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1.
International Journal of Angiology ; 2022.
Article in English | Web of Science | ID: covidwho-2016948

ABSTRACT

This is a case of acute coronavirus disease 2019 pneumonia that revealed an incidental large atrial myxoma with obstructive physiology that ultimately required emergent treatment with a definitive atriotomy and resection of the underlying myxoma.

2.
Critical Care Medicine ; 50:38-38, 2022.
Article in English | Academic Search Complete | ID: covidwho-1597787

ABSTRACT

Fulminant myocarditis occurs quickly and leads to severe heart failure or circulatory failure, with 50-70% mortality rates. B Introduction: b COVID-19 is known to be a cause of myocarditis, both in the acute phase and as part of the delayed multisystem inflammatory syndrome in adults (MIS-A). [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

3.
J Am Heart Assoc ; 10(16): e020255, 2021 08 17.
Article in English | MEDLINE | ID: covidwho-1356988

ABSTRACT

Background The acuity and magnitude of the first wave of the COVID-19 epidemic in New York mandated a drastic change in healthcare access and delivery of care. Methods and Results We retrospectively studied patients admitted with an acute cardiovascular syndrome as their principal diagnosis to 13 hospitals across Northwell Health during March 11 through May 26, 2020 (first COVID-19 epidemic wave) and the same period in 2019. Three thousand sixteen patients (242 COVID-19 positive) were admitted for an acute cardiovascular syndrome during the first COVID-19 wave compared with 9422 patients 1 year prior (decrease of 68.0%, P<0.001). During this time, patients with cardiovascular disease presented later to the hospital (360 versus 120 minutes for acute myocardial infarction), underwent fewer procedures (34.6% versus 45.6%, P<0.001), were less likely to be treated in an intensive care unit setting (8.7% versus 10.8%, P<0.001), and had a longer hospital stay (2.91 [1.71-6.05] versus 2.87 [1.82-4.95] days, P=0.033). Inpatient cardiovascular mortality during the first epidemic outbreak increased by 111.1% (3.8 versus 1.8, P<0.001) and was not related to COVID-19-related admissions, all cause in-hospital mortality, or incidence of out-of-hospital cardiac deaths in New York. Admission during the first COVID-19 surge along with age and positive COVID-19 test independently predicted mortality for cardiovascular admissions (odds ratios, 1.30, 1.05, and 5.09, respectively, P<0.0001). Conclusions A lower rate and later presentation of patients with cardiovascular pathology, coupled with deviation from common clinical practice mandated by the first wave of the COVID-19 pandemic, might have accounted for higher in-hospital cardiovascular mortality during that period.


Subject(s)
COVID-19 , Cardiovascular Diseases/mortality , Hospital Mortality/trends , Hospitalization , Inpatients , Adult , Aged , Aged, 80 and over , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/therapy , Female , Humans , Male , Middle Aged , New York City/epidemiology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Young Adult
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7.
Catheter Cardiovasc Interv ; 96(2): 336-345, 2020 08.
Article in English | MEDLINE | ID: covidwho-730300

ABSTRACT

The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 has resulted in a new and lethal disease termed coronavirus disease 2019 (COVID-19). Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with this novel coronavirus. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. Cardiovascular manifestations of COVID-19 are complex with patients presenting with AMI, myocarditis simulating an ST-elevation myocardial infarction (STEMI) presentation, stress cardiomyopathy, non-ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury, and the prevalence of COVID-19 disease in the US population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on (a) varied clinical presentations; (b) appropriate personal protection equipment (PPE) for health care workers; (c) the roles of the emergency department, emergency medical system, and the cardiac catheterization laboratory (CCL); and (4) regional STEMI systems of care. During the COVID-19 pandemic, primary percutaneous coronary intervention (PCI) remains the standard of care for STEMI patients at PCI-capable hospitals when it can be provided in a timely manner, with an expert team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI-capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option.


Subject(s)
Betacoronavirus , Cardiology , Consensus , Coronary Angiography , Coronavirus Infections/complications , Myocardial Infarction/therapy , Percutaneous Coronary Intervention/methods , Pneumonia, Viral/complications , COVID-19 , Coronavirus Infections/epidemiology , Disease Management , Electrocardiography , Humans , Incidence , Myocardial Infarction/complications , Myocardial Infarction/diagnosis , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Societies, Medical , Survival Rate/trends , United States/epidemiology
8.
Am J Cardiol ; 138: 100-106, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-856425

