Impact of COVID-19 pandemic on emergency reperfusion characteristics in patients with ST-segment elevation myocardial infarction

Aim To explore the impact of coronavirus-2019 disease (COVID-19) pandemic on emergency reper-fusion characteristics in patients with ST-segment elevation myocardial infarction (STEMI) from non-epicenter. Methods This was a retrospective study involved STEMI patients undergoing primary percutaneous coronary intervention (PPCI), who admitted to chest pain center in our hospital during the pandemic ( from January 23 to March 29 in 2020) and the same period in 2019, excluding the patients with COVID-19. Clinical characteristics and reperfusion parameters were compared between the two groups. Results A total of 64 STEMI patients undergoing PPCI were enrolled in our study, including 13 patients during the pandemic and 51 patients during the same period in 2019. No differences occurred in admission signs, GRACE scores, arrival periods, transferred patterns,the period from door to troponin,and the period from first medical contact to dual antiplatelet between the two groups ( P>0. 05). As compared with 2019, STEMI patients undergoing PPCI had an apparent reduction. Meanwhile, significant delays appeared in reperfusion parameters, in-cluding the period from symptom onset to first medical contact (10 h vs. 3. 0 h, P<0. 001), the period from first medical contact to electrocardiogram (6 min vs. 3 min, P<0. 001), the period from door to troponin (15 min vs. 12 min, P = 0. 048), the period from door to device (76 min vs. 62 min, P = 0. 017), the period from telephone to catheter activated (15 min vs. 5 min, P<0. 001) and the period from catheter arrival to device (52 min vs. 41 min, P = 0. 033). Conclusion Even in non-epicenter, the COVID-19 outbreak still delayed mechanical reperfusion significantly. © 2022, Editorial Office of Chinese Journal of Arteriosclerosis. All rights reserved.

Prediction of Stable Angina for Coronary Artery Diseases using Boosting Algorithm

Narrowed arteries block the blood flow to the heart muscle and other parts of the body, which can cause chest pain. Coronary arteries disease (CAD) can weaken the heart muscle causing heart failure, in which the heart cannot pump blood. A person with underlying diseases is more prone to get highly affected by COVID-19 because of the decreased immunity. Cardiovascular disease and coronary heart disease have been associated with worsened outcomes of COVID-19 patients. Thus, detecting CAD at a proper stage is crucial to avoid any further serious issues. This paper is an empirical analysis to predict stable angina for CAD using Histogram gradient boosting (HGB) and Adaboost (ADB) classifier algorithm and compared the performance with traditional Naïve Bayes (NB) algorithm. © 2023 IEEE.

Post-COVID-19 Complications and their Laboratory Findings: A Cohort Study.

Type 2 severe acute respiratory syndrome caused by coronavirus infection has become the most well-known pandemic infectious viral disease in the present century. This study aims to find out the post-COVID-19 infection complications via a well-designed observational study. A total of 986 recovered cases (only the period ranged between 2 to 3 months after recovery) were obtained from public and private hospitals in Kirkuk and Erbil governorates\Iraq. The admitted patients were asked to answer a questionnaire through interviews; the laboratory findings were obtained from the patients. The results suggested that approximately half of post-COVID-19 patients (%45.606) were suffering from chest pain, while (%32.357) of the cases suffered headache and chest pain. Liver enzymes (ALT, AST, and ALP) showed abnormal percent values of 38.6,24.07, and 26.09, respectively. Renal function enzymes, mainly urea, were found to be abnormal in 45.37% of recovered individuals. Furthermore, abnormal LDH levels were found in (77.9%) of post-COVID-19 patients. This finding revealed that chest pain was an inflammatory condition and liver and renal enzyme disturbances, while elevation in LDH was the predominant long-term complication in post-COVID-19 patients.

