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All Journal Heart Science Journal
Utama, Riawati
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Health Professions Immunology & microbiology Medicine & Pharmacology

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Journal : Heart Science Journal

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Optimal medical therapy as a foundational strategy in simultaneous cardiocerebral infarction: A case series Utama, Riawati; Suryono, Suryono; Candra Dewi, Yulia
Heart Science Journal Vol. 7 No. 1 (2026): Accelerating Clinical Breakthroughs: The Journey from Molecular Discovery to Pa
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2026.007.01.19

Abstract

Background: Cardiocerebral infarction (CCI), the simultaneous onset of acute myocardial infarction (AMI) and acute ischemic stroke (AIS), is a rare but fatal condition. Management is challenging due to a serious therapeutic dilemma: common reperfusion techniques for the heart and brain pose significant risks to other organ systems. This clinical contradiction, along with the high mortality rate, demonstrates how crucial it is to find a good way to deal with this situation. Case Illustration: This report describes two male patients, aged 69 and 66, who experienced concomitant ST-elevation myocardial infarction (STEMI) and acute ischemic stroke (AIS). The first patient was treated conservatively with complete optimal medical care (OMT) after the family declined primary percutaneous coronary intervention (PCI). The second patient, whose hemodynamics were stable, underwent PCI in addition to the same OMT treatment. Fibrinolytic treatment is not an option in any case. The OMT plan requires two antiplatelet medications, a statin, a beta-blocker, an anticoagulant, and a nitrate. Conclusions: Although the two patients underwent different types of treatment, both were discharged after seven days in the hospital in stable condition. These results demonstrate that a well-executed OMT regimen can serve as an important and fundamental approach that can provide beneficial short-term outcomes in CCI. OMT can serve as a stabilizing bridge to intervention or, in some cases, as an adequate final treatment.
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 Candra Dewi, Yulia Hidayat, Muhammad Rijal Fahrudin Pipin Ardhianto, Pipin Ramadhan, Hazbina Fauqi Suryono Suryono Tohari, Achmad Ilham