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Submission content Introduction: An unusual case of a very young patient without previously known cardiac disease presenting with severe left ventricular failure, detected by a point of care echocardiogram. Main Body: A 34 year old previously well man was brought to hospital after seeing his general practitioner with one month of progressive shortness of breath on exertion. This began around the time the patient received his second covid-19 vaccination. He was sleeping in a chair as he was unable to lie flat. Abnormal observations led the GP to call an ambulance. In the emergency department, the patient required oxygen 5L/min to maintain SpO2 >94%, but he was not in respiratory distress at rest. Blood pressure was 92/53mmHg, mean 67mmHg. Point of care testing for COVID-19 was negative. He was alert, with warm peripheries. Lactate was 1.0mmol/L and he was producing more than 0.5ml/kg/hr of urine. There was no ankle swelling. ECG showed sinus tachycardia. He underwent CT pulmonary angiography which demonstrated no pulmonary embolus, but there was bilateral pulmonary edema. Troponin was 17ng/l, BNP was 2700pg/ml. Furosemide 40mg was given intravenously by the general medical team. Critical care outreach asked for an urgent intensivist review given the highly unusual diagnosis of pulmonary edema in a man of this age. An immediate FUSIC Heart scan identified a dilated left ventricle with end diastolic diameter 7cm and severe global systolic impairment. The right ventricle was not severely impaired, with TAPSE 18mm. There was no significant pericardial effusion. Multiple B lines and trace pulmonary effusions were identified at the lung bases. The patient was urgently discussed with the regional cardiac unit in case of further deterioration, basic images were shared via a cloud system. A potential diagnosis of vaccination-associated myocarditis was considered,1 but in view of the low troponin, the presentation was felt most likely to represent decompensated chronic dilated cardiomyopathy. The patient disclosed a family history of early cardiac death in males. Aggressive diuresis was commenced. The patient was admitted to a monitored bed given the potential risk of arrhythmia or further haemodynamic deterioration. Advice was given that in the event of worsening hypotension, fluids should not be administered but the cardiac centre should be contacted immediately. Formal echocardiography confirmed the POCUS findings, with ejection fraction <35%. He was initiated on ACE inhibitors and beta adrenergic blockade. His symptoms improved and he was able to return home and to work, and is currently undergoing further investigations to establish the etiology of his condition. Conclusion(s): Early echocardiography provided early evidence of a cardiac cause for the patient's presentation and highlighted the severity of the underlying pathology. This directed early aggressive diuresis and safety-netting by virtue of discussion with a tertiary cardiac centre whilst it was established whether this was an acute or decompensated chronic pathology. Ultrasound findings: PLAX, PSAX and A4Ch views demonstrating a severely dilated (7cm end diastolic diameter) left ventricle with global severe systolic impairment.
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Background: Covid redefined how the world functions. The electrophysiology (EP) community identified multiple needs that arose due to this paradigm and redefined workflows. The geographic paucity of experienced clinical mapping support was a crucial issue that limited the worldwide adoption of complex ablation procedures. Objective(s): To ascertain the feasibility and safety of utilizing a novel software for remote mapping and remote clinical support for all spectrums of cardiac ablation procedures and to compare the adoption of ablation technology in that geography. Method(s): Ablation procedures performed at Metromed International Cardiac Centre (MICC), India were included in this early feasibility analysis (EFA). All procedures were performed by a single EP operator. Remote Clinical support was provided by an EP physician (primary operator's sibling) in the USA. All mapping was performed by an experienced mapper from a remote location 400 miles away from the primary EP operator in India. The mapping system utilized was Ensite Precision with SJM Connect software. Result(s): 300 contiguous ablation procedures from 2020 to 2022 were included in this EFA. The proprietory SJM Connect software allows remote access to the Ensite console via a secured connection. The software requires the operator to be granted access to the Ensite console via a permission request that must be acknowledged on the Ensite Console. The software will then allow the remote operator to levels of access to the system, view-only access, or complete control of the console to provide full remote support. Communication occurs between the remote user and the console via a chat function and over a voice call. This remote connection can be terminated at any time from either the console or the remote operator. There is no PHI displayed. Results detailing case demographics and acute procedural success and safety will be presented. Results comparing the adoption of ablation technology with the previous 3 years in this geography will be presented. Conclusion(s): This EFA demonstrates the safety and efficacy of using remote clinical support and remote mapping for ablation procedures. This opens a world of possibilities including the expansion of ablation technology to all corridors of the world with experienced clinical and mapping support connecting the EP community on a worldwide platform. Additional studies and strategies are needed to further understand the implication of remote support algorithms in bridging the healthcare gaps in the field of cardiac EP. [Formula presented]Copyright © 2023
