ABSTRACT
Background Fulminant myocarditis can cause biventricular dysfunction with a mortality rate over 40%. We report a case with severe biventricular failure due to fulminant myocarditis that was successfully supported by left and right ventricular assist devices. Case A 65-year-old woman presented with chest pain, abdominal pain and diarrhea. She was hypotensive and labs revealed elevated troponin-T of 13.5 ng/mL and lactate of 4.3 mmol/L. She was positive for COVID by antigen testing. She was started on multiple vasopressor infusions and admitted to the intensive care unit. Echocardiogram revealed a severely reduced left ventricular ejection fraction of 15% and severe global hypokinesis. The following day, she developed a wide complex tachycardia that was refractory to amiodarone, lidocaine and multiple defibrillation attempts. She was transferred emergently to the cardiac cath lab where coronary angiography revealed an isolated 70% stenosis of the distal left circumflex artery. A Swan-Ganz catheter was placed that yielded a cardiac index by Fick of 1.2 L/min/m2, systemic vascular resistance of 1270 dynesseccm-5 and mixed venous oxygen saturation of 35%. Decision was made to emergently insert an Impella CP device. That evening, she developed complete heart block and transvenous pacing wire was inserted. Due to frequent suction alarms, decision was made to insert ProtekDuo device, which resulted in hemodynamic stabilization. A temporary coronary sinus pacing lead for atrial capture was inserted to improve atrioventricular synchrony. After several days of monitoring, repeat echocardiogram showed complete recovery of biventricular function and Impella CP and ProtekDuo devices were removed. Decision-making The decision of early implantation of ProtekDuo device was made to provide adequate blood flow to the left ventricular assist device for hemodynamic support. In addition, increased atrioventricular synchrony via insertion of temporary coronary sinus pacing wire improved cardiac output. Conclusion Fulminant myocarditis involving biventricular dysfunction can be supported by the use of simultaneous left and right ventricular assist devices.Copyright © 2023 American College of Cardiology Foundation
ABSTRACT
Background: Same day discharge (SDD) is a validated option for selected patients (pts) undergoing coronary angiography (CAG) and percutaneous coronary interventions (PCI). We analyzed how the COVID-19 pandemic influenced patients' admissions to and discharges from our SDD radial lounge. We focused on safety and complications. Method(s): In 2021, 817 pts (age 65+/-11 years, 28% female) were admitted to the lounge. CAG was performed in 729 pts, and 176 (24%) underwent ad hoc PCI. Furthermore, 88 pts were admitted for implantable device replacement procedures. Result(s): Out of 729 transradial CAGs 621 were performed by using the proximal radial approach (PRA) and 108 (15%) via the distal radial approach (DRA). Ninety % of all these procedures (n = 655) were performed from the nondominant left hand. PRA was associated with one radial artery occlusion (RAO) and longer compression time (92+/-24 min vs 75+/-26 min, p <0.05). In the PRA group 23 postprocedural local hematomas <5 cm (3%) and 17 hematomas <10 cm (2%) were observed but did not require specific treatment. DRA was associated with only 4 super-ficial hematomas <2 cm and no RAO. No other relevant complications occurred in the rest of pts. Ninety % of all pts (n = 732) were discharged home on the same day (<=6 hours after procedures) and none of them was readmitted within the next 24 hours. The remaining 10% of the patients (n = 85) were hospitalized after CAG and PCI, mostly because of severe coronary artery disease findings. Conclusion(s): During COVID-19 pandemic, CAG and PCI together with device replacement procedures in our SDD program were associated with a one-year saving of more than 700 overnight stays, minimal complications and 0,1% RAO rate. Supported by the Charles University Research program "Cooperatio-Cardiovascular Science" and by MH CZ-DRO (Faculty Hospital in Pilsen-FNPl, 00669806).
ABSTRACT
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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Aim: Coronavirus disease 2019 (COVID-19) has caused thrombotic disease. In this study, we aimed to determine the demographic and clinical characteristics of acute coronary syndrome (ACS) patients infected with COVID-19 and to investigate whether they differ from patients with ACS without COVID-19 in terms of these characteristics. Material(s) and Method(s): The study was designed as a single-center retrospective study. Thirty-three COVID-19 infected ACS patients (Group 1) and 100 ACS patients without COVID-19 infection (Group 2) were included in the study. Result(s): The groups were compared in terms of coronary angiographic data. Twenty-eight (84.8%) patients in Group 1 and 74 (74%) patients in Group 2 were presented as non-ST elevation myocardial infarctus. Patients were compared in terms of baseline Thrombolysis in Myocardial Infarctus (TIMI) flow, thrombus stage, myocardial blush (end), using of thrombus aspiration catheter, stent thrombosis, and TIMI flow after percutaneous coronary intervention, and it was observed that there was no statistical difference between the groups (p> 0.05). Discussion(s): COVID-19 infection can cause plaque rupture, myocardial damage, coronary spasm and cytokine storm by triggering the coagulation and inflammation process. The fact is that we did not encounter an increased thrombus load in this study.Copyright © 2022, Derman Medical Publishing. All rights reserved.
ABSTRACT
We describe a patient presenting with chest discomfort, anterolateral ST elevation, and developing acute cardiogenic shock secondary to SARS-COV-2infection-patient zero presenting to our institution's cardiac catheterization laboratory. The emergent presentation with limited clinical information led to exposure of personnel. The diagnosis was complicated by two negative tests for SARS-COV-2, and high-clinical suspicion from the patient's occupational history led to additional testing in order to confirm the diagnosis.