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The aim of the study is to describe a case of COVID-19 and myocardial infarction in an elderly patient. Material and methods. The analysis of medical documentation (outpatient card of the patient, medical history, postmortem report) was carried out. Studied macro- and micropreparations (staining with hematoxylin and eosin). Results. A 67-year-old patient, from 23.04.2020 to 26.04.2020, was hospitalized with a diagnosis of suspected coronavirus infection (COVID-19). On the background of the treatment, the patient's biological death occurred (26.04.2020). The sectional study revealed signs of bilateral total hemorrhagic pneumonia. The signs of acute transmural myocardial infarction of the anterior wall of the left ventricle were determined. Posthumously, SARS-CoV-2 RNA was detected in the lung tissue by nucleic acid amplification. In the described clinical case, a patient with concomitant cardiovascular diseases, such as arterial hypertension, coronary heart disease, developed complications against the background of COVID-19: hemorrhagic pneumonia and myocardial infarction with a fatal outcome.Copyright © Infectious Diseases: News, Opinions, Training.
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Introduction: Due to the COVID-19 outbreak, many chronic patients and elective surgical procedures have been postponed to create spaces for the hospitalization of COVID-19 patients, raising issues related to this change. The objective of this study is to assess the effect of the COVID-19 pandemic on the demand for blood products transfusion. Materials ant methods: The study presents the results of a retrospective study of blood transfusions in COVID-19 patients admitted to the Constanta County Emergency Clinical Hospital. The period of study was January-December 2021. We compared the transfusion requirement for each type of blood component in COVID 19 patients versus patients with non-COVID pathology. Results and discussions: During 2021, we transfused 282 COVID-19 patients;150 patients had only Covid pneumonia (of which 19 patients with severe forms needed intensive care in ICU-Covid), and 132 patients had various co-morbidities. The maximum blood requests was registered in the period February - April 2021, with a peak of 63 patients in April 2021. The main co-morbidities in patients with Covid 19 were: severe anemia in patients with malignant hemopathies. Anemia at admission in patients with Covid pneumonia is reported in more than 40% of patients. Moderate anemia (Hb <11 g/dL) is considered as an independent risk factor for the severe course of COVID-19 infection and mortality in these patients. The transfusion requirement in these patients was greater than 1.43 RBC (units/patient), 0.81 Plasma units/patient, 0.40 Platelets concentrate units + single donor platelet concentrate units/patient, in accordance with the associated pathology. Conclusion(s): The most requested product was packed red blood cells, the correction of anaemia being an important factor in preventing the severe course of the disease. The platelet requirement was 0.15 units/patient, thrombocytopenia being present in patients with severe evolution of the infection (hospitalized in ICU-COVID). The most requested blood groups were O+ and A+. COVID-19 transfusion data will help plan and prepare for the use of blood resources during the pandemic.Copyright © 2022 Sevigean Ali et al., published by Sciendo.
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The aim of this research is to describe the use of telemedicine applied to patients characterised by a particular state of illness, which often drives them toward a frail and chronic status, in a systematic manner. This work employed the Tranfield approach to carry out a systematic literature review (SLR), in order to provide an efficient and high-quality method for identifying and evaluating extensive studies. The methodology was pursued step by step, analysing keywords, topics, journal quality to arrive at a set of relevant open access papers that was analysed in detail. The same papers were compared to each other and then, they were categorised according to significant metrics, also evaluating technologies and methods employed. Through our systematic review we found that most of the patients involved in telemedicine programs agreed with this service model and the clinical results appeared encouraging. Findings suggested that telemedicine services were appreciated by patients, they increased the access to care and could be a better way to face emergencies and pandemics, lowering overall costs and promoting social inclusion.Copyright © 2022 Inderscience Enterprises Ltd.