ABSTRACT

Elevations in troponin levels have been shown to predict mortality in patients with coronavirus disease 2019 (COVID-19). The role of inflammation in myocardial injury remains unclear. We sought to determine the association of elevated troponin with mortality in a large, ethnically diverse population of patients hospitalized with COVID-19, and to determine the association of elevated inflammatory markers with increased troponin levels. We reviewed all patients admitted at our health system with COVID-19 from March 1 to April 27, 2020, who had a troponin assessment within 48 hours of admission. We used logistic regression to calculate odds ratios (ORs) for mortality during hospitalization, controlling for demographics, co-morbidities, and markers of inflammation. Of 11,159 patients hospitalized with COVID-19, 6,247 had a troponin assessment within 48 hours. Of these, 4,426 (71%) patients had normal, 919 (15%) had mildly elevated, and 902 (14%) had severely elevated troponin. Acute phase and inflammatory markers were significantly elevated in patients with mildly and severely elevated troponin compared with normal troponin. Patients with elevated troponin had significantly increased odds of death for mildly elevated compared with normal troponin (adjusted OR, 2.06; 95% confidence interval, 1.68 to 2.53; p < 0.001) and for severely elevated compared with normal troponin (OR, 4.51; 95% confidence interval, 3.66 to 5.54; p < 0.001) independently of elevation in inflammatory markers. In conclusion, patients hospitalized with COVID-19 and elevated troponin had markedly increased mortality compared with patients with normal troponin levels. This risk was independent of cardiovascular co-morbidities and elevated markers of inflammation.


Subject(s)
COVID-19/blood , COVID-19/mortality , SARS-CoV-2 , Troponin/blood , Aged , Biomarkers/blood , COVID-19/diagnosis , Female , Hospital Mortality , Hospitalization , Humans , Logistic Models , Male , Middle Aged , Odds Ratio , Predictive Value of Tests , Retrospective Studies , Risk Factors , Survival Rate
9.
J Am Coll Cardiol ; 76(11): 1375-1384, 2020 09 15.
Article in English | MEDLINE | ID: covidwho-764912

ABSTRACT

The worldwide pandemic caused by the novel acute respiratory syndrome coronavirus 2 has resulted in a new and lethal disease termed coronavirus disease-2019 (COVID-19). Although there is an association between cardiovascular disease and COVID-19, the majority of patients who need cardiovascular care for the management of ischemic heart disease may not be infected with this novel coronavirus. The objective of this document is to provide recommendations for a systematic approach for the care of patients with an acute myocardial infarction (AMI) during the COVID-19 pandemic. There is a recognition of two major challenges in providing recommendations for AMI care in the COVID-19 era. Cardiovascular manifestations of COVID-19 are complex with patients presenting with AMI, myocarditis simulating an ST-elevation myocardial infarction (STEMI) presentation, stress cardiomyopathy, non-ischemic cardiomyopathy, coronary spasm, or nonspecific myocardial injury, and the prevalence of COVID-19 disease in the U.S. population remains unknown with risk of asymptomatic spread. This document addresses the care of these patients focusing on 1) the varied clinical presentations; 2) appropriate personal protection equipment (PPE) for health care workers; 3) role of the Emergency Department, Emergency Medical System and the Cardiac Catheterization Laboratory; and 4) Regional STEMI systems of care. During the COVID-19 pandemic, primary PCI remains the standard of care for STEMI patients at PCI capable hospitals when it can be provided in a timely fashion, with an expert team outfitted with PPE in a dedicated CCL room. A fibrinolysis-based strategy may be entertained at non-PCI capable referral hospitals or in specific situations where primary PCI cannot be executed or is not deemed the best option.


Subject(s)
Cardiology Service, Hospital/organization & administration , Coronavirus Infections , Emergency Service, Hospital/organization & administration , Infection Control , Myocardial Infarction , Pandemics , Percutaneous Coronary Intervention , Pneumonia, Viral , Thrombolytic Therapy , Betacoronavirus , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/prevention & control , Diagnosis, Differential , Humans , Infection Control/methods , Infection Control/organization & administration , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Organizational Innovation , Pandemics/prevention & control , Percutaneous Coronary Intervention/methods , Percutaneous Coronary Intervention/trends , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/prevention & control , Risk Assessment , SARS-CoV-2 , Thrombolytic Therapy/methods , Thrombolytic Therapy/trends , United States
10.
Curr Probl Cardiol ; 46(3): 100675, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-743929

ABSTRACT

The coronavirus disease-2019 (COVID-19) pandemic has overwhelmed healthcare systems around the world, resulting in morbidity, mortality, and a dramatic economic downturn In the United States. Urgent responses to the pandemic halted routine hospital workflow in an effort to increase hospital capacity, maintain staffing, and ration protective gear. Most notably, New York saw the largest surge of COVID-19 cases nationwide. Healthcare personnel and physician leaders at Northwell Health, the largest healthcare system in New York, have worked together to successfully implement operational changes resulting in a paradigm shift in cardiac care delivery. In this manuscript, we detail specific protocol adjustments made in our cardiology department, cardiology service line, and healthcare system in the face of the COVID-19 pandemic. We discuss the sustainability of this shift moving forward and the opportunity to optimize care for cardiovascular patients in the post COVID-19 era.


