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INDONESIA
Indonesian Journal of Cardiology
Published by Indonesian Heart Association
ISSN : 28303105     EISSN : 29647304     DOI : -
Core Subject : Health,
Health Professions Medicine & Pharmacology
Indonesian Journal of Cardiology (IJC) is a peer-reviewed and open-access journal established by Indonesian Heart Association (IHA)/Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI) [www.inaheart.org] on the year 1979. This journal is published to meet the needs of physicians and other health professionals for scientific articles in the cardiovascular field. All articles (research, case report, review article, and others) should be original and has never been published in any magazine/journal. Prior to publication, every manuscript will be subjected to double-blind review by peer-reviewers. We consider articles on all aspects of the cardiovascular system including clinical, translational, epidemiological, and basic studies. Subjects suitable for publication include but are not limited to the following fields: Acute Cardiovascular Care Arrhythmia / Cardiac Electrophysiology Cardiovascular Imaging Cardiovascular Pharmacotherapy Cardiovascular Public Health Policy Cardiovascular Rehabilitation Cardiovascular Research General Cardiology Heart Failure Hypertension Interventional Cardiology Pediatric Cardiology Preventive Cardiology Vascular Medicine
Arjuna Subject : Kedokteran - Cardiology and Cardiovascular Medicine
Articles 753 Documents
 72   73   74   75   76 
Myocarditis Mimicking STEMI Complicated by Complete Atrioventricular Block: Diagnostic and Therapeutic Insights Rido Mulawarman; Hiradipta Ardining; Celly Anantaria Atmadikoesoemah; Dony Yugo Hermanto; Bambang Widyantoro; Rarsari Soerarso
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1921

Abstract

Background: Myocarditis, or myocardial inflammation, may share similar characteristics to Acute Coronary Syndrome (ACS), particularly ST-Elevation Myocardial Infarction (STEMI). This condition is further augmented when a Complete Atrioventricular Block (CAVB) is present. Despite being rare, this condition may pose additional diagnostic and therapeutic challenges. Case Illustration: We report a 54-year-old woman with fatigue, dyspnea, fever, nausea, and watery diarrhea for three days. Upon admission, she experienced hypotension, pulmonary congestion, and a complete Atrioventricular (AV) block, with ST-segment elevation seen on the lateral leads. Initial laboratory results revealed markedly elevated high-sensitivity troponin T and C-reactive Protein (CRP). Bedside echocardiography showed a prominently reduced Ejection Fraction (EF) (40%) alongside the presence of regional wall motion abnormalities. Urgent coronary angiography revealed only non-obstructive coronary disease and no obstructive coronary disease. A temporary pacemaker and inotropic support were initiated. Given the presence of systemic prodromal symptoms and the absence of coronary obstruction, myocarditis was strongly suspected. High‑dose intravenous methylprednisolone was given as an anti‑inflammatory treatment in suspected fulminant myocarditis with cardiogenic shock and complete AV block. Recognizing that immunosuppressive therapy is not routinely recommended for all myocarditis cases, especially without biopsy confirmation. Cardiac magnetic resonance imaging subsequently confirmed myocarditis, demonstrating myocardial edema and subepicardial late gadolinium enhancement. The patient was discharged after receiving guideline-directed medical therapy and tapering corticosteroids, with preserved ventricular function on follow-up 1 month after discharge. Conclusions: This report illustrates the importance of a stepwise diagnostic approach to differentiate myocarditis from STEMI, particularly when complicated by conduction disturbances such as CAVB. Early recognition and timely initiation of immunosuppressive therapy can lead to favorable outcomes.
Cardiac Tamponade due to Purulent Pericarditis Jessica Anastasia Setiawan; Danayu Sanni Prahasti
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1963

