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1.
Acta Odontologica Turcica ; 39(2):45-51, 2022.
Article in English | ProQuest Central | ID: covidwho-1837184

ABSTRACT

in English is at the end of the manuscript] Objective: This study aimed to evaluate the effect of long-term use of N95 masks on dentists' oxygen saturation values and pulse rates due to dental procedures performed during the COVID-19 pandemic, and to determine the subjective complaints that occur during use. Participants scored subjective symptoms ranging from 1 to 10, including questions about nausea, headache, dizziness, visual impairment, shortness of breath, tachycardia, confusion, communication difficulties, fatigue, breath odor, mask moisture, temperature, and itching. Nausea, visual impairment, temperature, and itching scores in the female group were significantly higher than the male group (p=0.001). Istatistiksel analizler için NCSS (Number Cruncher Statistical System) 2007 (Kaysville, UT, ABD) programi kullanildi.

2.
Nederlands Tijdschrift voor Geneeskunde ; 166(03):17, 2022.
Article in Dutch | MEDLINE | ID: covidwho-1824509

ABSTRACT

BACKGROUND: The case gives the reader a valuable insight in pathophysiology and treatment in atrioventricular nodal re-entry tachycardia (AVNRT) and vagal manoeuvres available to treat this phenomenon. CASE DESCRIPTION: A 85-year-old woman with a medical history of heart failure and aortic valve stenosis presents herself on the Emergency Department with cardiac shock and cardiac asthma. The ECG showed an AVNRT with 170 beats per minute (bpm) and a left bundle branch block (LBBB). After nasal swab for COVID-19 cardiac rhythm converted to a sinus or atrial tachycardia with 116bpm. The patients circulatory status improved and could then be treated with diuretics. Nasal swabs can lead to stimulation of the glossopharyngeal nerve with increase parasympathetic activity leading to a remission of atrioventricular re-entry tachycardia. CONCLUSION: Nasal swabs can lead to increased parasympathetic activity in the atrioventricular node and cause conversion of supraventricular tachycardia to sinus rhythm.

3.
Journal of Clinical Neonatology ; 11(2):139-142, 2022.
Article in English | EMBASE | ID: covidwho-1822509

ABSTRACT

In the face of the emergence of COVID-19, the multisystem inflammatory syndrome in neonates, which is associated with severe acute respiratory syndrome-related coronavirus, has increasingly been reported. The clinical presentation and evolution of multisystem inflammatory syndrome (MIS) mimics neonatal diseases such as sepsis. Because of the similarities, these cases present clinical and laboratory peculiarities that necessitate distinguishing them from more common neonatal illnesses to reach a consensus on this new disease in the future. Here, we present two cases from India in which neonates had MIS-like manifestations but were later diagnosed with sepsis and metabolic disorder, posing a management dilemma.

4.
Current Cardiology Reviews ; 18(1):1, 2022.
Article in English | EMBASE | ID: covidwho-1817769
5.
U.S. Pharm. ; 47:HS-1-HS-7, 2022.
Article in English | EMBASE | ID: covidwho-1812784

ABSTRACT

Postural orthostatic tachycardia syndrome (POTS) is a disorder of the autonomic nervous system that is often misunderstood and is typically seen in younger women. Emerging data suggest an association between coronavirus disease 2019 and POTS. Given the rise in POTS cases, it is imperative that clinicians and other healthcare professionals better understand this condition. Although several nonpharmacologic and pharmacologic treatments exist for patients with POTS, none are currently FDA-approved. As therapeutics experts and the most accessible members of the healthcare team, pharmacists play a pivotal role in optimizing treatment outcomes by directing patients to further evaluate symptoms and in proposing therapeutics to other healthcare professionals.