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Background: It has been previously reported during the first COVID outbreak that patients presenting with ST-Segment Elevation Myocardial Infarction (STEMI) and concurrent COVID-19 infection have increased thrombus burden and poorer outcomes [1]. Subsequently, there have been multiple further waves of the pandemic with the emergence of at least two new COVID-19 variants and the emergence of vaccinations. To-date, there have been no reports comparing the outcomes of COVID-19-positive STEMI patients across all waves of the pandemic. Purpose(s): The purpose of this study was to compare the baseline demographic, procedural and angiographic characteristics alongside the clinical outcomes of patients presenting with STEMI and concurrent COVID-19 infection across the COVID-19 pandemic in the UK. Method(s): This was a single-centre, observational study of 1250 consecutive patients admitted with confirmed STEMI treated with primary percutaneous coronary intervention (PCI) at Barts Heart Centre between 01/03/2020 and 10/03/2022. COVID +ve patients were split into 3 groups based upon the time course of the pandemic (Wave 1: March 2020-June 2020, Wave 2: Sept 2020-March 2021, Wave 3: October 2021-March 2022). Comparison was made between waves and with a control group of COVID-ve patients treated during the same timeframe. Result(s): A total of 135 COVID +ive patients with STEMI (1st Wave: 39 patients, 2nd Wave: 60 patients, 3rd wave 35 pts) were included in the present analysis;and compared with 1115 COVID negative patients. Significant changes in the baseline characteristics, angiographic features and clinical outcomes of COVID +ive patients occurred over time. Early during the pandemic (Wave 1 2020), STEMI patients presenting with concurrent COVID-19 infection had high rates of cardiac arrest, evidence of increased thrombus burden (higher rates of multi-vessel thrombosis, stent thrombosis, higher modified thrombus grade higher use of GP IIb/IIIa inhibitors and thrombus aspiration, coagulability (more heparin for therapeutic ACT), bigger infarcts (lower myocardial blush grade and left ventricular function) and worse outcomes (mortality). However, by wave 3 (late 2021/2022), no differences existed in clinical characteristics, thrombus burden, infarct size or outcomes between COVID +ive patients and those without concurrent COVID-19 infection with significant differences compared to earlier COVID +ve patients. Poor outcomes later in the study period were predominantly in unvaccinated individuals. Conclusion(s): Significant changes have occurred in the clinical characteristics, angiographic features and outcomes of STEMI patients with COVID- 19 infection treated by primary PCI during the course of the pandemic. Importantly it appears that angiographic features and outcomes of recent waves are no different to a non-COVID-19 population.
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Background: Coronavirus disease 2019 (Covid-19) has become a global pandemic. Covid-19 increases morbidity in patients with underlying cardiovascular disease. The six-minute walk test (6MWT) is a simple test for assessing cardiopulmonary fitness and has been applied to assess post-surgical recovery in cardiac populations. Decreased heart rate recovery (HRR) over 1 or 2 minutes after exercise shows autonomic dysfunction and is associated with an increased risk of mortality. We conducted a cross sectional study to determine if Covid-19 affects cardiac rehabilitation parameters, such as 6MWT distance, HRR-1, and HRR-2 among patients who have undergone cardiac surgery. Method(s): This analysis included 155 adults who had elective cardiac surgery at the National Heart Center Harapan Kita (NHCHK) from January to June 2022. Each participant performed a 6MWT and treadmill evaluation in phase II cardiac rehabilitation (CR) program. To analyze the association of 6mwt distances and heart rate recovery among patients with covid-19 and without covid-19 who had undergone elective cardiac surgery using Mann Whitney and Chi-Square tests. Result(s): Forty-Seven (30.3%) patients had a history of Covid-19. The mean 6MWT was 339.53 +/- 59.90 m in the pre-CR program, increased to 415.37 +/- 46.46 m in the post-CR program. The mean HRR1 was 15.16 +/- 9.44, and HRR2 was 56.59+/- 35.47. There were no differences in 6MWT distance, HRR1, and HRR2 among patients with a history of Covid-19 and without a history of Covid-19 (P= 0.48, p=0.56, p=0.12). Conclusion(s): The cardiac rehabilitation (CR) program improves the 6MWT distance. Covid-19 does not affect the ability of patients to do six-minute walk tests;neither HRR-1 nor HRR-2 among patients who have undergone cardiac surgery.