Abstract

Background: Purulent pericarditis, though uncommon in the antibiotic era, remains highly fatal when diagnosis or drainage is delayed. Its presentation often mimics viral hepatitis, sepsis, or parasitic infections—particularly in endemic, low-resource regions—leading to underrecognition. This case reported the development of purulent pericarditis with initial equivocal signs and symptoms, followed by progressive hemodynamic deterioration. Case Illustration: A 40-year-old previously healthy man presented with fever, dyspnea, stabbing chest and abdominal pain, and dark urine. Examination revealed jaundice, pericardial friction rub, and hepatosplenomegaly. Laboratory tests showed leukocytosis, hyperbilirubinemia, and elevated liver enzymes. Initial echocardiography demonstrated a 2-cm circumferential effusion without signs of tamponade. Two days later, despite stable symptoms, he developed hypotension with new fibrinous effusion and right atrium collapse. Emergency pericardiocentesis drained 1.7 L of thick, purulent fluid. Hemodynamics improved rapidly after drainage. Prednisone and colchicine were initiated once infection control was achieved to limit fibro-inflammatory response and reduce the risk of constriction. Liver function normalized, and follow-up echocardiography showed minimal residual effusion. At follow-up, the patient remained asymptomatic. Conclusion: This case highlights that purulent pericarditis can occur in immunocompetent individuals without typical risk factors, possibly from overlooked infection in low-resource settings. Hemodynamic collapse may occur even with small increases in pericardial effusion volume, owing to fibrin-induced pericardial stiffness and reduced compliance. Serial echocardiography is therefore critical when symptoms appear stable. Early pericardiocentesis is both diagnostic and therapeutic, reducing bacterial and inflammatory load, while carefully selected adjunctive anti-inflammatory therapy may prevent chronic constrictive sequelae.
One-Year Outcomes of Major Adverse Cardiac Events in Patients with ST-Segment Elevation Myocardial Infarction Who Received Delayed PCI in a Type-B Hospital Nova Maryani; Gagah Buana Putra; Farhan Hanifati; Muhammad K. Abdillah
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2038

Abstract

Background: Delayed Percutaneous Coronary Intervention (PCI) remains common in resource-limited hospitals due to system-related delays, often resulting in prolonged ischemic time. Although early reperfusion is the standard of care for ST-segment Elevation Myocardial Infarction (STEMI), delayed PCI may still be performed in selected, clinically stable patients. This study aimed to evaluate the one-year incidence of Major Adverse Cardiac Events (MACE) among STEMI patients undergoing PCI in a Type-B hospital, where delayed PCI was the predominant treatment pattern. Methods: This retrospective cohort study included adult STEMI patients who underwent PCI at PKU Muhammadiyah Gamping Hospital, Yogyakarta, Indonesia, between September 2018 and December 2020. Patients with incomplete medical records or loss to follow-up were excluded. Baseline clinical characteristics, comorbidities, infarct location, and door-to-wire-crossing time were collected. MACE included all-cause mortality, acute pulmonary edema, non-ST-segment elevation myocardial infarction, stroke, and rehospitalization due to reinfarction or acute heart failure within one year after PCI. Kaplan-Meier survival analysis and Mann-Whitney testing were applied. Results: Among 130 STEMI patients who underwent PCI, 123 (94.6%) received delayed PCI, with a median door-to-wire-crossing time of 10 hours 34 minutes. During one-year follow-up, MACE occurred in 10 patients (7.7%), corresponding to a 92.3% event-free survival rate. No significant association was observed between door-to-wire-crossing time and one-year MACE (p = 0.927). Conclusions: In this single-center study conducted at a Type-B hospital, one-year MACE occurred in 7.7% of STEMI patients undergoing PCI, most of whom received delayed PCI. No significant association was observed between door-to-wire-crossing time and MACE occurrence. Given the observational design and the limited number of events, these findings should be interpreted with caution. Delayed PCI appears feasible in selected patients, but should not be considered equivalent to guideline-recommended early PCI.
Excessive Polypharmacy Among Indonesian Heart Failure Patients: Clinical Correlates and Care Implications Yogi Puji Rachmawan; Witri Pratiwi; Bambang Budi Siswanto
Jurnal Kardiologi Indonesia Vol 47 No 2 (2026): April - June, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2138