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Background: COVID-19 carries a high risk of vascular thrombosis. This joint analysis of two randomized-controlled trials (RCTs) aims to assess the safety and efficacy of enoxaparin at therapeutic dose compared to prophylactic dose in people hospitalized with COVID-19. Method(s): A joint analysis of two RCTs, COVID-19 HD (NCT044082359) and EMOS-COVID (NCT04646655), was performed. Both studies enrolled inpatients with COVID-19- associated respiratory compromise (as identified by respiratory rate >=25 breaths/min or arterial oxygen saturation <=93% at rest or PaO2/FiO2 <=300 mmHg for COVID-19 HD and by PaO2/FiO2 <=250 mmHg for EMOS-COVID) and/or coagulopathy (D-dimer > 2000 ng/ml for both RCTs or sepsis-Induced coagulopathy score >4 for COVIDHD). In both RCTs patients were randomly assigned to two arms: enoxaparin at prophylactic dose (standard 4.000 IU;in the EMOS-COVID 6000 IU if body weight >100 kg) and at therapeutic dose (70 U/Kg every 12 h). The primary efficacy endpoint of the joint analysis was clinical worsening, defined as the occurrence of at least one among: in-hospital death;acute myocardial infarction;symptomatic arterial or venous thromboembolism;need of either Continuous Positive Airway Pressure (Cpap) or Non-Invasive Ventilation (NIV) in patients who were in standard oxygen therapy at randomization;need for IMV in any patient. The primary outcome was assessed as time-to-event, described with hazard ratio (HR) and with Kaplan-Meier survival estimate. The primary safety endpoint was major bleeding for both trials and for the joint analysis. Result(s): COVID-19 HD enrolled 142 people between July 2, 2020 and February 15, 2022, while EMOS-COVID enrolled 141 people from July 27, 2020 to June 5, 2021, resulting in 283 patients included in this joint analysis. Two-hundredseven (73.1%) were males, with a mean age of 61.1 years (SD +/-10.7), a mean BMI of 29.7 kg/m2 (SD +/-5.0), and 115 (40.6%) were on NIV or Cpap at randomization, with no significant difference between the study groups. 21/139 people in the high dose group reached the primary endpoint compared to 32/144 in the prophylactic group (HR 0.63, 95%CI 0.36 to 1.10). Figure 1 shows the Kaplan- Meier survival estimates of clinical worsening. No major bleeding was observed during the study time. Conclusion(s): The results of this joint analysis did not highlight significant differences in clinical worsening between COVID-19 patients that received enoxaparin at therapeutic compared to prophylactic dose. (Figure Presented).
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It is now widely known that COVID-19 can also cause various extrapulmonary manifestations. Possible mechanisms of cardiovascular damage include direct myocardial damage due to hypercoagulability caused by systemic inflammation, which may also lead to destabilisation of coronary plaques. We present a case of a 30-year-old young man following asymptomatic COVID-19 infection, who was admitted to the emergency room of the Grande Ospedale Metropolitano di Reggio Calabria, Italy, with typical chest pain. The patient had no cardiovascular disease, cardiovascular risk factors including no family history of cardiovascular disease. Urgent coronary angiography showed critical stenosis of the middle-proximal portion of the left anterior descending artery (80%) with ulcerated plaque appearance. Regardless of cardiovascular risk factors, our case report emphasises the need to determine COVID-19 status in all patients with acute myocardial infarction during this pandemic.Copyright © 2023, CKS.
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BACKGROUND: The current COVID-19 pandemic mainly affects the respiratory system;however, with the increase in cases worldwide, there is evidence of compromise at the cardiovascular level, which can manifest as acute myocardial infarction, myocarditis, pericarditis, myopericarditis, heart failure, cardiogenic shock, vasculitis, deep vein thrombosis, pulmonary embolism, ischemic stroke, acute arterial insufficiency, arrhythmias, and sudden death. CLINICAL CASE: A 70-year-old male patient who simultaneously presented multisystemic thrombosis manifested by cerebral vascular event, pulmonary thromboembolism, acute myocardial infarction and acute arterial insufficiency in the context of SARSCoV-2 pneumonia. CONCLUSION(S): In patients with COVID-19 there is a high thrombogenic potential secondary to blood stasis, hypercoagulability and endothelial dysfunction, which worsens the prognosis and increases mortality, mainly in patients who require ICU stay, so an adequate thromboprophylactic or anticoagulant scheme and follow-up in the convalescent phase must be provided to detect sequelae associated with COVID-19.Copyright © 2022 Comunicaciones Cientificas Mexicanas S.A. de C.V.. All rights reserved.