6.
Clin Cardiol ; 45(5): 583-589, 2022 May.
Article in English | MEDLINE | ID: covidwho-1802116

ABSTRACT

BACKGROUND: Adenosine has been recommended as a first-line treatment for stable supraventricular tachycardia (SVT). Standard guidelines recommend 6-mg of adenosine administered intravenously (IV) with an immediate 20-ml IV bolus of normal saline solution (NSS; double syringe technique [DST]). However, a newly proposed single-syringe technique (SST), in which adenosine is diluted with an up to 20 ml IV bolus of NSS, was found to be beneficial. HYPOTHESIS: We hypothesized that the SST was noninferior to the DST for terminating stable SVT. METHODS: A pilot multicenter, single-blind, randomized controlled study was conducted at nine hospitals in north and northeast Thailand. Thirty patients who were diagnosed with stable SVT were randomized into two groups of 15, with one receiving adenosine via the DST and the other via the SST. We examined SVT termination, the average successful dose, and the complication rate of each group. Analyses were based on the intention-to-treat principle. RESULT: The termination rate was 93.3% in the DST and 100% in the SST group (p = 1.000), and the success rate of the first 6-mg dose of adenosine was 73.3% and 80%, respectively (p = 1.000). The total administered dose was 8.6 ± 5.1 mg in the DST group and 7.6 ± 4.5 mg in the SST group (p = .608). No complications were found in either group. CONCLUSIONS: The SST was non-inferior to the DST for termination of SVT. However, a further definitive study with a larger sample size is required.


Subject(s)
Tachycardia, Paroxysmal , Tachycardia, Supraventricular , Adenosine , Anti-Arrhythmia Agents/therapeutic use , Humans , Single-Blind Method , Syringes , Tachycardia, Supraventricular/diagnosis , Tachycardia, Supraventricular/drug therapy
7.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793844

ABSTRACT

Introduction: Although COVID-19 affects primarily the respiratory system, several studies have shown evidence of cardiovascular alterations and right ventricular dysfunction. Our aim was to evaluated cardiac function and its association with lung function, hemodynamic compromise and mortality. Methods: Prospective, cross-sectional multicenter study in four university-affiliated hospitals in Chile. All consecutive patients with COVID-19 ARDS on mechanical ventilation admitted between April and July 2020 were included. Transthoracic echocardiography was performed within the first 24 h of intubation. Results: Consecutive 140 patients on mechanical ventilation with COVID-19 ARDS were included in the study, the mean age was 57 ± 11 years, PaO2/FiO2 ratio was 155 [IQR 107-177], cardiac output was 5.1 L/min [IQR 4.5-6.2] and 86% of the patients required norepinephrine. ICU mortality was 29% (40 patients). Fifty-four patients (39%) exhibited right ventricle dilation and 20 of them (37%) exhibited acute cor pulmonale (ACP). Eight of twenty (40%) patients with ACP exhibited pulmonary embolism. Patients with ACP had higher norepinephrine requirement, lower stroke volume, tachycardia, prolonged capillary refill time and higher lactate levels. In addition, acute cor pulmonale patients presented lower compliance, higher driving pressure and the presence of respiratory acidosis. Left ventricular systolic function was normal or hyperkinetic in most cases and only thirteen patients (9%) exhibited left ventricular systolic dysfunction (ejection fraction < 45%). In the multivariate analysis acute core pulmonale, PaO2/FiO2 ratio and pH were independent predictors of mortality (Table 1). Conclusions: Right ventricular dilation is highly prevalent in mechanically ventilated patients with COVID-19 ARDS. The presence of acute cor pulmonale is associated with poorer lung function, but only in 40% of patients it was associated to pulmonary embolism. Acute cor pulmonale is an independent risk factor for mortality in the ICU. (Table Presented).

8.
Cells ; 11(7)2022 03 28.
Article in English | MEDLINE | ID: covidwho-1785536

ABSTRACT

The use of cannabis preparations has steadily increased. Although cannabis was traditionally assumed to only have mild vegetative side effects, it has become evident in recent years that severe cardiovascular complications can occur. Cannabis use has recently even been added to the risk factors for myocardial infarction. This review is dedicated to pathogenetic factors contributing to cannabis-related myocardial infarction. Tachycardia is highly important in this respect, and we provide evidence that activation of CB1 receptors in brain regions important for cardiovascular regulation and of presynaptic CB1 receptors on sympathetic and/or parasympathetic nerve fibers are involved. The prototypical factors for myocardial infarction, i.e., thrombus formation and coronary constriction, have also been considered, but there is little evidence that they play a decisive role. On the other hand, an increase in the formation of carboxyhemoglobin, impaired mitochondrial respiration, cardiotoxic reactions and tachyarrhythmias associated with the increased sympathetic tone are factors possibly intensifying myocardial infarction. A particularly important factor is that cannabis use is frequently accompanied by tobacco smoking. In conclusion, additional research is warranted to decipher the mechanisms involved, since cannabis use is being legalized increasingly and Δ9-tetrahydrocannabinol and its synthetic analogue nabilone are indicated for the treatment of various disease states.


