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All Journal Nusantara Medical Science Journal Indonesian Journal of Cardiology Tarumanagara Medical Journal
Afandy, Jonathan Edbert
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Biochemistry, Genetics & Molecular Biology Health Professions Materials Science & Nanotechnology Medicine & Pharmacology Neuroscience Public Health

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Case report: Unexpected presentation of Wellens’ syndrome in Public Health Centers Afandy, Jonathan Edbert; Taslim; Putra, Swastya Dwi
Tarumanagara Medical Journal Vol. 6 No. 2 (2024): TARUMANAGARA MEDICAL JOURNAL
Publisher : Fakultas Kedokteran Universitas Tarumanagara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.24912/tmj.v6i2.30337

Abstract

Electrocardiography (ECG) is an essential tool for diagnosing and risk-stratifying acute coronary syndrome patients. Only 20% of acute ischemia ECG changes are recognized by emergency medical service (EMS) providers. Wellens’ syndrome is an ECG characteristic, as certain ST-T segment abnormalities in the setting of impending myocardial infarction (MI) patients suggestively caused by critical stenosis in the proximal left anterior descending (LAD) artery. Myocardial infarction from a culprit lesion in the LAD artery is related to worse clinical outcomes. The first patient was a 27-year-old man smoker who presented with epigastric pain accompanied by shortness of breath in the past 1 hour. His blood pressure was 170/100 mmHg and physical examination revealed epigastric tenderness. ECG revealed biphasic T waves in leads V2-V5, suggestive of Wellens type A. The second patient was a 37-year-old man who presented after being stung by an insect 15 minutes before. Upon observation, the patient suddenly experienced left-sided chest pain accompanied by diaphoresis. ECG revealed inverted T waves in leads V2-V4, suggestive of Wellens type B. Further history-taking revealed that he had experienced this kind of symptoms three months prior and had a history of hypertension, dyslipidemia, and a current smoker. Unfortunately, both patients refused to be referred for further examination and management. Physicians and EMS providers should be aware of Wellen’s syndrome. Misinterpretation of this ECG characteristic could lead to fatal outcomes. Educating patients thoroughly about their condition is also important.
Challenges in Managing Myocardial Stunning Following Cardiac Arrest in a Very High-Risk NSTE-ACS Patient: A Case Report Afandy, Jonathan Edbert; Taslim
Nusantara Medical Science Journal Vol. 10 No. 1 (2025): Volume 10 Issue 1, January - June 2025
Publisher : Faculty of Medicine, Hasanuddin University.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20956/nmsj.v10i1.44050

Abstract

Introduction: Myocardial stunning is a reversible myocardial dysfunction that can occur due to various conditions, including focal ischemia—such as acute coronary syndrome (ACS)—and global ischemia, such as cardiac arrest. The proposed mechanisms include oxygen free radical damage during early reperfusion and altered calcium inflow leading to transient myofilament desensitization. Case Presentation: A 61-year-old woman with a history of uncontrolled hypertension and obesity presented with sudden loss of consciousness lasting one hour, preceded by chest pain and dyspnea. She experienced cardiac arrest and achieved return of spontaneous circulation (ROSC) after 10 minutes of cardiopulmonary resuscitation. Initial echocardiography showed a left ventricular ejection fraction (LVEF) of 32.9% and global hypokinesia. She was diagnosed with very high-risk non-ST-elevation ACS (NSTE-ACS), with suspected left main coronary artery obstruction or three-vessel disease. Her clinical course was complicated by acute pulmonary edema, respiratory failure, and cardiogenic shock. Management included intubation, dual antiplatelet therapy, anticoagulation, statin therapy, and inotropic support with dopamine and dobutamine. Her hemodynamic status improved within 18 hours, and she was extubated. On the third day post-arrest, follow-up echocardiography revealed a restored LVEF of 69.5% with normal wall motion. The patient was discharged after 9 days and continued to do well on outpatient follow-up for at least 6 months. Conclusions: Myocardial stunning should be considered in post-cardiac arrest and ACS patients with transient ventricular dysfunction. Early supportive care and close monitoring are essential, particularly in settings lacking advanced cardiac interventions.
Hemodynamic impairment of double culprit ST-elevation myocardial infarction, double the trouble: a case report Asaf, Mikhael; Afandy, Jonathan Edbert; Danny, Siska Suridanda
Jurnal Kardiologi Indonesia Vol 46 No 2 (2025): April - June, 2025
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1791