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Background: Patients with COVID-19 have an increased risk of cardiovascular adverse events during the acute phase. However, the long-term cardiovascular outcomes are unknown. Objective(s): We aimed to determine the long-term effects of COVID-19 in the cardiovascular system. Method(s): This is a multicenter, observational, retrospective registry conducted at 17 centers in Spain and Italy. Consecutive patients older than 18 years who underwent a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) for SARS-CoV2 in the participating institutions were included. Patients were classified into two groups, according to the results of the RT-PCR: COVID-19 positive or negative. The primary outcome was cardiovascular (CV) death at 1-year. The secondary outcomes included acute myocardial infarction, stroke, heart failure hospitalization, pulmonary embolism, and serious cardiac arrhythmias at 1-year. Outcomes were compared between the two groups. An independent clinical event committee adjudicated events. Result(s): A total of 4427 patients were included, 3578 (80.8%) patients with COVID-19 and 849 (19.2%) without COVID-19. COVID-19 patients were older, had a higher rate of classical cardiovascular risk factors, except for active smoking, and had fewer comorbidities. At a median time of 13.5 (IQR 11.8-15.8) months, after an adjustment by baseline characteristics, there was no difference in CV death (1.4% vs. 1.1%;HR 1.03 [0.49-2.18];p=0.941) between patients with COVID-19 and without. However, COVID- 19 patients experienced higher rate of venous thromboembolism (VTE) (3.9% vs. 0.6%, HR 6.11 [2.46-15.16];p=0.001), major bleeding (2.9% vs. 0.5%, HR 5.38 [1.95-14.84];p=0.001), and serious cardiac arrhythmias (2.6% vs. 0.9%, HR 2.25 [1.07-4.73];p=0.033). During follow-up, between discharge and end of follow-up, COVID-19 patients did not experience a higher risk of adverse cardiovascular outcomes (composite of CV death, any MI, ischemic stroke, systemic arterial thrombosis, VTE, heart failure hospitalization, or any serious arrhythmia) compared to patients without (HR 0.80;[0.53-1.21];p=0.298). Conclusion(s): At 1-year follow-up, COVID-19 was not associated with an increased risk of cardiovascular death but with a higher risk of VTE events, major bleeding, and serious cardiac arrhythmias. COVID-19 was not associated with a higher risk of adverse cardiovascular events during follow-up.
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Background: Anticoagulation with fondaparinux (FPX) has shown benefit to improve clinical outcomes in hospitalized patients with COVID-19. However, optimal thromboprophylaxis dosing in critically ill patients remains unknown. Purpose(s): To evaluate the effects of D-dimer-driven (DDD) FPX compared with standard prophylactic-dose (SPD) FPX in critically ill patients with COVID-19 and associated coagulopathy. Method(s): This was a single-center, open-label, two-arms, parallel-group, randomized controlled trial conducted between April 1, 2021 and Feb 28, 2022. The eligible COVID-19 patients who were critically ill (defined as a presence of critical care-level organ support at enrollment) and presented with coagulopathy were randomly assigned (1:1 ratio) to receive pragmatically defined regimens of either DDD FPX or SPD FPX throughout hospitalization. The primary efficacy outcome was a composite of all-cause mortality (ACM), acute myocardial infarction (MI), confirmed arterial (ATE) or venous thromboembolisms (VTE), assessed up to 30 days. The secondary efficacy outcomes were 30-day ACM, composite thrombotic events, progression to invasive mechanical ventilation (IMV) or ARDS, and acute kidney injury (AKI). The safety outcomes included major