Evolving Landscape of Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.02.15

Abstract

Background: Myocardial infarction needs revascularization and antiplatelet agents. Nonetheless, the use of antiplatelet agents exacerbates hemorrhagic manifestations in individuals with pre-existing gastrointestinal bleeding.  This case involves a patient who suffered from both a myocardial infarction and gastrointestinal hemorrhage. Case Illustration: An 84-year-old man had escalating chest pain for 10 days before to admission, with a history of heart failure for the last 3 years. He also had melena caused by over-the-counter analgesics. The ECG in the emergency department indicated ST elevation in aVR and ST depression in leads I, II, III, aVL, and V4-V6, accompanied with hs-Troponin I levels of 1945 ng/L and hemoglobin at 5 g/dL. He was assessed as high-risk Non ST Eleveation Myocardial Infarction (NSTEMI), with a Grace score of 210, while experiencing severe anemia owing to ongoing gastrointestinal bleeding. The patient received a PRC transfusion, a proton pump inhibitor, and sucralfate syrup. Angiography revealed critical stenosis with thrombus in diagonal one of the left anterior descending artery and significant calcified stenosis in the distal left circumflex artery. Consequently, one drug-eluting stent was inserted in the osteal-distal left anterior descending artery.  The clinical symptom subsequently improved. Aspirin and Clopidogrel were provided post-stent implantation with sequential blood assessments. An endoscopy was also conducted to assess  bleeding source. Conclusion: A patient with NSTEMI and severe anemia owing to active gastrointestinal bleeding had an invasive approach, during which a drug-eluting stent was placed. Administration of dual antiplatelet therapy must be carefully managed.
Co-Authors Cholid Tri Tjahjono Kurnianingsih, Novi Kurniawan, Dea Mayangsari, Veny Mohammad Saifur Rohman