Indonesian Journal of Cardiology <p><strong>Indonesian Journal of Cardiology (IJC)&nbsp;</strong>is a peer-reviewed and open-access journal established by Indonesian Heart Association (IHA)/<em>Perhimpunan Dokter Spesialis Kardiovaskular Indonesia (PERKI)</em>&nbsp;[] on the year 1979. This journal is published to meet the needs of physicians and other health professionals for scientific articles in the cardiovascular field. All articles (research, case report, review article, and others) should be original and has never been published in any magazine/journal. Prior to publication, every manuscript will be subjected to double-blind review by peer-reviewers. We consider articles on all aspects of the cardiovascular system including clinical, translational, epidemiological, and basic studies.</p> <p>Subjects suitable for publication include but are not limited to the following fields:</p> <ul> <li class="show">Acute Cardiovascular Care</li> <li class="show">Arrhythmia / Cardiac Electrophysiology</li> <li class="show">Cardiovascular Imaging</li> <li class="show">Cardiovascular Pharmacotherapy</li> <li class="show">Cardiovascular Public Health Policy</li> <li class="show">Cardiovascular Rehabilitation</li> <li class="show">Cardiovascular Research</li> <li class="show">General Cardiology</li> <li class="show">Heart Failure</li> <li class="show">Hypertension</li> <li class="show">Interventional Cardiology</li> <li class="show">Pediatric Cardiology</li> <li class="show">Preventive Cardiology</li> <li class="show">Vascular Medicine</li> </ul> <p>All articles published in the Indonesian journal of Cardiology are indexed in:</p> <ul> <li class="show">BASE</li> <li class="show">CiteFactor</li> <li class="show">CNKI</li> <li class="show">Crossref</li> <li class="show">DOAJ</li> <li class="show">GARUDA</li> <li class="show">Hinari</li> <li class="show">Embase</li> <li class="show">Google Scholar</li> <li class="show">WorldCat</li> </ul> The Indonesian Heart Association en-US Indonesian Journal of Cardiology 0126-3773 <p>Authors who publish with this journal agree to the following terms:<br><br></p> <ol type="a"> <ul> <li class="show">Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a <a href="" target="_new">Creative Commons Attribution License</a> that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.</li> </ul> </ol> <ol type="a"> <ul> <li class="show">Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.</li> </ul> </ol> <ol type="a"> <ul> <li class="show">Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See <a href="" target="_new">The Effect of Open Access</a>).</li> </ul> </ol> Echocardiography Detection of High-Risk Patent Foramen Ovale Morphology <p>Patent Foramen Ovale occurs in 25% of the general population<a href="#_ENREF_1"><sup>1</sup></a>. Several studies suggested that paradoxical embolism through a patent foramen ovale (PFO) correlate with cryptogenic strokes (CS). Many epidemiological and clinical observational studies, showed the association between CS and the presence of PFO.&nbsp; There is still a controversy whether PFO should be closed.&nbsp;The information about PFO morphology might be useful for the management of PFO. This article is discussing a technical information about how echocardiography detects PFO and identifies high risk morphologies for the occurrence of PFO related -stroke.</p> Amiliana M Soesanto ##submission.copyrightStatement## 2021-09-16 2021-09-16 42 3 10.30701/ijc.1098 Patent Foramen Ovale Implying Paradoxical Embolism as a New Insight in Cryptogenic Stroke <p>Cerebrovascular thromboembolism is responsible annually for 510.000 ischaemic stroke in the united states alone. PFO mechanism as a paradoxical embolism transit from right to left-sided chambers to intracranial vessels has a tremendous impact in neurological deficits. The aggressive treatment started since 2016 when the US Food and Drug Administration (FDA) approved the Amplatzer PFO occluder for recurrent stroke prevention of cryptogenic stroke with PFO. The trials show positive results since 2017 and the collaboration and partnership between neurologist and cardiologist are more needed to build a holistic and comprehensive treatment for cryptogenic stroke patient with PFO.&nbsp;</p> Indah Aprianti Putri ##submission.copyrightStatement## 2021-09-16 2021-09-16 42 3 10.30701/ijc.1152 Patent Foramen Ovale Closure Procedure <p>Patent foramen ovale is strongly associated with cryptogenic stroke. Various<br>clinical trials has shown the association between cryptogenic stroke and<br>incidence of undelrying patent foramen ovale, these trials also shown the<br>decrease of cryptogenic stroke incidence with the treatment of patent<br>foramen ovale Lesion. In the absence of absolute contraindications, patients<br>with patent foramen ovale are advised to undergo closure. Preprocedural<br>examinations such as trans esophageal echocardiography and pretreatment<br>with anticoagulants are required to prevent peri and postprocedural adverse<br>events. Currently, patent foramen ovale Closure can be done through a<br>percutaneous access with minimal risk. Treatment of patent foramen ovale<br>can help decrease future incidences of