bleeding and clinically relevant non-major bleeding (CRNMB). Outcomes were blindly adjudicated and analysed on a 30-day intention-to-treat basis. Result(s): During allocated period, 270 (58%) of 465 patients were eligible and were equally assigned to DDD and SPD groups. The baseline characteristics were well-matched between groups (all p>0.05). At 30 days, the primary efficacy outcome was met in 49 of 135 patients (36.3%) with DDD FPX versus 47 of 135 patients (34.8%) with SPD FPX (hazard ratio [HR], 1.32;95% CI, 0.89-1.98;p=0.17). DDD group compared with SPD group revealed no significant difference in 30-day ACM (22.9% vs 31.8%;HR, 0.73;p=0.17). At 30 days, DDD group demonstrated no significant reduction in thromboembolism, i.e. acute MI (14.1% vs 11.8%;HR, 1.53;p=0.21);ATE (3.0% vs 3.0%;HR, 1.27;p=0.74);and VTE (2.2% vs 4.4%;HR, 0.69;p=0.59) when compared with SPD group. Among those not on IMV at randomization, DDD group showed no significant reduction in the proportion of patients meeting the need for IMV (18.5% vs 32.6%;HR, 0.72;p=0.18) or progression to ARDS (17.8% vs 27.4%;HR, 0.81;p=0.43). Allocation to DDD FPX had no significant effect on the proportion of patients experiencing AKI within 30 days (17.8% vs 14.8%;HR, 1.36;p=0.39). There was no significant difference between DDD and SPD groups in terms of major bleeding (2.2% vs 0%;HR, 8.35;p=0.35) or CRNMB (3.0% vs 2.2%;HR, 1.70;p=0.48) at 30 days. Conclusion(s): In critically ill patients with COVID-19 and coagulopathy, D-dimer-driven anticoagulation with fondaparinux did not significantly improve clinical outcomes at 30 days as compared to standard prophylacticdose. The risk of bleeding was not significantly increased in this trial. (Table Presented).
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To assess the effectiveness of remote clinical quality management of endovascular Aim care. The system of clinical quality management of medical care in myocardial infarction (MI) including the quality of remote control of endovascular care was developed and introduced into the health care system of the Moscow Region as a part of the comprehensive study in 2008-2020. The number of people under the study was 8375. The ground for assessing the effectiveness of remote clinical management in 2019-2020 was the health care system of megapolis. Based on the analysis of 2966 endovascular procedures protocols, the treatment tactics effectiveness of intraoperative decisions was studied after an emergency coronary angiography (ECA) had been performed by interventional cardiologists. The Methods system of remote clinical quality management of endovascular care included a complex of audiovisual communications, computer system processes, mentoring and the algorithm for making an intraoperative decision. The effectiveness of remote clinical quality management of endovascular care was investigated on the number of percutaneous coronary interventions (PCI) in MI, mortality of patients with MI in the Regional vascular center in 2019-2020. The T-criteria was used to assess the reliability. The material statistical processing was carried out in the Statistica 6.0 package calculating adequate statistical indicators and their reliability at p<=0.005. Ratio PCI/ECA in 2019, January-March 2020 counted up to 48.95%. In April-December 2020 it increased up to 71.6% (p<0.001). The frequency of performing Results PCI increased by 1.46 times (p<0.001). Hospital mortality from MI decreased during the following period 2019, April-December 2020 from 9.7% to 8.2% (p = 0.005). Remote clinical management based on telemedicine and mentoring process Conclusion technologies contributes to improving the quality of endovascular care in MI.Copyright © 2021 Angles. All rights reserved.
