Cardiovascular and Cardiometabolic Journal (CCJ)

Fistula Coronary and Coronary Steal Syndrome: A Case Report

Saskia Handari, Puspa Lestari — Fri, 30 Sep 2022 00:00:00 +0700

Background: A coronary artery fistula (CAF) is an aberrant vascular contact of coronary arteries with cardiac chambers or any section of the pulmonary or systemic circulation, which accounts for 0.3% of congenital heart disorders. CAFs have been observed to be as common as 0.9% at computed tomographic (CT) angiography, which is greater than the previously estimated prevalence of 0.002 – 0.3% at invasive angiography.

Case Summary: A 76-year-old woman reported with repeated episodes of chest pain. A considerable diameter of fistula from the proximal LAD and proximal RCA to the MPA was discovered on CT angiography, which could be the cause of coronary steal syndrome. Microflex10 7 mm/22 cm was used to perform coil embolization at the proximal RCA. After the procedure, the patient had no more chest pain.

Discussion: CT angiography is usefsul for determining coronary architecture and guiding therapeutic intervention. CAF data was gathered during pre- and post-procedural CT angiography evaluations.

Keyword: Fistula coronary, coronary steal syndrome, CCTA, percutaneous coil embolization

Ventricular Septal Rupture (VSR) in Post-Acute Anterior Myocardial Infarction Patients : A Case Series

Ken Christian Kawilarang, I Kadek Herry Hermawan, Febryanti Hartono — Fri, 30 Sep 2022 00:00:00 +0700

Case Summary: We present 2 cases of post-STEMI VSR. They had anterior AMI without reperfusion therapy because of patient delay and limited resources. Thereafter apical VSR occurs on 5^th day. VSR was suspected because of sudden hemodynamic deterioration and new holosystolic murmur (Grade III/VI) at left parasternal line of fourth-fifth ICS. Then it was confirmed by echocardiography. Both patients underwent hemodynamic stabilization while waiting for surgical therapy. Unfortunately, they deceased because of cardiogenic shock accompanied by other comorbidities. Discussion: VSR causes shunt from left to the right ventricle, which overloads the RV, leading to cardiogenic shock. The peak incidence of VSR in the first 24 hours or 3-5 days post-AMI. This fits both of our cases. VSR occurs in total coronary occlusion, which then causes coagulation necrosis in the ischemic area, characterized by neutrophils that trigger apoptosis and lytic enzymes, so that septum becomes thin, brittle then ruptures. VSR is most common in anterior AMI and the defect is at apical septum, as in our patients. Definitive therapy for VSR is surgical closure, but the best timing is still under debate. This article is expected to make us more aware of post-AMI VSR, so we can quickly diagnose and promptly treat the patients with multidisciplinary approach. This is very important to optimize patient’s outcomes even in limited resources area.

A Late Prosthetic Mitral Valve Infective Endocarditis Caused by Micrococcus spp. that Fully Recovered by Antibiotics Treatment : A Rare Case

Imam Mahbub Zam Zami, Agus Subagjo — Fri, 30 Sep 2022 00:00:00 +0700

Prosthetic valve endocarditis is the most severe form endocarditis with prevalence of 5.7% at 5 years and mortality with medical treatment is 26%-75%. Case Summary: Male, 46 years old, with mechanic mitral prosthetic valve >5 years, hemiparesis sinistra due to embolic stroke >4 weeks prior, was suffering from persistent fever >38,5⁰ for 2 weeks without heart failure. Three separate blood cultures came positive with Micrococcus spp. and Osler’s node was noticed. Echocardiography shown 1.0 cm x 0.9 cm vegetation at mitral prosthetic valve without paravalvular leakage. Patient was assessed as late mitral PVE. Discussion: Gentamycin, Levofloxacin, and Erythromycin were given based on susceptibility test continued by Meropenem as therapy of urinary tract infection based on susceptibility test after second blood culture result was negative. The patient underwent 42 weeks of antibiotics course. The patient was discharged with good condition, no signs and symptoms of infection or heart failure, blood test was within normal limit, no vegetations with prosthetic mitral valve functioned normally. This case shows that late PVE caused by Micrococcus spp. can be treated by 42 weeks course of antibiotics according to microbial susceptibility test.

