Pulmonary Hypertension in Adult Congenital Heart Disease: From Registry to Policy

Pulmonary Hypertension in Adult Congenital Heart Disease: From Registry to Polic

Sympathetic Overdrive in Hypertension, The Role of Beta Blocker, Focus on Bisoprolol

Sympathetic neural factors played an important role in homeostatic blood pressure control. Dysregulation in sympathetic function may favor the development and progression of the hypertensive state. Beta-blocker, as one of antihypertensive drugs, provides several positive effects to hinder overactivity of sympathetic nerve in patients with hypertension

The Shared Pathogenesis of Pulmonary Artery Hypertension

Pulmonary artery hypertension is defined as an increased in pulmonary artery pressureexceeding 25 mmHg with normal pulmonary wedge pressure. The pathogenesis of pulmonaryartery hypertension involves interaction among vascular, cellular and biomarker componentsin the pulmonary tissue; with eventual result is elevated pulmonary artery pressure. Vascularcomponents are remodeling of intimal, medial and adventitial layers. Cellular components areplayed by apoptosis-resistant endothelial cells, proliferative-prone pulmonary artery smoothmuscle cells, fibroblasts and inflammatory cells. The functional biomarkers are produced andmediated by these cellular changes, mainly endothelin-1, thromboxane, serotonin, nitric oxide,and prostacyclin. The pulmonary vascular remodeling in pulmonary artery hypertension arediverse and may present in various severity based on underlying etiology. Understanding theshared pathogenesis in pulmonary artery hypertension is of paramount importance in order toimprove the disease management and treatment approach

Association Between Mean Platelet Volume (MPV) with Major Adverse Cardiovascular Events in Acute Coronary Syndrome during Hospitalization

Background: Platelets play a central role in the pathogenesis of acute coronary syndrome with various clinical manifestations of unstable angina pectoris, myocardial infarction with ST segment elevation, and myocardial infarction without ST segment elevation. Mean platelet volume (MPV), the average size of platelets in blood obtained from routine blood tests, reflects the activation of platelets. Previous study revealed that higher MPV showed a higher thrombotic potential, by increasing the platelet activation, secretion of tromboxan A2 and the expression of glycoprotein Ib and IIb/IIIa receptors. This study aims to determine whether the MPV may predict the major cardiovascular events in patients with acute coronary syndrome.Metode: We perform a retrospective cohort study involving 372 patients with acute coroanry syndrome who admitted to Intensive Cardiac Care Unit Dr. Sardjito Hospital Yogyakarta. The research is conducted between January 2009 to January 2011, comprising 180 (48.3%) STEMI patients, 87 (23.3%)NSTEMI patients and 105 (28.4%) unastable angina patients. Subjects are further grouped as those with high MPV and low MPV. MPV measurement is obtained on routine blood tests of those patients.The major adverse cardiovascular events are cardiovascular death, non fatal reinfarction, stroke, acute heart failure and cardiogenic shock.Result: Cut-off value of MPV in this study is 8.85 fL determined with ROC curve analysis. The major adverse cardiovascular events is significantly higher in those with MPV >8.85 fL compared with those with the MPV ≤8.85 fL (incidence: 28.4% vs. 18.9%, p = 0.034), with the relative risk (RR) 1.65, 95% CI 1.037-2.783. The mean MPV in patients with major adverse cardiovascular events was significantly higher as compared to those without major adverse cardiovascular events (9.506 ± 1.76 fl vs.8.96 ± 1.45 fl, p = 0.001).Conclusion: Mean platelet volume (MPV) are associated with major adverse cardiovascular events in acute coronary syndrome. The high MPV may be considered as a predictor of major cardiovascular events in patients with acute coronary syndrome.Keywords: acute coronary syndrome, mean platelet volume, major adverse cardiovascular events

Atrial Arrhythmia in Atrial Septal Defect Patient: A Case Report and Review of Literature

Atrial fibrillation (AF) and atrial flutter are the most common cardiac arrhythmias associated with atrial septal defects (ASD) in adult patients. The incidence could be as high as 52% in patients ages 60 years or more.Patient with congenital heart disease who developed atrial arrhythmias had a >50% increased stroke risk. Nevertheless, studies regarding the pathophysiological mechanism underlying the high incidence of atrial fibrillation in adult patients with ASD remain relatively few. We reported a female 46 years referred to Sardjito hospital with chest discomfort and palpitation. ECG showed atrial flutter, 90 beat per minute, incomplete RBBB, RAD and RVH. Transthoracal echocardiography shown ASD left to right shunt with diameter 1.2 -1.8 cm, LA, RA and RV dilatation, with normal systolic function. From right heart catetherization, the result is ASD High Flow Low Resistance, with pulmonary hypertension (mPAP 44 mmHg).The consequences of left to right shunt across an ASD is RV volume overload and pulmonary overcirculation. Atrial arrhytmia are a common result of long standing right side heart volume and pressure overload. The idea of combining ASD closure and arrhythmia intervention is another approach to consider

Scoring system based on electrocardiogram features to predict the type of heart failure in patients with chronic heart failure

