Cardiovascular and Cardiometabolic Journal (CCJ)

Profile of Maternal Mortality due to Cardiovascular Disease Based on Determinant Factors at Dr. Soetomo Regional General Hospital

Akhmad Adam Mahendra — 2025-03-30

Background: Although Indonesia’s maternal mortality rate (MMR) decreased from 346 per 100,000 live births in 2010 to 189 in 2020, it remains high compared to other Southeast Asian countries. Cardiovascular diseases are among the leading indirect causes of maternal deaths globally, accounting for over 33% of cases.

Objectives: This study aims to analyze maternal mortality due to cardiovascular disease at Dr. Soetomo Regional General Hospital based on determinant factors.

Methods: This study was a descriptive analytical study utilized secondary data from medical records of 123 patients who experienced maternal deaths due to cardiovascular disease at Dr. Soetomo Hospital between January 2020 and December 2023. Determinants were categorized as near (cardiovascular diagnosis), intermediate (maternal age, gestational age, obstetric status, and delivery mode), and distant (occupation) factors.

Results: Of 123 cases, the leading cardiovascular complications were hypertension in pregnancy (58.5%), congenital heart disease and pulmonary hypertension (15.4%), and cardiomyopathy and heart failure (14.6%). Intermediate determinants included maternal age >35 years (28.5%), multigravida status (60.2%), multiparity (56.9%), and third-trimester presentation (65%). Most deaths (96.7%) occurred postpartum, with cesarean section being the predominant delivery mode (74.8%). The majority of patients were housewives (53.7%).

Conclusion: Hypertension in pregnancy remains a primary near determinant of maternal mortality. Intermediate and distant determinants, such as maternal age, obstetric status, and socioeconomic factors, also contribute significantly. Efforts to reduce maternal mortality should include improved antenatal care, early cardiovascular screening, and targeted public health interventions.

Highlights:

1. This study reinforces hypertension in pregnancy (58.5%) as the leading cause of maternal mortality due to cardiovascular disease, highlighting its significant contribution compared to other conditions like congenital heart disease (15.4%) and cardiomyopathy (14.6%).

2. A striking 96.7% of maternal deaths occurred postpartum, with cesarean section (74.8%) being the predominant delivery mode, suggesting a need for enhanced postpartum monitoring and cardiovascular care in high-risk pregnancies.

Managing Acute Lung Edema During Hyperglycemic Crises: Prioritizing Fluid Reduction or Blood Sugar Control in Non-Specialist Settings

Ryan Ardiansyah — 2025-03-30

Background: Emergency admissions acute lung oedema and hyperglycemic crisis still very common and challenging. Both conditions are emergencies, where delay in treatment will cause increased morbidity and mortality. This report will discuss the case of a 62-year-old woman with acute lung oedema and hyperglycemia, as well as her emergency management.

Case Summary: A 62-year-old woman present with severe shortness of breath since 2 hours before admission. The patient has a history of hypertension, diabetes mellitus, and heart disease and has not recently taken medication regularly. Physical examination revealed blood pressure: 260/132 mmHg, and SpO2: 86% Room Air. Thorax examination revealed vesicular sounds +/+, wheezing +/+, and full rhonki +/+ throughout the lung fields. Laboratory examination showed a blood sugar value of 539mg/dL. Chest X-ray shows cardiomegaly and pulmonary edema. Our patient was diagnosed with Acute Lung Oedema, hyperglycemia crisis, Hypertensive emergency.

Conclusion: Management of patients with hyperglycemia and acute lung oedema is carried out simultaneously by the respective recommendations given. However, the rehydration volume in this case needs to be modified and it is important to provide fluid resuscitation conservatively. Hemodynamic assessments need to be carried out to ensure adequate fluid administration so as not to cause overhydration.

Highlights:

1. This case underscores the challenge of managing hyperglycemic crisis alongside acute lung edema, emphasizing the importance of conservative, hemodynamically guided fluid resuscitation to balance rehydration needs with pulmonary safety.

