Indonesian Journal of Cardiology

Does Chronic Inflammation Play a Role in Rheumatic Mitral Valve Restenosis after Percutaneous Transvenous Mitral Commissurotomy?

2023-08-19T15:23:31+07:00

ABSTRACT

Background: Mitral valve restenosis is defined as decreased mitral valve area (MVA) <1.5 cm² or decreased MVA >50% after PTMC. It is time-dependent and associated with major adverse cardiovascular events (MACE), such as congestive heart failure, cardiac death, mitral valve replacement, and redo PTMC. The mechanism is not yet known; however, chronic inflammation may have a role. Objective: To know the association between chronic inflammation and mitral valve restenosis after PTMC. Methods: A total of 40 patients with mitral valve stenosis who underwent successful PTMC were matched and classified into restenosis/case group (n=20) and no restenosis/control group (n=20). Secondary data was taken from electronic medical records such as patient characteristics (gender, age & 2^nd prophylaxis), echocardiography data before PTMC (Wilkins’ score and MVA before PTMC), and echocardiography data after PTMC (MVA after PTMC). Follow-up echocardiography examination (follow-up MVA) and laboratory assessment of chronic inflammation marker (IL-6) were done on all patients. Statistical analyses were done to look for an association between the level of chronic inflammation marker & other independent variables with mitral valve restenosis. Results: Median IL-6 concentration was 2.39 (0.03 – 11.4) pg/mL. There was no statistically significant difference in IL-6 levels between both groups (p-value >0.05). MVA decrement was 0.13 (0 – 0.62) cm²/year with rate of MVA decrement ≥0.155 cm²/year was predictor of mitral valve restenosis (p-value <0.001, OR = 46.72, 95% CI 6.69 – 326.19). Conclusion: Chronic inflammation assessed by IL-6 was not associated with mitral valve restenosis.

Hemodynamic and Clinical Outcomes of Milrinone Compared to Dobutamine in Cardiogenic Shock: A-Systematic Review and Meta-Analysis

2023-08-19T15:23:32+07:00

Background

Despite years of clinical experience with the two most commonly used inotropes i.e dobutamine and milrinone, in the cardiogenic shock setting, there is a lack of head-to-head comparison between inotropes in cardiogenic shock. We conducted a systematic review and meta-analysis on the comparison of hemodynamic and clinical effects of dobutamine and milrinone in cardiogenic shock.

Methods

A comprehensive literature search using PubMed and Scopus was performed. Among 40 studies retrieved from the database, 3 studies were included for hemodynamic comparison outcome and 2 studies for clinical outcomes.

Results

Three studies with 101 patients were included for hemodynamic analysis and two studies with 146 patients for clinical analysis. We observed no significant difference between cardiac index, pulmonary capillary wedge pressure, and mean arterial pressure at 1 hour after milrinone and dobutamine administration. However, there is significantly lower mPAP after milrinone infusion compared to dobutamine (mean difference -8,7 (-9,97 to -7,43) mmHg, p<0,01). We also observed no significant difference in in-hospital mortality but significantly shorter ICU length of stay in the milrinone group (mean difference -1 (-1,92 to -0,08) days).

Conclusion

Administration of milrinone resulted in lower PA pressure and shorter ICU LOS compared to dobutamine in patients with cardiogenic shock.

High Degree AV Block in Infants

2023-08-19T15:23:31+07:00

Background: Atrioventricular (AV) block in children may pose a challenge for phycisians. However, it can be detected with careful physical examination.

Case illustration: A 4 month old infant presented with bradycardia that did not improve during observation period. Her electrocardiography (ECG) showed complete atrioventricular block and her echocardiography showed secundum atrial septal defect (ASD) and patent ductus arteriosus (PDA). Her father’s ECG showed first degree AV block. She was recovered well after pacemaker implantation and PDA ligation.

Conclusion: An infant who suffered from complete AV block was successfully treated with pacemaker.

The Importance of Hyperthyroid Screening in Acute Decompensated Heart Failure with Persistent Tachycardia Despite Optimal Decongestion: A Case Report

2023-08-19T15:23:32+07:00

Background: Hyperthyroid has various effects on the cardiovascular system. Cardiac arrhythmias ranging from sinus tachycardia to atrial fibrillation and low/high cardiac output state to congestive heart failure are observed in patients with hyperthyroidism. If hyperthyroidism is recognized and treated early, the cardiac dysfunction could be corrected. This case presentation will discuss the importance of thyroid function screening.

Case Illustration and Discussion: A man was admitted to the emergency department with signs and symptoms of acute decompensated heart failure. Further examination was performed to confirm the diagnosis, namely ECG, laboratory examination including thyroid function test, and echocardiography. During hospitalization, heart failure medication was given and up titrated. The patient was still tachycardia until hyperthyroid was corrected with anti-thyroid medicines.

Conclusion: Hyperthyroidism can cause or worsen left ventricular dysfunction, especially in individuals with a history of cardiovascular disease. Thus, thyroid function tests should be assessed during initial laboratory examination, especially on patients with acute decompensated heart failure.

An Acute Anterior Reinfarction Complicating with Transient Symptomatic Total Atrioventricular Block

2023-08-19T15:23:32+07:00

Abstract

Background

Acute stent thrombosis is a frequent cause of myocardial infarct (MI) after stent placement. Total atrioventricular (AV) block is frequently become the conductive disturbance complication of acute reinfarct. Inferior MI has Low long-term mortality and greater reversibility than anterior MI which has higher in-hospital and long-term mortality.

Case Illustration

44 years man, came to emergency department Cardiovascular Centre Harapan Kita with altered mental status since 12 hours ago.
PPCI stenting at proximal LAD of his acute anterior MI 2 days ago. Patient had acute stent thrombosis then underwent urgent PCI at referring hospital. Patient present with blood pressure 57/30, heart rate 20 -30 with TAVB rhythm. Laboratory showed increased serum lactate level 5.2. Patient was diagnosed with Total AV block caused by MI. Patient was planned for emergency temporary pacemaker (TPM) implantation. After 24 hours close monitoring, the patient intrinsic rhythm resolved with spontaneous recovery. Patient was hemodynamically stable until discharge.

Discussion

Stent thrombosis of proximal stent of LAD will cause TAVB because of the source of the distal portion of the AV node is originating from septal branch of LAD. It is caused by extensive necrosis with higher in-hospital and long-term mortality, often culminated in permanent pacemaker. However, spontaneous recovery of TAVB into sinus rhythm take place. This could be caused by transient reversible ischemia of infra nodal region of AV node which supplied by septal perforator branch

Conclusion

This case reporting a complete atrioventricular block during the course of acute anterior reinfarct and had spontaneous resolution of the AV block. Mechanisms of spontaneous resolution of complete AV block in the setting of acute MI is associated transient ischemia after occlusion of proximal LAD.

Keyword: Reinfarct, Stent Thrombosis, Total AV Block