Introduction: The Triglycerides-Glucose Index (TyG), as a cost-effective and novel biomarker for insulin resistance, plays a pivotal role in the pathogenesis of heart disease. This study aims to assess the TyG’s capacity to predict cardiovascular risk. To investigate the correlation between the TyG and the 10-year risk of heart disease determined by the Framingham Risk Score (FRS). Materials and methods: A comprehensive study of 3,832 Indonesian participants (aged 19-65, Male 3,415). TyG Index threshold determined by ROC curve analyses. Its relationship with cardiovascular risk was assessed using the chi-square test and bivariate correlation analysis. Results: 3,832 participants (1,647 with high TyG≥8.7795, mean age 38.86). There was a significant association between TyG Index and FRS (P=0.02, sensitivity 0.53 specificity 0.57 PR 1.537). TyG-BMI and FRS (P<0.001, sensitivity 0.63, specificity 0.55, PR 2.18). METS-IR (P<0.001, sensitivity 0.59, specificity 0.55, PR 1.862), treadmill exercise test and FRS (P<0.025, sensitivity 0.07, specificity 0.96, PR 2). Bivariate correlation analysis between FRS and TyG, TyG BMI, METS-IR, SBP, heart rate, weight, waist circumference, and fasting blood glucose (P<0.001). In subgroup analyses, there was no significant correlation between TyG Index and FRS in the diabetes and hypertension groups (P=0.360, P=0.344). Conclusion: This study shows a strong connection between the Triglycerides-Glucose Index and an elevated 10-year cardiovascular disease risk as determined by Framingham Risk Score. The effectiveness of The TyG Index in predicting cardiovascular risk is affected by hypertension and diabetes.

Introduction: Fibrinolytic therapy remains a viable reperfusion strategy in STEMI patients in locations with limited facilities. However, reperfusion injury following fibrinolysis has also led to myocardial injury. One potential intervention to prevent this injury is through remote ischemic conditioning (RIC). This study aims to evaluate the effects of RIC in reducing myocardial injury in STEMI patients undergoing fibrinolysis. Materials and methods: A systematic review is conducted from PubMed and CochraneLibrary. Inclusion criteria are RCTs enrolling STEMI patients on fibrinolysis therapy. Outcome measured are difference peak troponin I/ T and CKMB levels and incidence of ST resolution (STR). Data are pooled using random effects model as odds ratio and risk of biases assessed with RoB2 tool.Results: 4 studies with a total of 849 patients are included. Peak troponin I/ T levels are lower in the intervention in two studies. Peak CKMB level is also lower in intervention group in 2 studies while one study reported vice versa result. The results from these outcome measures however cannot be pooled due to different unit of measurements. Additionally, 2 studies demonstrate a higher incidence of STR in RIC intervention group with significant OR 1.92 (1.11 – 3.33, p = 0.02 I2 = 13%). There is no substantial risk of biases. Conclusion: RIC intervention resulted in a lower peak enzymatic troponin and CKMB level and also increases the incidence of STR in STEMI population on fibrinolysis. Further studies are required to evaluate the potential of RIC in reducing major clinical outcomes.

Introduction: Ischemic thromboembolic stroke is a significant complication in patients with atrial fibrillation. Cancer will aggravate this event due to increased clot formation and thromboembolism processes but simultaneously propose high-risk bleeding for oral anticoagulation. Left Atrial Appendage Occlusion (LAAO) is an alternative strategy to prevent stroke events with promising efficacy features without the bleeding risk of anticoagulation. This systematic review and meta-analysis aimed to compare LAAO as a safety choice for ischemic stroke prevention in atrial fibrillation patients with and without cancer. Materials and methods: We conducted systematic literature searching from the database until August 2023. Studies were eligible if cohort studies performed LAAO in atrial fibrillation patients with and without cancer. A risk of bias assessment was performed using the Newcastle-Ottawa Scale (NOS). Results: Three studies met the criteria, comparing 318 patients with cancer and 544 without cancer. Among these, two were included in the meta-analysis. The pooled analysis showed no significant difference between the two groups in stroke incidence (Hazard Ratio (HR) 0.62; 95% CI 0.26−1.50; p= 0.93), bleeding episodes (HR 0.93; 95% CI 0.47−1.84; p= 0.45), and death (HR 1.34; 95% CI 0.87−2.07; p= 0.19) following the procedure. Regarding device-related complications, there was also no difference (HR: 1.3; 95% 0.81−2.08; p= 0.28). Conclusion: LAAO has safety features in atrial fibrillation patients with cancer and has no significant differences in outcome, such as stroke incidence, bleeding episodes, death, and device-related complications, compared with non-cancer patients.

Sepsis is a life-threatening organ dysfunction resulting from a dysregulated host response to infection. Septic shock, a severe subset of sepsis, must be promptly recognized and managed as a medical emergency. We present the case of a 51-year-old male who developed shock during hospitalization for infected leg ulcers, with a background of chronic heart failure (HF), hypertension, and poorly controlled type 2 diabetes mellitus. Despite his history of HF, bedside echocardiography revealed low systemic vascular resistance and preserved cardiac output, findings more consistent with septic shock than cardiogenic shock. This case underscores the pivotal role of early hemodynamic assessment, particularly with echocardiography, in accurately identifying the type of shock in patients with pre-existing HF. Differentiating the underlying etiology is essential to initiate appropriate therapy and improve clinical outcomes.

