ABSTRACT
Coronavirus disease 2019 (COVID-19) has been reported to cause cardiovascular complications such as myocardial injury, thromboembolic events, arrhythmia, and heart failure. Multiple mechanisms-some overlapping, notably the role of inflammation and IL-6-potentially underlie these complications. The reported cardiac injury may be a result of direct viral invasion of cardiomyocytes with consequent unopposed effects of angiotensin II, increased metabolic demand, immune activation, or microvascular dysfunction. Thromboembolic events have been widely reported in both the venous and arterial systems that have attracted intense interest in the underlying mechanisms. These could potentially be due to endothelial dysfunction secondary to direct viral invasion or inflammation. Additionally, thromboembolic events may also be a consequence of an attempt by the immune system to contain the infection through immunothrombosis and neutrophil extracellular traps. Cardiac arrhythmias have also been reported with a wide range of implicated contributory factors, ranging from direct viral myocardial injury, as well as other factors, including at-risk individuals with underlying inherited arrhythmia syndromes. Heart failure may also occur as a progression from cardiac injury, precipitation secondary to the initiation or withdrawal of certain drugs, or the accumulation of des-Arg9-bradykinin (DABK) with excessive induction of pro-inflammatory G protein coupled receptor B1 (BK1). The presenting cardiovascular symptoms include chest pain, dyspnoea, and palpitations. There is currently intense interest in vaccine-induced thrombosis and in the treatment of Long COVID since many patients who have survived COVID-19 describe persisting health problems. This review will summarise the proposed physiological mechanisms of COVID-19-associated cardiovascular complications. Copyright © 2022, Anka Publishers. All rights reserved.
ABSTRACT
Coronavirus disease 2019 (COVID-19) has been reported to cause cardiovascular complications such as myocardial injury, thromboembolic events, arrhythmia, and heart failure. Multiple mechanisms-some overlapping, notably the role of inflammation and IL-6-potentially underlie these complications. The reported cardiac injury may be a result of direct viral invasion of cardiomyocytes with consequent unopposed effects of angiotensin II, increased metabolic demand, immune activation, or microvascular dysfunction. Thromboembolic events have been widely reported in both the venous and arterial systems that have attracted intense interest in the underlying mechanisms. These could potentially be due to endothelial dysfunction secondary to direct viral invasion or inflammation. Additionally, thromboembolic events may also be a consequence of an attempt by the immune system to contain the infection through immunothrombosis and neutrophil extracellular traps. Cardiac arrhythmias have also been reported with a wide range of implicated contributory factors, ranging from direct viral myocardial injury, as well as other factors, including at-risk individuals with underlying inherited arrhythmia syndromes. Heart failure may also occur as a progression from cardiac injury, precipitation secondary to the initiation or withdrawal of certain drugs, or the accumulation of des-Arg9-bradykinin (DABK) with excessive induction of pro-inflammatory G protein coupled receptor B1 (BK1). The presenting cardiovascular symptoms include chest pain, dyspnoea, and palpitations. There is currently intense interest in vaccine-induced thrombosis and in the treatment of Long COVID since many patients who have survived COVID-19 describe persisting health problems. This review will summarise the proposed physiological mechanisms of COVID-19-associated cardiovascular complications. Copyright © 2022, Anka Publishers. All rights reserved.