High Output Heart Failure Secondary Due to Large Arteriovenous Fistula

Willis Kwandou — 2025-03-30

Background: Arteriovenous fistula (AVF) creation is a commonly performed procedure for patients who suffered from end-stage renal disease (ESRD) and require a permanent vascular access in order to receive long-term hemodialysis. However, these AVF may have a significant deleterious effect on cardiac hemodynamic functions due to increasing cardiac output (CO) and can lead into high output heart failure.

Case Summary: Female, 36 years old complained dyspnea on effort, ascites and lower extremity oedema since 6 months ago. She had history of chronic kidney disease and routinely undergoing hemodialysis with brachiocephalic AVF that enlarged since 2 years ago. Physical examination revealed increased jugular vein pressure, hepatomegaly, ascites and giant draining vein of left brachiocephalic AVF with positive Nicoladoni-Branham sign. Echocardiography examination showed dilated right atrium and right ventricle, left ventricle diastolic D-shaped, normal left ventricular ejection fraction with increase right ventricle CO and cardiac index (CI) 7,8 L/minutes/m², moderate pulmonary regurgitation, severe tricuspid regurgitation (TR) and high probability of pulmonary hypertension. Vascular ultrasound revealed enlarged draining vein with high AVF blood flow rate. Patient then referred to vascular surgeon and decided to undergo ligation of AVF draining vein. After ligation, patient’s right heart failure symptoms were improved and had a better quality of life. upon echocardiography control examination revealed significant improvement of left ventricle diastolic D-shaped.

Conclusion: High output heart failure is one of a potential serious complication upon creating AVF hemodialysis vascular access. Routine screening of AVF blood flow rate, identifying high risk patients, and early management is very important to prevent irreversible myocardial damage.

Highlights:

1. This case illustrates that high-output heart failure from an excessively flowing AVF—though rare in younger patients—can be dramatically reversed with AVF ligation, highlighting the importance of flow assessment and timely intervention in dialysis patients with unexplained right heart failure.

Balancing Risk and Benefit of Antiplatelet Therapy in the Acute Coronary Syndrome Patient with Thrombocytopenia: A Case Report

Ngurah Agung Reza Satria Nugraha Putra — 2025-03-30

Background: Antiplatelets are one of the cornerstones of treatment for Acute coronary syndrome (ACS), although it is risky in patients with thrombocytopenia. In choosing antiplatelets, physicians must carefully weigh the risks of ischemia and bleeding.

Case Summary: A 68-year-old male came to ED with a 2-day history of left-sided chest pain, exacerbated 1 hour before admission. The preliminary ECG revealed ST elevation in lead V2-V5 and laboratory examination showed low platelets in four days (32x10³/uL; 29x10³/uL; 47x10³/uL; 87x10³/uL). The patient received a loading dose of Aspirin 160 mg. However, Clopidogrel 1x75mg was administered on the second day of treatment. After 5 days of treatment, the patient's condition improved, and his platelet count increased steadily.

Conclusion: Antiplatelet therapy is required to avoid ischemic complications, but it enhances the risk of bleeding in individuals with thrombocytopenia. There have been few studies on the use of antiplatelets in thrombocytopenia. Monotherapy is preferred over dual therapy, however the risk/benefit ratio, clinical response, and monitoring for bleeding issues in the patient must all be considered.

Highlights:

1. This case illustrates that cautious antiplatelet monotherapy may be a viable strategy in ACS patients with thrombocytopenia. In this 68-year-old with ST-elevation MI and platelets <50×10³/μL, delayed Clopidogrel monotherapy—guided by clinical stability and rising platelet counts—led to improvement without bleeding complications.

Distinguished VT and SVT with aberrations in Young Aged Patient : A Case Report

Pradnya Wirawan — 2025-03-30

Background: Arrhythmia with tachycardia is one of the emergencies that is often found in the ER. However, very often VT and SVT with aberrant especially in young aged patients make general practitioners confused about taking further action.

Case Summary: A 19 year old male patient came to the ER with complaints of palpitations since 30 minutes. From the physical examination, the BP was 102/60, the pulse was 160x/minute. The ECG showed signs of arrhythmia with tachycardia.