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Background: The COVID-19 pandemic had influenced the patient's behavior and impacted the homeostasis to a pro-thrombotic niveau. Aim(s): The study aimed to follow the impact of COVID-19 on the incidence and prognosis of cardiogenic shock complicated initially acute myocardial infarction (CS-AMI). Method(s): We used data entered into a large national all-comers registry of coronary intervention over five years. From 1/2016 to 12/2020, 50,745 AMI patients were included, and 2,822 (5.6%) initially had CS. Result(s): The incidence of CS-AMI was significantly higher in the COVID period (2020) than the mean incidence in 2016-2019 (5.5% vs 6%, p=0.032). The difference was caused by significant increase of CS in acute STEMI (7.6% vs. 8.7%, p=0.011);it was 7.1% in 2016, 7.8% (2017), 7.6% (2018), 7.8% (2019), and 8.7% (2020). The CS complicated 2.3% (2016), 2.7% (2017), 2.7% (2018), 2.8% (2019), and 2.8% (2020) of NSTEMI. The observed rise in CS-STEMI incidence each month during the pandemic compared to the average incidence in non-pandemic years correlated with the substantial increase in the number of COVID infected/ hospitalized (Table 1). In these months, no changes in time delay to reperfusion layout were observed in CS-STEMI patients (Table 2). Except of less frequent history of previous PCI (13.9% and 8.2%, p<0.001), we found no significant differences in the followed CS-STEMI patient characteristics in 2016-2019 and 2020;men 72.7% and 75.4% (p=0.1), mean age (SD) 66.3 (12.3)yrs and 66.3 (12.2) yrs, Diabetes 20.9% and 19.1% (p=0.2), CKD 5.4% and 5.7% (p=0.4), previous CABG 4.5 and 4.2% (p=0.5), left main disease (14.3% and 16%, p=0.5), one vessel disease 24.9% and 32.1% (p=0.9), pre-PCI TIMI flow 0 64.4% and 66.2% (p=0.6), post-PCI TIMI flow 3 76.7% and 76.9%. The COVID pandemic didn't influence the proportions of pre-hospital resuscitated CS-AMI patients (57.5% and 58.7%, p=0.6) and those on mechanical ventilation (67.8% and 68.3%, p=0.8). The 30-day mortality trend of CS-AMI was 53.7% in 2016, 51.6% (2017), 49.7% (2018), 49.3% (2019), and 47.9% (2020). And in CS-STEMI it was 50.8%, 47.1%, 46.4%, 44.1%, and 45.3% (P2019 vs. 2020 =0.8), respectively. Conclusion(s): Data from a large national all-comer registry showed an increase in the proportion of patients admitted to hospitals with STEMI complicated by CS in the year of the COVID pandemic. The CS rise correlated with the increase in the COVID infected population. Factors other than the patient's cardiovascular risk profile or prolongation of a time delay to reperfusion influenced this trend. We suggest that the availability of health care and patient adherence may have affected the risks control. We did not observe any effect of the pandemic on CS-AMI mortality. (Figure Presented).
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Background: Takotsubo cardiomyopathy is characterized by left ventricular dysfunction with apical ballooning in the absence of significant coronary artery disease. Though rare in pregnancy, this transient cardiac dysfunction may affect women in antepartum, intrapartum, or postpartum period, making it difficult to discern the inciting event or differentiate from spontaneous coronary artery dissection or peripartum cardiomyopathy. Most patients respond well to medical management with spontaneous resolution of cardiac dysfunction within weeks of diagnosis. Case presentation: A 38-year-old female G3P0202 at 36 weeks of gestation with a history of preeclampsia, hypertension, hyperlipidemia, and recent COVID-19 infection presented with severe substernal chest pain. She was hypertensive on arrival with a blood pressure of 220/120 mm Hg. Electrocardiogram showed T-wave inversion in the anterior leads and troponin I level was 2.6 ng/ml. She was treated with aspirin 324 mg, IV hydralazine 20 mg, IV magnesium sulfate infusion for seizure prophylaxis and fetal neuroprotection. A transthoracic echocardiogram revealed left ventricular ejection fraction of 35-40% with apical ballooning. Urgent left heart catheterization did not show signs of epicardial coronary artery disease, prompting the diagnosis of Takotsubo cardiomyopathy. Hospital course included interdisciplinary team-based medical therapy until cesarean section 24 hours after arrival. Following delivery, she was started on guideline directed medical therapy for heart failure and discharged home. At her one month follow-up, she was still experiencing symptoms of heart failure and classified as New York Heart Association Class II. Conclusion(s): Stress-induced cardiomyopathy rarely occurs in gravid females with chest pain;however, it should be considered after ruling out acute myocardial infarction. Distinguishing Takotsubo cardiomyopathy from peripartum cardiomyopathy is important as peripartum cardiomyopathy is considered a contraindication for future pregnancies. Clinical suspicion for Takotsubo cardiomyopathy should be increased in patients with a history of superimposed preeclampsia. Whether COVID-19 infection-associated inflammatory state predisposes high risk pregnant patients to Takotsubo cardiomyopathy is unknown, but this is a possible inciting factor that should be assessed in patient work up. Management should involve an interdisciplinary team approach to ensure the safety of mother and child.Copyright © 2022
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Cardiovascular disease (CVD) is the leading cause of death in most developed countries, including the United States, with a significant economic impact. Lifestyle changes and the administration of antiplatelet medication, like aspirin, may significantly contribute to the secondary prevention of CVD in adults. For years, aspirin has been utilized for both secondary and primary cardiovascular disease prevention. Aspirin has been extensively used because of the belief that it may have a positive impact on primary prevention, despite the debate surrounding its usage. This study briefly examines usage patterns and discusses the potential variables and factors that can decrease the ability of aspirin to prevent cardiovascular disease. The present study also explore the key studies of aspirin use in the context of recent recommendations. The risk of bleeding has been observed to significantly rise, although large randomized clinical studies have demonstrated a reduction or absence of CVD events. Prevention strategies for cardiovascular disease with low-dose aspirin are no longer advised for persons at intermediate risk. To determine whether taking aspirin is worth the potential dangers, the benefits must be evaluated.Copyright © 2022 Novyi Russkii Universitet. All rights reserved.