Subject(s)
Cannabinoids , Cannabis , Myocardial Infarction , Adolescent , Analgesics , Cannabinoid Receptor Agonists , Cannabinoids/adverse effects , Cannabis/adverse effects , Heart , Humans , Myocardial Infarction/chemically induced , Myocardial Infarction/drug therapy
9.
Open Dentistry Journal ; 16(1), 2022.
Article in English | EMBASE | ID: covidwho-1779848

ABSTRACT

Background: Despite using biosafety protocols, dentists fear contracting COVID-19 and face economic uncertainties about their professional future caused by the pandemic. Objective: This study aimed at determining the prevalence of anxiety and identifying factors associated with it among dentists during the COVID-19 pandemic in Brazil. Methods: A cross-sectional study involving 408 Brazilian dental surgeons selected by snowball technique who filled an electronic questionnaire about sex, race, dental specialty, health habits, health-related quality of life, anxiety, and COVID-19-related aspects. Symptoms of anxiety were measured by the Beck anxiety inventory, and health-related quality of life was assessed by the World Health Organization Quality of Life questionnaire. Poisson regression was used to obtain estimates of adjusted prevalence ratios. Results: The prevalence rate of anxiety was found to be 27.5% and it was significantly higher among dentists who were afraid of catching COVID-19 (Prevalence Ratio=PR=2.52), and among those who reported sweating, wheezing, and increased heart rate during work (PR=3.67). Afro-American dentists were 48% more anxious than dentists belonging to the white/yellow race. The mean value of the quality of life of anxious dentists compared to non-anxious dentists was 13% lower in the physical domain, 12% lower in the psychological domain, and 7% higher in the social relationship domain. Conclusion: The prevalence of anxiety among Brazilian dentists, in the context of economic uncertainty and social distance imposed by the COVID-19 pandemic, is high and associated with the fear of contracting the disease, physical symptomatology of stress, being Afro-American, and altered quality of life in the physical, psychological, and social relationships domains.

10.
BMC Infect Dis ; 22(1): 214, 2022 Mar 03.
Article in English | MEDLINE | ID: covidwho-1779602

ABSTRACT

BACKGROUND: The emergence of dysautonomia as a consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; or COVID-19) is becoming more prevalent. We have seen evidence in several post-COVID patients and in the literature of varying degrees of autonomic dysfunction. Symptoms, among others, include inappropriate tachycardia, sweating, anxiety, insomnia and blood pressure variability from the effects of excessive catecholamine, as well as cognitive impairment, fatigue, headaches and orthostatic intolerance from decreased brain perfusion. CASE PRESENTATION: We present a case of severe dysautonomia in a previously healthy 27-year-old runner. About five weeks after her initial mild COVID-19 infection, the patient began to develop weakness, which progressed into severe post-exertional fatigue, slowed cognition, headaches, blurred vision and generalized body aches. She also endorsed palpitations, especially when getting up from a seated or lying position as well as with mild exertion. She became reliant on her husband for help with her activities of daily living. Exam was significant for orthostasis; laboratory workup unremarkable. Over the following months, the patient's symptoms have improved slowly with fluid and sodium intake, compression stockings and participating in a graduated exercise program. CONCLUSIONS: Dysautonomia as a consequence of infection with COVID-19 is becoming increasingly discussed, especially as more patients recover from COVID-19. This is a case of a non-hospitalized patient with a mild initial presentation and significant, debilitating dysautonomia symptoms. More research on its pathophysiology, especially in relation to a precedent viral insult, as well as its treatment, is needed.