strokes</p> Arwin Saleh Mangkuanom Doni Firman ##submission.copyrightStatement## 2021-09-16 2021-09-16 42 3 10.30701/ijc.1131 Cryptogenic Stroke: Cardiac Rhythm Monitoring as An Indispensable Screening Modality <p>The prevalence of stroke in Indonesia increased overtime. CS ranges from 15 to 40% from all ischemic strokes. Finding the etiology of ischemic stroke is important to prevent recurrence. AF is predicted as the etiology behind CS. The current recommendation only supports short period of ECG monitoring. However, studies have shown that a higher detection rate can be achieved with longer duration of monitoring. ICM, a diagnostic tool with the highest detection rate, is still considered cost-effective when the calculation takes into account the QALY gained. Digital health tools such as handheld devices and smartwatch ECG have revolutionized the screening of AF however it is still considered as pre-diagnostic and verification is needed to confirm the rhythm generated.</p> Sunu Budhi Raharjo Sarah Humaira Lies Dina Liastuti ##submission.copyrightStatement## 2021-09-16 2021-09-16 42 3 10.30701/ijc.1143 Cryptogenic Stroke: A Challenge in Diagnosis and Management <p>Ischemic stroke is responsible for 85% of all stroke globally. However, the etiology of around a quarter of ischemic stroke are undetermined, this is called cryptogenic stroke. This kind of stroke affects younger population. Several mechanism are associated with the incidence of cryptogenic stroke such as paroxysmal atrial fibrillation, patent foramen ovale, atherosclerosis, and atrial cardiopathy. Despite many advanced knowledge on stroke generally, cryptogenic stroke is still a challenge in clinical settings. To understand more about cryptogenic stroke, a new term of embolic strokes of undetermined source (ESUS) is proposed and may need a specific workup. Specific workup aims to detect any silent risk factors and also to evaluate the cardiac structure. The term of ESUS also leads to the understanding that cryptogenic stroke is highly related to embolic mechanism and anticoagulation administration might benefit the patients. However, the result of several recent studies showed that anticoagulant was not superior to antiplatelet, and antiplatelet is still the preferred treatment. Studies on PFO closure also shows different result, but the majority of the trials showed benefit of PFO closure in reducing the risk of stroke recurrence.</p> Sidhi Laksono Purwowiyoto Budhi Setianto Gea Panindhita Reynaldo Halomoan I Nyoman Wiryawan ##submission.copyrightStatement## 2021-09-16 2021-09-16 42 3 10.30701/ijc.1149 Patent Foramen Ovale and Cryptogenic Stroke: Challenges in Diagnosis and Management <p><span style="font-weight: 400;">A patent foramen ovale (PFO) is a common disorder that affects between 20-34% of the adult population. This condition is a benign finding for most people. However, In some the PFO can open widely and enabling paradoxical embolism to transit from venous to arterial circulation, which is associated with stroke and systemic embolization. There are still unclear to date regarding the effectiveness of pharmacological anticoagulant therapy, defined as antithrombin or antiplatelet therapy, which has proven to be more beneficial for patients with PFO and cryptogenic stroke. In addition, surgical and transcutaneous PFO closure has been proposed for secondary prevention of stroke in patients with cryptogenic stroke with PFO. Both catheter-based and surgical modes of closure have been shown to reduce the incidence of subsequent embolism substantially. This review will discuss the evidence regarding the relationship between PFO and cryptogenic stroke and decision making for management strategies.</span></p> Dhanang Ali Yafi Azmi Azmi ##submission.copyrightStatement## 2021-09-16 2021-09-16 42 3 10.30701/ijc.1144 A Case Series Coexistence of PFO with Other Conditions - Who’s the Culprit? <p><strong>Abstract</strong>.&nbsp;</p> <ul> <li class="show"><strong>Background</strong>: Patent foramen ovale (PFO) is a major cause of cryptogenic stroke (CS). However, it is still possible that PFO comes with those other conditions during evaluation. This paper presents a series of CS cases highly suspected due to PFO origin with each of its special presentations.</li> </ul> <ul> <li class="show"><strong>Case illustration/summary of a review article: </strong>We present three cases of CS with PFO as a possible contributing factor. Case 1 showed a patient with repeated ischemic strokes that was investigated to be cryptogenic in origin. Case 2 showed CS with PFO and occult atrial fibrillation. Case 3 showed CS at a young age caused by a PFO with protein C/S deficiency.</li> </ul> <ul> <li class="show"><strong>Conclusion:</strong> The role of PFO as a culprit, risk factor, or a coincidental finding in CS is still debatable and is a controversial issue. Determining PFO as a cause of CS requires a thorough consideration of clinical and PFO anatomical/morphological factors.</li> </ul> Dessytha Nathania Hudaja Aurea Stella Soetjipto Queen Sugih Ariyani Michael Soesanto Ingrid Maria Pardede ##submission.copyrightStatement## 2021-09-16 2021-09-16 42 3 10.30701/ijc.1155