It is uncommon to have pulmonary hypertension. We describe a case of pulmonary hypertension in which the underlying etiology was determined to be hyperthyroidism. Clinical manifestations of hyperthyroidism-induced pulmonary hypertension can result in cyanosis and heart rhythm abnormalities, which are indicators of right heart failure. The 56-year-old woman in this case study complained of tightness and edema in both of her legs when she arrived at the emergency room. Upon examination, cyanosis, atrial fibrillation, and right heart failure were noted. Due to the patient's prior history of hyperthyroidism, secondary pulmonary hypertension is currently complicating the condition. In order to improve the prognosis for pulmonary hypertension, the patient's thyroid function is managed with medication while receiving treatment in the hospital.

Pulmonary atresia and ventricular septal defect (PA-VSD) with major aorto-pulmonary collaterals (MAPCAs) is a complex and extremely heterogeneous anomaly. Most untreated patients die in their first decade of life because of intractable congestive heart failure or respiratory distress. PA-VSD is characterized by a wide variety of anatomy of central pulmonary artery and nature of collateral lung perfusion. In most patients, collateral perfusion is provided either by MAPCAs or by patent ductus arteriosus (PDA). The management of infants and children with pulmonary atresia, ventricular septal defect, and MAPCAs has proven to be challenging. Therapeutic approaches include onestage surgical repair, staged unifocalization, shunting, and coiling of collateral vessels. Results have been variable and frustrating. In this case report, we discuss the characteristic, variants, and how far we can manage the patient who suffered from PA-VSD.

Rheumatic fever is the main cause of mitral stenosis worldwide. Ortner’s syndrome (cardio-vocal syndrome) is a rare complication of rheumatic mitral stenosis. It is caused by recurring paralysis of the left laryngeal nerve, mainly caused by mechanosuppression of the nerve from enlarged cardiovascular structures. A 76-year-old woman with chronic rheumatic heart disease (RHD) complained of hoarseness for 17 days, accompanied by shortness of breath, nausea, and vomiting for 1 week. Auscultatory examination revealed a loud first heart sound in the mitral region as well as an irregular rhythm. An electrocardiogram examination revealed right axis deviation and atrial fibrillation. Chest X-ray showed cardiomegaly. Despite normal left and right ventricular function, echocardiography showed severe mitral stenosis with mild mitral regurgitation. Conservative treatment was given with a combination of diuretics, beta-blockers, vitamin K antagonists, and angiotensin receptor blockers. An otolaryngologist was consulted, and the patient was treated conservatively.

Ventricular septal rupture (VSR) after acute myocardial infarction (MI) is a rare yet fatal complication. Although surgical repair is essential, the optimal timing remains controversial. We report a case of ST-Elevation Myocardial Infarction (STEMI) complicated by VSR. Fibrinolytic therapy was initially considered successful; however, the patient developed worsening dyspnoea. Further evaluation confirmed an apical VSR by echocardiography. The patient received intensive monitoring and supported with an Intra-Aortic Balloon Pump (IABP). Surgical repair was performed on day 26. Hemodynamic initially improved postoperatively, but the condition deteriorated again on the ninth day after surgery, and the patient ultimately died. This case underscores that while surgical repair is the preferred definitive treatment for VSR, the timing of intervention is critical. Proper timing requires balancing surgical risks with tissue readiness and hemodynamic stability. The interval between VSR detection and surgical repair plays a pivotal role in determining patient survival.

Pericardial effusion is the abnormal fluid accumulation in the pericardial space. This journal describes the management of massive pericardial effusion with pericardial adhesion. A 10-year-old girl with a history of failed arterial switch operation and post-ASD (atrial septal defect) closure using the pericardial patch and TVr De Vega procedure came with chest tightness. The transesophageal echocardiography showed massive pericardial effusion with collapsed right atrium and ventricle, severe tricuspid regurgitation, adhesion of cardiac apex with the pericardium. Urgent sub-xiphoid pericardiostomy was performed. Intrapericardial pigtail insertion was performed and produced 320 ml of fluid after 9 hours. The pericardial effusion may be due to severe pulmonary hypertension and pericardial injury syndrome. Open pericardiostomy should be considered if hemopericardium is suspected to prevent Pericardial Effusion.

Pulmonary Hypertension (PH) is a heterogeneous condition defined by a mean pulmonary artery pressure (mPAP) >20 mmHg at rest, confirmed via right heart catheterization. PH can be classified into several groups based on underlying mechanisms, and mixed type PH involves overlapping features from different categories. We report a case of a 49-year-old woman with a history of HIV infection and hyperthyroidism who presented with progressive shortness of breath. Transthoracic echocardiography suggested severe pulmonary hypertension, while further evaluation revealed a combination of pre-capillary and post-capillary components, consistent with mixed type PH. Contributing factors included HIV-associated pulmonary vasculopathy and hyperthyroidism-induced high-output cardiac failure. The patient was treated with intravenous Furosemide, Beraprost sodium, Spironolactone, Digoxin, Warfarin, and Omeprazole. During hospitalization, she developed distributive shock requiring norepinephrine infusion. This case highlights the importance of thorough diagnostic evaluation to identify multifactorial causes of PH, especially in patients with coexisting HIV infection and hyperthyroidism. Management strategies should be tailored to address the complex interplay of underlying conditions while considering drug interactions and local therapeutic resources.