The Past, Present, and Future of Myocardial Revascularization

One of the important diagnostic modalities in cardiology is cardiac catheterization, which is onetool for myocardial revascularization. This examination is particularly useful in the aspect ofcardiac hemodynamic evaluation, among other utilities. This review describes the advance ofcardiac catheterization from the beginning of its discovery to future development

Role of Non-Vitamin K Oral Anticoagulants for Prevention of Stroke in Renal Impaired Atrial Fibrillation Patients

Atrial fibrillation (AF) and chronic kidney disease (CKD) are highly prevalent, particularly with increasing of age and associated comorbidities, such as hypertension, diabetes, heart failure, and vascular disease. The relationship between AF and CKD seems to be bidirectional. CKD predisposes to AF while onset of AF seems to lead to progression of CKD. Stroke prevention is the cornerstone of AF management, and AF patients with CKD are at higher risk of stroke, mortality, cardiac events, and bleeding. Stroke prevention requires use of oral anticoagulants, which are either vitamin K antagonists (e.g. warfarin), or the non-vitamin K antagonist oral anticoagulants (NOAC). While NOAC have been shown to be effective in mild-to-moderate renal dysfunction, there are a paucity of data regarding NOAC in severe and end-stage renal dysfunction. The followingwill discuss the evidence for NOAC in CKD, and summarize the current knowledge regarding the efficacy and safety of NOAC to prevent AF-related stroke and systemic embolism in severe and end-stage renal disease

Navigating Your Acute Heart Failure Patient in Emergency and Pre-Discharge Phase

Heart failure (HF) leads to frequent hospitalizations. The presence of re-hospitalization risk among patientshospitalized for heart failure is important, especially hemodynamic instability and neurohormonal over activation. ARNI is needed to restore the balance of neurohormonal system in HF. PARADIGM-HF study provide insight on long term benefit of ARNI (i.e. sacubitril/valsartan) in ambulatory setting. How is the evidence of ARNI use for in hospitalization phase of HF? PIONEER and TRANSITION showed that initiation of sacubitril/valsartan shortly after an ADHF event is feasible and well tolerated. In-hospital initiation of sacubitril/valsartan is associated with early and sustained improvements in biomarkers of cardiac wall stress and myocardial injury, indicating pathophysiological benefits in a wide range of HFrEF patients

Mean Platelet Volume as a Predictor of Atherosclerotic Severity in Non ST Elevation Acute Myocardial Infarction

Background: Acute myocardial infarction (AMI) is the leading cause of death in the world. AMI is classified into ST-elevation myocardial infarction (STEMI) and Non-ST elevation myocardial infarction (NSTEMI). Diagnosis and prediction of severity of atherosclerotic in NSTEMI is a challenge. Despite the risk stratification, 14-20% of patients that undergo coronary angiography have normal or non significant coronary artery disease. The role of platelet and the extent of atherotrombosis in patients with NSTEMI are interesting field of research. Mean platelet volume (MPV) reflects platelet size and reactivity. It can be used as a diagnostic marker and may have predictive value. This study aims to prove the role of MPV as a predictor of the degree of atherosclerotic based on Syntax score in patients with NSTEMI undergoing coronary angiography.Methods: This is a cross sectional study enrolled 86 subjects with NSTEMI. Blood samples were taken at the time of admission to the hospital. An MPV was measured by automated machine. Subsequent coronary angiography was performed using standardized method. Syntax score was determined to reflect the atherosclerotic severity. Statistical analysis was used to assess whether an MPV as a predictor of atherosclerotic severity based on Syntax score.Results: The chi-square analysis showed that high MPV could not be used as a predictor of the atherosclerotic severity based on Syntax score in NSTEMI patients (p value =0.5, prevalence ratio 1.15 (95% CI: 0.755-1.753). From multivariate analysis, only smoking factor had an independent relationship with Syntax score (p value =0.047; Odds ratio 2.531(95% CI: 1.012-6.328).Conclusions: High MPV cannot be used as a predictor of atherosclerotic severity based on Syntax score in NSTEMI patients

Non-ST elevation of acute myocardial infarction caused by probable acute stent thrombosis after drug eluting stent implantation: a case report

