Cardiovascular and Cardiometabolic Journal (CCJ)

A Rare Case of Acute Purulent Myopericarditis Due To Klebsiella Pneumoniae

2025-05-22T07:22:28+07:00

Background: Acute purulent myopericarditis caused by Klebsiella pneumoniae is a rare condition in the modern antibiotic era. It can progress to pericardial effusion that can cause a life-threatening cardiac tamponade. The typical manifestation of myopericarditis may be absent and possess significant challenge in diagnosis and treatment. This article is conducted to report a case of acute purulent myopericarditis caused by of Klebsiella pneumoniae that are barely reported.

Case Summary: Male, 52 years-old, presented with prolonged fever, progressive dyspnea and palpitation. The physical and supporting examination only shown the clinical symptoms of thyroid storm, heart failure, and coronary artery disease. After 2 days of treatment, he developed cardiac tamponade. Purulent mixed hemorrhagic fluid was evacuated from pericardiocentesis with positive culture for Klebsiella pneumoniae sensitive for ceftriaxone. Ceftriaxone, ibuprofen, and colchicine were given.

Conclusion: Myopericarditis should always kept in mind as differential diagnosis in patient with pericardial effusion and when it rapidly deteriorated, purulent bacterial infection although rare could be the possible cause. Prompt intervention through fluid evacuation, adequate antibiotic therapy and surgical pericardiectomy when indicated, were needed to improve disease outcome.

Cardiac Tamponade in Post Coronary Artery Bypass Graft Surgery Patient, Is it Post-Pericardiotomy Syndrome : A Case Report

2025-05-22T07:21:21+07:00

Background: Cardiac tamponade is defined as a medical emergency that could lead to shock. Cardiac tamponade prevalence in post open heart surgery is common especially Coronary Artery Bypass Graft (CABG) surgery (24%) and related to Post-Pericardiotomy Syndrome (PPS).

Case Summary: A 57-year-old Asian female with a history of CABG surgery presented to emergency with chief complaints of shortness of breath in the last 3 days especially when lying down. Patient underwent CABG surgery from CAD2VD + LM in the last month. Physical examination found a muffled first & second heart sound and distended jugular vein. Electrocardiograph of the patient showed sinus rhythm with low voltage. Echocardiography was done in the patient and the result showed severe pericardial effusion with D shape and collapse of the right ventricle. Pericardiocentesis is performed and results in 737cc serosanguineous fluid. Post-procedural echocardiography showed reduced pericardial effusion, good LV contractility, and RV not collapsed. Pericardial fluid analysis concluded as a transudative type.

Conclusion: This patient developed pericardial effusion with cardiac tamponade with history of CABG surgery as the only significant history. Early identification of PPS is important and preventive strategies need to be done to prevent unwanted complication.

Invasive Strategy of STEMI in Patients with TAVB, RBBB, and Dual High-Risk Profiles: Navigating the Challenges of Antithrombotic Therapy – A Case Report

2025-03-24T14:00:45+07:00

Highlights:

1. The complexity of managing high-risk STEMI patients with significant conduction abnormalities and bleeding risk.

2. Right bundle branch block (RBBB) and total AV block complicate an uncommon, high-risk STEMI case.

Background: It is imperative to diagnose and treat acute coronary occlusion as soon as possible, especially in patients with complicated conduction anomalies. Although electrocardiography (ECG) is still the gold standard for diagnosis, it has drawbacks, particularly when conduction abnormalities such as bundle branch block are present.

Case Summary: In this case study, a 60-year-old woman with cardiovascular risk factors and type 2 diabetes had an anteroseptal STEMI that was worsened by RBBB and total AV block. The patient's recovery was complicated by extensive gastrointestinal bleeding after a successful percutaneous coronary intervention (PCI) and the implantation of a stent in the left anterior descending artery.

Conclusion: In addition to highlighting the difficulties of striking a balance between dual antiplatelet therapy (DAPT) and reperfusion strategies in a high bleeding risk setting, this also highlights the management of a high-risk STEMI patient with total atrioventricular (AV) block, right bundle branch block (RBBB), and severe gastrointestinal complications.

Keywords: Bleeding risk; RBBB; STEMI; Total AV Block

Consequences of Hypervitaminosis D in NZW Rabbit Model

2025-08-29T15:12:26+07:00

Background and Aim: This study examines the effect of hypervitaminosis D on serum lipids and on kidney functions in New Zealand White (NZW) rabbit. It aims to study whether renal insufficiency or failure, due to hypervitaminosis D, is calcium-related or not. As well, it also discusses a possible link between hypervitaminosis D and hypercholesterolemia.

Methods: Four Groups of six animals each, were divided into: Group I, received regular diet, Group II received regular diet +10,000/day vitamin D2; Group III, received 0.25% cholesterol diet; as well as Groups IV received 0.25% cholesterol diet plus 10,000 IU. Blood samples were taken at the end of the study and examined for Total Cholesterol (TC), Triglycerides (TG), Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Blood Urea Nitrogen (BUN), Creatinine, Alanine Aminotransferase (ALT), Aspartate Aminotransferase (AST), Alkaline Phosphatase (ALP), Calcium and Phosphate. As well, 25- hydroxyvitamin D (25 (OH) D) was measured using tandem LC-MS/MS.