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Background and Aims: The COVID 19 pandemic have affected the patients with ST segment elevation myocardial infarction as the number of patients presenting with STEMI declined substantially and those who underwent primary PCI had poor outcome. Our aim was to analyze the in-hospital and 30-days mortality in STEMI undergoing Primary PCI during second wave of COVID 19. Method(s): A prospective cohort study was conducted at Shahid Gangalal National Heart Centre, Bansbari, Kathmandu. Convenience sampling of patients who underwent primary PCI were enrolled in this study and were followed up for 30 days. Numerical variables were described as Mean +/- Standard Deviation (SD) and categorical variables were described as frequency and percentage. p values were calculated and considered significant if < 0.05. Result(s): During this study period of 2 months from 1st May 2021 to 30th June 2021, 97 patients with STEMI underwent primary PCI, including 12 (12.47%) COVID 19 positive cases. 30 days mortality was 15.4% including in-hospital mortality of 11.34%. Among COVID 19 positive cases, in-hospital mortality was 33.33% and 30-days mortality was 55.55% which was significantly higher than non COVID 19 patient who underwent primary PCI (P=0.003). Conclusion(s): Overall, mortality rate of primary PCI during COVID 19 second wave has been increased and mortality of COVID 19 positive patients who underwent primary PCI was significantly higher than non-COVID 19 patients who underwent primary PCI. Copyright © 2022 Cardiac Society of Nepal. All rights reserved.
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INTRODUCTION: Healthcare throughput is the progression of patients from admission to discharge, limited by bed occupancy and hospital capacity. This study examines Heart Center throughput, cascading effects of limited beds, transfer delays, and nursing assignments on outcomes utilizing elective surgery cancellation during the initial COVID-19 pandemic wave. METHOD(S): Nursing assignments, patient data, and transfers were collected. Elective surgery cancellation was March-May 2020. Heart Center occupancy (Stepdown Unit and Cardiac Intensive Care Unit), transfer delays, and patient outcomes were analyzed controlling for patient factors, surgical risk, staffing, and time effects. Setting(s): Retrospective single-center study Patients: Heart Center admissions January 1, 2018 - December 31, 2020. RESULT(S): There were 2,589 patients, median age 5 months (6 days-4 years), 1,543 (60%) surgical, 1,046 (40%) medical. Mortality was 3.9% (n=101), median stay 5 days (3- 11 days), median 1:1 nursing assignments 40% (33%-48%), median occupancy 54% (43%-65%) for Stepdown Unit and 81% (74%-85%) for Cardiac Intensive Care Unit. Every 10% increase in Stepdown Unit occupancy had a 0.5-day increase in Cardiac Intensive Care Unit stay (p=0.044), 2.1% increase 2-day readmission (p=0.023), and 2.6% mortality increase (p< 0.001). Every 10% increase in Cardiac Intensive Care Unit occupancy had 3.4% increase in surgical delay (p=0.016) and 6.5% increase in transfer delay (p=0.020). Elective surgery cancellation reduced high occupancy days (23% to 10%, p< 0.001), increased 1:1 nursing (34% to 55%, p< 0.001), decreased transfer delays (19% to 4%, p=0.008), and decreased mortality (3.7% to 1.5%, p=0.044). CONCLUSION(S): Cancelation of elective surgery was associated with increased 1:1 nursing assignments and decreased mortality. Increased Cardiac Stepdown Unit occupancy resulted in longer Cardiac Intensive Care Unit stay, and increased Cardiac Intensive Care Unit occupancy increased transfer and surgical delays. Additional studies are need to understand the interaction of staffing and outcomes.
