NEW ONSET HYPERTENSION AND EARLY CHANGES IN LEFT VENTRICULAR FUNCTION IN POST COVID -19 CONDITION

Background: Post COVID19 condition occurs in individuals with a history of probable or confirmed SARS Cov2 infection, usually 3 months from the onset of COVID19 with symptoms that last for up to at least 2 months and cannot be explained by an alternative diagnosis. Common symptoms include fatigue, shortness of breath, cognitive dysfunction, but also arterial hypertension (AH) and generally have an impact on everyday function. Aim: COVID 19 pneumonia initiates new onset AH and aggravates the structural and functional myocardium remodeling in the long term after hospitalization. Methods: The study population /initially questioned 1500 patients for symptoms after acute COVID 19 pneumonia / included 220 patients without history of any disease, mean age of 45 ± 12 years, male 145 (43 ± 10 years) female 75 (52 ± 14 years). The global longitudinal strain (GLS) was extracted for left ventricle (LV) and right ventricle(RV) and AMBP analysis, mean arterial pressure (MAP)and heart rate HR were performed at baseline /30-40 days after acute infection/ 3rd and 12th months follow up. CMR was performed at 3rd (3mFU) and 12th months (12mFU) also to confirm our resulst. Results: From initial population /1500 pts/ self-reported symptoms at 12mFU are 1265 (84.6 %) and 235 /15.4 %) are symptom free at 12mFU. At 3mFU HR and MAP increased significantly / from 75 ± 6 beats /min to 88 ± 12 beats/ min, 109 ± 15 mmHg to 118 ± 19mmHg. Sys BP increased slightly at 3mFU /128 ± 14, p = 0.6/ and continue at 12mFU / 129 ± 12, p = 0.7/. Diastolic BP increased significantly at 12mFU /86 ± 12.3 to 91 ± 10.0, p > 0.01/ and AH presence at 3mFU in 143 (65%)up to 161(73%) at 12mFU. Symptoms of heart failure with preserved EF were found at 3mFU in 91 pts (41%) and in 99 pts (45%) at 12mFU. Echocardiography showed predominantly decrease of the load on the right heart at 3mFU and 12mFU (RV FAC % p < 0.019, TAPSE p < 0.05, RVOT VTI p < 0.01). LV function showd increased EDD, ESD, EDV, ESV, and decreased EF and GLS at 3mFU and slightly improvement at 12mFU. Despite normal EF, GLS / 18.5 %, p < 0.01) and segmental LS in all apical and mid anteroseptal, inferoseptal and basal anteroseptal and inferoseptal levels (16% to 18%, p < 0.01) and RV (22.3% to 24%) at 12mFU shown diminished and still preserved values. Conclusion: New onset AH is one of major symptoms after COVID 19 and remains at 12mFU. Despite of satisfactory improvement of conventional parameters for LV and RV function, GLS indicate worsening of the LV systolic function.

Life-threatening rhythm and conduction disorders by a child with MIS-C

Background and Aim: Cardiac involvement is seen in the majority of cases with multisystem inflammatory syndrome in children (MIS-C). Various rhythm and conduction disturbances, as well as repolarization abnormalities, have been described by more than 50% of the patients, while there are few cases with complete heart block or with asystole. Method(s): Case report Results: 8-year old girl presented with a 5-day history of fever, cough, headache, and abdominal pain. Because of the critical con-dition, with respiratory insufficiency and heart failure symptoms, the child was intubated and started on inotropic support. ECG showed complete AV-block with a ventricular rate of 75/min and with ST-T changes;echocardiography revealed dilated left ventricle with reduced contractility, CT-scan of the lungs showed bilateral pneumonia, the inflammatory markers were elevated, in combination with high troponin levels, and positive SARS-CoV2-IgG antibodies. The diagnosis MIS-C was made and treatment with immunoglobulins, antibiotics, corticosteroids, and anticoagulants was initiated. During the next 2 days, the cardiac function deteriorated further, and while still on mechanical ventilation and inotropic support, extreme bradycardia with a ventricular rate of 35/min was regis-tered, and the patient was indicated for temporary emergency pac-ing. Upon induction of anesthesia, the child became asystolic, requiring extensive resuscitation. After circulation recovery, the ECG showed nodal tachycardia with a heart rate of 140-170/min. A temporary transvenous pacemaker (PM) was inserted, and the patient was started on intravenous amiodarone which resulted in a slower ventricular rate of 70/min. 3 days later sinus rhythm was restored, with first-degree AV-block, which allowed removal of the PM 5 days after its insertion. Left ventricular dimensions were normalized and contractility remained low-normal (EF 56%). During the 6-month follow-up, the ECG and the Holter-monitoring showed sinus rhythm with first-degree AV-block. Magnetic resonance imaging (MRI) on day 15 of the hospital stay demonstrated scattered areas of myocarditis and ischemia predominantly in the left ventricle, as well as thickening of the basal septum. Six months later the MRI changes were reduced but still persistent. Conclusion(s): MIS-C can present with serious and life-threatening rhythm and conduction disturbances in children;this is why extensive cardiac monitoring is obligatory by all patients.