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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is named as the coronavirus disease of 2019 (COVID-19). Patients with SARS-CoV-2 infection experience a wide range of symptoms and they are at the risk of various systemic complications. Besides the pulmonary complications, COVID-19 cases may develop cardiovascular and hematological complications. This study aimed to review the most important hematological and cardiovascular complications caused by SARS-CoV-2 infection. Method(s): The English databases, including Pubmed, ScienceDirect, Cochrane Library, Scopus, and Google Scholar, were searched. The published papers were selected and reviewed based on the subject of this study. Result(s): The review of the literature showed that several cardiovascular complications related to COVID-19, including acute myocardial infarction, cardiomyopathy, acute heart failure, and venous thromboembolic events due to coagulation abnormalities, have been reported. COVID-19 associated hematological complications include elevated levels of hematological factors including C-reactive pro-tein, lactate dehydrogenase, procalcitonin, and ferritin. Furthermore, the levels of blood cells, including lymphocytes and thrombocytes, can be reduced. Conclusion(s): This study reviewed COVID-19-associated cardiovascular and hematopoietic complica-tions. In conclusion, the patients may experience a wide range of cardiovascular and hematological is-sues during the illness. These complications are often associated with the need for ICU support and care which imposes further costs to the healthcare system. So the healthcare team must consider the possible complications when treating COVID-19 patients to reduce the treatment costs and mortality of patients.Copyright © 2021 Bentham Science Publishers.
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Introduction: The global prevalence of chronic kidney disease (CKD) is approximately between 9 and 12%. One of the main predictors of CKD is elderly age, and about 38% of patients are older than 65 years of age. People with CKD have impairment of the normal reaction of the innate and adaptive immune systems. Therefore, this cohort of patients is more predisposed to chronic comorbid conditions and viral infections. The COVID-19 pandemic shifted the morbidity and mortality of people with CKD. The research shows that patients with kidney disease were more likely to have worse outcomes from coronavirus infection compared to patients without CKD. The aim of this study is to investigate in-hospital mortality of CKD patients and its risk factors with coronavirus in Almaty, Kazakhstan. Method(s): The retrospective analysis includes patients, who had been admitted to a hospital with coronavirus infection, in the Almaty region of Kazakhstan, between June 2020 and June 2022. The database was extracted from the Unified National Electronic Healthcare System (UNEHS). Patients were included if they had been hospitalized with the main diagnosis of U07.1 (COVID-19, virus identified) and U07.2. (COVID-19, virus not identified). Patients' unique IDs were used to merge the database of CKD patients to define whether they had the disease or not. The statistical analysis was performed with STATA 16.0. Person's chi-square test was used for bivariate analysis, and Logistic regression was used for estimation of the relationship between in-hospital mortality and predictors. Result(s): The final cohort consisted of 58,970 patients, and 929 (2%) of them had CKD. The age of patients with kidney disease was statistically significantly higher than that of the comparison group (Table 1). As for the comorbid conditions, CKD patients had a higher ratio of acute myocardial infarction (AMI), diabetes, hypertension, congestive heart failure (CHF), and cerebrovascular disease (CVD) compared to the reference group. The mortality ratio was statistically significantly different in two groups. Table 1. Demographic characteristics and comorbidities of patients with and without CKD. [Formula presented] People of elderly age, male gender, having CKD, AMI, diabetes, hypertension, CHF, and CVD had higher odds of death according to unadjusted logistic regression (Table 2). After