Conclusion: Treatment for SVT is clearly very different from VT, but sometimes making a diagnosis in the ER is still a challenge. It is necessary to looking at the history and the ECG so that the therapy given is appropiate.

Highlight:

1. This case underscores the diagnostic challenge of distinguishing VT from SVT with aberrancy in young patients presenting with tachycardia. In this 19-year-old male with stable vitals and a wide-complex tachycardia, careful ECG interpretation and clinical history were essential to guide appropriate therapy and avoid mismanagement.

Assessing Cardiovascular Fitness on Military Recruitment

Jonathan Koswara — 2025-03-30

Background: Military recruitment demands optimal health, with cardiovascular fitness being a key criterion. To assess candidates, military organizations worldwide employ standardized screening protocols. Initial evaluations typically involve history-taking and physical examinations based on guidelines from the American Heart Association and the European Society of Cardiology.

Method: Electrocardiography (ECG) serves as an accessible and cost-effective screening tool. Abnormal findings in these initial tests necessitate further assessments to determine a candidate’s fitness for service. Depending on the severity and context, additional tests such as echocardiography or, in rare cases, coronary angiography may be conducted. However, cost constraints influence the extent of these evaluations in some countries.

Aim: This article examines cardiovascular screening in military recruitment and the variations in assessment practices across different nations.

Highlights:

1. This article addresses the importance of standardized yet flexible cardiovascular assessments essential for military screenings. While standardized protocols are essential for consistency, military screenings should also adapt to environmental factors, individual differences, and evolving fitness benchmarks to ensure accurate evaluations.

Investigation on Prediction of Life-Threatening Arrhythmia in Long QT Syndrome : A Systematic Review and Meta-Analysis

Jonathan Vincent Lee — 2025-03-30

Introduction : Use of risk stratification tools in Long QT Syndrome (LQTS) will be important to direct treatment strategy on each patient and risk of arrhythmia. There are still other factor that could improve the predictive performance of the risk stratification. This study aims to find a new predictor of Life-Threatening Arrhythmia in the LQTS population.

Methods : Based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA) Protocol 2015, studies extracted from Pubmed, Science Direct, Pubmed Central, EuroPMC, Frontiers with MeSH keywords “Long QT Syndrome AND Predictor AND Life-threatening arrhythmia”. The inclusion criteria were cohort studies in LQTS patients (LQT 1, 2, 3) and the endpoint was life-threatening arrhythmia such as aborted cardiac arrest or sudden cardiac death. Study quality assessed with Newcastle-Ottawa Scale and RevMan 5.4 were used to analyse the data with hazard ratio as the measures.

Results : Six cohort studies (12.343 subjects) fulfilled the inclusion criteria. Male <13 years old (HR = 2.73, 95% CI = 1.72-4.33, p = <0.0001) and female >13 years old (HR = 1.81, 95% CI = 1.36-2.41, p = <0.0001) were significant as predictor of life-threatening arrhythmia. Patients with LQT2 (HR = 1.84, 95% CI = 1.36-2.49, p = <0.0001), LQT3 genotype (HR = 3.88, 95% CI = 2.27-6.62, p = <0.00001), and QTc >530 (HR = 2.45, 95% CI = 1.96-3.06, p <0.00001) were also at increased risk of life-threatening arrhythmia. Syncope occurrence increased the risk (HR = 3.11, 95% CI = 2.47-3.91, p = <0.00001) while beta-blockers usage significantly decreased the risk of life-threatening arrhythmia (HR = 0.46, 95% CI = 0.36-0.60, p = <0.00001). All studies were low risk of bias.

Conclusion : There were other predictors of life-threatening arrhythmia in LQTS that might be considered to improve the stratification performance.

Highlights:

1. In patients with Long QT Syndrome, life-threatening arrhythmia risk is strongly predicted by age-dependent gender differences, prolonged QTc (>530 ms), prior syncope, genotype (LQT2/3), and mitigated by beta-blocker use—offering a sharper edge for clinical risk stratification.