Abstract

Background: Multiple culprit artery involvement is rare (2.5%) among ST-segment elevation myocardial infarction (STEMI) patients undergoing primary coronary intervention (PCI). It can occur due to multiple factors and reflects a widespread pathophysiologic process. Most patients present with unstable hemodynamics and cardiogenic shock (CS), which results in a high mortality rate. Currently, there are no guidelines or consensuses on the management of multiple culprit arteries in STEMI patients. Case Illustration: A 51-year-old man with chest pain in the past 16 hours was referred to the National Cardiovascular Center Harapan Kita. ECG at presentation revealed sinus rhythm with ST elevation in the inferior, posterior, and right leads. He was diagnosed with late-onset infero-posterior STEMI + right ventricle infarction, Killip IV, and thrombolysis in myocardial infarction 6/14, then was prepared for early PCI due to ongoing chest pain and CS. The patient underwent complete revascularization with drug-eluting stents and thrombus aspiration due to the high thrombus burden of the lesion in the right coronary artery and first obtuse marginal artery. After early PCI, his hemodynamic condition improved, and epigastric pain was his only complaint. However, on the following day, the patient experienced acute pulmonary edema and rhythm conversion to total AV block. He was managed conservatively with heparinization, inotropes, vasopressors, diuretics, and noninvasive ventilation. After 14 days of hospitalization, the patient was discharged without any complaints. Conclusion: Double culprit STEMI is rare and associated with catastrophic hemodynamic impairment, including CS, at presentation. Individualized treatment with early and aggressive revascularization yields relatively good results.
Twists and Turns in The Fibrinolytic Therapy of Infero-Posterior ST Elevation Myocardial Infarction and Right Ventricular Infarction Patient with Cardiogenic Shock: A Case Report Afandy, Jonathan Edbert; Taslim
Nusantara Medical Science Journal Vol. 10 No. 2 (2025): Volume 10 Issue 2, July - December 2025
Publisher : Faculty of Medicine, Hasanuddin University.

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20956/nmsj.v10i2.45901

Abstract

Introduction: Fibrinolytic therapy is preferred for ST-segment elevation myocardial infarction (STEMI) when the timeframe for percutaneous coronary intervention (PCI) cannot be achieved. Although effective, fibrinolytics are also associated with several adverse effects in addition to the complications of STEMI itself. Case: A 45-year-old active smoker man presented with chest pain, dyspnea, and diaphoresis for the past hour. Electrocardiography revealed infero-posterior STEMI with right ventricular infarction. Echocardiography demonstrated akinetic inferior, infero-septal, and posterior walls with an estimated right atrial pressure of 15 mmHg. Management: Therapy consisted of aspirin, clopidogrel, furosemide, and streptokinase infusion. Within five minutes of initiating streptokinase, the patient developed sudden hypotension that required norepinephrine, dobutamine, and dopamine. At approximately halfway of the streptokinase infusion, he developed accelerated idioventricular rhythm which progressed to pulseless ventricular tachycardia lasting for one minute.  Before defibrillation was performed, his rhythm reverted to sinus, after which a bolus of amiodarone was administered. Given his instability, streptokinase was discontinued after approximately 70 percent of the total dose had been delivered. Outcome: The patient was transferred to the intensive care unit with stable hemodynamic, resolved chest pain, and more than 50 percent ST-segment resolution on ECG. Heparin, atorvastatin, maintenance amiodarone, and furosemide were added to his regimen. He continued to improve clinically and was discharged without complication. Conclusion: This case shows that fibrinolysis remains essential when PCI is unavailable, but streptokinase can cause hemodynamic and arrhythmic complications, highlighting the need for close monitoring and rapid intervention in resource-limited settings.
Co-Authors Asaf, Mikhael Putra, Swastya Dwi Siska Suridanda Danny Taslim