Nowadays, one of the modalities in performing reperfusion in coronary artery disease ispercutaneous coronary intervention. Before drug eluting stent era, the problem that occurs themost among interventional cardiologists is restenosis. After drug eluting stent era, restenosiscan be reduced significantly. Unfortunately, it further develops another problem, that is calledstent thrombosis. Mechanism of stent thrombosis is related to vascular response, thrombosis,coagulation, and clinical factors. Based on our experience, non-ST elevation acute myocardialinfarction is caused by probable acute stent thrombosis after drug eluting stent implantation.Therefore, the prevention and therapeutic approaches should be put first in our priority becauseit can provide a serious complication

Distal embolization durante percutaneous coronary intervention: a case report

Distal embolization is an acute complication of percutaneous coronary intervention (PCI). Distal embolization of plaque and thrombus material is considered as a major cause of insufficient reperfusion despite a fully patent infarct-related artery, apart from ischemic microvascular damage and reperfusion induced regional inflammatory responses. In a recent study, angiographic evidence of distal embolization was associated with an 8-fold increase in 5-year mortality. We reported on our experience with distal embolization durante PCI which lead the patient developed ST-Elevation Myocardial Infarct (STEMI) inferior and posterior accompanied with severe chest pain and was treated in the Intesive Coronary Care Unit (lCCU). Distal embolization is the case that we should be put into our awareness because it can worse the after procedural outcome

29-Years Old Woman Presenting with ST Elevation Myocardial Infarction

Myocardial infarction in young female is rare condition, but carries significant morbidity and mortality. The recognition management for MI in young female is challenging due to its unspecific clinical presentation and lack of guidance in the current guidelines. We reported a 29-years old woman presenting with infarction type chest pain, showing ST- elevation in the inferior leads with total AVblock as complication. The risk factors in this patient were smoking, family history, cardiomyopathy, and preeclampsia history. The cause for myocardial infarction in this patient was atherosclerotic plaque rupture, but we did not manage to performed coronary intervention due to her low ventricular function and unavailability data for myocardial viability at the time of hospitalization

Surgical and Non Surgical Interventions in Adult Congenital Heart Disease: Our Experience from COHARD registry

Surgical and Non Surgical Interventions in Adult Congenital Heart Disease:Our Experience from COHARD registr

C O R R E L AT I O N S B E T W E E N S E R U M L E V E L O F M AT R I X METALLOPROTEINASE-9 (MMP-9) AND SERUM LEVEL OF TROPONIN-I IN PATIENT WITH ACUTE CORONARY SYNDROME (ACS)

Background: The pathophysiology of acute coronary syndromes (ACS) is now accepted as the rupture or erosion of an atherosclerotic plaque, which initially occurs at the shoulder of the plaque and is followed by intra-plaque thrombosis then spread to the vascular lumen and cause total partial vascular occlusion. MMP-9 is an extracellular matrix degrading enzyme that plays a crucial role in the breakdown of the fibrous cap of plaque and subsequent rupture in the pathogenesis of ACS. Cardiac troponins are currently the most sensitive and specific biochemical markers of myocytes necrosis. Objective: To know the correlation between serum level MMP-9 and serum level of Troponin-I in patients with ACS Method: Study design was cross sectional. Data were collected by consecutive sampling from patients in ICCU ward of RSUP Dr. Sardjito General Hospital, Yogyakarta, from June 2008-August 2010. A questionnaire was used to collect information from patient. After admission, peripheral venous blood was drawn once and measured concentration of serum level of MMP-9 and Troponin-I before definitive thrombolysis. Data were expressed as means ± standard deviation (SD). Correlation between serum level of MMP-9 and serum level of Troponin-I were assessed using Spearman\u27s rank correlations test. A value of

Distal embolization durante percutaneous coronary intervention: a case report

Distal embolization is an acute complication of percutaneous coronary intervention (PCI). Distal embolization ofplaque and thrombus material is considered as a major cause of insufficient reperfusion despite a fully patent infarctrelatedartery, apart from ischemic microvascular damage and reperfusion-induced regional inflammatory responses.In a recent study, angiographic evidence of distal embolization was associated with an 8-fold increase in 5-yearmortality.We reported on our experience with distal embolization durante PCI which lead the patient developed STElevationMyocardial Infarct (STEMI) inferior and posterior accompanied with severe chest pain and was treated inthe Intesive Coronary Care Unit (ICCU). Distal embolization is the case that we should be put into our awarenessbecause it can worse the after procedural outcome.Key words: distal embolization-percutaneous coronary intervention-insufficient reperfusion- myocardial ischemiaangiographi