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Background: During the initial surge of the COVID-19 pandemic in the spring and summer of 2020, pediatric heart centers were forced to rapidly alter the way patient care was provided in order to minimize interruption to patient care as well as exposure to the virus. In this study, we used a survey-based approach to characterize the changes that occurred in pediatric cardiology practices across the country during and just following the initial peak of COVID-19. Methods: In this survey based descriptive study we characterize changes that occurred within pediatric cardiology practices across the United States and describe provider experience and attitudes towards these changes during the pandemic. decision making during this period. This survey was emailed to an existing list serve of American Academy of Pediatrics Section on Cardiology and Cardiothoracic Surgery (AAP:SOCCS) members. Recipients of the survey included pediatric cardiologists, cardiothoracic surgeons, and fellows-intraining. The questionnaire was initially distributed in June 2020 and was active through August 2020. Results: Surveys were returned by 79 participants across 28 states. Areas of practice of respondents included general cardiology, non-invasive imaging, electrophysiology, heart failure/transplant, interventional cardiology, and adults with congenital heart disease. Common changes that were implemented included decreased numbers of procedures, limiting visitors, and shifting towards telemedicine encounters. There was a high level of satisfaction among providers with telemedicine encounters and a variety of platforms were utilized. Echocardiography was less likely to be performed during the pandemic as compared to prior to the pandemic in nearly all clinical scenarios presented. More than half of respondents expressed concerns about financial stability with regards to personal or practice situation but most were not frequently concerned about their personal safety. Conclusion: Pediatric cardiology practice across the country was heavily impacted by COVID-19 and required many adaptations including minimization of non-essential procedures and increasing use of telemedicine. Providers were generally satisfied with telemedicine and utilized several platforms. Financial concerns were common;however, most participants were not frequently concerned about personal safety. Inter-institutional collaboration could be useful in creating standardized protocols based on shared experiences that could be rapidly implemented in future public health crises. Experience with Telemedicine. A) Barriers to implementing telemedicine. B) Provider rated effectiveness of telemedicine. C) Home monitoring devices used as part of telemedicine program. D) Provider satisfaction vs perceived patient satisfaction with telemedicine encounters. Likelihood of Performing Echocardiography Prior to and During COVID-19 Pandemic. Participants were asked to rate the likelihood for each scenario as always, frequently, occasionally, or never. Responses were converted to a 5-point scale. Pre- and post- responses were analyzed using Wilcoxon signed-rank test. Significant decreases in likelihood of echocardiography were found in nearly all situations.
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COVID-19 is a pandemic threat that affects every aspect of life on the planet. Hundreds of thousands of cases were diagnosed around the world in a short period of time. Health workers are critical to the health-care system and play a critical role during global pandemics. They are also a high-risk group that must wear a face mask for extended periods of time. The purpose of this study was to determine the effects of prolonged facemask use on healthcare workers. A descriptive cross-sectional study was conducted at Shahid Gangalal National Heart Centre, Kathmandu, Nepal. The information from 335 healthcare personnel was collected using a self-administered questionnaire technique. This study included all of the hospital’s healthcare workers from various departments. The descriptive analysis was carried out using SPSS statistical software, version 26. Out of 355 respondents, the majority of responders (69.9%) were under 30 years old, with a mean age of 29.03 (± 4.7) years. Regarding the effects of wearing a face mask for a longer length of time, 99.70 % of the health workers experienced some sort of effect. The most prevalent effects were pain behind the ear (84.2%), difficult during exertion (71.0%), headache (57.6%), and the least common was alteration in sense of smell (15.2 %). According to the findings, almost all of the participants experienced some form of effect from wearing a face mask, hence necessary action by concerned authorities and participants is required to minimize these effects.
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Objective: The patient was a 59-year-old man who was referred to the hospital due to shortness of breath due to increased activity, accompanied by cough, weakness, and lethargy. The patient also had a history of diabetes, hypertension, hyperlipidemia, and asthma. The patient also underwent cardiac stenting last year. LCX and LAD stenting Design and method: He had a continuous pan-systolic murmur on cardiac examination diagnosed with valvular dysfunction. Severe aortic regurgitation was reported on echo. The patient underwent a CT scan of the lungs and a PCR test to rule out Covid-19, which was negative. Finally, the patient was diagnosed with severe aortic regurgitation and underwent aortic valve replacement surgery. Echocardiography was performed before the operation, and the diagnosis was confirmed. Results: Echocardiography was performed postoperatively, which showed good valve function and no valve leakage. From the 5th day after the operation, the patient developed fever and increased leukocytosis. Suspected of having Covid19 and accordingly underwent PCR test, the test result was positive;the patient underwent a CT scan of the lungs. After that, he was transferred to the corona ICU. The patient was treated with Remdesivir, and after two weeks, his PCR was negative, and he was almost ready to be discharged. The patient had completed the entire course of treatment and developed pulmonary fibrosis due to Covid disease, but suddenly, after two weeks from the onset of the illness, she developed severe shortness of breath, which led to intubation. We find severe pulmonary fibrosis in the re-CT scan, especially in the left lung, where the entire left lung had fibrosis. Prednisolone was started at a dose of 50 mg three times a day. The patient was intubated for ten days, then gradually removed from the device. Now the patient is extubated and ready for discharge. Conclusions: Risk factors such as Past cardiac surgery and present cardiac intervention with diabetes mellitus increase the risk of developing lung failure in these Covid19 patients. Elective intubation is better than emergency intubation in patients with comorbidities. Corticosteroids can be effective in treating pulmonary insufficiency.
