ABSTRACT
Since the beginning of the COVID-19 (Coronavirus Disease of 2019) pandemic, myocarditis has received much attention and controversy as one of the more worrisome cardiovascular complications. After the availability of highly effective COVID-19 mRNA vaccines in late 2020, myocarditis was also appreciated as an important vaccine-related adverse event. Though the overall frequency of clinically evident viral myocarditis is rare in the general population, young males show a higher predilection for COVID vaccine-induced myocarditis. The severity of COVID-19 viral myocarditis is variable, ranging from very mild to severe, while vaccine-induced myocarditis is usually mild, and rarely a severe or fatal disease. The diagnosis of either COVID-19 or vaccine-induced myocarditis is based on typical clinical features, laboratory investigations, and imaging, preferably with cardiac magnetic resonance. The management of COVID-19 myocarditis is supportive care for mild or moderate disease. For the rare patient who develops severe disease, advanced heart failure therapies such as mechanical circulatory support devices may have to be employed and can be lifesaving. Avoidance of strenuous exercise during the bout of myocarditis and its recovery phase is important. Despite the small but finite risk of vaccine-induced myocarditis, the benefits of protection against COVID-19 disease and its attendant complications far outweigh the risks.
Subject(s)
COVID-19 , Myocarditis , Vaccines , Male , Humans , Myocarditis/etiology , Myocarditis/therapy , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , SARS-CoV-2ABSTRACT
The coronavirus disease 2019 (COVID-19) presents with variable clinical syndromes, from asymptomatic disease to acute respiratory failure. Complications such as acute respiratory distress syndrome (ARDS), secondary infection, acute cardiac injury, liver failure, renal failure, coagulable disorders and in many cases, death have been recognized. Venous thromboembolism (VTE) was found to be present in up to one-third of critically ill COVID-19 patients. Our case demonstrated a patient with COVID-19 who developed a massive pulmonary embolism leading to cardiac arrest, despite having an initial normal D-dimer level, normal chest imaging, and while maintained on appropriate VTE prophylaxis during hospitalization.
Subject(s)
Anticoagulants , Aspirin , Biomarkers, Pharmacological/blood , COVID-19 Drug Treatment , COVID-19 , Heparin , Point-of-Care Testing/statistics & numerical data , Thrombelastography/methods , Black or African American/statistics & numerical data , Anticoagulants/administration & dosage , Anticoagulants/pharmacokinetics , Aspirin/administration & dosage , Aspirin/pharmacokinetics , Biological Availability , COVID-19/blood , COVID-19/diagnosis , COVID-19/physiopathology , Female , Hemostasis/drug effects , Hemostasis/physiology , Heparin/administration & dosage , Heparin/pharmacokinetics , Humans , Male , Middle Aged , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/pharmacokinetics , Platelet Function Tests/methods , Platelet Function Tests/statistics & numerical data , SARS-CoV-2 , United States/epidemiologyABSTRACT
BACKGROUND: As the pandemic of coronavirus disease 2019 (COVID-19) continues, prognostic markers are now being identified. The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are easily accessible values that have been known to correlate with inflammation and prognosis in several conditions. We used the available data to identify the association of NLR and PLR with the severity of COVID-19. METHODS: A literature search using EMBASE, MEDLINE, and Google Scholar for studies reporting the use of NLR and PLR in COVID-19 published until April 28, 2020, was performed. Random effects meta-analysis was done to estimate standard mean difference (SMD) of NLR and PLR values with 95% confidence interval (CI) between severe and non-severe COVID-19 cases. RESULTS: A total of 20 studies with 3,508 patients were included. Nineteen studies reported NLR values, while five studies reported PLR values between severe and non-severe COVID-19 patients. Higher levels of NLR (SMD: 2.80, 95% CI: 2.12 - 3.48, P < 0.00001) and PLR (SMD: 1.82, 95% CI: 1.03 - 2.61, P < 0.00001)) were seen in patients with severe disease compared to non-severe disease. CONCLUSIONS: NLR and PLR can be used as independent prognostic markers of disease severity in COVID-19.