The Impact of Illness Perception on Delay in Seeking Medical Help in Patients with Acute Chest Pain: A Cross-sectional Study in the United Arab Emirates

Background: The concern of contracting COVID-19 has prevented numerous individuals with ambiguous myocardial infarction symptoms from seeking medical attention, leading to delayed presentation and treatment of acute coronary syndrome (ACS). This delay could increase the risk of long-term consequences. Aim: The aim of this study is to evaluate the impact of illness perception on delay in seeking medical help in patients with acute chest pain in UAE during COVID-19 pandemic. Methods: A descriptive cross-sectional design was used. Results: A total of 222 in-patients participated in the study, with an average age of 54.3 years (SD=14, Range= 20-86). The average score of illness perception was 5.66 (SD=0.92), which indicates that CVD was perceived as moderately threatening to physical and emotional status. Univariate analysis showed that illness coherence having previous cardiac catheterization, diabetes and asthma were factors associated with delay in seeking medical services. The linear regression showed that college education was a strong predictor of delay, while a history of asthma and undergoing cardiac catheterization were independent predictors of shorter delay. Conclusion: Illness coherence perception and time of seeking medical help are correlated. In addition, illness perception of personal control is low, which indicates the need for educational intervention. Other clinical factors also impact patients' decisions, such as previous cardiac intervention and comorbidity, highlighting the target group for further attention from the healthcare team. © 2023 Mosleh et al.

Tietze Syndrome as a Cause of Chest Pain in the Post-COVID-19 Period.

Tietze syndrome is a rare disease. It is mainly characterized by chest pain caused by a unilateral and monoarticular lesion of the second-fifth costal joints. Tietze syndrome is one of the potential complications in the post-COVID-19 period. It is one of the differential diagnoses for non-ischemic chest pain. With early diagnosis and appropriate treatment, this syndrome is easily manageable. The authors present a case of a 38-year-old male who had been diagnosed with Tietze syndrome in the post-coronavirus disease 2019 (COVID-19) period.

A Rare Case of Rapidly Progressive Extragonadal Mature Cystic Teratoma Presenting With Chest Pain.

Mature cystic teratomas represent the most prevalent subtype of germ cell tumors affecting the ovaries. Typically, these neoplasms are benign and characterized by a slow growth pattern. Nevertheless, malignant transformation of these tumors is a rare event that may occur. Despite their typically indolent behavior, some cases may exhibit rapid growth rates and give rise to a variety of complications, including rupture and consequent manifestation of a wide range of clinical signs and symptoms. This report details the case of a 49-year-old woman who presented to the hospital with a chief complaint of chest pain. The onset of her symptoms occurred several days prior to admission and was associated with fatigue without shortness of breath. Imaging studies, including computed tomography angiography and magnetic resonance imaging of the chest, revealed a mediastinal mass measuring 5.9 x 7.4 cm in a cross-sectional area that displayed features consistent with a mature cystic teratoma, including the presence of soft tissue, fat, fluid, and areas of calcification. Notably, a prior computed tomography scan of the chest, performed 20 months before her presentation, did not reveal any evidence of masses. The patient subsequently underwent successful robot-assisted resection of the mediastinal mass, with complete resolution of her symptoms. Histopathologic examination of the excised mass confirmed the absence of malignancy.

The Stressed Heart: A Case Report of Takotsubo Cardiomyopathy in a Patient With Known Coronary Artery Disease.

Takotsubo cardiomyopathy and acute coronary syndrome are often clinically indistinguishable, making their differentiation challenging for physicians. We present a case of a 65-year-old female who presented with acute chest pain, shortness of breath, and a recent psychosocial stressor. This is a unique case in which our patient, with known history of coronary artery disease and recent percutaneous intervention, favored a misleading initial diagnosis of non-ST elevation myocardial infarction.

Cardiac Symptoms During the Russia-Ukraine War: A Google Trends Analysis.

