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<![CDATA[High-Dose Nitroglycerin Bolus and Non-Invasive Ventilation Prevent Intubation or ICU Admission on Hypertensive Emergency and Acute Pulmonary Edema: Sympathetic Crashing Acute Pulmonary Edema (SCAPE) Treatment on STEMI Patient: A Case Report ]]>
<![CDATA[Mahendra Eko Saputra]]>;
<![CDATA[Achmad Lefi]]>;
<![CDATA[Makhyan Jibril Al Farabi]]>;
<![CDATA[Pandit Bagus Tri Saputra]]>;
<![CDATA[Ariikah Dyah Lamara]]>
<![CDATA[ Cardiovascular and Cardiometabolic Journal (CCJ) Vol. 4 No. 2 (2023): Cardiovascular and Cardiometabolic Journal ]]>
Publisher : <![CDATA[Universitas Airlangga ]]>
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DOI: 10.20473/ccj.v4i2.2023.99-104
<![CDATA[Highlight: 1. SCAPE could lead to respiratory failure when not treated promptly. 2. High-dose NTG and NIV support can be used as an alternative treatment to overcome hypertensive emergency and pulmonary edema, thus preventing the need for endotracheal intubation and ICU admission. - Background: A marked elevation in blood pressure that causes acute heart failure and fluid accumulation in the lungs is known as sympathetic crashing acute pulmonary edema (SCAPE). Here, we present a SCAPE patient with severe respiratory failure who was successfully treated with high-dose nitroglycerin (NTG) bolus and non-invasive ventilation (NIV). Case summary: A 48-year-old male was referred to our center with typical chest pain and dyspnea. Physical and additional examination found hypertensive emergency (196/66 mmHg), acute pulmonary edema, and acute heart failure, accompanied by anterior STEMI and severe respiratory failure (P/F ratio of 72) in need of intubation. He was given 2 mg intravenous NTG bolus twice supported with NIV, diuretics followed by the primary percutaneous coronary intervention (PCI) stenting in mid left anterior descending (LAD). The patient recovered from acute pulmonary edema, and the P/F ratio improved from 72 to 321 without intubation. Discussion: SCAPE could lead to respiratory failure requiring intubation and intensive care unit (ICU) admission when not treated promptly. The administration of large doses of NTG and NIV was safe and resulted in a speedy improvement in symptoms. Conclusion: SCAPE can be resolved without invasive procedures, using high-dose NTG and NIV support to overcome hypertensive emergency and pulmonary edema.]]>
<![CDATA[Reperfusion Time of STEMI Patients in Indonesia and Outside Indonesia ]]>
<![CDATA[Muhammad Fachriyan Romadhona]]>;
<![CDATA[Yudi Her Oktaviono]]>;
<![CDATA[Sundari Indah Wiyasihati]]>;
<![CDATA[Rosi Amrilla Fagi]]>
<![CDATA[ Cardiovascular and Cardiometabolic Journal (CCJ) Vol. 4 No. 2 (2023): Cardiovascular and Cardiometabolic Journal ]]>
Publisher : <![CDATA[Universitas Airlangga ]]>
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DOI: 10.20473/ccj.v4i2.2023.85-98
<![CDATA[Highlights: 1. The median of door-to-ballon in handling STEMI and total ischemic time is longer in Indonesia than other countries. - Background: STEMI is a medical emergency that requires quick treatment. Several problems might arise from the improper and delayed treatment of STEMI patients. Objective: This study aimed to examine the differences in the reperfusion time of STEMI patients in Indonesia and outside Indonesia. Method: Systematic Review method is used without meta-analysis. The variables to be studied in this study are Door-to-Balloon time and Total Ischemic Time. PubMed, Science Direct, and Scopus are used as search tools using the MeSH terms and keywords that have been determined to look for articles within 2017 – 2020. The selection of the literature that has been obtained was carried out according to the PRISMA algorithm. Results: Twelve journals were used that were relevant, compatible, and following the inclusion and exclusion criteria. It was found that the median door-to-balloon in handling STEMI in Indonesia ranged from 70 to 94 minutes, while the median total ischemic time ranged from 275 to 461 minutes. Meanwhile, the median door-to-balloon time and total ischemic time outside Indonesia ranged from 41 to 87 minutes and 112 to 273 minutes, respectively. Conclusion: In conclusion, the median and average door-to-balloon time and total ischemic time in Indonesia are longer than the door-to-balloon time and total ischemic time outside Indonesia in handling STEMI.]]>