adjustment for the abovementioned predictors, age, male gender, CKD, diabetes, and CVD showed higher risks of mortality and remained statistically significant. Table 2. Association between socio-demographic and medical characteristics and in-hospital mortality of patients. [Formula presented] Conclusion(s): This research evaluated hospitalization outcomes of coronavirus patients with and without CKD in Almaty, Kazakhstan. The effect of socio-demographic factors and comorbidities on mortality was analyzed. Although CKD can be prevented and treated to a large extent, multimorbid conditions, especially viruses causing a pandemic, can alter the situation. Therefore, it is necessary to establish a comprehensive disease management strategy for unexpected infectious disease outbreaks. No conflict of interestCopyright © 2023
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Background We aimed to evaluate the incidence of acute myocardial infarction (AMI) in New Orleans in the sixteen years after Hurricane Katrina. Methods This was a single-center, retrospective study performed at Tulane University Health Sciences Center of patients admitted for AMI during two years prior to Hurricane Katrina and sixteen years after Hurricane Katrina. The pre-Katrina and post-Katrina cohorts were compared according to pre-specified demographic and clinical data. Results In the sixteen-year post-Katrina period, there were 3696 admissions for AMI out of a total census of 128,276 (2.9%) compared to 150 admissions out of a census of 21,079 (0.7%) in the pre-Katrina group (p<0.0001). The post-Katrina group had a higher prevalence of known coronary artery disease (CAD) (43.8% vs. 30.7%, p<0.0001), diabetes mellitus (40.7% vs. 28.7%, p<0.002), hypertension (80.1% vs. 74.0%, p<0.05), hyperlipidemia (54.2% vs. 44.7%, p<0.0001), smoking (54.2% vs. 39.3%, p<0.0002), drug abuse (18.7% vs. 6.7%, p<0.0002), and psychiatric disease (15.3% vs. 6.7%, p<0.0004). The post-Katrina group was more often prescribed aspirin (49.6% vs. 31.3%, p<0.0001), beta-blocker (46.9% vs. 34.0%, p<0.004), ACE inhibitor or ARB (51.9% vs. 36.0%, p<0.0004), and statin (52.6% vs. 28.0%, p<0.0001) but with higher medication non-adherence (15.8% vs. 7.3%, p<0.0001). The post-Katrina patients were also more likely to be unemployed (75.6% vs 22.7%, p<0.0001) and non-married (56.3% vs. 52.7%, p<0.0001). Rates of STEMI were lower in the post-Katrina group (29.1% vs 42.0%, p<0.002). There was no significant difference in terms of sex, being uninsured, or prior coronary artery bypass grafting. Four patients were COVID positive in the post-Katrina cohort. Conclusion There was a 4-fold increase in the incidence of AMI sixteen years after Hurricane Katrina. Psychosocial, behavioral, and traditional CAD risk factors were significantly higher among the post-Katrina group. These findings add to the growth of literature demonstrating the adverse cardiovascular outcomes that occur after a natural disaster. Further research is needed to explain the underlying mechanisms to help diminish future cardiac morbidity.Copyright © 2023 American College of Cardiology Foundation
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The proceedings contain 138 papers. The topics discussed include: cardiovascular profile and electrocardiographic findings of hospitalized adult patients during the surge of delta and omicron variants of COVID-19 in a COVID-19 tertiary referral center;abnormal left atrial strain is associated with eventual diagnosis of atrial fibrillation in patients with embolic stroke of undetermined source;sex differences in the evaluation and outcomes of multi-ethnic Asian patients undergoing stress echocardiography;intraventricular pressure gradient: a novel color M-mode echocardiographic-derived imaging modality to assess and predict the alterations following acute myocardial infarction;nationwide trends of gatekeeper to invasive coronary angiography in suspected coronary artery disease;change in minimum indexed left atrial volume predicts incident heart failure: the multi-ethnic study of atherosclerosis;and the diagnostic utility of cardiac imaging (echocardiogram and cardiac MRI) in COVID 19 patients and cardiac complications: retrospective cohort study in Saudi Arabia.