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Introduction: Social distancing, extensive bans on contacts, curfews, and required wearing of masks in public places have -while unavoidable for disease containment purposes -caused major disruptions to everyday life in face of the Coronavirus Disease 2019 (COVID-19) pandemic. The aim of this study was to figure out how the COVID-19 pandemic affects the Health-related Quality of Life (HRQoL) of children and adolescents with CHD, as well as how the parents perceive the HRQoL of their children. Methods: HRQoL was assessed by KINDL® questionnaire during the COVID-19 pandemic and compared to the children's most recent completion of the questionnaire out of the FOOTLOOSE study setting (German-Clinical-Trial-Register-ID: DRKS00018853) at the outpatient department of the German Heart Center Munich (DHM). From May 27th to June 29th 2020, 160 German children with various CHD (15.2 ± 2.5 years, 62 girls) completed this re-assessment of HRQoL. Mean follow-up period was 2.1 ± 1.7 years. Difference between children's self-reported HRQoL and parents' proxy report was calculated with a paired student T-Test, and agreement of the respective ratings with intraclass correlation coefficient (ICC) and their 95% confidence intervals. Results: HRQoL in children with CHD was significantly lower during COVID-19 pandemic compared to before in total KINDL® score (by -2.1 ± 12.3, p=.030), and the subcategories emotional well-being (by -5.4 ± 1.2, p<.001) and friends (by -4.5 ± 1.7, p=.009). Parents of children with CHD rate the HRQoL in total KINDL® score (mean difference: 3.9 ± 1.2, p=.002), and the subcategories family (mean difference: 8.8 ± 1.7 SEE, p<.001) and friends (mean difference: 7.6 ± 2.2 SEE, p<.001) even worse than their children. Only moderate degree of agreement was found between most of the sub-categorical HRQoL assessment of children with CHD and their parents. Conclusions: The COVID-19 pandemic had a negative impact on HRQoL in children and adolescents with CHD and their families. Furthermore, parents rate the HRQoL of their chronically ill children even worse than the children themselves. Specifically, psychological concerns of children with CHD and their families should also be considered by health care providers during the COVID-19 pandemic.
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Background: A pandemic caused by a new coronavirus particularly threatens the high risk groups of patients, incuding those with pulmonary arterial hypertension. We evaluated the occurrence of COVID-19 in the group of patients with pulmonary arterial hypertension (PAH), course of disease, mortality and the attitude of patients to vaccination. Data collection. During the period of two weeks before May 15th 2021 we collected, by analysis of documentation and telephone survey, data on adult patients managed from 01.03. 2020 to 15.05.2021 in 3 centers for PAH and the Children‘s Cardiac Centre. Information on deceased patients was provided by medical staff from the particular PAH centre. Results: Out of the total number of 168 adult patients (mean age of 54 ± 22 years, 121 females) 32 (19%) had COVID-19 infection during the first or second wave of the epidemic in Slovakia. During this time period 12 patients died and 1 one lung transplantation was performed. 3 of the 12 patients who died suffered from COVID-19 infection. Of the 32 patients infected 7 (21%) were hospitalized, 10 needed oxygen, one artifitial ventilation, and 3 (9%) patients died. Only 74 (47.7%) were vaccinated to date of data collection, although the availability of vaccination for this group of patients was not limited. Conclusion: Despite the fact that PAH is a severe lung and heart disease with a poor prognosis, the course of the disease and mortality were better than could be expected. Results are limited by low patient numbers, but 6% mortality in people with a mean age of 54 years may still be considered high. Vaccination is low despite good access to the vaccine and clear recommendations. Tab. 2, Ref. 15, on-line full text (Free, PDF) www.cardiologyletters.sk.