<![CDATA[Atrial Septal Defect with Paroxysmal Atrial Tachyarrhythmia in Middle Age Soldier Patient: A Case Report ]]>
<![CDATA[Ford Ance E. Aritonang]]>;
<![CDATA[Hasanah Mumpuni]]>;
<![CDATA[Real Kusumanjaya Marsam]]>;
<![CDATA[Lucia Kris Dinarti]]>
<![CDATA[ Cardiovascular and Cardiometabolic Journal (CCJ) Vol. 4 No. 2 (2023): Cardiovascular and Cardiometabolic Journal ]]>
Publisher : <![CDATA[Universitas Airlangga ]]>
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DOI: 10.20473/ccj.v4i2.2023.105-114
<![CDATA[Highlights: 1. ASD closure is still recommendable in late middle-aged patients, especially one that is combined with arrhythmias management. 2. ASD closure after age 40 seems to not affect the frequency of arrhythmia development during follow up. - Background: Atrial septal defects (ASDs) are frequently asymptomatic and can remain undiagnosed until adulthood. Atrial tachyarrhythmias are not uncommon seen in patients with ASDs. Atrial fibrillation and atrial flutter are relatively rare in childhood, but become more prevalent with increasing age at time of repair or closure. Case Summary: The present case was an active duty 50-year-old male soldier, referred to the arrhythmia division of Gatot Soebroto Army Hospital with palpitations and physical intolerance. Holter examination and electrophysiology study revealed atrial tachyarrhythmias. Transesophageal echocardiography was performed before radiofrequency catheter ablation, and unexpectedly found left to right shunt ostium secundum ASD. Right heart catheterization confirmed left to right shunt ASD with high flow-low resistance. He then underwent paroxysmal atrial tachyarrhythmias catheter ablation, followed by percutaneous transcatheter ASD closure using occluder device without fluoroscopy within six months. Both the procedures went well without any complications. His symptoms had improved during follow up, although he had episode of rapid paroxysmal atrial fibrillation on holter evaluation six months later. Conclusion: We conclude that ASD closure is still recommendable even in late middle age patients combined with arrhythmias management.]]>
<![CDATA[Unresponsive to Cardioversion Pre-excited Irregular Rhythm ]]>
<![CDATA[Mochamad Yusuf A, MD, PhD]]>;
<![CDATA[Dara N. Ghassani, M.D]]>;
<![CDATA[Nupriyanto, MD]]>;
<![CDATA[Rerdin Julario, M.D]]>
<![CDATA[ Cardiovascular and Cardiometabolic Journal (CCJ) Vol. 4 No. 2 (2023): Cardiovascular and Cardiometabolic Journal ]]>
Publisher : <![CDATA[Universitas Airlangga ]]>
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DOI: 10.20473/ccj.v4i2.2023.115-123
<![CDATA[Highlights: 1. Atrial fibrillation in the presence of an accessory pathway may present with confounding electrocardiographic signs. 2. The clinical recognition of WPW may be hindered by the presence of pre-excited AF. - Case Summary: A 46-year-old man without known past medical history was referred to the tertiary hospital emergency department after being found collapsed at home. There are no any complaints of any headache, nausea, chest pain, or paralysis of extremities before losing consciousness. His chest examination to bilateral auscultation was clear. Chest X-ray, routine blood work, and transthoracic echocardiography did not reveal any abnormalities. The initial heart rate before referral was 250-300/min and the ECG shows irregular wide QRS complex tachycardia. The ECG after cardioversions shows sinus rhythm 86 bpm with WPW type A pattern. The patient got intravenous amiodarone and intravenous lidocaine during the transfer. And the ECG on arrival at the emergency department, the heart rate was 50-150 bpm irregularly and the ECG shows atrial fibrillation with a narrow QRS complex. Discussion: Rapid anterograde accessory pathway conduction during atrial fibrillation (AF) can result in sudden cardiac death. During pre-excited AF, delta waves as the key feature of Wolff-Parkinson-White (WPW) syndrome might be obscured. We should keep in mind the diagnosis of pre-excited AF in patients presenting with irregular and wide complex tachycardia.]]>
