The complex relationship between arterial carbon dioxide levels and acute heart failure: implications for prognosis and management

Acute Heart Failure (AHF) can affect carbon dioxide levels in the body by altering the balance between ventilation and carbon dioxide production, leading to either hypocapnia or hypercapnia. Arterial carbon dioxide (CO2) levels are essential for maintaining respiratory function and acid-base balance. However, the relationship between arterial CO2 levels and AHF remains complex and not fully understood. Diverse factors affect arterial CO2 levels in patients with AHF, including neurohormonal activation, respiratory compensation for hypoxemia, and changes in pulmonary perfusion. Hypocapnia, characterized by low arterial CO2 levels (PaCO2 < 35 mmHg), is commonly observed in AHF due to hyperventilation-driven respiratory alkalosis secondary to pulmonary congestion. It showed a strong connection with the survival rates of patients following a cardiac arrest. Nevertheless, elevated levels of carbon dioxide in the blood, known as hypercapnia, with a partial pressure of arterial carbon dioxide (PaCO2) exceeding 45 mmHg, can also arise in the later phases of acute heart failure (AHF), indicating fatigue in respiratory muscles or deterioration in pulmonary edema. Abnormal arterial CO2 levels have been associated with increased morbidity and mortality in AHF patients, serving as a valuable prognostic marker.

Case series analysis: Atrial fibrillation ablation with normal vs. left atrium enlargement

Background: Atrial fibrillation (AF) is one of the most common cardiac arrhythmias, and its incidence is gradually increasing worldwide. It can develop such life-threatening conditions as heart failure, myocardial infarction, and thromboembolism. Catheter ablation, as a minimally invasive procedure to eliminate AF triggers, demonstrates different levels of success, particularly in relation to the size of the left atrium (LA). Even though left atrium enlargement (LAE) associates with worse ablation outcomes, its mechanisms are poorly understood. Case Illustration: This case report investigated the treatment results in AF ablation cases with normal LA size and LAE. This case report described two paroxysmal AF patients who underwent catheter ablation. The patient of the first case is a 45-year-old male with normal LA Size, while the second case is a 55-year-old male with LAE. Both of these patients underwent pulmonary vein isolation (PVI) using a 3D mapping system. Sinus rhythm was gained in both patients before the discharge and both performed the ablation successfully. Conclusion: Left Atrial Enlargement (LAE) exposed patient to more difficult procedures and greater risk of recurrence. LA size is one of the predictor of long term outcome in AF ablation patients, but with proper management, the prognosis might still be favourable. More studies need to determine how to manage AF ablation in patients with high-risk characteristics

Giant left coronary artery with coronary cameral fistula in significant coronary artery disease : A case report

Background : Coronary Artery Fistula are coronary anomalies that affected populations with rare incidences. Concomitant disease such as coronary artery disease (CAD) may be occurred in CAF and causing complexity to its management. Objective : This case presentation aimed to describe the characteristic, diagnosis and management of CAF with concomitant disease such as CAD. Case Presentation : We will discuss A 56 year old male admitted as an outpatient with left sided chest pain as the chief complain. The chest pain was described as ischemic chest pain with supporting examination lead to the suspicion of coronary artery disease.  Contrast enhanced CT Angiography examination was planned for diagnosing Coronary Artery Disease in this patient. 3D reconstruction of the coronary tree revealed giant LAD (Diameter 6.5 – 7mm) with normal size of LCx and Dominant RCA. The distal LAD was communicating with the LV cavity through big coronary fistulae. Impression of significant stenosis showed in the proximal RCA described as mixed plaque causing >70% Stenosis. PCI of the RCA and CAF Closure management was proposed but there was a disagreement of further coronary intervention from the patient. Conclusion : CAF in concomitant CAD is a complex structural disease with challenging management. Combination of surgical procedure was the recommendation for the management of this case

The role of GALNT and EGFR in vascular calcification: Study on pathophysiology and its implications in vascular therapy