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Background: Despite increasing incidence of cardiac diseases,there has been only one public cardiac centre for many years. Even in this centre the output has remained on the lower side and cannot cope with increasing demand for heart surgery.This paper describes successes and challenges of cardiac surgery in a Kenyan public hospital Methods: Coast general teaching and referral hospital has the necessary layout and infrastructure for cardiac surgery.Initial preparation involved convincing the county government and hospital fraternity to support the programme. Once this was accepted a planning committee was set up. The task of the committee was to enable purchase and acquisition of equipment and supplies and to ensure proper patient selection.Further, the committee organised for the assembly of kenyan experts and the necessary staff members. Later ,the committee started organising for foreign teams to visit and help the local team Results: A total of 68 patients have undergone open heart surgeries for the past 5 years.These were distributed as follows: Mitral valve replacement 38,intrcardiac repair for congenital heart disease 14,aortic valve replacement 7,mitral valve repair 6,double valve replacement 3. 6 patients died within the first month of surgery and 14 patients out of the 68 have succumbed so far.The small numbers were due to lack of serious political and administrative support,poor funding,lack of full complement of staff and of late, the covid pandemic Conclusion: Open heart surgery is cost intensive.Political support,interactions between surgeons ,collaboration between heart centres in Kenya and abroad is necessary successful establishment of an efficient heart centre.
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Background and purpose: Clinical epidemiology of deceased COVID-19 patients is of great importance in identifying the risk factors for mortality and controlling the pandemic. In this study, we studied the demographic and clinical characteristics of deceased COVID-19 patients in Sari Fatemeh Zahra Hospital, Iran, between March 2020 and February 2021. Materials and methods: This retrospective cross-sectional study was performed by reviewing hospital records of deceased patients diagnosed with COVID-19 (n=214). Diagnosis of COVID-19 was confirmed on the basis of positive RT-PCR test and lung CT scan findings. Information about demographic and imaging characteristics, underlying diseases, and risk factors were collected. Data were analyzed in SPSS V25. Results: The mean age of deceased patients was 68.37 ± 14.1. The most common underlying diseases were hypertension(47.2%), cardiovascular disease (45.8%), and diabetes (40.7%). Abnormalities in lung imaging included peripheral lesions of ground glass in 149 (69.6%), ground glass with consolidation in 46 (21.4%), and crazy paving in 19 (9%) patients, respectively. There was no difference in mean age, sex, underlying diseases, and type of supportive care in patients who died during the epidemic waves of one to three. Conclusion: Underlying diseases were the most critical risk factors for the death of patients with COVID-19 and should be given special attention in assessing the need for hospitalization and treatment of these patients. It is also recommended to conduct a comprehensive study of deceased patients before and after vaccination to evaluate the final effects of general immunization.
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Introduction: Shab Teaching Hospital is a tertiary referral center for cardiology and cardio-thoracic surgery, located in Khartoum, the capital of Sudan. It provides emergency room (ER) services to cardiac patients as well as being a nationwide major referral center. Furthermore, it has a very active cardiac catheterization laboratory ( cath lab) performing coronary and valvular interventions as well as implanting cardiac devices. The COVID-19 pandemic had major impact on medical services in the country, and hospitals had to cope with unprecedented challenges. The first COVID-19 case was confirmed in Sudan on the 13th of March, 2020 and that was followed by major disruptions in the healthcare services especially for non-covid emergencies, a phenomenon seen worldwide. Objectives: To study the impact of COVID-19 on the emergency and cardiac catheterization services especially for acute MI ( acute myocardial infarction) Methods: This a retrospective hospital based study conducted at Shab Teaching Hospital. Data on total ER visits and MI admissions were collected for the months of April, May and June for the years 2019, 20202, and 2021. The volume of coronary angiographies and percutaneous coronary interventions for MI were also collected for the same periods. Results: The average monthly ER visits ( April, May and June) for the years 2019, 2020 and 2021 were 24,252, 25,548 and 31,889 per month respectively. Average monthly admissions for MI for 2019, 2020 and 2021 were 1603, 965 and 2,251 per month respectively . During the months of April , May and June of 2019, 2020 and 2021 the average number of diagnostic coronary angiograms, were 495, 186, and 408 per month respectively whereas average PCI volumes were 195,109, and 164 per month respectively . Conclusion: Cardiac emergency and interventional services at Shab Teaching hospital continued even at the height of the epidemic . Significant drop in emergency department visits was seen for MI in 2020 followed by a strong rebound and increase from pre-COVID 19 level in 2021. This may represent a delayed effect of patients avoiding ER visits during the peak of the epidemic. Regarding cardiac catheterization volumes and PCI for MI, there was also a significant drop in 2020 with partial rebound in 2021.
