Poor Outcome of Right Bundle Branch Block Coexist with ST-Elevation Myocardial Infarction

BACKGROUND: The incidence of new-onset right bundle branch block (RBBB) coexistence with ST-elevation myocardial infarction (STEMI) has been associated with higher in-hospital mortality compared with those without RBBB.CASES: We present three cases of new-onset RBBB coexist with STEMI. Case I: a 64 years old male presented Killip I STEMI inferior-anterior with RBBB as new-onset. Rescue percutaneous coronary intervention (PCI) after failed thrombolytic was performed. New-onset atrial fibrillation (AF) with rapid ventricular response worsened his hemodynamic profile, leading to cardiogenic shock. Case II: an 80 years old male presented Killip IV late-onset anterior STEMI with new-onset RBBB. Cardiogenic shock got worsened after PCI stent. Case III: a 65 years old male presented Killip II extensive anterior STEMI with new-onset RBBB who underwent a primary PCI stent. Recurrent ventricular tachycardia (VT), worsening cardiogenic shock, and transient AV block occurred after PCI. The right bundle branch blood supply is mainly provided by a septal branch of left descending artery (LAD). Therefore, it may indicate proximal LAD occlusion and extensive infarction. Thus, catastrophic events may occur, which including acute heart failure, AV block, malignant ventricular arrhythmia, new-onset AF, and mostly cardiogenic shock, despite initiate reperfusion was performed without delay once the diagnosis is confirmed.  CONCLUSION: New RBBB suggests poor short-term prognosis due to its complication. Higher mortality is mostly linked to worsening cardiogenic shock

Pengaruh Pemberian Platelet Rich Plasma (Prp) Terhadap Diferensiasi Adipose-Derived Mesenchymal Stem Cell (Amscs) Menjadi Sel Kardiomiosit

Latar Belakang : Pasien paska infark miokard disertai gagal jantung akan berkembang menjadi kardiomiopati iskemik bila tidak mendapat terapi yang adjuvant. Meskipun berbagai tindakan telah diterapkan pada praktek klinis dan mencapai efek kuratif, prognosis yang buruk dan bersifat irreversible masih dilaporkan di negara berkembang. Tantangan terapi saat ini adalah ketidakmampuan jantung untuk melakukan self-regeneration. Kardiomiopati iskemik merupakan keadaan yang cocok untuk menjadi target terapi stem cell. Adipocyte-derived mesenchymal stem cells (AMSCs) sebagai sumber stem cell memiliki potensi yang sama dengan bone marrow-derived MSCs (BMSCs). Platelet-rich plasma (PRP) merupakan gel platelet autologous kaya akan faktor pertumbuhan yang mempunyai efek regulator terhadap MSCs. Sehingga dapat dikatakan PRP dapat meningkatkan proses diferensiasi menjadi sel kardiomiosit. Tujuan : Untuk menganalisis pengaruh pemberian PRP terhadap diferensiasi AMSCs menjadi sel kardiomiosit serta membandingkang dengan kelompok tanpa pemberian PRP. Metode : Penelitian ini merupakan true experimental randomized post-test design study. Sel AMSCs diisolasi dari jaringan adiposa dan dikultur hingga pasase 4. Karakteristik AMSCs dinilai secara flowcytometry pada CD 34-, 45-, dan CD 105+. Sampel kemudian dibagi menjadi 3 kelompok yaitu kelompok negatif (α- MEM), kontrol positif (madium diferensiasi), dan perlakuan (PRP). Penilaian ekspresi marker GATA-4 dilakukan secara Flow Cytometry pada hari ke-5 dan cTnT dilakukan secara imunositokimia pada hari-10 untuk mengetahui keberhasilan diferensiasi menjadi sel kardiomiosit. Analisis data dilakukan dengan menggunakan uji T-test dan One Way Anova pada data yang terdistribusi normal menggunakan uji Shapiro Wilk. Hasil : Flow Cytometry pada ekspresi GATA-4 menunjukkan peningkatan yang bermakna pada kelompok PRP dibandingkan kelompok kontrol negatif dan kontrol positif (67.04 ± 4.49 vs 58.15 ± 1.23 p<0.05; 67.04 ± 4.49 vs 52.96 ± 2.02 p<0.05). Hal ini didukung dengan hasil imunositokimia pada ekspresi troponin menunjukkan peningkatan yang bermakna pada kelompok PRP dibandingkan kelompok kontrol negatif dan kontrol positif (38.13 ± 5.2 vs 10.73 ± 2.39 p<0.05; 38.13 ± 5.2 vs 26.00 ± 0.4 p<0.05). Hal ini sesuai dengan hipotesis penelitian yang menyatakan terdapat pengaruh pemberian PRP terhadap diferensiasi AMSCs menjadi sel kardiomiosit. Kesimpulan : Pemberian PRP pada kultur AMSCs secara signifikan meningkatkan diferensiasi menjadi sel kardiomiosit dengan ekspresi GATA-4 dan cTnT

Anomalous Coronary Artery Presented with Typical Chest Pain: What is Defi ne The Malignant from Benign Anomalous Coronary Artery (A Case Series)

Background: Congenital coronary anomalies (CCA) are the important causes of morbidity and mortality associated with angina or SCD. CCA divided into two groups, depending on the origin and course of the coronary artery. Malignant CCA comprises arteries with ectopic origin from the contralateral side of the heart followed by an inter-arterial course. Case summary: We presented two distinct characteristics of coronary anomalies with typical chest pain presentation. Both patients had a normal physical examination and no ischemia sign. Coronary CT-angiography showed a malignant type of right anomalous coronary artery from the opposite sinus (R-ACAOS) with an inter-arterial course in case 1. A napkin-ring sign mixed plaque single vessel disease following benign type LCx originating from right coronary sinus anomaly found in case 2. Both patients have different mechanisms causing angina presentation, but both are at high risk of fatal cardiac events. A higher acute coronary syndrome risk and sudden cardiac death were found in patients with the napkin-ring sign, which in case 2 were possibly caused by acute take-off angle features. These supported the term “malignant” caused by inter-arterial course features but followed by several other features. Conclusions: ACAOS is a rare congenital abnormality and not clinically signifi cant, but some have potentially severe symptoms. From the case presented, we could learn that some abnormalities could redefi ne the terms malignantly even in the so-called benign ACAOS. Surgery could be performed besides OMT in reducing the risk of fatal cardiac events and SCD