Physiotherapy Screening for Referral of a Patient with Patent Foramen Ovale Presenting with Neck Pain as Primary Complaint: A Case Report.

Neck pain is a common musculoskeletal disorder encountered by physiotherapists. However, it may be the early manifestation of more alarming conditions, such as cardiovascular diseases mimicking musculoskeletal pain. Patent foramen ovale (PFO) is a congenital heart defect consisting of a small opening between the right and the left atrium. A 56-year-old male presented with neck pain and head heaviness as primary complaints. The cardiovascular profile and the behavioral symptoms led the physiotherapist to find an exaggerated blood pressure response during exercise; in addition to subtle neurological signs, this prompted the physiotherapist to make an urgent referral. At the emergency department a PFO was diagnosed. To the best of the authors' knowledge, this is the first case to describe a rare clinical presentation of a PFO presenting neck pain as primary complaint. This case report emphasizes the importance for physiotherapists to be able to triage patients for conditions outside their scope suggestive of further medical investigation.

Ambulatory blood pressure monitoring in treated patients with hypertension in the COVID-19 pandemic - The study of European society of hypertension (ESH ABPM COVID-19 study).

PURPOSE: The coronavirus disease 2019 (COVID-19) pandemic and the subsequent lockdown profoundly affected almost all aspects of daily life including health services worldwide. The established risk factors for increased blood pressure (BP) and hypertension may also demonstrate significant changes during the pandemic. This study aims to determine the impact of the COVID-19 pandemic on BP control and BP phenotypes as assessed with 24-hour ambulatory BP monitoring (ABPM). MATERIALS AND METHODS: This is a multi-centre, observational, retrospective and comparative study involving Excellence Centres of the European Society of Hypertension across Europe. Along with clinical data and office BP, ABPM recordings will be collected in adult patients with treated arterial hypertension. There will be two groups in the study: Group 1 will consist of participants who have undergone two ABPM recordings - the second one occurring during the COVID-19 pandemic, i.e. after March 2020, and the first one 9-15 months prior to the second. Participants in Group 2 will have two repeated ABPM recordings - both performed before the pandemic within a similar 9-15 month interval between the recordings. Within each group, we will analyse and compare BP variables and phenotypes (including averaged daytime and night-time BP, BP variability, dipper and non-dipper status, white-coat and masked hypertension) between the two respective ABPM recordings and compare these changes between the two groups. The target sample size will amount to least 590 participants in each of the study groups, which means a total of at least 2360 ABPM recordings overall. EXPECTED OUTCOMES: As a result, we expect to identify the impact of a COVID-19 pandemic on blood pressure control and the quality of medical care in order to develop the strategy to control cardiovascular risk factors during unpredictable global events.

What is the context?A wide range of daily activities, including health care worldwide, were deeply affected by the Coronavirus disease 2019 pandemic and the subsequent lockdown.What is new?Our multicenter study will examine the impact of the COVID-19 pandemic on blood pressure control in hypertensive patients across Europe by analysing results of 24-hour ambulatory blood pressure monitoring.What is the impact?Optimising strategies for dealing with future unpredictable global situations will depend on understanding how the pandemic affected blood pressure control.

COVID-19 IMPACT ON THE PREVALENCE OF SUBCLINICAL HYPERTENSION AMONG PRACTICALLY HEALTHY MEDICAL STUDENTS

Objective: Silent arterial hypertension is not rare among young adults suffering chronic distress like medical students. COVID-19 pandemic with increased fears and anxiety, social isolation, distant learning, and decreased ACE2 receptor activity could boost hypertension and other cardiovascular risk factors. The study was aimed to compare the frequency of subclinical hypertension in cohorts of 'apparently healthy' young adults revealed before the COVID-19 pandemic and two years after its onset. Design and method: Medical students without any known diseases or apparent signs of 'health problems' enrolled. 24-hour BP monitoring and test questioning with “International Physical Activity Questionnaire” and “The Perceived Stress Scale-10” were performed in 'pre-COVID' November and December of 2019 (Group 1) and the same months of 'peak-COVID' of 2021 (Group 2). Results: A total of 160 students aged 19 to 26 years were enrolled (group 1, n = 74;group 2, n = 86). The groups did not differ with respect to gender, age, body mass index (BMI) or physical activity (table). The proportion of participants with high perceived stress level (24 and more points) was higher in group 2 vs group 1 (58.1% vs 11.2%, p < 0.001). Masked hypertension prevalence and average values of systolic and diastolic blood pressure (SBP and DBP) did not differ between groups, however daytime and nighttime BP load index was significantly higher in group 2 vs group 1 for both SBP and DBP. Conclusions: Despite the absence of significant differences in the mean BP variables, when compared with similar group from 'pre-COVID' period, 'apparently healthy' students examined after two years of the COVID-19 pandemic had significantly worsened day and night BP load indexes. These changes correlated with the increase of perceived stress levels. (Table Presented).

EKG Abnormalities in a Youth Athlete Following COVID-19: It's Not Always Myocarditis!

COVID-19 associated myocarditis following mild infections is rare while incidental findings may be more common. A young athlete fully recovered from a mild COVID-19 infection presented with inferolateral T-wave inversions and left ventricular hypertrophy on imaging. Exercise testing aided in correctly diagnosing the patient with masked systolic hypertension.