Cardiovascular and Cardiometabolic Journal (CCJ)

Reperfusion Time of STEMI Patients in Indonesia and Outside Indonesia

Muhammad Fachriyan Romadhona — 2023-09-30

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.

Ameliorative Activity of Vitamin C against Alcohol Induced Cardio-toxicity in Adult Male Wistar Rats

OLUSOJI OYESOLA — 2023-09-30

Highlights:

1. Ameliorative effects of vitamin C against alcohol in this research are very interesting to be observed.

2. Vitamin C may have some beneficial effects on heart function by acting as an antioxidant.

Background: Alcohol and it metabolites causes cardiomyopathy, which is one of the main form of alcohol induced heart damage. The aim of the present study was to investigate the protective effect of vitamin C against alcohol-induced heart toxicity and selected indices.

Material and Methods: Forty healthy male Wistar rats were used in this experiment, which lasted 21 days. The rats were divided into eight groups, with five rats in each group. Group A received only distilled water, Group B received 6000 mg/kg of alcohol, and Groups C to H received different doses of vitamin C and alcohol in varying combinations. Blood samples were collected and analyzed for levels of sodium, potassium, and chloride ions. The hearts were also analyzed for antioxidant activities and histo-pathological changes.

Results: The findings indicated that alcohol administration caused a decrease in blood electrolyte levels compared to the control group, while treatment with vitamin C and co-administration of vitamin C and alcohol improved blood electrolyte levels. The antioxidant enzymes activity of the heart improved in the vitamin C and co-administration groups, as evidenced by increased GSH, SOD, and CAT activity and decreased MDA levels when compared to the alcohol-only group.

Conclusion: Therefore, this study suggests that commercial grade vitamin C at doses of 100 mg/kg, 200 mg/kg, and 300 mg/kg can protect the heart against alcohol-induced toxicity. However, further research is necessary to examine the anti-inflammatory effect of commercial grade vitamin C.

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

Mahendra Eko Saputra — 2023-09-30

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.

Atrial Septal Defect with Paroxysmal Atrial Tachyarrhythmia in Middle Age Soldier Patient: A Case Report

Ford Ance E. Aritonang — 2023-09-30

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.

Unresponsive to Cardioversion Pre-excited Irregular Rhythm

Mochamad Yusuf A, MD, PhD — 2023-09-30

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.