Mitral valve chordal rupture against the background of cardiac SARS-CoV-2 infection. Cases series.

In an ever-changing information flow on coronavirus disease 2019 by the fact that the infection symptoms were mild, followed by signs (COVID-19) pandemic, we describe a case series of mitral valve chordal of probable endomyocarditis, unrecognized in time, and acute mitral rupture (MVCR) in non-comorbid middle-aged men that occurred over valve regurgitation developed against the background of physical a period of 3 to 5 weeks after Severe Acute Respiratory Syndrome provocation (exercise and cough). Two patients had previously been CoronaVirus 2 (SARS-CoV-2) infection. With significant advances diagnosed with mitral valve prolapse (myxomatous degeneration in the prevention of acute rheumatic fever, the treatment of bacterial and connective tissue disease). Two patients were successfully endocarditis and acute coronary syndrome, acute mitral regurgitation operated on in different clinics. The described cases emphasize that has become a relatively rare diagnosis. During the pandemic, there has the consequences of inflammation persistence may be more severe been a surge in the incidence of spontaneous MVCR, and new data on than the primary viral damage, which determines the importance of a the problem are accumulating. The presented case series are united comprehensive examination and long-term follow-up. To date, the differential diagnosis of patients with sudden onset of dyspnea and chest pain associated with an infectious process should include MVCR.Copyright © 2023 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.

Telemedicine to Timor-Leste: Implementing an International Cardiac Telehealth Service During Population Dislocation, Floods and COVID-19

Background: The East Timor Hearts Fund (ETHF) has provided cardiac services in Timor-Leste since 2010, conducting three clinics yearly. With international border closures due to the COVID-19 pandemic, development of collaborative telehealth services was required. Methods: Scoping discussions identified major challenges (structural, patient-related and medical system-related). At two pilot clinics, patient history, investigation and management were collated. Clinic metrics were compared to an index face-to-face clinic in February 2019. Post-clinic discussions identified areas of success and shortfall in the conduct of the telehealth clinics. Results: 23 patients were reviewed at the online telehealth clinics held onsite at Timorese medical facilities. Compared to an index 2019 clinic, there were markedly lower numbers of new referrals (2 vs 190 patients, 8.7% vs 59.4%). Patients seen at the online clinic were predominantly female (17/23, 73.9%) and Dili-based (18/23, 78.3%) with a mean age of 25.9 ± 7.2 years old. The majority (12/23, 52.2%) had isolated rheumatic mitral valve disease. Investigations including electrocardiography, pathology, echocardiography and 6-minute walk tests were conducted in select patients. Medication advice was provided for 10 (43.5%) patients. 11 patients (47.8%) were deemed to require urgent intervention. Post-clinic discussions indicated general satisfaction with telehealth clinics, although frustration at current inability to provide interventional services was highlighted. Conclusion: Our pilot telehealth clinics indicate that capacity-building telemedicine can be rapidly implemented in an emergency setting internationally. Clinic design benefits from careful identification and resolution of challenges to optimise flow. Cardiac patients in Timor-Leste have a significant burden of disease amenable to intervention.

Secondary prevention of rheumatic heart disease in ethiopia

Introduction: Acute rheumatic fever (ARF) and rheumatic heart disease (RHD) are significant causes of morbidity and mortality. Ethiopia has a high RHD prevalence but has no national strategic guidelines for preventing RHD and no data on the status of secondary prevention in children with RHD. Generating local information is essential to designing effective prevention and control strategies. This study describes the status of secondary RHD prevention in Ethiopian children. Methods: A multicenter, cross-sectional study was performed in children aged 5-17 years with an echocardiogram-based RHD diagnosis. Participants with congenital heart disease and a recent RHD diagnosis (<1 year) were excluded. Good adherence was defined as at least 80% completion of intramuscular benzathine penicillin (BPG) or oral Amoxicillin within the previous year. The primary outcome measure was adherence to prophylaxis, expressed as a proportion. Covariates included socio-demographics, type and severity of RHD, and ARF recurrence. Chi-square test and Student's t-test were used to assess differences. Multivariate logistic regression was performed. Results: We included 337 participants with a mean age (±standard deviation) of 12.9±2.6 years. The majority were females (54%) and 73% had severe aortic/mitral disease. BPG (80%) and Amoxicillin (20%) were the prophylaxis of choice. Predictors of good adherence were female sex (P=0.04), use of BPG (0.03), and shorter mean duration of prophylaxis in months (48.5±31.5 vs. 60.7±33, P<0.008). Running out of medicines (35%), interrupted follow-up (27%), and the COVID pandemic (26%) were the three most common reasons for missing prophylaxis. Recurrence of ARF was higher in participants on Amoxicillin (40% vs. 16%, P<0.001) and in those with poor adherence (36.8% vs. 17.9%, P=0.005). Type and duration of prophylaxis (OR 0.5, P=0.02;OR=1.1, P=0.04, respectively), and sex (OR=1.9, P=0.03) were independent predictors of poor adherence. Conclusion: Poor adherence is prevalent in Ethiopian children with RHD. Amoxicillin is a suboptimal option for prophylaxis associated with lower adherence and a higher rate of ARF recurrence.