Subject(s)
COVID-19/epidemiology , Cardiovascular Diseases/therapy , Disease Management , Emergency Service, Hospital/organization & administration , Pandemics , Cardiovascular Diseases/epidemiology , Comorbidity , Humans , New York/epidemiology , SARS-CoV-2
11.
Am J Cardiol ; 133: 148-153, 2020 10 15.
Article in English | MEDLINE | ID: covidwho-671949

ABSTRACT

Pulmonary embolisms (PEs) in coronavirus disease 2019 (COVID-19) have increasingly been reported in observational studies. However, limited information describing their clinical characteristics and outcomes exists. Our study aims to describe clinical features and risk stratification strategies of hospitalized COVID-19 patients with PE. We retrospectively analyzed 101 hospitalized patients with COVID-19 infection and acute PE. Clinical outcomes measured were intensive care unit admission, mechanical ventilation, bleeding and transfusion events, acute kidney injury (AKI) and mortality. Pulmonary severity index (PESI) scores were used for risk stratification. The most common comorbidities were hypertension (50%), obesity (27%) and hyperlipidemia (32%) among this cohort. Baseline D-dimer abnormalities (4,647.0 ± 8,281.8) were noted on admission with a 3-fold increase at the time of PE diagnosis (13,288.4 ± 14,917.9; p <0.05). Five (5%) patients required systemic thrombolysis and 12 (12%) patients experienced moderate to severe bleeding. Thirty-one (31%) patients developed AKI and 1 (1%) patient required renal replacement therapy. Twenty-three (23%) patients were admitted to intensive care unit, of which 20 (20%) patients received mechanical ventilation. The mortality rate was 20%. Most patients (65%) had Intermediate to high risk PESI scores (>85), which portended a worse prognosis with higher mortality rate and length of stay. In conclusion, this study provides characteristics and early outcomes for hospitalized patients with COVID-19 and acute pulmonary embolism. PESI scores were utilized for risk stratifying clinical outcomes. Our results should serve to alert the medical community to heighted vigilance of this VTE complication associated with COVID-19 infection.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Intensive Care Units/statistics & numerical data , Pneumonia, Viral/complications , Pulmonary Embolism/etiology , Acute Disease , COVID-19 , Coronavirus Infections/epidemiology , Female , Humans , Incidence , Male , Middle Aged , New York/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Prognosis , Pulmonary Embolism/epidemiology , Retrospective Studies , SARS-CoV-2 , Survival Rate/trends
13.
Catheter Cardiovasc Interv ; 97(2): 201-205, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-270251

ABSTRACT

BACKGROUND: The healthcare burden posed by the coronavirus disease 2019 (COVID-19) pandemic in the New York Metropolitan area has necessitated the postponement of elective procedures resulting in a marked reduction in cardiac catheterization laboratory (CCL) volumes with a potential to impact interventional cardiology (IC) fellowship training. METHODS: We conducted a web-based survey sent electronically to 21 Accreditation Council for Graduate Medical Education accredited IC fellowship program directors (PDs) and their respective fellows. RESULTS: Fourteen programs (67%) responded to the survey and all acknowledged a significant decrease in CCL procedural volumes. More than half of the PDs reported part of their CCL being converted to inpatient units and IC fellows being redeployed to COVID-19 related duties. More than two-thirds of PDs believed that the COVID-19 pandemic would have a moderate (57%) or severe (14%) adverse impact on IC fellowship training, and 21% of the PDs expected their current fellows' average percutaneous coronary intervention (PCI) volume to be below 250. Of 25 IC fellow respondents, 95% expressed concern that the pandemic would have a moderate (72%) or severe (24%) adverse impact on their fellowship training, and nearly one-fourth of fellows reported performing fewer than 250 PCIs as of March 1st. Finally, roughly one-third of PDs and IC fellows felt that there should be consideration of an extension of fellowship training or a period of early career mentorship after fellowship. CONCLUSIONS: The COVID-19 pandemic has caused a significant reduction in CCL procedural volumes that is impacting IC fellowship training in the NY metropolitan area. These results should inform professional societies and accreditation bodies to offer tailored opportunities for remediation of affected trainees.


Subject(s)
COVID-19/epidemiology , Cardiac Catheterization , Cardiology/education , Education, Medical, Graduate/organization & administration , Fellowships and Scholarships/organization & administration , Percutaneous Coronary Intervention/education , Accreditation , Humans , New Jersey , New York City , Physician Executives , Surveys and Questionnaires
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