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Background/Introduction: Previous reports from the first COVID wave have documented a 15-40% reduction in admissions of AMI most likely as the result of the stringent public containment measures taken to mitigate the spread of the virus Purpose: To assess the impact of COVID-19 related public containment measures during recurrent COVID-19 waves on hospital admission rate for acute myocardial infarction (AMI). Method(s): Clinical characteristics, reperfusion therapy modalities, COVID-19 status and in hospital mortality of consecutive AMI patients who were admitted in a regional AMI network were recorded during 1 year starting in March 2020 and were compared with the year before. The COVID-19 study period encompassed two waves: the first in March-May 2020 and the second in October-December 2020. Result(s): A total of 1349 AMI patients were hospitalized of which 725 during the pre-COVID period and 624 during the COVID period (incidence rate ratio of 1.16, p=0,006). The impact was predominantly present in the first wave (32% reduction: n=204 vs 152) and evanished during the second wave (3% increase (152 vs 156) (see Figure 1). A similar pattern was observed for ACS with cardiac arrest with a 92% reduction (n=36 vs 3) during the first wave and no change during the second wave (18 vs 18). After correction for temperature and air quality, COVID-19 epidemic remained associated with a decrease of AMI hospitalization (p=0.046) Reperfusion strategy for AMI patients, were comparable between both study periods. The in hospital mortality between the two periods was comparable (2.6 % versus 1.9 %), but COVID-19 positive ACS patients (n=7) had a high mortality rate (14%). Conclusion(s): COVID-19 related public containment measures resulted during the first wave in a 32% reduction of AMI hospitalization, but this impact was not visible anymore during the second wave.
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Introduction: Coronavirus disease 2019 (COVID-19) was described for the first time in December 2019. Symptoms include cough, fever, myalgia, headache, dyspnea, sore throat, diarrhoea, nausea, vomiting, and loss of smell or taste. Viral-induced myocarditis and pericarditis have been described in developed countries, and SARS-CoV-2 is cardiotropic. Pericarditis can mimic myocardial infarction (MI) in its presentation and ECG findings. Case report: A 46-year-old smoker with no previous medical condition presented with left-sided chest pain, sweating, trouble breathing, palpitations, and left-hand numbness. He denied having reduced effort tolerance, orthopnea, or paroxysmal nocturnal dyspnea. Three weeks earlier, he was infected with Covid-19 category 2A infection. On examination, he is haemodynamically stable, and his respiratory and cardiovascular exams were unremarkable. His ECG showed anterior ST elevation, and the bedside echocardiography showed no hypokinesia or pericardial effusion. High-sensitive cardiac troponin T reached 5000. The emergency team contacted the on-call cardiologist for primary PCI. After analysing the serial ECG and bedside echocardiography, he decided against primary PCI due to acute pericarditis. He was started on intravenous diclofenac acid and colchicine. His pain subsided after 3 days with NSAIDs and colchicine. He was reviewed back in the clinic and had a normal ECG and ECHO. Discussion(s): Pericardial disease caused by COVID-19 has been more common since the pandemic outbreak. Mycobacterium tuberculosis, Borrelia burgdorferi, Parvovirus B19, and Epstein-Barr virus are the most common infecting agents. Most cases of acute pericarditis in developing nations are due to tuberculosis infection. Nearly half of all patients who had previously recovered from COVID-19 infection have now presented with new cardiac MRI findings indicating pericardial involvement. Fibrosis and/or oedema may be linked to persisting active pericarditis following infection resolution, which may lead to short and long-term clinical consequences. Conclusion(s): The ST elevation in post-covid patients does not always signify myocardial infarction. Despite complaints and ECG findings, this could not be an acute myocardial infarction, for which clinicians should have a high index of suspicion.Copyright © 2023