Background The 2022 Ukraine-Russian War has led to significant anxiety, anguish, and trauma among the people in Ukraine. The objective of this study was to analyze the Google Trend results of common cardiac symptoms in Ukraine, Russia, and worldwide in 2022 and compare that to 2021 with the hypothesis that common cardiac symptoms in the war-affected regions would be higher compared to the rest of the world. We hypothesize that the search trends of cardiac symptoms would increase in Ukraine given the turmoil caused by the Russian invasion. Methods We queried Google Trends for common cardiac symptoms such as chest pain, dizziness, palpitations, syncope, etc. Google Trends provides results as relative search volume (RSV) displayed in a geographical format. The RSV ranges from 0 to 100, with 0 indicating that the search term is not popular, and 100 indicating the search term's popularity is at its peak. Google Trends of cardiac symptoms in Russia, Ukraine, and worldwide was taken two weeks before and after February 24, 2022, compared with the same period in 2021. To assess the difference in Google Trends between the study periods in 2022 and 2021, the paired t-test was used. Results Overall, Google Trends for cardiac symptoms was lower in Ukraine and Russia than worldwide, in both 2021 and 2022 during the study period. There was a significant reduction in search for chest pain (14 vs. 30.5; p<0.049), pedal edema (40.0 vs 66.6; p approaching 0), and syncope (37.8 vs. 58.4; p<0.002) in Ukraine during the study periods in 2022 compared to 2021. There was a decrease in the searches for dyspnea (44.6 vs. 55.4; p<0.029) in Russia and for dizziness (87.6 vs. 92.8; p<0.005) worldwide. There was an increase in the searches for edema (93.6 vs. 91; p <0.002) and for fatigue (88.6 vs 79.5; p approaching 0) worldwide in study periods in 2022 as compared to 2021. There was no other significant difference between cardiac symptom search trends during the periods evaluated in Ukraine, Russia, and worldwide. Conclusion There appears to be a significant reduction in searching for a few cardiovascular symptoms, namely, chest pain, pedal edema, and syncope in Ukraine, which may be due to a focus on other immediate problems related to war and the availability of the Internet.

Biventricular Takotsubo Cardiomyopathy Secondary to COVID-19.

Takotsubo cardiomyopathy (TCM) is a heart failure syndrome characterized by acute and transient dysfunction of the apical segment of the left ventricle. Since the emergence of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the diagnosis of TCM has increased in prevalence. Here we present an intriguing case of a patient who initially presented to the hospital with respiratory failure and received a diagnosis of COVID-19. During the patient's hospital course, he was also diagnosed with biventricular TCM and subsequently experienced complete resolution of TCM before discharge. Providers should be cognizant of the potential cardiovascular complications of COVID-19 and consider those heart failure syndromes, including TCM, could be causing some of the respiratory dysfunction in these patients.

Evaluating chest pain in patients with post COVID conditions permission to think outside of the box.

Chest pain is among the most common symptoms of post-COVID-19 Conditions (PCC) that prompts medical attention. Because the SARS-CoV-2 virus has proclivity for many organs and organ systems in the chest, ranging from the heart, lungs, great vessels, lymphatics, and peripheral nerves, clinicians evaluating patients with chest pain must consider a broad differential diagnosis and take a comprehensive approach to management.

Implementation and Outcomes of an Advanced Nurse Practitioner Telephone Chest Pain Clinic Developed in Response to the COVID-19 Pandemic.

Introduction: During the COVID-19 pandemic, a virtual telephone advanced nurse practitioner (ANP) led chest pain clinic was set up because face-to-face clinic visits had ceased. Methods: This retrospective cohort analysis compared the ANP virtual chest pain clinic to the face-to-face nurse specialist-led clinic. Results: Autonomous nursing management was significantly higher in the virtual clinic, and significantly fewer patients were referred for functional testing. Coronary arterial disease (CAD) diagnosis did not differ. Conclusion: ANP autonomy and experience enabled continued chest pain assessment and CAD diagnosis via a virtual telephone clinic.

COVID-19 Vaccine Cardiac Complications: A Case Series on Implications of Marijuana in Adolescents With Myopericarditis.

We report on two critically ill pediatric patients, aged 16 and 18 years, presenting with acute myopericarditis at a tertiary-care center in New Jersey, United States. Both patients had their severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccinations, tested negative for SARS-CoV-2, and shared only significant history of asthma. Clinical presentations were similar to acute onset chest pain that worsened with deep inspiration. One patient reported a history of vaping and escalating marijuana use several hours preceding presentation. Both patients had elevated troponin on admission and had ST-segment elevation on electrocardiogram (EKG), thus prompting admission to the pediatric intensive care unit (PICU) for cardiac monitoring. Myopericarditis has multiple etiologies and is a newly described rare complication of the SARS-CoV-2 vaccine. It can also occur as a complication of vaping and frequent marijuana drug use. Our paper highlights the importance of a detailed social and drug history in adolescents presenting with chest pain. The clinical characterization is necessary to promote better case definitions and the design of targeted interventions for this vulnerable group.

[Myocarditis following mRNA vaccine]. / Myokarditis nach mRNA-Impfung.