Vascular calcification is a complex biomineralization process that occurs in arteries, primarily driven by the activity of vascular smooth muscle cells (VSMCs). This process involves the deposition of hydroxyapatite minerals in the arterial walls, particularly within the intima and media layers. Vascular calcification significantly increases the risk of cardiovascular diseases, including myocardial infarction, stroke, and heart failure. Understanding the role of GalNAc-transferase (GALNT) and the epidermal growth factor receptor (EGFR) in vascular calcification has advanced significantly. GALNT is involved in the regulation of glycosylation and affects various biochemical pathways, including insulin signaling and lipid metabolism. Variations in GALNT expression can influence the risk of vascular calcification, highlighting the crucial role of glycosylation in the pathogenesis of vascular calcification. On the other hand, EGFR contributes to vascular calcification by modulating the activity of tissue-nonspecific alkaline phosphatase (TNAP) and the formation of calcifying extracellular vesicles, as well as through the proliferation and migration of VSMCs. A deeper understanding of the roles of GALNT and EGFR provides new insights into the pathophysiological mechanisms of vascular calcification and opens up opportunities for the development of more effective therapies. This review aims to enhance scientific knowledge and provide a foundation for further research and the development of more targeted and personalized therapies in the prevention and treatment of vascular calcification

Diagnostic and therapeutic challenges in managing purulent pericardial effusion with concurrent pneumonia: A geriatric case report

Introduction: Purulent pericarditis is defined as an infection in the pericardial space that produces macroscopically or microscopically purulent fluid. It was a rare but life-threatening condition. It may be primary or secondary to another infectious process. This condition, characterised by an infectious or inflammatory accumulation of fluid in the pericardial cavity, presents significant diagnostic and therapeutic challenges, particularly in the context of multiple comorbidities. The purpose of this case report is to provide descriptive information about rare clinical patient scenario of purulent massive pericardial effusion in elderly. Case Description: The patient\u27s presentation, complicated by pneumonia and diabetes mellitus, underscores the complexities in diagnosing and managing an 85-year-old male patient with diverse medical backgrounds. Echocardiography confirmed the diagnosis of massive pericardial effusion and showed the purulent fluid from the pericardiocentesis procedure. Nevertheless, despite various efforts to find the origin of the infection and treat it with antibiotics according to the sensitivity test, the patient\u27s outcome with many risk factors, immunocompromised condition, unclear source of infection, aside from septic shock that led to the patient\u27s death during treatment. Conclusion: Clinicians need to be aware of immunocompromised elderly patients and act quickly to help them. They also need to deal with the diagnostic difficulties of identifying definitive infectious sources, the high risk of death even with modern treatments, and the important role that underlying comorbidities play in prognosis. Clinical evidence shows that purulent pericarditis is still a serious condition that can have adverse outcomes, especially in older patients who already have a lot of health problems

Are mechanical and electromechanical methods accurately interchangeable for measuring plasma prothrombin time and activated partial thromboplastin time? A comparative analysis study and potential implication to cardiovascular disease

INTRODUCTION: The DT100 offers both optical and mechanical modes, with its mechanical mode showing better homogenization than the STAGO, but comparative study is limited. OBJECTIVES: The study aimed to evaluate the diagnostic accuracy of plasma Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) measurements using the DT100 and STAGO instruments. METHODS: Designated as a cross-sectional study, this study was conducted at RSUD Dr. Soetomo from October 2022 to January 2023. Venous blood samples with plasma citrate anticoagulant 0.109 M 3.2% were consecutively collected from hospitalized patients, and all samples underwent testing using both the DT100 in mechanical mode (DT100, TCoag Ireland Limited, Ireland) and the STAGO employing an electromechanical method (Compact Max3, STAGO, France). Statistical analysis included comparison using Paired t-test, Pearson correlation, and Bland-Altman analysis to assess agreement between the results obtained from the two instruments. RESULTS: The study included 51 patients. PT levels were significantly lower with the DT100 compared to STAGO (MD: -2.0; 95%CI: (-2.30) – (-1.3); p<0.0001), and showed a strong positive correlation between methods (r:0.9535; p<0.0001). However, Bland-Altman analysis for PT showed a bias of 1.84, with limits of agreement (3.30-0.37), indicating systematic differences and variability. APTT levels were significantly higher with DT100 compared to STAGO (MD:3.60; 95%CI: 2.13–5.07; p<0.0001), with a moderate positive correlation (r:0.6690; p<0.0001). For APTT, bias of Bland-Altman analysis was -3.60, with limits ((-9.84) – (2.64)), suggesting significant discrepancies and variability between methods. CONCLUSION: The study found significant variability in PT and APTT measurements between the DT100 and STAGO methods