Subject(s)
COVID-19 , Primary Dysautonomias , Activities of Daily Living , Adult , COVID-19/complications , Exercise , Female , Humans , Primary Dysautonomias/diagnosis , Primary Dysautonomias/etiology , SARS-CoV-2
11.
Front Cardiovasc Med ; 9: 860198, 2022.
Article in English | MEDLINE | ID: covidwho-1771032

ABSTRACT

While the increased arrhythmic tendency during acute COVID-19 infection is recognised, the long-term cardiac electrophysiological complications are less well known. There are a high number of patients reporting ongoing symptoms post-infection, termed long COVID. A recent hypothesis is that long COVID symptoms could be attributed to dysautonomia, defined as malfunction of the autonomic nervous system (ANS). The most prevalent cardiovascular dysautonomia amongst young people is postural orthostatic tachycardia syndrome (POTS). Numerous reports have described the development of POTS as part of long COVID. Possible underlying mechanisms, although not mutually exclusive or exhaustive, include hypovolaemia, neurotropism, inflammation and autoimmunity. Treatment options for POTS and other long COVID symptoms are currently limited. Future research studies should aim to elucidate the underlying mechanisms of dysautonomia to enable the development of targeted therapies. Furthermore, it is important to educate healthcare professionals to recognise complications and conditions arising from COVID-19, such as POTS, to allow prompt diagnosis and access to early treatment.

12.
Circ Res ; 130(7): 978-980, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1770079
13.
Blood ; 138(SUPPL 1):1549, 2021.
Article in English | EMBASE | ID: covidwho-1770204

ABSTRACT

Introduction: TG-1701 is an irreversible, selective, novel Bruton's tyrosine kinase inhibitor (BTKi) administered once daily (QD). BTK inhibitors, as well as the U2 combination (anti-CD20 mAb ublituximab + the PI3Kδ-CK1ϵ inhibitor umbralisib), are highly efficacious in chronic lymphocytic leukemia (CLL), each of which have been previously demonstrated to be superior over standard chemoimmunotherapy. Treatment with a more selective BTK inhibitor could result in improved efficacy and safety outcomes compared with ibrutinib (ALPINE study, EHA 2021), and we hypothesized that dual blockade of the B-cell receptor (BCR) pathway through combination of TG-1701 with U2 may confer greater depth of response compared to either regimen alone. Methods: Patients with CLL and non-Hodgkin lymphoma (NHL) were enrolled in an ongoing Phase 1 study. After characterizing the safety profile of TG-1701 monotherapy, a parallel dose escalation arm of TG-1701+U2 was implemented. Select dose levels of TG-1701 monotherapy and TG-1701+U2 were also expanded. All patients were treated until disease progression, unacceptable toxicity, or investigator/patient decision to withdraw. Safety was evaluated in all treated patients, and efficacy was evaluated in all treated patients who had at least 1 post-baseline assessment. TG-1701 monotherapy data were previously presented;herein we present data from the TG-1701+U2 dose escalation/expansion and the TG-1701 monotherapy CLL expansion cohorts Results: As of July 2021, 142 patients were treated with TG-1701, 36 of whom were enrolled in the TG-1701+U2 arm. The median # of prior therapies across all treated patients was 1 (range, 0-10) and all patients were BTKi-naïve. Among the 36 patients treated with U2+1701, 19 were evaluable for efficacy and safety (17 too early to evaluate). The median age was 69 years (range 47-81), and 56% were male. TG-1701+U2 was well tolerated at 4 different dose levels without dose-limiting toxicities. The most common (>30%) all-causality, all grade treatment-emergent adverse events (TEAEs) were diarrhea (53%) contusion (42%), nausea (37%), hypertension, ALT/AST increase, and fatigue (all 32% each) with TG-1701+U2. Grade 3/4 AEs >15% were limited to ALT/AST increase (21%). Dose reduction occurred in 1 patient due to an AE, and 4 patients discontinued at least 1 study drug due to an AE: 2 discontinued umbralisib, 1 discontinued umbralisib and TG-1701, and 1 discontinued all 3 agents. At the data cut-off, overall response rate (ORR) was 84% (4 CR and 12 PR) among 19 evaluable patients, with remaining patients awaiting post-baseline assessment. In the monotherapy CLL-specific cohorts (200 mg QD, n=20;and 300 mg QD, n=20), 40 pts were evaluable for safety, and 39 for efficacy (1 pt withdrew due to COVID prior to first response assessment). The median age was 71 (range 49-86), and 43% were male. The most common TEAEs were increased ALT/AST (all grades: 18%;grade ≥3: 3%), followed by diarrhea (all grades: 15%;grade ≥3: none), and neutropenia (all grades: 13%;grades ≥3: 13%). There were no cases of atrial fibrillation, major bleeding, or ventricular tachyarrhythmia in the CLL cohorts at a median follow-up of 12.8 months (range 2.5 - 20.8). TEAEs leading to TG-1701 dose reduction occurred in 1 (3%) patient. No patients in the 200 mg or 300 mg CLL cohorts have discontinued due to AEs. In patients with anemia and thrombocytopenia at baseline, sustained improvement in hematologic variables was observed. The ORR among 39 patients was 97% (all PR/PR-L). Lymphocytosis resolved to normal value or <50% of baseline in 69% (24 of 35 of patients with lymphocytosis). Consistent response rates were observed across all subgroups, including the following high-risk genomic features: del17p/TP53 mutations, unmutated immunoglobulin heavy-chain variable-region (IGHV), and complex karyotype (defined as 3 ≤cytogenetic abnormalities). The median duration of response has not been reached in either cohort. Best change in tumor burden from baseline in patients with CLL is presented in Figure 1. C nclusions: TG-1701 exhibits an encouraging safety and efficacy profile as monotherapy in patients with CLL and additionally shows promising activity and a manageable tolerability profile in combination with U2. Future registration trials are being planned in CLL with TG-1701. Recruitment to this study (NCT03671590) continues. (Figure Presented).

