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All Journal Heart Science Journal
Fahmy Rusnanta
Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Brawijaya
Health Professions Immunology & microbiology Medicine & Pharmacology

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The Prothrombotic Predominance in Metabolic Syndrome: A Complex Patomechanism Fahmy Rusnanta; Mohammmad Saifur Rohman
Heart Science Journal Vol 2, No 4 (2021): Management of Thrombosis in Covid-19 Patient with Cardiovascular Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.04.2

Abstract

Patients with metabolic syndrome (MS) have many cardiovascular complications related to atherothrombotic complications. MS contributes premature atherosclerosis, increase platelet activation, promote coagulation factors, and reduce fibrinolytic activity. The last step in the atherotrombotic cascade is blood clot formation, and altered clot structure is a key role to determine cardiovascular complications. This review discusses imbalance of hemostasis and eludicate their role of increased propensity to CVD. The correlation of MS and fibrinolysis is reviewed and complex mechanisms that promote coagulation are discussed. Understanding these effects on hemostasis pathway helps to build more effective treatment and preventive strategies to diminish the complication in this condition. 
Right-Sided Heart Failure Presentation in Severe Valvular Aortic Stenosis: How to Deal with Diuretic Use? Fahmy Rusnanta; Cholid Tri Tjahjono; Anna Fuji Rahimah; Heny Martini
Heart Science Journal Vol 2, No 1 (2021): How to Diagnose Heart Failure and Deal with The Treatment Complexity
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.01.07

Abstract

BACKGROUND: Patients with right-sided heart failure and severe aortic stenosis (AS) have many clinical challenges to overcome fluid retention. Typical diuretic therapeutic approach can be recommended for the guidance of removing fluid overload in severe AS with right ventricular (RV) failure. The aim of this case review is to understand how to assess and manage  RHF and severe AS. CASE SUMMARY: A 65-year-old female with worsening bilateral leg swelling and she aware of shortness of breath for 3 months. Physical examination revealed a grade 3/6 ejection systolic murmur at the aortic area radiating to the neck, a grade 2/6 diastolic murmur at the pulmonic area, and  a grade 3/6 systolic murmur at the apex radiating to the axilla, increased jugular venous pressure, prominent bilateral leg swelling, and minimal rhonci at the base of the lungs. The chest X-ray showed worsening cardiomegaly in the last 3 months. Echocardiography revealed high gradient severe valvular AS, decreased systolic RV function, and other valvular dysfunctions including moderate mitral regurgitation, moderate pulmonary regurgitation, and mild tricuspid regurgitation. She was introduced high dose furosemide infusion. The average urine output production was 5 L/day and negative fluid balance was 3 L/day. Furosemide dose was adjusted daily according to urine output production and she was discharged after 6 days hospitalization. DISCUSSION:  This case report provides an example of RV failure in severe AS patient. Hemodynamic monitoring and typical approach of diuretic therapies should be needed in the management of fluid overload in severe AS. KEYWORDS: right-sided heart failure, severe aortic stenosis, diuretic.
Co-Authors Anna Fuji Rahimah Cholid Tri Tjahjono Heny Martini Mohammmad Saifur Rohman