Coronary artery perforation (CAP) after percutaneous coronary intervention is a rare, but potentially life-threatening complication. The source of the bleeding is usually from one of the coronary arteries. In the era of chronic total occlusion technique, retrograde approach strategy sometimes is performed using collateral channels. When CAP occurs distal from the collateral channel, the source of bleeding can be from dual arteries, i.e., main and contra-lateral artery. Therefore, management of this bleeding should be intended to close the channel from both the arteries. We have successfully performed an emergent microcoil embolization in a patient with uncontrolled Ellis grade III perforation resulting cardiac tamponade which need pericardiocentesis. The perforation was sealed with the use of cutting the distal part of spring guidewire deployed at the septal collateral channel and fibered microcoil embolization deployed at the distal part of the other vessel. During 1 month follow-up, the patient was found to be well. In conclusion, CAP may result from two source of bleeding and should be kept into consideration. We successfully stopped the bleeding using the combination of fibered microcoil and tip of the spring guidewire.

Acute coronary syndrome (ACS) in young adults is a rare entity, yet it occurs. We present a case of a man 25 years old with no history of certain diseases, suddenly come up with ST elevation myocardial infarct. Young patients have different risk factors, clinical features and prognosis as compared to elderly patients. The diagnosis of ACS is also often overlooked in this subset of population. Furthermore, it constitutes an important problem because of the devastating effect of this disease on the more active lifestyle of young adults. This case report was an attempt to look for the risk factors most prevalent in young patients and its management prior and during the hospital stay.

Cardiovascular disease is a major cause of heart failure and premature deaths worldwide. It contributes substantially to the increase in health care costs. 1 The previous study showed 48% of deaths in the world were caused by cardiovascular disease. A cohort study at the Harapan Kita National Heart Center and 5 hospitals in Indonesia suggested that the death rate due to heart disease in the hospital was around 6-12% and the re-hospitalization rate was 29%. 2 Hidayat et al. reported that the total cost of INA-CBG claim for in-patient services for 18 months was Rp 42.4 triliun. 3 Up to now, the therapy for stable coronary artery disease was medical treatment in accordance with the recommendation, because it was proven to improve symptoms and prognosis unless progression of worsening occurred should be sent for revascularization. Revascularization either with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) is more effective in treating angina, reducing of anti-angina drugs need, improving exercise capacity, and quality of life, compared to medical treatment strategies alone. 4 After revascularization procedures, the coronary artery disease (CAD) patients recommended to perform in hospital base followed by community based cardiac rehabilitation.

Background : Atherosclerosis is the pivotal role in cardiovascular disease (CVD) involving oxidative stress dan inflammation. Garcia Mangostana has been proven to have an antioxidant property for years; however, the application of this compound in the case of atherosclerosis has not been performed. Objectives : This study was performed to explore the role of α-Mangostin of Garcia Mangostana Pericarp Extract as an antioxidant to inhibit atherosclerotic process in patients with high-risk Framingham score. Methods : This prospective cohort study was conducted in patients with high-risk Framingham score. The patients were divided into two groups. The first group was administered 2520 mg/day of Garcinia mangostana Linn extracts (GMLE) in 3 divided doses for 90 days. The second group was administered a placebo. The outcome measures in our study were Nitric Oxide (NO), Superoxide Dismutase (SOD), and Malondialdehyde (MDA). They were measured at baseline and 90 days after treatment. The independent T-test was performed to assess the homogeneity of data, and the multiple logistic regression was used to assess the association. Results: Among the 77 subjects, we found that the plasma MDA concentration was significantly decreased compared with placebo 0,29±0.5 vs -0.04±0.25, respectively p = 0.011). SOD level significantly decreased in GMLE patients compared with placebo (0,17±0.79 vs -0.27±0.67, respectively, p=0.010) and we found that there was slightly increased of nitric oxide (NO), but no significantly compared with placebo 4.34±10.01 and 2.35±7.39, respectively, p = 0.37). Conclusion: Garcinia mangostana pericarp extract has an antioxidant effect that significantly inhibits atherosclero- sis process in high-risk Framingham score patients.

Acute decompensated heart failure (ADHF) continues to be the leading cause of hospitalization and has a poor prognosis. Loop diuretic had been long used as cornerstone therapy for congestion and volume overload. However, several factors including diuretic resistance and declining renal function reduced the loop diuretic's effectiveness, necessitating a different treatment strategy. In ADHF, ultrafiltration (UF) could be a promising method to volume management. UF appears to be more effective at removing fluid than diuretics, according to several studies, with better quality of life and lower rehospitalization. This review highlights the current state of knowledge regarding the use of diuretics and UF in ADHF patients, as well as the challenges and questions raised associated with each approach.