<![CDATA[Antiarrhythmic Effect of SGLT-2 Inhibitors in high-degree AV Block Caused by Heart Failure: A Case Report ]]>
<![CDATA[Ngurah Agung Reza Satria Nugraha Putra]]>;
<![CDATA[I Ketut Susila]]>
<![CDATA[ Cardiovascular and Cardiometabolic Journal (CCJ) Vol. 5 No. 1 (2024): Cardiovascular and Cardiometabolic Journal ]]>
Publisher : <![CDATA[Universitas Airlangga ]]>
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DOI: 10.20473/ccj.v5i1.2024.49-61
<![CDATA[Highlights: 1. The antiarrhythmic effect of SGLT-2 inhibitors, particularly empagliflozin, is a very interesting topic to discuss further. 2. In patients with high degree AV block due to HF in rural areas, the use of SGLT-2 inhibitors is quite rare in Indonesia. - Background: According to WHO's Top 10 Global Health Threats, non-communicable diseases such as heart failure contribute to more than 70% of all deaths worldwide. Several studies have shown that SGLT-2 inhibitors can considerably reduce HF. As research progresses, SGLT-2 inhibitors may lessen the risk of arrhythmias in HF patients. Case Summary: A 57-year-old female with uncontrolled hypertension came to the ED after collapsing at home. The vital signs and physical examination are normal. The preliminary ECG showed a high degree AV Block with multiple multifocal PVC. Early laboratory revealed mild hypokalemia. The patient experienced a seizure the next day, and an ECG showed total AV block with a non-sustained VT episode with PVC R on T. Following critical cardiac care and stabilization, the patient underwent echocardiography, which showed mild MR and AR with a reduced ejection fraction (47.7%). Once the patient's condition has stabilized, the patient is given 1x10mg Empagliflozin PO. Discussion: SGLT-2 inhibitors are beneficial in the treatment of heart failure and arrhythmia. SGLT-2 inhibitors have antiarrhythmic effects through a variety of pathways, such as lowering preload and afterload, inhibition of sodium-hydrogen exchange in myocardial cells, and suppression of the sympathetic nervous system. ]]>
<![CDATA[The Risk Factors and Hospital Mortality of Percutaneous Coronary Intervention Patients in Prepandemic and During Pandemic COVID-19: A Systematic Review ]]>
<![CDATA[Hidtsa Aqila Noor Arasyi]]>;
<![CDATA[Rizky Pratama]]>;
<![CDATA[Muhammad Hendi Saputra]]>
<![CDATA[ Cardiovascular and Cardiometabolic Journal (CCJ) Vol. 5 No. 1 (2024): Cardiovascular and Cardiometabolic Journal ]]>
Publisher : <![CDATA[Universitas Airlangga ]]>
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DOI: 10.20473/ccj.v5i1.2024.35-48
<![CDATA[Highlights: 1. COVID-19 pandemic remains one of the interesting subject to discuss due to its large scale impact. 2. PCI is one of the popularly known method to screen COVID-19, however, depending on the prior screening, this may or may not be conducted. Thus, its frequency is reviewed in this study. - Backgroud: The COVID-19 pandemic is a global health issue that impact healthcare systems. COVID-19 infections affect the risk factors and mortality in patients undergoing PCI. The aim of this study is to determine the differences in risk factors and mortality rates of patients undergoing PCI before and during the COVID-19 pandemic. Method: We performed a systematic search on risk factors and hospital mortality of PCI patients in prepandemic and during pandemic COVID-19. Study reporting patient after year 2022 are excluded. The article published between 2019 - 2022. The literature selection was conducted following the PRISMA algorithm. Result: Eight journals were utilized, ensuring their relevance, compatibility, and adherence to the inclusion and exclusion criteria. In this study, it is explained that there has been a decrease in the number of patients undergoing PCI procedures during the COVID-19 pandemic. The increase of risk factor and there is no significant different hospital mortality of PCI patients before and during pandemic.]]>
