Rate and spectrum of incidental findings on CT pulmonary angiogram of COVID-19 patients

Introduction: Patients admitted with COVID-19 infection and had suspected pulmonary embolism were investigated with CT pulmonary angiogram(CTPA). Apart from the features of COVID pneumonitis, other incidental findings can be reported on the scan. Aim(s): This study illustrates the rate and spectrum of incidental findings on CTPA performed on patients admitted with COVID-19 in a busy district general hospital. Method(s): Electronic patient record and CTPA report of patients admitted with COVID-19 confirmed from SARS-COV2 PCR test were retrospectively analysed using Allscripts Gateway and Sectra software respectively between March 2020 to March 2021. Descriptive and statistical data analysis were undertaken in Excel and GraphPad Prism software. Result(s): 874 patients with COVID-19 with median age of 69 yrs were studied and 218 patients had CTPA (25%). 219 Incidental findings were noted in 112 (51%) patients who had CTPA. Patients with incidental findings are older (68 yrs vs 59yrs, p value 0.0005). 35 patients(16%) were found to have pulmonary embolism in our cohort. Conclusion : This study illustrates that incidental findings are common when COVID-19 patients had CTPA scans, and these patients were older. These incidental findings were both varied and clinically significant. This would increase the pressure on respiratory and cardiology services to investigate these incidental findings, further management and subsequent follow up.

Profile of Cardiac Involvement in Children After Exposure to COVID-19

OBJECTIVE: To evaluate the incidence and pattern of cardiac involvement in children post-COVID (coronavirus disease) infection in a tertiary care referral hospital in India. METHOD(S): A prospective observational study was conducted including all consecutive children with suspected MIS-C referred to the cardiology services. RESULT(S): Of the 111 children with mean (SD) age was 3.5 (3.6) years, 95.4% had cardiac involvement. Abnormalities detected were coronary vasculopathy, pericardial effusion, valvular regurgitation, ventricular dysfunction, diastolic flow reversal in aorta, pulmonary hypertension, bradycardia and intra-cardiac thrombus. The survival rate post treatment was 99%. Early and short-term follow-up data was available in 95% and 70%, respectively. Cardiac parameters improved in majority. CONCLUSION(S): Cardiac involvement post COVID-19 is often a silent entity and may be missed unless specifically evaluated for. Early echocardiography aided prompt diagnosis, triaging, and treatment, and helps in favorable outcomes.

Impact of the COVID-19 pandemic on cardiology services in the second year at a South Asian cardiac centre

Background: Little has been reported on the impact of the COVID-19 pandemic and the new delta variant, on cardiology services and catheterization volumes in South Asia, during the second year of the pandemic. Purpose: We aimed to assess this impact during the second year of the pandemic on cardiology services, procedures and catheterization volumes at a tertiary cardiac centre in Bangladesh. Methods: Data on patient visits (outpatient and emergency), admissions, procedures and catheterization volumes were collected for January to June 2020 and 2021 via hospital electronic records. Comparisons for each corresponding month were made between 2021 and 2020. The differences were expressed as a percentage (%Δ). Results: Trends showed that admissions in cardiology and cardiac surgery units, outpatient visits, procedures and cardiac catheterization volumes had reached almost pre-pandemic levels in the first quarter of 2021, as compared to 2020. However, ER visits showed >50% reductions in February (Δ-58.7%) and March (Δ -51.9%) 2021, compared to 2020. Admissions and procedures showed a steep decline from March to April 2021, coinciding with the COVID19 surge owing to the Delta variant. A gradual increase in numbers of admissions, patient visits, and procedures were seen in May and June 2021, as compared with corresponding months in 2020. In terms of catheterization volumes, a sharp decline was seen in angiographies and percutaneous coronary intervention (PCI) from March to April 2021, similar to 2020. Cath lab procedures showed an increasing trend in May-June 2021, and were greater in numbers, compared to corresponding volumes in 2020 [May: Δ+36.9%;June: Δ+33.2% in 2021]. A greater increase was seen for PCI (May Δ+ 46.8%;June Δ+367%) than angiographies (May Δ+32.5%;June Δ+32.5%). Conclusion: Cardiology services and cath lab volumes had reached almost pre-pandemic levels in January and February 2021. The surge caused by the delta variant resulted in reduced admissions, outpatient and cath lab volumes beginning from April 2021, however numbers remained greater in 2021 than corresponding months in March-June 2020, possibly indicating an adaptation of the healthcare system to the prevailing pandemic.