Technical procedure of endovenous laser ablation for chronic venous insufficiency

Venous insufficiency is an often-encountered medical issue. In recent years, a number of procedures have been developed for the treatment of venous insufficiency within the context of minimally invasive surgery. Endovenous laser ablation (EVLA) is a commonly used contemporary method. The ultimate outcome is the formation of fibrotic tissue that seals the lumen of the treated vein. Vein ablation procedures are often performed with local-tumescent anaesthesia, allowing patients to be treated in an office environment and resume full activity immediately afterwards. The use of EVLA is strongly recommended above surgical intervention or foam sclerotherapy, as indicated by a 1A class recommendation. The approach seems to possess significant attributes and benefits in terms of safety and efficacy. This article provides an overview of the technical technique involved in EVLA for the treatment of venous insufficiency. Additionally, it emphasises the significance of EVLA in managing venous insufficiency

Determinants of cost discrepancies in inpatients with acute decompensated heart failure

BACKGROUND: Acute decompensated heart failure (ADHF) is a prevalent and complex condition that significantly burdens healthcare systems, requiring intensive care and leading to high treatment costs. OBJECTIVES: This study aims to identify factors influencing cost discrepancies in hospitalized ADHF patients. METHODS: This retrospective study was conducted at Universitas Brawijaya Hospital from July to August 2024. Data were collected from 86 ADHF patients who were hospitalized between January 2021 and December 2023. Information regarding the patients\u27 clinical conditions, comorbidities, and medical procedures was extracted from their case histories. Statistical analyses included t-tests and Mann-Whitney tests. RESULTS: In this study of 86 individuals with ADHF, 58.1% were over 65 years old, 31.4% were between 45 and 64 years old, and 10.5% were between 18 and 44 years old. By classification of care, 58.1% were admitted for Class 1 care, 30.2% for Class 2, and 11.6% for Class 3. Our findings indicated that the costs of treatment for patients with moderate and severe diseases were higher as compared to those of mild severity. Patients who had a length of stay over 7 days had higher costs than the ones whose length of stay was 1 to 3 days. Furthermore, Class 2 care was associated with higher costs than Class 3 care. The analysis also revealed that an increase in the number of comorbidities and medical procedures corresponded with higher treatment costs. CONCLUSION: This study identified factors that increase the cost of treatment for patients with ADHF

Optimal treatment resolves total atrioventricular block in patient with myocardial infarction non-obstructive coronary artery: A case report

Background: Total atrioventricular block (TAVB) cause of myocardial infarction non-obstructive coronary artery (MINOCA) in the anteroseptal segment is an uncommon case. Appropriate treatment can prevent worsening and give the best outcome to the patient. Case Presentation: We present a TAVB patient with unstable hemodynamics and complains of severe chest pain. Narrowing in the LAD segment was found in the coronary angiography without any sign of atherosclerosis. The patient improved with optimal reperfusion, and TAVB resolved within 24 hours. Conclusion: Optimal treatment focused on rapid reperfusion due to vasospasm can resolve TAVB and improve clinical conditions in the patients

Transcatheter atrial septal defect closure: Focus on tips and tricks for interventional procedure in challenging cases

The ostium secundum defect is the most prevalent form of atrial septal defect (ASD). The development and refinement of devices and techniques for transcatheter ASD closure have led to its acceptance as the preferred management for most patients with secundum ASD. Meticulous planning and execution constitute the key to achieving success in a procedure. It entails a thorough assessment of the patient, beginning with selecting suitable cases, as well as detailed pre- and intraprocedural imaging, knowledge of various device deployment techniques, anticipation of potential complications, and appropriate management strategies. This review article will discuss tips and tricks to overcome the technical intricacies of achieving a successful transcatheter ASD closure and address some challenging cases associated with its use