Successful Typical AVNRT Ablation

Angela Bety Ratnasari, Budi Baktijasa Dharmadjati — Fri, 30 Sep 2022 00:00:00 +0700

AVNRT is the most common regular arrhythmia in humans, and therefore the most commonly encountered during ablation attempts for regular tachycardias. Case Summary: We present a 41-year-old female patient with chest palpitations in the last 10 years, but prior to hospitalization felt heavy sensation on her chest and hospitalized due to heavy chest palpitations and documented SVT. She had no history of hypertension, diabetes mellitus, coronary heart conditions, or stroke. Physical examination showed fair general condition with GCS E4V5M6, blood pressure 130/80, pulse rate 96x / minute, breath rate 18 x / minute and saturation of 99%. Physical examinations are within normal limits. Discussion: Catheter ablation for AVNRT is the current treatment of choice in symptomatic patients. It reduces arrhythmia-related hospitalizations and costs, and substantially improves quality of life. Catheter ablation approaches aimed at the fast pathway have been abandoned; slow pathway ablation, using a combined anatomical and mapping approach, is now the method of choice. This approach offers a success rate of 95 %, has a recurrence rate of approximately 1.3 – 4.0 %, and has been associated with a low risk of atrioventricular (AV) block.

Coronary Thrombosis Case in Female Patient with COVID-19 Confirmed Case: Coincidence or Complication?

Yosua Hendriko Manurung, Yusuf Galenta — Fri, 30 Sep 2022 00:00:00 +0700

The worldwide health impact of the COVID-19 epidemic has been felt all across the world, mostly due to respiratory issues, but many additional signs such as cardiac manifestations and different thromboembolisms have also been observed. Case Summary. We provide you with a 48-year-old female patient with COVID-19 pneumonia following a severe infection, who developed Unstable Angina due to coronary thrombosis. She has a history of hypertension and obese posture. No diabetes, hypercholesterolemia, or smoking habit had been recorded. And she still has regular menstrual cycle. Around a month prior to being referred to our hospital, this patient has been admitted to ICU of satellite hospital. She was treated with ventilator and discharged around a week before she was admitted to our Emergency Department. She had typical chest pain with ST-segment depression ECG at antero-septal area. PCI was performed and a large thrombosis was found at LAD artery. Discussion: Many studies have showed that COVID-19, through various ways, has developed thromboembolism both in arteries and venous system. The actual process of thrombus development in the coronary arteries is unknown, however, it is thought that pro-inflammatory cytokinesis released by the body, which stimulates the coagulation cascade and prevent fibrinolysis, are the major cause. This condition that leads to hypercoagulable state which eventually makes an increased risk of thromboembolism.

Correlation of Neutrophyl-Lymphocyte Ratio, Vessel Score based on Sullivan Scoring System, and Troponin in Acute Coronary Syndrome Patients

Chelssi Gloria Tessari, Achmad Lefi, Yetti Hernaningsih — Fri, 30 Sep 2022 00:00:00 +0700

Acute Coronary Syndrome (ACS) is one of the highest causes of death globally, with the number of deaths reaching more than 9 million people in 2016. Therefore, a fast and accurate ACS diagnosis is needed. This study aimed to determine the relationship between the neutrophil-lymphocyte ratio, the number of coronary artery lesions evaluated by angiography, and troponin I in ACS patients Material and Methods: This research is an analytic observational with a retrospective cross-sectional design. Sampling was carried out using a total sampling technique and obtained 87 samples that met the inclusion and exclusion criteria for the 2019-2020 period at Dr. Soetomo Regional General Hospital Surabaya. The correlation between the number of coronary artery lesions and the neutrophil-lymphocyte ratio to troponin I levels were respectively analyzed using chi-square and spearman-rho with SPSS ver. 25. Results: The results showed a moderately significant correlation between the neutrophil-lymphocyte ratio and troponin I levels (p =0.003, rs = 0.319). While the correlation analysis between the number of coronary artery lesions and the vessel score on troponin I showed insignificant results (p = 0.525), which means that the number of coronary artery lesions was not correlated with troponin I. Conclusion: This study concludes a significant correlation with moderate correlation between the neutrophil-lymphocyte ratio and troponin I. However, there is no significant correlation between the number of coronary artery lesions assessed by the Sullivan and troponin I levels.

The Role of Aerobic Exercise to Prevent Coronary Artery Disease

Fri, 30 Sep 2022 00:00:00 +0700

Abstract: Background: Coronary Artery Disease (CAD) is a disorder of heart function caused by blockage or narrowing of the coronary arteries so that there is an insufficiency of blood and oxygen flow to the myocardium and becomes the leading cause of death in the world. CAD is one of the causes of the decline in the quality of life of a human being. Methods: This study used a literature review method using 11 scientific articles as online data sources which were then further analyzed. Result and Discussion: Exercise is a recommended therapy as half of the pharmacotherapy. Moderate intensity exercise of 150 minutes per week and vigorous-intensity of more than 75 minutes per week greatly help CR also provide significant benefits when started within 15 days of cardiovascular symptoms appearing. Conclussion: CAD causes the most deaths in the world. From various scientific articles that have been analyzed, exercise, especially aerobic exercise, has been shown to have a good impact on people with CAD that affect lipid metabolism, heart remodeling, insulin resistance, and endothelial function.