A case of severe rhabdomyolysis and acute myocarditis in an adolescent female

INTRODUCTION: Rhabdomyolysis describes a condition where muscle tissue destruction occurs. Mortality and morbidity can be significant especially when multi-organ injury ensues. In very few instances, myocarditis has been described in association with this condition. DESCRIPTION: An 11-year-old previously healthy female presents with vomiting, diarrhea, tactile fever, worsening severe bilateral leg pain and gross hematuria for four days. At the Emergency Department, her ECG showed ST depression in lateral leads and abnormal Q waves. Laboratory studies were notable for significantly elevated CK >330,000 U/L. Elevated Troponin T and Troponin I at 3.60 ng/ml and 0.54 ng/mL, respectively. Elevation of CRP 23.5 mg/dl, ALT 1,966 U/L, AST 5,956 U/L, and Ferritin 712.1 ng/ml. Patient had dark brown urine, which was positive for blood, and urine myoglobin peaked at 2690 ng/mL. Her renal function was normal with blood urea nitrogen 8 mg/dl and creatinine 0.4 mg/dl. C3 and C4 levels were decreased, 45 mg/dl and 5 mg/dl, respectively. Anti-dsDNA negative, ANCA negative, and ANA negative. Nasopharyngeal PCR was negative for Mycoplasma pneumoniae, influenza A and B. Blood enterovirus PCR negative. COVID PCR and antibodies negative. Neuromuscular genetic testing was non-diagnostic. Her echocardiography showed thin rim of pericardial effusion and normal ejection fraction. Cardiac MRI demonstrated myocardial edema and regional sub-epicardial delayed enhancement consistent with acute myocarditis. Patient was started on hyperhydration therapy, Solumedrol and intravenous immunoglobulin. The rhabdomyolysis resulted in severe extremity weakness requiring prolonged rehabilitation. Her condition and biomarkers normalized and was subsequently discharged home. Follow up cardiac MRI 6 months later showed increased extracellular volume (ECV) of 38% suggestive of focal and diffuse areas of fibrosis. Patient remains under physical activity restrictions and is being followed by cardiology service. DISCUSSION: Our case highlights severe rhabdomyolysis in association with acute myocarditis and subsequent cardiac structural abnormalities. Although it remains unclear whether myocarditis evolved as a complication of rhabdomyolysis or was triggered by same inciting agent, an infectious etiology overall remains the most likely culprit.

Impact of the COVID-19 pandemic on cardiology services at a tertiary cardiac centre in a lowand middle-income country in Asia

Background: The COVID-19 pandemic resulted in reduced numbers of patients presenting with and undergoing procedures for cardiac conditions worldwide. This impact, specifically looking at the changes in patient visits, admissions and procedure volumes, has not been recorded thus far, in terms of a South Asian LMIC setting. Purpose: We aimed to assess the impact of the pandemic on emergency room (ER) visits, cardiology admissions, out-patient and in-patient procedures at a LMIC tertiary cardiac centre. Methods: Data on ER visits, specific in-patient and out-patient procedures (echocardiography, exercise stress tests, electrocardiography [ECG]) were collected via hospital electronic records from January to December 2020, and compared with corresponding data for the same months in 2019. The difference or deficits were expressed as a percentage (%Δ). Data for each quarter were compared using paired t-test. A p value <0.05 was considered significant. Results: There were significantly reduced numbers of out-patient visits (Δ -31.2%;p=0.007), ER visits (%Δ -59.5%;p=0.0), in-patient admissions (Δ -33.1%;p=0.005), total out-patient procedures (%Δ -31.9%;p=0.008) and catheterization volumes (%Δ-29.7%;p=0.001) in 2020, as compared with 2019 (Table 1 & Figure 1). Among out-patient procedures, adult transthoracic echo, ECG and stress tests showed greatest deficits in April 2020. No trans-oesophageal echocardiograms were performed in April to July 2020. The greatest deficits were observed in April 2020, as compared with 2019 (out-patient visits: Δ-92.7%;out-patient procedures: %Δ-94.5%;inpatient admissions: %Δ-85.9%;catheterization procedures: %Δ-85.2%), except for ER visits, where the greatest deficit was seen in June 2020: %Δ-90.7%). Numbers continued to remain extremely low in May 2020, coinciding with the nation-wide lockdown measures. Out-patient visits, procedures and in-patient admissions have gradually increased since July 2020. However, the greatest impact seems to have been on ER visits, continued to remain low, with significantly reduced volumes in both 2nd and 3rd quarters of 2020. The lowest deficits in outpatient visits (Δ-4.9%), ER visits (Δ-31.9%) and out-patient procedures (Δ-0.9%) were seen in December 2020, while for in-patient admissions (Δ-7.9%) and catheterization procedures (Δ-6.5%) this was in October 2020. Conclusion: There was a significant reduction of out-patient and in-patient cardiology services volumes in 2020, with the greatest reduction in April and May, coinciding with a general lockdown. ER visits were the most greatly affected. Trends show a steady increase in out-patient and catheterization procedures, beginning from July, but have not yet reached pre- COVID volumes, even by the end of 2020. These findings indicate that, the pandemic has resulted in significantly fewer ER visits;however, patients still present as outpatients, both for procedures and catheterization.