This article presents the case of a 15-year-old adolescent presenting with myocarditis 4 days after receiving the 2nd dose of BNT162b2 mRNA vaccine (Comirnaty®) with no other identifiable cause. The main clinical symptom at presentation was chest pain. We found an elevated level of Troponin­I with preserved left ventricular systolic function. The cardiac MRI showed a clear pathologic result. With symptomatic therapy and strict bed rest, the symptoms resolved quickly and revealed a mild course.

Anti-fibrotic agents could be the game-changer for post-COVID-19 pulmonary fibrosis treatment

More than 220 countries and territories are globally affected by the recent pandemic COVID-19 which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is possibility of third wave of this pandemic as per epidemiological and public health experts. Besides that post-COVID-19 complications are alarming matter to look upon. Post-COVID-19 complications include several symptoms like as persistent fever;cough;fatigue;headache;attention disorder;dyspnea;anosmia;ageusia;chest pain discomfort;various respiratory illness;acute respiratory distress syndrome (ARDS) etc., and here the things to worry about is the development of pulmonary fibrosis after COVID-19. In some COVID-19 patients, hyper-inflammation in the form of 'cytokine storm' along with dysregulated immune response, alveolar epithelial tissue injury and wound repair collectively cause this secondary pulmonary fibrosis. Therefore, using anti-fibrotic agents e.g. pirfenidone, nintedanib and other natural compounds could be meaningful in these circumstances although their efficacy in treating COVID-19 is subject to more detailed laboratory research works. In this review article, we have discussed the progression of pulmonary fibrosis development which is triggered by COVID-19;probable solutions with anti-fibrotic agents including anti-fibrotic drugs, some well-known natural compounds, combined anti-fibrotic therapies;and the current challenges of this field.

Evaluation of Chest Pain and Dyspnea Symptoms Using Speckle-Tracking Echocardiography in Patients Recovering from COVID-19

Objectives: At present, clinicians face plenty of patients complaining of post-COVID-19 chest pain and dyspnea. However, it remains to be seen if these symptoms indicate pathology of the cardiovascular system. We aimed to evaluate heart functions in outpatients with post-COVID-19 chest pain and dyspnea, using 2D speckle-tracking echocardiography (2D-STE). Method(s): This cross-sectional study recruited consecutive patients who presented to cardiology outpatient clinics between June 15, 2021, and July 15, 2021. A total of 78 patients had recovered from COVID-19 1-2 months before admission were included in the study. ECG and echocardiography, including 2D-STE images, were obtained for all patients. Findings were compared with sex- and an age-matched control group of 67 healthy adults. Result(s): The median age was 38 (IQR, 34-45) years, and 64.1% were female. There were no significant differences between the patients and control group regarding laboratory, ECG, and echocardiography findings. Moreover, the left ventricle global longitudinal strain measurements in both the patient and control groups were within the normal ranges and did not show a significant difference (-20.5 [-21.8- -17.9] vs. -19.8 [-21.4-18.9], p=0.894). Conclusion(s): Post-COVID-19 chest pain and dyspnea are unlikely signs of cardiovascular involvement in outpatient young adults who have not been hospitalized with COVID-19.©Copyright 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.

IoT-Based Heart Monitoring System Implementation and Analysis

This paper presents an IoT-based heart monitoring system using 8266 NodeMCU. According to the Malaysian Department of Statistics, ischemic heart disease is the leading cause of death, accounting for 15.0% of the 109,164 medically certified deaths in 2019. The coronary heart is a vital organ that pumps oxygen and blood across the body. Meanwhile, if the heart is not getting sufficient oxygen, the patient will experience chest pain, typically on the left side of the body, which can be mistaken for a heart problem. During the Covid-19 pandemic, a patient cannot attend regular treatment at the hospital as it is operating at full capacity. During this phase, the hospital can only focus on the critical and high-risk patient. The proposed heart monitoring system monitors the patient by measuring the heart rate and oxygen level in the comforts of home. Therefore, the patient can provide his current health record for the doctor's evaluation. The idea behind this proposed system is to construct an IOT-based system that automatically monitors the health condition in terms of heartbeat and oxygen detection. The prototype provides data to the Blynk for the patient and the I-Heart web-based application for the medical practitioner. © 2022 IEEE.

Acute pulmonary embolism mimicking COVID-19 pneumonia.