Multisystem Inflammatory Syndrome and acute myocarditis after SARSCoV-2 in Children - Case Descritpion and Review of the Literature

Symptoms of acute Covid-19 infection are less common in children than in adults. In most cases, the symptoms are mild or absent. However, after contact with SARS-CoV-2, children may develop post-infectious hyperinflammatory syndrome - multisystem inflammatory syndrome in children (Multisystem Inflammatory Syndrome in Children MIS-C). We present 6 children with MIS-C, observed in November and December 2020 during the peak incidence of Covid-19 infection in Bulgaria. Patients have a mean age of 9.7 years. Four of the children had a history of contact with Covid-19. Clinically, they presented with fever and gastrointestinal symptoms. SARSCoV2 IgM and IgG serology was positive in all patients. Troponin and pro-BNP (B-type natriuretic peptide) levels were elevated in all six children. Cardiac ultrasound revealed systolic dysfunction of the left ventricle (reduce ejection fraction) in all of them. When cardiac MRI was performed, limited areas of left ventricular myocardial edema, as well as areas of late non-ischemic gadolinium amplification involving up to 25% of the myocardium, were founded. Treatment in all patients includes a broad-spectrum antibiotic, intravenous immunoglobulin, corticosteroids, diuretic, ACE inhibitor, and low molecular weight heparin. At discharge, all patients were in good overall condition, with no signs of heart failure, normal echocardiographic findings, and laboratory tests. In children the mortality from MIS-C is not high, despite significant increase in inflammatory markers and multisystem symptoms. In our patients, the short term outcome of MIS-C is favorable. However, long-term follow-up is needed for late complications. © 2021 Academy of Medicine. All rights reserved.

Magnetic resonance imaging in monitoring of the changes in the lungs in the course of COVID-19- A clinical case

Multidetector computed tomography is the .,gold standard" for assessing lung changes in diffuse interstitial diseases, including interstitial inflammatory changes in patients with COVID-19. Computed tomography as an X-ray based method is associated with radiation exposure, which is a limiting factor for follow-up the patients over time. At this stage, it is still unclear when and whether complete recovery of lung changes occurs in patients after COVID-19. Modern magnetic resonance imaging allows detection of changes in the interstitium and, despite the lack of sufficient experience, are a promising alternative method for monitoring these patients. We present a clinical case with imaging of residual changes in the lungs with magnetic resonance imaging in a patient 45 days after the disappearance of clinical symptoms and negation of the PCR test.

COVID-19: Typical imaging findings in a RT-PCR confirmed symptomatic patient

A case of a 63-year-old female with COVID-19 pneumonia is presented, admitted at the emergency department with lower respiratory tract infection symptoms and a positive real-time RT-PCR test result. Even though the RT-PCR (real-time reverse-transcription polymerase chain reaction) test is by now the only diagnostic method with 100% specificity for the detection of SARS-CoV-2, the available scientific data clearly indicates about the important role of medical imaging procedures in the diagnostic process, in the follow-up of the disease and in the evaluation of potential long-term complications. Currently numerous studies have been published, describing the characteristic imaging findings and define criteria for the radiological suspicion. In the presented case, the imaging pattern of parenchymal lung disease, observed on the performed conventional radiography and chest CT, complies with the typical for COVID-19 pneumonia radiological signs, according to the up-to-date guidelines.

Diagnostic imaging in COVID-19 - Initial finding in Bulgaria

In the midst of the COVID-19 pandemic, the role of diagnostic imaging in the identification of patients with the disease and the evolution in individual cases is widely discussed. We share our initial experience based on 16 patients. The analysis of the imaging findings in individual patients revealed the high sensitivity of computed tomography to identify lung changes associated with COVID-19, both in the primary negative results of conventional radiographs and in the primary negative test results from the RT-RCT. Conventional radiographs play an important role mainly in the follow-up of the disease. © 2020 Izdatelstvo Medicina i Fizkultura. All rights reserved.