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Background:Within the scope of the ongoing COVID-19 pandemic, risk assessment and adequate therapy for patients on VAD support remain problematic,The aim of this study was to describe the clinical presentation of COVID-19 in patients on VAD and share the experience we have had during the first year of the pandemic,Method:Retrospective analysis of adult patients on VAD support at the German Heart Center Berlin with a laboratory-confirmed SARS-CoV-2 infection,Of 458 patients on VAD support between 01/03/20 and 01/03/21, a total of 93 patients received the VAD during that time period, a SARS-CoV-2 infection was confirmed in 30 (6.6%) patients,Results:Twenty-nine (96.7%) patients were male, the mean age was 65 years, and the mean BMI was 28.7 kg/m2,Comorbidities included hypertension (46.7%), diabetes mellitus (33.3%), COPD (23.3%), renal insufficiency (56.7%), heparin-induced thrombocytopenia type II (10%), and a history of stroke (23.3%),Eighteen patients were completely asymptomatic at the time of SARS-CoV-2 confirmation,Nine spent the mandatory quarantine at home, whereas 21 were admitted to hospital or had, in most cases, already been hospitalized,Dexamethasone administration was necessary in ten patients, 90% of whom were symptomatic at the time of confirmation;however, 50% died nonetheless,With a median follow-up of 83 days in all patients, seven (23.3%) patients died, 6 of who died as a result of severe acute respiratory distress (5) and/or hemorrhagic stroke (3) associated with COVID-19 within less than 3 weeks after the first confirmation of the SARS-CoV-2 infection,Two out of these six patients died despite not showing any symptoms at the time of confirmation,Furthermore, six patients developed acute renal failure, out of which four patients died,In the context of renal failure, two patients developed a hemorrhagic stroke due to accumulation of anticoagulant drugs and resulting derailment in coagulation,However, with all patients in anticoagulation therapy with a target INR of 2.5 to 3, there were no thromboembolic events,Our analysis did not identify any risk factors for a severe manifestation of COVID-19,Conclusion:VAD patients represent a population with a higher risk for a severe clinical course of COVID-19 compared with the general population and a SARS-CoV-2 infection should raise suspicion regardless of whether the patient has symptoms or not.
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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.
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Background: SARS-CoV2 pandemic has caused major impact on patient care worldwide. We experienced a surge of cases beginning March 2020 leading to the government imposing a movement control order, more commonly known as 'lockdown' starting 18th March 2020. As such, various changes were implemented by our center to the clinical pathway for STEMI patients including using thrombolysis as the preferred initial treatment modality. Purpose: We aim to determine the impact of SARS-CoV2 pandemic on the clinical outcome of acute STEMI patients in our center which is a large regional tertiary hospital for cardiology. Methods and results: This is a single center retrospective cross-sectional study from 1st January 2020 until 31st May 2020. We compared clinical outcomes of patients admitted for acute STEMI before (group 1) and after (group 2) 15th March 2020 which is the date our center implemented changes to our STEMI care pathway. A total of 172 cases of acute STEMI was admitted to our center during this period. Admission for STEMI was noticeably lower after the lockdown implementation (group 1, n = 97 vs group 2, n = 75). The median time from symptom to presentation at our center did not differ between the two groups being 4.15h[2.78,7.28] vs 4.42h[2.97,8.01] p = 0.702, suggesting no outof- hospital delays in management. Majority of the patients in group 1 (n = 75, 77.2%) received primary percutaneous coronary intervention (PCI) vs only 17 (22.7%) in group 2. Most in group 2 (n = 54, 72%) received thrombolytic therapy and subsequently underwent coronary intervention within the same admission. This shows a shift in the preferred initial treatment modality for STEMI at our center during this period. The door to balloon time for patients undergoing primary PCI during this period was also numerically higher in group 2 but the difference was not statistically significant at 46min [38,63] vs 59min [45,72], p = 0.063, most likely due to the additional preparation needed in terms of SARS-CoV2 testing and personal protective equipment (PPE) prior to the procedure. The primary composite endpoint of in-hospital mortality and cardiogenic shock between the two groups (17.5% vs 24.3%, p = 0.275) did not show any significant difference. The incidence of inhospital mortality and cardiogenic shock were 4.1% vs 6.7% (p = 0.458) and 15.5% vs 21.9% (p = 0.281) respectively. Conclusions: This study suggests that thrombolysis as the preferred initial treatment modality for STEMI could be a reasonable temporary measure during the initial phase of a global pandemic to reduce infection risk of healthcare providers without compromising patient outcomes until adequate PPE and testing modalities are available for primary PCI to be performed safely. A follow-up study is needed to determine the long-term outcome of these patients.