<![CDATA[Correlation Between Cardiopulmonary Bypass Time (CPB Time) during Coronary Artery Bypass Graft on ICU Length of Stay ]]>
<![CDATA[Andreas Rama Arkananta Nugraha]]>;
<![CDATA[Danang Himawan Limanto]]>;
<![CDATA[Philia Setiawan]]>;
<![CDATA[Atika]]>
<![CDATA[ Cardiovascular and Cardiometabolic Journal (CCJ) Vol. 5 No. 1 (2024): Cardiovascular and Cardiometabolic Journal ]]>
Publisher : <![CDATA[Universitas Airlangga ]]>
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DOI: 10.20473/ccj.v5i1.2024.1-10
<![CDATA[Highlight: 1. CHD remains one of the most threatening CVD in Indonesia. Studies discussing CHD will contribute in future studies for cardiologists to assert better options for treatment. - Abstract Background: Coronary heart disease (CHD) is one of the deadliest diseases in Indonesia. Coronary artery bypass graft using cardiopulmonary bypass (CPB) is an integral measure in its treatment. The objective of this study is to identify the correlation of CPB Time and Length of Stay (LOS) in the Intensive Care Unit (ICU) in Dr.Soetomo General Academic Hospital, Surabaya. Material and Methods: This study was conducted using observational and analytic methods. The population are coronary heart disease patients who underwent coronary artery bypass graft. A total sampling method was used from the medical records of Dr. Soetomo General Academic Hospital, Surabaya from October 2021 until September 2022. The research variables are: CPB time and ICU LOS. The relationship between CPB and ICU LOS was analyzed using the Spearman correlation test and logistic regression as well Mann-Whitney test using Microsoft Excel and SPSS version 25. Results: From the results of the correlation test, there is no correlation between CPB Time and ICU LOS with a correlation coefficient of r=0212, there is no significant difference between CPB ≤180 minutes and CPB >180 minutes on ICU LOS p=0.123. From the overall sample, the average age was 62.24+7.765 years, with the majority of the sample were male 87.3%. Conclusion: There is no correlation between the CPB Time and ICU LOS in patients after coronary artery bypass graft at RSUD Dr. Soetomo.]]>
<![CDATA[Silent Threat: Ascending Aortic Dissection Triggering Congestive Heart Failure in A Young Indonesian Woman Suspected of Marfan Syndrome – A Case Report ]]>
<![CDATA[Shinta Dewi Rasti]]>;
<![CDATA[Richardus Rukma Juslim]]>;
<![CDATA[Febryanti Hartono]]>
<![CDATA[ Cardiovascular and Cardiometabolic Journal (CCJ) Vol. 5 No. 1 (2024): Cardiovascular and Cardiometabolic Journal ]]>
Publisher : <![CDATA[Universitas Airlangga ]]>
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DOI: 10.20473/ccj.v5i1.2024.62-71
<![CDATA[Highlights: 1. Thoracic Aortic Aneurysm is not frequently discussed. However, this study analyzed it and pointed out how life-threatening a disease with silent nature could be. 2. It shows how screening for patient needed to be conducted thoroughly to ensure there is no potential threat left undiagnosed. - Background: A considerable number of thoracic aortic aneurysms (TAAs) remain unidentified or misdiagnosed owing to the silent nature of the disease and the lack of a screening program. The diagnostic process is frequently intricate, leading to potentially catastrophic outcomes. Case presentation: A 32-year-old woman presented with shortness of breath and swelling in both legs, resembling symptoms of heart failure. Despite the absence of known cardiovascular risk factors, echocardiography unveiled a critical condition; painless ascending aortic aneurysm with dissection, posing a life-threatening risk. Conclusion: Initially, the patient's susceptibility to the disease was not readily apparent. Interestingly, aortic dissection patients presenting with heart failure symptoms were less inclined to experience chest pain compared to those without such symptoms. This disparity might triple the time required for diagnosis and elevate mortality risk to 33%. Thus, this case report aims to increase awareness in the medical community about rare and subtle cases that might be overlooked or misdiagnosed due to atypical presentations.]]>