Abstract

Background: Heart Failure (HF) is a major global health problem that often coexists with multiple chronic comorbidities, requiring complex pharmacotherapy. The use of numerous concurrent medications increases the risk of polypharmacy and excessive polypharmacy, which may lead to adverse drug reactions, drug–drug interactions, poor adherence, and higher healthcare utilization. Despite growing awareness of this issue, evidence on the prevalence and determinants of excessive polypharmacy among Indonesian HF patients remains scarce. Methods: This single-center cross-sectional sub-analysis was derived from a cross-sectional study involving 494 adult HF patients treated at Hasna Medika Cardiovascular Hospital, Cirebon, between January and December 2023. HF diagnosis was confirmed by cardiologists using the European Society of Cardiology (ESC) criteria. Polypharmacy was defined as the use of ≥7 medications, while excessive polypharmacy was defined as ≥10 medications. Clinical and demographic variables were extracted from electronic medical records (EMR). Bivariate analysis was performed using Chi-square or Fisher’s exact tests, followed by multivariate logistic regression to identify independent determinants of excessive polypharmacy. Results: The mean age of participants was 58.1 ± 10.5 years, and 53.4% were male. Overall, 42.5% of patients met the criteria for polypharmacy, and 15.6% (n=77) met the criteria for excessive polypharmacy. The most frequent comorbidities were Coronary Artery Disease (CAD) (80.2%), hypertension (23.1%), and Type 2 Diabetes Mellitus (T2DM, 20.0%). In multivariate analysis, T2DM (Adjusted Odds Ratio [AOR] 17.21, 95% CI 8.39–35.34), Chronic Kidney Disease (CKD) (AOR 5.97, 95% CI 2.37–15.03), Chronic Obstructive Pulmonary Disease (COPD) (AOR 6.64, 95% CI 2.64–16.69), and asthma (AOR 26.32, 95% CI 5.79–119.67) were identified as independent determinants of excessive polypharmacy. The model demonstrated good fit (McFadden pseudo-R² = 0.351; Hosmer–Lemeshow p = 0.62). Conclusion: Excessive medication burden is common among HF patients, particularly among those with metabolic and pulmonary comorbidities. These findings highlight the need for systematic medication review and rational prescribing strategies while recognizing that higher medication counts do not necessarily indicate inappropriate prescribing.
A Comparative Study of sFt-1 and Prolactin Levels in Peripartum Cardiomyopathy Patients With and Without Preeclampsia Triwedya Indra Dewi; Faris Dwiki Adithya; Chaerul Achmad; Sanny Nurfitrica; Hawani Sasmaya Prameswari
Jurnal Kardiologi Indonesia Vol 47 No 2 (2026): April - June, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2163

Abstract

Introduction: Peripartum Cardiomyopathy (PPCM) is a type of heart failure that occurs from late pregnancy to the early postpartum period. While the exact etiology of PPCM remains unclear, several risk factors, including preeclampsia, have been identified. It is hypothesized that PPCM with and without preeclampsia may involve distinct pathophysiological mechanisms, which could be reflected in differences in biomarker levels. This study aims to explore this hypothesis by comparing prolactin levels between PPCM patients with and without preeclampsia. Methods: This observational analytical study employed a cross-sectional design. The study population consisted of PPCM patients registered at Dr. Hasan Sadikin Hospital, Bandung, from September 2018 to June 2024. Subjects were classified into two groups: PPCM with preeclampsia and PPCM without preeclampsia. Soluble Fms-Like Tyrosine Kinase-1 (sFlt-1) and prolactin levels were measured at the time of PPCM diagnosis. Results: A total of 66 patients were included in the final analysis (43 with PPCM and preeclampsia and 23 without preeclampsia). Patients with PPCM and preeclampsia had higher sFlt-1 levels than patients with PPCM without preeclampsia (128.1 [Interquartile Range (IQR) 90.8–279.5] vs. 94.9 [IQR 82.7–110.6] pg/ml; p = 0.046), while prolactin levels did not differ significantly between two groups (36.52 [15.59–88.58] vs. 22.11 [12.69–44.25] ng/ml; p = 0.176). In the PPCM group with preeclampsia, 44.2% (p = 0.002) of patients had elevated levels of both sFlt-1 and prolactin, while none of the subjects without preeclampsia exhibited this combination. Conclusion: sFlt-1 levels are higher in PPCM with preeclampsia, whereas prolactin levels do not differ significantly between the two groups.
The Forgotten Spongy Myocardium: Clinical Trajectory of Left Ventricular Noncompaction Cardiomyopathy in an Asymptomatic Adult Leonardo Paskah Suciadi; Dony Yugo Hermanto; Surya Sinaga Immanuel; Jason Wirandy Haryanto; Harvian Satya Dharma
Jurnal Kardiologi Indonesia Vol 47 No 2 (2026): April - June, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2180