ABSTRACT Heart failure is divided into heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Additional studies are required to distinguish between these two types of HF. A previous study showed that HFrEF is less likely when ECG findings are normal. This study aims to create a scoring system based on ECG findings that will predict the type of HF. We performed a cross-sectional study analyzing ECG and echocardiographic data from 110 subjects. HFrEF was defined as an ejection fraction ≤40%. Fifty people were diagnosed with HFpEF and 60 people suffered from HFrEF. Multiple logistic regression analysis revealed certain ECG variables that were independent predictors of HFrEF i.e., LAH, QRS duration >100 ms, RBBB, ST-T segment changes and prolongation of the QT interval. Based on ROC curve analysis, we obtained a score for HFpEF of -1 to +3, while HFrEF had a score of +4 to +6 with 76% sensitivity, 96% specificity, 95% positive predictive value, an 80% negative predictive value and an accuracy of 86%. The scoring system derived from this study, including the presence or absence of LAH, QRS duration >100 ms, RBBB, ST-T segment changes and prolongation of the QT interval can be used to predict the type of HF with satisfactory sensitivity and specificit

Clinical cardiac manifestations in patients with coronavirus disease 2019 (COVID-19)

The pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected more than 2 million people worldwide with case fatality rates between 3-15%. The pathophysiology of this newly emerging disease in affecting cardiovascular system is poorly understood. This review aimed to understand from various retrospective studies and case reports that have been published and updated during the pandemic of COVID-19 related to the underlying mechanism and cardiovascular interaction with coronavirus. A literature search was done with Google search, PubMed, European Society of Cardiology (ESC) and Journal of American Medical Association (JAMA) network since the early days of COVID-19 pandemic. Clinical presentation may be asymptomatic or the severe cases will have acute respiratory distress syndrome (ARDS). Protein spikes of SARS-CoV-2 virus use the angiotensin-converting enzyme 2 (ACE2) as viral entry to host cells. Due to the upregulation of ACE2, people with any pre-existing cardiac diseases are more vulnerable to the infection and more likely to have a severe condition of COVID-19 infection with a higher risk of mortality. On the other hand, ACE2 has protective effects against myocardial inflammation and lung injuries. Several cases of COVID-19 infection may have cardiac manifestations as a chief complaint or acute cardiac injury as the complication. Recent case reports show that acute cardiac injury, myocarditis, cardiogenic shock, thromboembolism, and arrhythmias could be the complications of COVID-19 even without history or risk factors of cardiovascular disease. There are several hypotheses related to the mechanism of acute cardiac injury in COVID-19 patients, including damage through ACE2 receptors, hypoxia, cardiac microvascular damage, and inflammatory response.COVID-19 infection can cause many interactions in the cardiovascular system, whether the patients already had chronic heart disease or not. Considering the lack of evidence of the RAS inhibitor in COVID-19, the use of ACE inhibitor/ARB should be continued unless contraindicated and may be beneficial in patients with hypertension, heart failure and diabetes mellitus. Early recognition of cardiac manifestations from COVID-19 infections will be the key to prevent short and long term cardiac adverse events

Recurrent Hemoptysis in Patient with Primary Pulmonary Hypertension – A Case Report and Literature Review

Pulmonary hypertension (PH) is defned as an increase in mean pulmonary arterial pressure (mPAP) ≥ 25 mmHg at rest as assessed by right heart catheterization (RHC). The symptoms of PH are non-specifc and mainly related to progressive right ventricular (RV) dysfunction. In some patients the clinical presentation may be related to mechanical complications of PH andthe abnormal distribution of blood flow in the pulmonary vascular bed, include hemoptysis related to rupture of hypertrophied bronchial arteries. Hemoptysis is a serious complication that is rarely reported in patients with pulmonary arterial hypertension (PAH). Hemoptysis severity ranges from mild to very severe leading tosudden death. Hemoptysis are reported to be a terminal stage ofa complication due to PAH with prevalence is variable, from 1% to 6%. Although the incidence is quite rare, the presence of recurrent hemoptysis in patients with pulmonary hypertension is a sign of poor prognosis. Bronchial artery embolization is suggested as an acute emergency procedure in the case of severe hemoptysis or as elective intervention in cases of frequent mild or moderate episodes.

Pemeriksaan Trans Esophageal Echocardiografi (TEE)

Perkembangan Trans Esophageal Echocardiografi (TEE) merupakan penemuan besar dalam sejarah pencitraan jantung. TEE adalah cara pendekatan pencitraan jantung dengan menggunakan sebuah transducer khusus yang ddiletakkan pada esopha-gus dengan cara dimasukkan melalui mulut pasien. Transducer khusus tadi dengan frekuensi berkisar 5-7 M?z, pada ujung gastroskop yang ditempatkan dari arah kerongkongan atau esophagus. Pendekatan ini menghasilkan pencitraan interior dari struktur jantung yang lebih sempurna oleh karena haantaran suara ultra dari dank etransducer TEE terhindar dari bayangan dinding dada atau jaringaan paru

Isolated Persistent Left Superior Vena Cava, Role of Echocardiography Screening and CT angiography

Background: An isolated persistent left SVC with concomittant agenesis of right SVC in adult patients is a very rare abnormality. Physician should consider it particularly in patients, in which venous acces will be performed. Our rare case deals with the importance of detailed echocardiographic examination with screening of coronary sinus dilatation before the electrophysiology study.Case: A 65-year-old woman came to outpatient clinic for a chief complaint of palpitations. Her ECG showed paroxysmal SVT with WPW syndrome. She underwent echocardiography examination before electrophysiology study and it was found that she had a dilated coronary sinus. Therefore we performed cardiac CT. It was found that she had a persistent left superior vena cava (SVC) and an absence of a right SVC with no other congenital anomaly.Conclusion: A comprehensive echocardiography examination to look for a dilation of coronary sinus is a first suggestion to screen this anomaly, eventually followed by echocardiography with agitated saline injection and/or computed tomography can help physician to anticipate the anomaly before the invasive procedure involving the thoracic vein.Keywords: echocardiography, cardiac CT angiography, vascular malformation, superiorvena cav