Chronic limb ischemia (CLI) is a type of peripheral arterial disease (PAD) that is still underdiagnosed and undertreated despite the increasing incidence, thus becoming a global health burden. And CLI reflects the local manifestations of a lethal systemic disease — atherosclerosis. If left untreated, chronic limb ischemia can result in major limb loss. In this pandemic era, limb ischemia has become one of several clinical manifestations that occur in patients with COVID-19 infection. Systemic inflammation in COVID-19 infection, direct viral infection, hypercoagulable state, and hyperinflammatory response are responsible for damage to the arterial system, causing endothelial dysfunction. Diagnosing PAD has become a challenge especially in the early stage and in the asymptomatic phase. The untreated condition could lead to the development of CLI. The primary physicians in the primary health facilities hold an important role in the early diagnosis and management of patients with CLI symptoms or with risk factors of CLI, especially in patients who have experienced COVID-19 infection. Due to the limitation of diagnostic testing modalities at primary health facilities, the physician can assess the ankle-brachial index (ABI) to determine the presence of CLI. Management of the disease is different for every patient and is customized based on the other comorbidities. Risk factors should be controlled in order to achieve a better outcome. A good management strategy will improve the quality of life of the patient. This review will discuss the occurrence of CLI in COVID-19 infection.
Arrhythmia is one of the significant reversible causes in patients with heart disease and left ventricular dysfunction. Tachycardia, atrial fibrillation, and premature ventricular contractions have indeed been related to arrhythmia-induced cardiomyopathy (CM), a reversible dilated CM. Effective arrhythmia suppression will entirely or partially recover ventricular function, lowering morbidity and mortality. However, the importance of arrhythmia-induced CM (ARiCM) is often underestimated in clinical practice because arrhythmia is often seen as a result rather than a cause of CM, leading in treatment delays and failure to increase the quality of life and better clinical outcomes. This article review aims to summarize the pathomechanisms, and a general approach to the management of ARiCM and its long-term outcomes. ARiCM can cause a variety of clinical signs, ranging from asymptomatic to severe heart failure symptoms. Electrocardiogram, 24 h Holter monitoring, echocardiography, and cardiac magnetic resonance are all recommended for diagnosis. More research is required to better understand the pathogenesis of ARiCM and to differentiate treatment alternatives to choose the ideal ARiCM management approach.
Cardiology services have been affected by the COVID-19 pandemic. The consequences of the disease on cardiology services have not been studied in Indonesia, especially in the second year of this pandemic, as the surge in infections is currently declining. It is necessary to quantify the impact of the COVID-19 pandemic on cardiology services to evaluate whether or not cardiac services have returned to normal during this second year of the pandemic. The basis of research used in this study is a survey using a Google Form application. The technique to determine the research subjects carried out in this study is non-random sampling with the Purposive Sampling technique.One hundred and fifty-seven subjects were included in this study, with the majority gender of men (61.1%) as a clinical cardiologist (50.3%). Data were collected from several provinces in Indonesia from Jakarta to West Nusa Tenggara, with National Cardiovascular Center Harapan Kita as a majority hospital (n=15, 9.55%). There were generally sustained reductions in all aspects of cardiology service. However, the number of outpatients who underwent cardiac device implantation procedures did not increase. Telemedicine has been applied to 52.9% in the hospital where the subject works, yet the proportion of patients receiving telemedicine are less than 25%. During the second year of the COVID-19 pandemic, cardiology services need to establish new strategies to aid people with cardiovascular disease. More research is also needed in order to improve the efficacy of telemedicine in the future. Keywords: Hospital Cardiology Service, Telemedicine, COVID-19 Pandemic
A permanent pacemaker (PPM) is currently the definitive treatment for patients with a total atrioventricular block (TAVB). The number of pacemaker implantation has been increasing every year. However, PPM implantation increases the risk of developing left ventricular (LV) dysfunction and becoming pacemaker-induced cardiomyopathy (PICM). There has never been a published study on the cellular mechanism of LV dysfunction caused by PPM implantation. The mechanism of pacemaker-induced left ventricular dysfunction (PILVD) study is a multi-center, quasi-experimental, etiognostic study with a time-series design. This etiognostic study aims to investigate the mechanism of cellular level changes in TAVB patients who had PPM implanted. In particular, the difference in serum miR-155 levels and plasma levels of IL-6, sTNFR-2, MMP-9, N-Cad, and ZO-1 in TAVB patients had LV dysfunction caused by right ventricular dysfunction septal PPM implantation measured by global longitudinal strain (GLS) obtained from echocardiography. Blood samples and echocardiographic examinations will be performed on patients who satisfied the inclusion criteria prior to pacemaker implantation, one month after, and three months following pacemaker implantation. The ELISA method will be used to assess IL-6, sTNFR-2, MMP-9, ZO-1, and N-Cad from plasma samples. MiR-155 levels in serum will be determined using the reverse-transcriptase polymerase chain reaction (RT-PCR) technique. The main findings are a decrease in serum miR-155 levels and increased plasma IL-6, sTNFR-2, MMP-9, N-Cad, and ZO-1 levels in TAVB patients who developed LV dysfunction due to right ventricular septal pacemaker implantation measured by GLS at 1 and 3 months.
Background: Myocardial work (MW) is a novel imaging modality that has emerged as a potential left ventricular (LV) function assessment in various clinical settings. MW calculates speckle-tracking echocardiography strain curves with an estimated LV pressure curve by non-invasively utilizing standard brachial blood pressure curves. Objective: This study aimed to provide a summary of current knowledge of non-invasive MW and its clinical applications, including in heart failure, coronary artery disease, cardiomyopathy, and hypertension. In addition, the limitations, and recommendations of MW in clinical practice are discussed. Methods: We searched the PubMed database using the following keywords: (myocardial constructive work) OR (wasted septal work) OR (global myocardial work) OR (myocardial work) OR (myocardial constructive work) OR (novel echocardiography). We further subjected 12 studies to full-text review and included them in this systematic review. Results: While MW indices, particularly global work index and global constructed work, have shown good correlations with ejection fraction (EF) and strain parameters, the opportunity of offering incremental information that is unaffected by loading conditions has made MW application particularly useful in a variety of clinical settings. Conclusion: Compared to EF and global longitudinal strain, MW is a promising test with higher sensitivity and accuracy for identifying individuals with cardiovascular disease. Clinicians should also evaluate symptoms and electrocardiographic findings until extensive multicenter studies validating this strategy are performed to establish the incremental value of MW in daily echocardiographic assessments.
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