Results: The initial (0 time) serum TC, TG, LDL, HDL, Creatinine, Calcium, Phosphate and 25 (OH) D levels were not significantly different among different groups including control. At 1- and 2-month time, values from serum TC, TG, LDL, HDL and TC/HDL-C ration of Groups III and IV were significantly different from controls (p<0.05). As well, values from serum 25 (OH) D of Group II and IV were significantly different from controls (p<0.05) at 1- and 2-month time. However, values from serum Creatinine and Calcium of Group II were significantly different from controls (p<0.05) at 1- and 2-month time.

Conclusion: Hypervitaminosis D may aggravate hypercholesterolemia, and it also induces renal insufficiency and/ or failure through a calcium-dependent mechanism.

Predictors of Radial Artery Occlusion in Patients with Coronary Heart Disease Undergoing Coronary Angiography or Percutaneous Coronary Intervention via Transradial Access

2025-03-13T10:31:52+07:00

Background: Transradial approach is currently the most recommended access for coronary angiography and percutaneous coronary intervention (PCI). However, the risk of developing radial artery occlusion (RAO) with this approach is not uncommon.

Objective: This study aims to determine the frequency and predictors of RAO in patients undergoing transradial access.

Method: This was a prospective study from January 2021 until December 2023. Participants underwent coronary angiography or PCI via transradial access. Radial artery patency was evaluated before and after the procedure.

Results: A total of 456 subjects were enrolled for the study. RAO was found in 37 of 456 subjects (8.1%). From the results of the multivariate analysis, it was found that age (p = 0.012), number of catheters used (p = 0.006), and the incidence of hematoma (p < 0.001) were independent predictors of the incidence of RAO.

Conclusion: RAO is a common complication of transradial access so identification of high-risk patients, prevention efforts and close follow-up must be carried out to maintain a patent radial artery.

Keywords: percutaneous coronary intervention; radial artery occlusion; transradial

Association between HbA1c and Non-HDL-Cholesterol in Type 2 Diabetes Mellitus at a Tertiary Hospital in Indonesia

2025-06-03T15:01:17+07:00

Abstract: Diabetic dyslipidaemia is considered a modifiable risk factor for cardiovascular disease (CVDs). Non-high-density lipoprotein-cholesterol (non-HDL-C) is a better predictive measure of CVD compared to glycosylated haemoglobin (HbA1c) in type 2 diabetic. This study aims to explore the intricate link between these variables, which contribute significantly to the health risks of T2DM, particularly in a clinical environment like Dr. Soetomo's Endocrinology Polyclinic.

Material and Methods: This study used a cross-sectional method with observational analytics design to determine the correlation between HbA1c and non-HDL cholesterol in Type 2 Diabetes Mellitus. Data was collected at Dr. Soetomo Surabaya's Endocrinology Polyclinic from April 2022 to May 2023, focusing on medical records of Type 2 Diabetes Mellitus (T2DM) patients with dyslipidaemia. The study involved T2DM outpatients meeting specific criteria and excluded those with incomplete records or stage 5 Chronic Kidney Disease (CKD) diagnosis at the clinic. The data processing utilized the SPSS statistical program to examine the correlation between independent and dependent variables, employing Pearson or Spearman Correlation based on the data's distribution.

Results: The study included mostly women (66.67%) averaging 52.11 years old (SD 4.61). Simvastatin was the most prescribed statin (60.92%). Mean values for HbA1c, total cholesterol, HDL, LDL, and non-HDL cholesterol were 8.155%, 217.29 mg/dL, 46.61 mg/dL, 141.37 mg/dL, and 170.68 mg/dL. Most had poor glycemic control and cholesterol ≥ 130 mg/dL. The Spearman test showed a strong positive correlation between HbA1c and non-HDL cholesterol (r=0.534; p<0.001) and a moderate positive correlation with LDL cholesterol (r=0.473; p<0.001).

Conclusion: There is a strong correlation between HbA1c and non-HDL cholesterol in Type 2 Diabetes Mellitus.

Low Testosteron Level In Worsening Symptom Of Heart Failure Patients : A Literature Review

2025-05-22T08:48:44+07:00

Abstract

Heart failure can be caused by a variety of factors, including high blood pressure, coronary artery disease, diabetes, obesity, smoking, and genetics. Testosterone is the primary male hormone responsible for regulating sex differentiation, producing male sex characteristics, spermatogenesis, and fertility. It plays a crucial role in various bodily functions, including the development of male reproductive tissues and the maintenance of muscle mass and bone density. Testosterone levels have been found to be significantly decreased in heart failure patients compared to healthy controls. This suggests that low testosterone levels may play a role in the development or progression of heart failure. The relationship between testosterone and heart failure is complex and warrants further investigation. Additional research is needed to better understand the role of testosterone in heart failure and to determine the optimal therapeutic strategy for its management. Based on these data, we decided to further investigate how low testosterone levels affect the symptoms of heart failure patients. This literature review study aims to examine further how low testosterone levels affect the symptoms of heart failure patients. Journals in this literature review used three databases, including Google Scholar, PubMed, and Science Direct, using the keywords "testosterone" and "heart failure." The literature search was adjusted based on the inclusion and exclusion criteria. The search results were obtained from 10 international journals. The results showed that testosterone is crucial in maintaining men's health and well-being. Testosterone deficiency was associated with a worsening of HFpEF in men, those with lower testosterone levels had worse symptoms and a lower quality of life. Testosterone exerts an important regulation of cardiovascular function through genomic and nongenomic pathways. It influences contractility, energy metabolism of myocardial cells, apoptosis, and the remodeling process. Reduced testosterone levels in men with heart failure are associated with increased mortality and poor prognosis.