Atrial Septal Defect secundum with inferior floppy rim in the elderly: surgical closure or transcatheter closure? A case report.

Atrial Septal Defect closure in childhood and early adulthood has a good prognosis, but in older individuals the risk-benefit ratio is not as straightforward. We report a 57-year-old man who was easily fatigued when exercising. The cardiac examination revealed a wide and fixed splitting of S2, a pulmonary ejection systolic murmur grade III/VI, and increased jugular venous pressure. The transesophageal echocardiography showed Atrial Septal Defect secundum with a diameter of 20 mm, L-to-R shunt, and 5 mm, a thin and floppy inferior rim. The patient underwent surgical Atrial Septal Defect closure. The deficient posteroinferior rim occurs only in 3.3% of patients with secundum Atrial Septal Defect. This condition will enhance the likelihood of occluder dislodgement in the transcatheter closure approach. We learn from this case that surgical Atrial Septal Defect closure may be an option for elderly patients if there is an inadequate, thin, and floppy inferior rim or no comorbidities.

ECG abnormality and predictor of new-onset atrial fibrillation in hypertension and diabetes mellitus population: An observational analytic study from cardiovascular outpatient clinic at a National Cardiovascular Center in Indonesia.

Background: Population-based studies have also found that diabetes mellitus (DM) and hypertension (HT) are independent risk factors for atrial fibrillation (AF). However, less is known about new-onset atrial fibrillation (NOAF) risk factors and its correlation with DM and HT. The aim of this study was to determine the prevalence and pattern of ECG abnormalities, and the predictor of NOAF in patients with HT and DM. Methods: This cross-sectional study was conducted at a tertiary hospital from May until December 2021. All medical record data from outpatients who had both diagnoses HT and DM were included in this study. Data from patients with unstable hemodynamics and lack of complete medical record data were excluded. Then, patient history, medical records, ECG, and laboratory information were reviewed. Results: There were 162 patients included in this study. Arrhythmia was found in 14.2% of the population, with new-onset AF (NOAF) as the most common finding with 8.6% incidence, followed by PVC (3.1%) and PAC (2.5%). Bivariate analysis showed that valvular heart disease, random blood glucose, LVEF, and infection status were associated with a higher incidence of NOA. Model from multivariate logistic regression showed that valvular heart disease and random blood glucose level were independently correlated with NOAF (p = .009). Conclusion: It can be concluded that random blood glucose level at a certain point and valvular heart disease can be used as a risk predictor of NOAF in the hypertension population with concomitant DM.

Impact of the virtual anti-hypertensive educational campaign towards knowledge, attitude, and practice of hypertension management during the COVID-19 pandemic.

BACKGROUND: One of the efforts to reduce hypertension rates in the community is through an educational campaign that refers to the NIH's National Heart, Lung, and Blood Institute curricula or abbreviated as NHLBI. However, during the coronavirus disease 2019 (COVID-19) pandemic, one of the hardest hit areas is health promotion, and there is a significant obstacle regarding the most effective way to transfer knowledge, attitude and practice towards society without transmitting the virus. AIM: To evaluate the impact of the virtual anti-hypertensive educational campaign towards knowledge, attitude, and the practice of hypertension management in the primary care setting during the COVID-19 pandemic. METHODS: An online action research with a randomized crossover-controlled trial using a pretest-posttest control group design. The study was conducted in October 2020-April 2021. The population in this study were patients with hypertension who were treated in the Mojo primary health care setting. A purposive sampling technique was done to receive 110 participants using an online questionnaire and invitation letter. RESULTS: A total of 110 participants were included in the analysis, 55 in the intervention group and 55 in the control group. Following the Virtual Anti-Hypertensive Educational Campaign implementation, the only parameter that showed significant improvement was knowledge and attitude (P < 0.001). There is no significant change in the practice parameters (P = 0.131). CONCLUSION: The Virtual Anti-Hypertensive Educational Campaign implementation in our study population seems to be effective to improve knowledge and attitude of participants, nevertheless, this program seems to be ineffective to improve the practice of hypertension management aspect in participants. Future study with longer durations and more comprehensive programs need to be done to scrutinize the clinical impact of this program nationwide.