Abstract

Background: Left Ventricular Noncompaction (LVNC) is a rare cardiomyopathy characterized by a thin compacted epicardial layer and an extensive noncompacted endocardial layer with prominent trabeculations and deep intertrabecular recesses that communicate with the Left Ventricular (LV) cavity. The classic triad of complications includes chronic heart failure, ventricular arrhythmias, and systemic embolic events. At present, evidence-based management guidelines remain limited. Case Illustration: We report a 42-year-old man with LVNC, initially detected as an incidental Left Bundle Branch Block (LBBB) on Electrocardiogram (ECG) during a routine medical checkup. Although he remained asymptomatic, LV Ejection Fraction (LVEF) progressively declined, accompanied by rising N-Terminal pro-B-type Natriuretic Peptide (NT-proBNP) levels. Coronary artery disease was excluded by coronary computed tomography angiography. Given worsening LV systolic function over 2 years, Cardiac Magnetic Resonance (CMR) demonstrated an LVNC phenotype consistent with cardiomyopathy. Guideline-Directed Medical Therapy (GDMT) for heart failure was initiated, along with oral anticoagulation for primary prevention of LV thrombus. After medication optimization, LVEF improved markedly, and NT-proBNP normalized. Conclusions: This case illustrates the value of comprehensive evaluation and multimodality imaging in patients with unexplained LBBB, even when asymptomatic. Early diagnosis, phenotype-guided treatment, and longitudinal surveillance may help prevent clinical progression and future heart-failure, arrhythmic, or thromboembolic complications.
Impact of Cardiac Contractility Modulation on Left Ventricular Ejection Fraction and Clinical Outcomes in Heart Failure: A Systematic Review and Meta-Analysis I Nyoman Wiryawan; David Yobel; Gusti Ngurah Prana Jagannatha; Ni Kadek Aristia Dewi; Cindy Amanda Shandy; Hendy Wirawan
Jurnal Kardiologi Indonesia Vol 47 No 2 (2026): April - June, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2182

Abstract

Patients with heart failure and narrow QRS often remain symptomatic despite Optimal Medical Therapy (OMT), while CRT is usually not indicated. Cardiac Contractility Modulation (CCM) may improve symptoms and quality of life in this population. This systematic review and meta-analysis included studies comparing CCM to either OMT alone or OMT with CRT. Assessed outcomes included improvements in clinical, structural, and physiological domains. Random-effects models were applied for all analyses, and results were reported as Odds Ratios (OR) or Mean Differences (MD) with 95% Confidence Intervals (CI). All statistical analyses were conducted using Review Manager V.5.4 A total of eight studies involving 1,486 patients with heart failure were included in this analysis. In terms of structural outcomes, CCM demonstrated improvements in LVEF comparable to those of CRT, with no statistically significant difference between the two therapies (p>0.05). Compared to the OMT-only group, CCM showed significantly greater improvements in VO₂ max (MD 0.91; 95%CI 0.44-1.37; p<0.001; I²=33%), 6MWD (MD 17.95; 95% CI 5.45-30.45; p=0.005; I²=0%), and MLHFQ (MD -7.56; 95% CI -11.65 to -3.47; p<0.001; I²=39%). Although no significant differences were observed between CCM and control in terms of all-cause mortality, MACE, or rehospitalization (p>0.05), CCM group showed significant improvements in quality of life, as measured by NYHA functional class (MD 2.74; 95%CI 1.47-5.12; p<0.001; I²=76%). CCM is a promising therapy for heart failure, offering structural benefits comparable to CRT in narrow QRS patients and improving function and quality of life beyond OMT, despite no significant reduction in hard clinical outcomes.
Factors Associated with Early Acute Kidney Injury in Patients with Acute Decompensated Heart Failure: A Retrospective Observational Study in Bandung, Indonesia Hawani Sasmaya Prameswari; Fanny Yulia Rachmawati; Rizky Andhika; Indra Wijaya; Januar Wibawa Martha; Lilik Sukesi
Jurnal Kardiologi Indonesia Vol 47 No 2 (2026): April - June, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2187