The case of 21-year-old man with an asthma history from childhood presenting severe respiratory distress associated with a right lower thoracic pain has been studied. The non-contrast Computed Tomography (CT)-chest scan showed a basal ground-glass opacity (GGO) of the right lung leading to suspicion of COVID-19 pneumonia. However, the molecular Reverse transcription polymerase chain reaction test and blood serology were negative while laboratory analyses revealed high levels of D-dimers (D-D). In addition, 2 repeated COVID-19 tests were negative. A thoracic CT angiography was disclosed due to the persistence of pain at the lower right thoracic side and hemoptysis that shows a bilateral distal pulmonary embolism with a right-sided basal subsegmental ischemia. We discuss a fortuitous discovery of pulmonary embolism associated with peripheral basal ground-glass opacities similar to radiological manifestations of SARS-CoV-2 pneumonia.

Diaphragmatic Rupture and Gastric Perforation in a Patient with COVID-19 Pneumonia.

We describe the case of a young female patient admitted to our emergency department during the Italian COVID-19 epidemic, for fever and dry cough associated with symptoms of gastric reflux over the previous 5 days. Lung ultrasound showed diffuse bilateral B lines with irregular pleural thickening, and consolidation with air bronchogram and slight pleural effusion in the lower left lobe. Chest HRCT and abdominal CT scanning with contrast revealed diaphragmatic rupture with gastric perforation, and atelectasis of the left pulmonary lobe with unilateral pleural effusion, diffuse ground-glass opacities and multiple small consolidations in both lobes. A nasopharyngeal swab for 2019-nCoV was positive. A diagnosis of diaphragmatic rupture and gastric perforation in COVID-19 pneumonia was made. The patient was immediately hospitalized and surgically treated. Treatment for COVID-19 and empiric antibiotic therapy were promptly started. LEARNING POINTS: Coronavirus disease (COVID-19) can cause fever, dry cough and acute respiratory failure.Cough can result in several complications, including rupture of the diaphragm and abdominal herniation.CT scanning is the gold standard technique to investigate COVID-19 pneumonia and diaphragmatic rupture.

Effect of a Senior Cardiology Nursing Role on Streamlining Assessment of Emergency Cardiology Presentations During COVID-19: An Observational Study.

INTRODUCTION: The Emergency Cardiology Coordinator (ECC) was a senior nursing role implemented from 14 April 2020 to 15 September 2020 at the Gold Coast Hospital and Health Service in South-East Queensland, Australia to streamline and expedite assessment of patients presenting to the Emergency Department (ED) with suspected cardiac problems. ECC implementation occurred in the context of the emergence of COVID-19. Evaluation of the impact of the ECC role focussed primarily on the time interval from triage to cardiology consult (TTCC). METHODS: ED and Cardiology Department data were extracted from electronic medical records for the period 2 September 2019 to 1 March 2021. The TTCC for each presenting problem (chest pain, palpitations, shortness of breath, altered level of consciousness) was compared between patients seen by the ECC and those not seen on the days the ECC worked. The effect of COVID-19 on TTCC was assessed by an interrupted time series analysis. Data recorded by the ECC included patients seen and interventions provided. RESULTS: The ECC saw 378 patients. Most presented with chest pain (269/378, 71.2%). The ECC determined that 68.8% (260/378) required a cardiac assessment. Following COVID-19 the median weekly TTCC increased by 0.029 hours (1.74 min) each week on average relative to that beforehand (p=0.008). For patients seen by the ECC the median TTCC was 2.07 hours (interquartile range [IQR]: 1.44, 3.16) compared to 2.58 hours (IQR: 1.73, 3.80; p=0.007) for patients not seen by the ECC. Chest pain (ECC: 1.94 hours; no ECC: 2.41 hours; p=0.06) and non-obvious cardiac presenting problems (ECC: 1.77 hours; no ECC 3.05 hours; p=0.004) displayed the largest reductions in TTCC when the ECC was involved. Presentations with palpitations, respiratory distress and altered level of consciousness had similar TTCCs. CONCLUSION: The ECC role resulted in an overall decrease in TTCC despite the role coinciding with the emergence of COVID-19. In order to clarify the optimal strategy for the ECC role, further analyses involving patient risk factors and presenting problems along with a health economic evaluation of this model of care and the effect on patient outcomes will be required.