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All Journal Syntax Literate: Jurnal Ilmiah Indonesia Jurnal Sehat Indonesia (JUSINDO)
Rezkinanda, Alief
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Patient With ST-Elevation Myocardial Infarction and Right Bundle Branch Block Refusing Reperfusion Therapy: A Case Report Rezkinanda, Alief; Akbar, Dzulfikri Aulia; Rosali, Wanda; Anwar, Sdjaiful
Syntax Literate Jurnal Ilmiah Indonesia
Publisher : Syntax Corporation

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.36418/syntax-literate.v10i10.61753

Abstract

ST-Elevation Myocardial Infarction (STEMI) is an emergency condition requiring prompt reperfusion therapy through fibrinolytic treatment or primary percutaneous coronary intervention (PCI) depending on what is available for the patient. However, in certain situations, especially in rural areas, patients may not receive these therapies. This case report reviews the condition of a STEMI patient who refused to be referred to the district hospital that provides reperfusion therapy and instead received dual antiplatelet therapy (DAPT), beta-blockers, angiotensin receptor blockers, statins, calcium channel blockers, and other supportive medications without any reperfusion therapy.
Repeat Acute Coronary Syndrome Following Percutaneous Coronary Intervention: A Case Report Rezkinanda, Alief; Anwar, Sjaiful
Jurnal Sehat Indonesia (JUSINDO) Vol. 8 No. 1 (2026): Jurnal Sehat Indonesia (JUSINDO)
Publisher : CV. Publikasi Indonesia

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Abstract

Percutaneous coronary intervention (PCI) is the primary reperfusion strategy for ST-elevation myocardial infarction (STEMI). Despite high procedural success rates, patients remain at risk for recurrent acute coronary syndrome (ACS), particularly those with significant comorbidities. We report a case of recurrent ACS in a patient less than one year following successful primary PCI. A 50-year-old female presented to the emergency department with typical angina, shortness of breath, nausea, and diaphoresis. Her medical history was significant for hypertension, type 2 diabetes mellitus, and a STEMI treated with primary PCI five months prior. Despite reported adherence to dual antiplatelet therapy (DAPT), she presented with tachycardia (104 bpm) and hypotension (155/55 mmHg). Electrocardiography revealed sinus tachycardia with pathological Q waves in leads V1–V4, consistent with a prior anterior myocardial infarction. Laboratory evaluation demonstrated hyperglycemia (228 mg/dL) and elevated cardiac troponin (44.2 ng/mL). The patient was diagnosed with recurrent ACS superimposed on an old anterior myocardial infarction. She was stabilized with loading doses of aspirin and clopidogrel and admitted to the Intensive Cardiac Care Unit (ICCU) for guideline-directed medical therapy, including beta-blockers and high-intensity statins. She was discharged in stable condition after five days. This case illustrates that recurrent ACS can occur shortly after successful revascularization, specifically in patients with persistent cardiovascular risk factors such as uncontrolled hyperglycemia and hypertension. It highlights the critical importance of aggressive secondary prevention, strict glycemic control, and close follow-up to mitigate the risk of adverse cardiac events in the post-PCI period.
Co-Authors Akbar, Dzulfikri Aulia Anwar, Sdjaiful Anwar, Sjaiful Rosali, Wanda