ABSTRACT
SESSION TITLE: Critical Cardiovascular Disorders SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 10:15 am - 11:10 am INTRODUCTION: Hemorrhagic shock is a life-threatening condition in which severe blood loss results in cellular and tissue hypoxia. The bleeding can be external or internal. Internal bleeding to one of the body cavities;retroperitoneum, as well as the proximal thigh. Diagnosing nontraumatic bleeding can be challenging and needs a high index of clinical suspension. Here we present a case of hemorrhagic shock secondary to spontaneous lumbar artery rupture causing retroperitoneal bleeding. CASE PRESENTATION: Here we present a 73-year-old male patient with a history of renal cell carcinoma metastatic to the lungs and stage 3 chronic kidney disease (CKD), who presented with confusion, one day after he tested positive for covid after he had a fever and flu-like symptoms for about 4 days. On admission, he was hemodynamically stable and saturating well on ambient air. Head computed tomography (CT) scan and Chest radiograph were negative for acute insults. On the day after admission, his mental status deteriorated, developed acute hypoxic respiratory failure requiring 4 liters of oxygen per minute, tachycardia, and skin mottling over his hands and feet. Labs revealed elevated serum D-dimer. He was started on full-dose anticoagulation with Enoxaparin, and a CT angiogram of the chest was done and revealed new multifocal infiltrates consistent with COVID pneumonia but no pulmonary embolism. He was treated started on IV antibiotics, in addition to Remdesivir and hydrocortisone were started. On the fourth day of admission, he collapsed suddenly and became profoundly hypotensive. Repeat labs revealed a significant hemoglobin drop from 12 to 7.5 g/dl, and creatinine went up to 2.8 mg/dl. An emergent CT of the abdomen revealed an acute retroperitoneal hematoma with active extravasation. After adequate resuscitation and vasopressor support, an aortic angiogram was done showing lumbar artery bleeding requiring embolization, which was done, however, he remained hypotensive and went into cardiac arrest with failed resuscitation. DISCUSSION: Spontaneous lumbar artery rupture is a rare entity (1). Most of the reported cases had chronic kidney disease and were receiving anticoagulation (2,3). It can result in retroperitoneal hematoma, which can present with abdominal pain, hemodynamic instability, and nonspecific symptoms. Abdomen pelvis CT scan with contrast is needed to evaluate for the presence of retroperitoneal hematoma. In addition to resuscitation with fluid and blood products, urgent angiography is needed to confirm the bleeding site and to control it (e.g. embolization). CONCLUSIONS: Spontaneous Lumbar artery rupture should be considered in patients with chronic kidney disease and/or on anticoagulation who are in shock without obvious cause. It's a life threatening condition that needs immediate recognition. Reference #1: Kim JY, Lee SA, Hwang JJ, Park JB, Park SW, Kim YH, et al. Spontaneous lumbar artery rupture and massive retroperitoneal hematoma, successfully treated with arteriographic embolization. Pak J Med Sci. 2019;35(2):569-574. doi: https://doi.org/10.12669/pjms.35.2.639 (Literature review) Reference #2: Hwang NK, Rhee H, Kim IY, et al. Three cases of spontaneous lumbar artery rupture in hemodialysis patients. Hemodial Int 2017;21: E18-21 Reference #3: Sun, PL., Lee, YC. & Chiu, KC. Retroperitoneal hemorrhage caused by enoxaparin-induced spontaneous lumbar artery bleeding and treated by transcatheter arterial embolization: a case report. Cases Journal 2, 9375 (2009). https://doi.org/10.1186/1757-1626-2-9375 DISCLOSURES: No relevant relationships by Mohamad Al-Momani No relevant relationships by Rami Dalbah No relevant relationships by Mohammad Darweesh No relevant relationships by Ratib Mahfouz No relevant relationships by nizar obeidat No relevant relationships by Ahmad Othman
ABSTRACT
Introduction: Lebanon received its first batch of Pfizer-BioNTech vaccines on February 13, 2021 to launch a free nationwide vaccination campaign led by the Ministry of Public Health. The country has suffered an increase in cases and fatalities after the Beirut explosion in August 4, 2021. Objectives: We analyzed the efficacy of vaccination on preventing COVID-19 among staff at the American University of Beirut Medical Center (AUBMC). Methods: The COVID-19 vaccination campaign started in different centers including AUBMC on February 14, 2021. Two doses of vaccine were administered at 3 weeks interval. Infection Control (IC) Program and Employee Health Unit (EHU) continued to raise awareness and investigate COVID-19 infections among staff. Positivity of cases is confirmed by antigen and/or PCR testing. Results: Till May 26, 2021, Lebanon reported 538,991 COVID cases (8% of population) and 7,690 deaths. While at AUBMC, a total of 1,133 (29%) staff developed COVID-19. To date, 8.6% of the population received the first dose of the vaccine, and 4.5% received the second dose. Eighty five percent of the hospital staff received the first dose and 80% received the second dose. The trend depicting COVID-19 cases at AUBMC followed the one observed in Lebanon. Following the end of year's celebrations an increase of cases was observed at AUBMC and in Lebanon during January. Inversely, we observed a decrease in the number of positive cases in May 2021 nationwide and at AUBMC. Conclusion: The trend in COVID-19 cases declined at the national level starting April 2021 similar to our trend. The decline at AUBMC was more pronounced most likely because of the rapidity of the immunization as most of the workforce was vaccinated within 4 weeks. The spread of the virus in Lebanon decreased due to vaccination and the natural immunization secondary to the infection. IC practices, mandatory masking, hand hygiene, and physical distancing, remain instrumental in halting COVID- 19 transmissions in the community in view of the slow vaccination rollout in Lebanon. (Figure Presented).