14.
European Heart Journal, Supplement ; 23(SUPPL F):F24-F25, 2021.
Article in English | EMBASE | ID: covidwho-1769265

ABSTRACT

Background: Takotsubo cardiomyopathy (TC) presents as a result of catecholamine surge. There are increase of TC among COVID-19 patients, which is induced by cytokine storm. TC is previously known as a self-limiting and benign cardiac manifestation, but it has been uncovered that TC can be associated with fatal cardiac outcome due to cardiogenic shock and life-threatening arrhythmia. Clinical Presentation: A 54-year-old woman presented to the emergency department with a fever since 9 days before admission accompanied by DOE, PND, and fatigue that worsened since 5 days before admission. Fifteen days before her complaints, she experience bereavement from his son death from motorcycle accident. She was referred from regional hospitals due to respiratory failure necessitating ventilator support. Physical examination revealed normal blood pressure and desaturation. ECG shows tachycardia with global ST-elevation. CXR shows cardiomegaly (CTR 62%) and pneumonia. The laboratory demonstrated increased Neutrophil to Lymphocyte Ratio (NLR), C-Reactive Protein, Troponin, and positive PCR COVID-19 swab. An echocardiography presented regional wall motion abnormality with apical ballooning appearance and reduced systolic function with LVEF of 51% resembling Takutsubo cardiomyopathy. Despite maximal ventilatory and pharmacology, she experienced malignant ventricular tachycardia not responding to defibrillation and expired in only 6 hours Discussion: The presence of cardiac arrhythmia followed by cardiac arrest in COVID-19 patient complicated by TC can be a direct effect of catecholamine surge and myocardial injury or indirect effect from QT-prolongation and inflammatory process. Concurrent COVID-19 pneumonia and TC may progress with dismal prognosis, so that in need of prompt referral system.

15.
European Heart Journal, Supplement ; 23(SUPPL F):F10, 2021.
Article in English | EMBASE | ID: covidwho-1769255

ABSTRACT

Aims: We aimed to examine whether there is abnormal value of index of cardiac electrophysiological balance (iCEB=QT/QRS) in patients with confirmed coronavirus disease 2019 (COVID-19), which can predict ventricular arrhythmias (VAs), including non-Torsades de Pointes-like ventricular tachycardia/ventricular fibrillation (non- TdPs-like VT/VF) in low iCEB and Torsades de Pointes (TdPs) in high iCEB. We also investigated low voltage ECG among COVID-19 group. Methods and Results: This is a cross-sectional, single center study with a total of 53 newly diagnosed COVID-19 patients (confirmed with polymerase chain reaction (PCR) test) and 63 age and sex-matched control subjects were included in the study. Electrocardiographic marker of iCEB were calculated manually from 12-lead ECG. Low voltage ECG defined as peak-to-peak QRS voltage less than 5mm in all limb leads and less than 10mm in all precordial leads. Patients with COVID-19 more often had low iCEB, defined as iCEB below 3.24 compared to control group (56.6% vs 11.1%), (OR=10.435;95%CI 4.015 - 27.123;p=0.000). There were no significant association between COVID-19 and high iCEB, defined as iCEB above 5.24 (OR=1.041;95%CI 0.485 - 2.235;p=0.917). There were no significant difference of the number of low voltage ECG between COVID-19 and control groups (15.1% vs 6.3%), (OR=2.622;95%CI 0.743 - 9.257, p=0.123). Conclusion: In this study showed that patients with COVID-19 are more likely to have low iCEB, suggesting that patients with COVID-19 may be proarrhytmic (towards non- TdPs-like VT/VF event), due to the alleged myocardial involvement in SARS-CoV-2 infection.