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Purpose of Study Coronavirus disease, caused by a beta-coronavirus, mostly affects the respiratory system. Since it is a novel disease, very little is known about the connection between heart involvement and COVID-19. This study will strengthen the current literature and demonstrate to what extent the coronavirus affects the cardiac system. This is a leap forward towards understanding how the heart responds to the virus;based on a cross sectional study of a Hispanic population. Methods Used In total, 50 patient records with positive PCR for SARS-CoV-2 were collected from the Heart Center Hospital. These 50 patients (P.) were admitted after coming into the emergency room. We studied age, sex, race, cardiac involvement, medications, EKGs, Chest Plates, X-rays, CT-Scans, and previous and current health problems. Within the medication section, our prime focus was to observe whether these P. were currently taking or took Losartan in the past, because this drug reduces the penetration intracellularly of the virus. For the chronically ill P., we analyzed underlying diseases, intubation and their role in complications or even death. Summary of Results All of the 50 P. were from Puerto Rico (P. R.), a Hispanic population. None of the P. was taking Losartan. According to the records 96% had severe health problems previously to being contaminated by the virus. Some had atherosclerosis, while others had cardiomyopathy or diabetes mellitus, not related to an acute viral infection. Ten percent of these P. died;however, their cause of death was not a result of a clear correlation between COVID-19 and other comorbidities. These P. were chronically ill and probably the virus further complicated their medical condition. Conclusions In P.R., and possibly other Hispanic countries, there are genes which we call 'protective genes' (P.G.) that control the incidence and degree of heart disease, especially atherosclerotic heart transmitted by evolution. We believe P.G. are crucial in reducing the risk of contracting severe complications by the COVID-19 virus. In addition, since none of the 50 P. was not taking Losartan, we also think this is a factor that will increase the incidence of getting the virus intracellularly, increasing the incidence of death.
ABSTRACT
Introduction: In 2020 the Austrian government has ordered two complete lockdowns and two lockdown lights to maintain control over the infection rate of Covid-19. Several studies have analysed the frequency and outcome of patients with acute coronary syndrome (ACS) during the pandemic. Some have described a decrease in the admission rate of patients with ST-elevated-myocardial-infarction (STEMI) and no-ST-elevatedmyocardial- infarction (NSTEMI), with the reasons still being discussed. Purpose: The aim of this study is to analyse possible differences in frequency, comorbidities and outcome of all STEMI and NSTEMI admissions over various lockdown (L) periods in Austria and to provide a possible explanation for the results. Methods: Analysis of prospectively gathered data on ACS patients in our heart center in the year 2020. Patients were split into 4 groups: no lockdown (NL): n=136;duration (dur): 36 weeks (w);lockdown 1 (L1): n=24;dur: 7w;lockdown 2 (L2): n=16;dur: 2.5w;lockdown light (LL): n=22;dur: 5.5w. To account for the different durations, we divided patients by lockdown duration (n/w). End of a L was defined as re-opening of shops;in LL period schools and restaurants were closed but shops were open. To compare the different groups, age, sex, BMI, comorbidities, cardiovascular risk factors (CVRF) duration of preclinical-symptomatic phase (onset of chest pain to PCI), blood parameters, indication, vascular access (femoral/radial) and target vessel were recorded. As outcome we defined CPR, shock and in hospital death. Results: Out of 198 patients 126 were male (63.6%) and 72 female (36.4%), with a mean age of 65±12 years. There were no statistically significant differences in age, BMI or CVRF between the 4 groups. A 50% higher number of diabetics in the LL group as compared to 25.3% in the NL group (p=0.005) was noticed. STEMI admissions from 2.2 patients/week (n/w) without L decreased to 1.4/w during L1. During L2, the frequency rate rose to 3.2/w in the LL group and admission rates to 2/w, which is almost as high as in the NL group. No differences in NSTEMI admissions between the NL (1.3/w), the L1 (1.4/w) and the LL group (1.8/w) were found. During L2 the frequency of NSTEMI patients increased to 3.2/w. We found a rise in in-hospital death rates from 4.4% without L to 9.1% during LL, though with boarder line statistical significance (p=0.05). Conclusion: Compared to the NL group, our data show a decrease of STEMI and NSTEMI admissions during L1. This trend was not confirmed during L2, despite identical government's restrictions. We, thus, postulate that the decrease of ACS admissions in L1 was caused by patients' concern regarding in-hospital Covid-19 infection rather than by actual restrictions.