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All Journal Heart Science Journal
Hidayat, Muhammad Rijal Fahrudin
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Health Professions Immunology & microbiology Medicine & Pharmacology

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Journal : heart science journal

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Optimal treatment resolves total atrioventricular block in patient with myocardial infarction non-obstructive coronary artery: A case report Suryono, Suryono; Hidayat, Muhammad Rijal Fahrudin; Amien, Muhammad Irsyad; Tohari, Achmad Ilham; Saputra, Antonius Dwi; Ramadhan, Hazbina Fauqi
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.16

Abstract

Background: Total atrioventricular block (TAVB) cause of myocardial infarction non-obstructive coronary artery (MINOCA) in the anteroseptal segment is an uncommon case. Appropriate treatment can prevent worsening and give the best outcome to the patient. Case Presentation: We present a TAVB patient with unstable hemodynamics and complains of severe chest pain. Narrowing in the LAD segment was found in the coronary angiography without any sign of atherosclerosis. The patient improved with optimal reperfusion, and TAVB resolved within 24 hours. Conclusion: Optimal treatment focused on rapid reperfusion due to vasospasm can resolve TAVB and improve clinical conditions in the patients.
Determining culprit lesion through the ECG pattern in wrapped LAD: A case series Suryono, Suryono; Ardhianto, Pipin; Tohari, Achmad Ilham; Utama, Riawati; Hidayat, Muhammad Rijal Fahrudin; Amien, Muhammad Irsyad; Ramadhan, Hazbina Fauqi
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: 10.21776/10.21776/ub.hsj.2026.007.02.19

Abstract

Background: Wrapped left anterior descending (LAD) artery is defined as an LAD that supplies the apex and more than 25% of the inferior wall. Patients with wrapped LAD may have higher morbidity and mortality, and the culprit-lesion ECG pattern can differ from typical LAD occlusion, potentially leading to misinterpretation during primary percutaneous coronary intervention (PCI). Recognizing ECG patterns suggestive of wrapped LAD may help clinicians identify the culprit lesion and initiate appropriate therapy promptly.​ Case presentation: Four patients with ST-elevation myocardial infarction and angiographically confirmed wrapped LAD occlusion are presented, each demonstrating distinct culprit sites inferred from ECG patterns. The first was a 43-year-old Javanese man with mid-LAD occlusion; the second, a 40-year-old Javanese man with proximal LAD occlusion involving the first diagonal branch; the third, a 57-year-old Javanese man with isolated proximal LAD occlusion; and the fourth, a 59-year-old Javanese woman with mid wrapped LAD stenosis. All patients underwent successful primary PCI. Conclusion: Clinicians should consider wrapped LAD when ECG suggests combined anterior and inferior involvement, as the cardiac vector in wrapped LAD can produce patterns mimicking multivessel occlusion. In cases where the ECG appears to indicate two infarct territories, a single wrapped LAD occlusion rather than double-vessel disease should be suspected, which may refine culprit-lesion localization and procedural strategy during primary PCI.
Co-Authors Amien, Muhammad Irsyad Pipin Ardhianto, Pipin Ramadhan, Hazbina Fauqi Saputra, Antonius Dwi Suryono Suryono Tohari, Achmad Ilham Utama, Riawati