Wide QRS Complex Transient Pattern in a Patient With Severe COVID-19.

This case report describes a patient in their 60s with shortness of breath who tested positive for COVID-19.

Social Vulnerability and Location of Death in Heart Failure in the United States.

Majority of patients with heart failure (HF) die in either nursing homes or inpatient facilities. Social vulnerability captures multiple domains of socioeconomic position and has been linked with higher HF mortality. We sought to investigate the trends in location of death in patients with HF and its association with social vulnerability. We utilized the multiple cause of death files from the United States (1999-2021) to identify decedents with HF as the underlying cause of death and linked them with county-level social vulnerability index (SVI) available from CDC/ATSDR database. Approximately 1.7 million HF deaths were examined across 3003 United States counties. Most patients (63%) died in a nursing home or inpatient facility, followed by home (28%), and only 4% died in hospice. Death at home had a positive correlation with higher SVI with Pearson's r = 0.26 (P < 0.001) as well as deaths in an inpatient facility r = 0.33 (P < 0.001). Death in a nursing home correlated negatively with SVI with r = -0.46 (P < 0.001). There was no association between hospice utilization and SVI. Locations of death were varied by geographic residence. More patients died at home during the COVID-19 pandemic (OR 1.39, P < 0.001). Social vulnerability was associated with location of death in patients with HF in the US. These associations varied by geographic location. Future studies should focus on social determinants of health and end-of-life care in HF.

A report of 2 cases of the use of the Inari FlowTriever System in the treatment of pulmonary embolism.

The FlowTriever System (Inari Medical, Irvine, California) is the first FDA-approved mechanical thrombectomy device used for treatment of pulmonary embolism. This device enables nonsurgical removal of pulmonary blood clots without the use of thrombolytic medication and its associated risks. We report 2 cases of successful application of the Inari FlowTriever in treatment of pulmonary embolism and right atrial thrombus.

Challenges in managing ST elevation myocardial infarction during the COVID-19 pandemic.

BACKGROUND: Coronavirus disease 2019 (COVID-19) may contribute to delayed presentations of acute myocardial infarction. Delayed presentation with late reperfusion is often associated with an increased risk of mechanical complications and adverse outcomes. Inherent delays are possible as every patient who is acutely sick is being considered a potential case or a career of COVID-19. Also, standardized personal protective equipment precautions are established for all members of the team, regardless of pending COVID-19 testing which might further add to delays. AIM: To compare performance measures and clinical outcomes of all patients who presented to our facility with ST elevation myocardial infarction (STEMI) during the COVID-19 pandemic to same time cohort from 2019. METHODS: All patients who presented to our facility with STEMI during the pandemic were compared to a matched cohort during the same time period in 2019. STEMI with unknown time of symptom onset and inpatient STEMI patients were excluded. Primary outcome was major adverse cardiac events (MACE) in-hospital and up to 14 d after STEMI, including death, myocardial infarction, cardiac arrest, or stroke. Significant differences among groups for continuous variables were tested through ANOVA, using SYSTAT, version 13. Chi-square tests of association were used to compare patient characteristics among groups using SYSTAT. Relative risk scores and associated tests for significance were calculated for discrete variables using MedCalc (MedCalc Software, Ostend, Belgium). RESULTS: There was a significantly longer time interval from symptom onset to first medical contact (FMC) in the COVID-19 group (P < 0.02). Time to first electrocardiogram, door-to-balloon time, and FMC to balloon time were not significantly affected. The right coronary artery was the most common culprit for STEMI in both the cohorts. Over 60% of patients had one or more obstructive (> 50%) lesion(s) remote from the culprit site. In-hospital and 14 d MACE were more prevalent in the COVID-19 group (P < 0.01 and P < 0.001). CONCLUSION: This single academic center study in the United States suggests that there is a delay in patients with STEMI seeking medical attention during the COVID-19 pandemic which could be translating into worse clinical outcomes.