Abstract

Background: Acute Kidney Injury (AKI) frequently complicates Acute Decompensated Heart Failure (ADHF) and is associated with adverse clinical outcomes. Early recognition of patients at higher risk is clinically important, particularly during the first 48 hours of hospitalization when decongestive treatment and renal monitoring are actively adjusted. Methods: This retrospective observational registry-based study analyzed adult patients hospitalized with ADHF at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, from January 2024 to October 2025. Of 279 screened registry records, 148 were included in the final analysis. AKI was defined as an increase in serum creatinine of at least 0.3 mg/dL within 48 hours after admission. Baseline demographic, clinical, echocardiographic, treatment, and laboratory variables were evaluated using bivariate analysis and multivariable logistic regression. Results: Among 148 included patients, AKI occurred in 67 patients (45.3%). The cohort was predominantly composed of patients with reduced Left Ventricular Ejection Fraction (LVEF), with 145 patients (98.0%) having LVEF <=40%. Admission N-Terminal pro-B-type Natriuretic Peptide (NT-proBNP) >5,000 pg/mL was associated with higher odds of early AKI in the adjusted model (Adjusted Odds Ratio [AOR] 2.04; 95% Confidence Interval [CI] 1.02-4.11; p=0.045). Hypertension and high initial furosemide dose showed nonsignificant trends, whereas other demographic and comorbidity variables did not show statistically significant associations in this cohort. Conclusions: Elevated admission NT-proBNP was associated with early AKI among patients hospitalized with ADHF. However, these findings should be interpreted as exploratory and hypothesis-generating rather than causal or predictive. Validation in larger and more diverse cohorts is required.
Bridging HFpEF Across the Care Continuum: From Screening to Phenotyping and Targeted Management Vebiona Kartini Prima Putri; Siti Elkana Nauli; Raja Ezman Faridz Raja Shariff
Jurnal Kardiologi Indonesia Vol 47 No 2 (2026): April - June, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2190

Abstract

Heart Failure with preserved Ejection Fraction (HFpEF) has become an important form of Heart Failure (HF), characterized by marked heterogeneity in pathophysiology, clinical presentation, and treatment response. It is an increasingly prevalent form of HF driven by aging populations and comorbidities such as hypertension, diabetes, obesity, and Chronic Kidney Disease (CKD). HFpEF is also associated with high morbidity, frequent hospitalizations, and diagnostic challenges, particularly in resource-limited settings. This manuscript provides a clinically focused overview of HFpEF, integrating current concepts in pathophysiology, diagnosis, phenotyping, and management. Its pathophysiology is multifactorial, involving systemic inflammation, endothelial dysfunction, myocardial stiffness, and contributions from comorbid conditions. Emerging evidence highlights the roles of adiposity and inflammatory pathways, reinforcing the view of HFpEF as a multisystem disorder rather than purely a cardiac condition. The condition is also markedly heterogeneous, with several phenotypes identified, including cardiometabolic, obesity-related, cardiorenal, chronotropic incompetence, and Atrial Fibrillation (AF)–associated HFpEF. These phenotypes influence disease progression and therapeutic response. Additionally, numerous clinical mimics, such as pulmonary disease, valvular heart disease, and infiltrative cardiomyopathies, complicate diagnosis. Diagnosis requires a structured, probability-based approach combining clinical assessment, biomarkers, echocardiography, and, when necessary, stress testing or invasive hemodynamics. However, limited access to advanced diagnostics necessitates pragmatic, tiered approaches, especially in low-resource settings. Management focuses on three pillars: optimization of comorbidities, guideline-directed medical therapy, and phenotype-specific treatment strategies. While no therapy conclusively reduces mortality, recent advances have improved symptom control and hospitalizations. Overall, HFpEF demands a holistic, individualized approach integrating pathophysiology, clinical phenotyping, and healthcare system constraints to improve patient outcomes.
Benign Prostate Hyperplasia (BPH) – Induced Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH): A Rare Precipitant of Acute Decompensated Heart Failure Wahyu Aditya; Bunga Dewanggi; Paskariatne Probo Dewi; Teuku Muhammad Haykal Putra; Hawani Sasmaya Prameswari
Jurnal Kardiologi Indonesia Vol 47 No 2 (2026): April - June, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2195

Abstract

In Acute decompensation of heart failure (ADHF), the precipitating factors need to be identified and treated promptly. Urinary retention is rarely recognized as a cause of ADHF. Here, we presented a case of Benign Prostate Hypertrophy (BPH) with urinary retention inducing SIADH, which precipitated an episode of decompensated heart failure. The correction of hyponatremia and placement of a DC catheter, along with diuretic and tolvaptan administration, dramatically improved the patient’s condition.

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