<![CDATA[Pulmonary Hypertension in Pregnancy: A Cardiological Approach to Maternal Outcomes as well as Neonatal and Therapeutic Management ]]>
<![CDATA[Zainur Hafiz Yusa]]>;
<![CDATA[Iqbal Maulana]]>
<![CDATA[ Cardiovascular and Cardiometabolic Journal (CCJ) Vol. 5 No. 1 (2024): Cardiovascular and Cardiometabolic Journal ]]>
Publisher : <![CDATA[Universitas Airlangga ]]>
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DOI: 10.20473/ccj.v5i1.2024.72-81
<![CDATA[Highlights: 1. Pulmonary hypertension is threatening to both the mother and the infant in the womb. 2. This report discusses the complexity of physiological changes in pregnant women with pulmonary hypertension. - Abstract Background: Maternal morbidity and mortality with pulmonary hypertension in pregnancy usually occur during labor until early postpartum. Historical reports have shown mortality rates as high as 30–56%. We report a 32-year-old female patient pregnant with her second child, with complaints of bleeding from the birth canal since 1 hour before admission to the hospital and a history of atrial septal defect type secundum. Case presentation: The patient was diagnosed with G2P1A0, 16–17 weeks pregnant, with death conception, thrombocytopenia, and ASD secundum with pulmonary hypertension. The patient was planned for dilation and curettage by the obstetrics and gynecology departments. As a result of consultation with the cardiology department, medication management was given, and the decision to tolerate CRI IV very high-risk surgery was given. Conclusion: Despite progress, pregnancy remains poorly tolerated in cases of pulmonary hypertension. Management should remain focused on contraceptive counseling and offering early termination when pregnancy does occur]]>
<![CDATA[Changes in Nutritional Status of Children Under Five with Acyanotic Congenital Heart Disease Left to Right Shunt Type After Defect Closure by Catheterization ]]>
<![CDATA[Marsa Hendra Utomo]]>;
<![CDATA[Taufiq Hidayat]]>;
<![CDATA[Heroe Soebroto]]>
<![CDATA[ Cardiovascular and Cardiometabolic Journal (CCJ) Vol. 5 No. 1 (2024): Cardiovascular and Cardiometabolic Journal ]]>
Publisher : <![CDATA[Universitas Airlangga ]]>
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DOI: 10.20473/ccj.v5i1.2024.11-22
<![CDATA[Highlights: 1. The nutritional status of children with CVD after therapy is interesting to discuss especially because children antibody varies. 2. Changes in their nutrition intake after the surgery would help for future treatments with related disease and same operation. - Background: One of the impacts that occur in patients with congenital heart disease (CHD) is malnutrition. Malnutrition will affect the growth of the child. Closure therapy with catheterization can improve nutritional status after a few months. This study aims to determine the nutritional status of toddlers with simple left to right shunt-type acyanotic CHD before and after closure therapy with catheterization. Material and Methods: This study is an analytical observational study with a retrospective cohort method using medical record data involving pediatric patients less than 5 years old with simple left to right shunt-type acyanotic CHD who received closure by catheterization at Dr. Soetomo General Hospital from January 2020 to December 2020. Results: From 10 samples, the characteristics of the most samples were women (90%), age group 2-5 years (60%), and PDA abnormalities (50%). In addition, nutritional status after closure by catheterization improved. Conclusion: There was an improvement in nutritional status (W/H) after defect closure with catheterization in patients aged less than 5 years with simple left to right shunt type acyanotic CHD within several months.]]>