16.
Journal of the American College of Cardiology ; 79(9):2659, 2022.
Article in English | EMBASE | ID: covidwho-1768647

ABSTRACT

Background: Delayed cancer screenings during COVID-19 pandemic are expected to increase use of chemotherapy agents like paclitaxel. Paclitaxel has been implicated in rare cases of acute myocardial infarction from chemotoxicity. We present a rare case and literature review of Paclitaxel-induced acute multiple vessel coronary thrombosis in absence of native coronary artery atherosclerosis. Case: A 68-year-old man with a history of metastatic stage IV non-small cell lung cancer, hypertension, hyperlipidemia, normal baseline left ventricular systolic function and without coronary disease on recent heart catheterization, was found unresponsive with telemetry showing monomorphic ventricular tachycardia six hours post Carboplatin-Paclitaxel infusion. Decision-making: The patient was emergently cardioverted at bedside, intubated, and started on amiodarone, lidocaine, and norepinephrine infusions. The patient was thrombocytopenic at 61K, leukopenic at 1.2K, and anemic at 7.1 with INR of 1.8. ECG showed new ST-elevation in inferior leads. Bedside echocardiogram revealed global hypokinesis with apical akinesis and a newly reduced LVEF 25%. Troponin measured 0.5 ng/mL (normal <0.04 ng/mL), creatinine 1.4, K+ 3.4, and Mg2+ 1.8. After cardio-oncology led multidisciplinary discussion, a decision was made to pursue invasive angiogram. Found to have de novo triple-vessel coronary thrombosis in mid-LAD, proximal OM1 and mid RCA (Figure 2), percutaneous intervention was performed with drug-eluting stents placed in mid-LAD and mid-RCA, with staged PCI planned on proximal OM1 if needed. Patient responded well to the intervention and was extubated the same day. Patient remained medically stable at 3-month follow-up despite continued chemotherapy. Staged PCI to OM1 was not needed. Conclusion: Paclitaxel based therapy can cause ventricular arrhythmias and sudden cardiac death secondary to acute multi-vessel coronary thrombosis in patients without underlying coronary artery disease in the setting of pronounced thrombocytopenia. Prompt recognition of this severe adverse effect and timely utilization of multidisciplinary care models led by a cardio-oncologist achieves optimal outcomes.

17.
Journal of the American College of Cardiology ; 79(9):2570, 2022.
Article in English | EMBASE | ID: covidwho-1768645

ABSTRACT

Background: The mRNA COVID vaccine is a rare cause of myocarditis in young patients. We describe a case of cardiogenic shock with extensive workup ruling out COVID vaccine induced myocarditis. Case: 42-year-old female who drinks 5 Monster energy drinks and 3-4 cups of coffee daily presented to the hospital with palpitations two weeks following her mRNA COVID vaccine. EKG showed atrial tachycardia with heart rates of 160 beats per minute. Adenosine and Lopressor were administered resulting in hemodynamic instability requiring norepinephrine. An echocardiogram showed dilated cardiomyopathy with ejection fraction of 15%. Right heart catheterization was performed, and the cardiac index was 1.22 L/min/m², systemic vascular resistance was 1918 dynes*sec*cm-5 and wedge pressure was 31 mm Hg. The patient was started on nitroprusside, furosemide, and milrinone drips and she began to improve. The patient was adamant the vaccine is what triggered her heart failure and extensive testing was performed to rule out COVID vaccine induced myocarditis. Workup showed normal coronary arteries and no evidence of infiltrative disease or myocarditis on cardiac MRI. The etiology was from tachycardia induced cardiomyopathy triggered by excessive stimulants and the patient had successful atrial tachycardia ablation of the right superior pulmonary vein. She was discharged on medical therapy for heart failure and advised to stop drinking energy drinks. Decision-making: Once the patient did not respond to the rate controlling agents an echocardiogram showed reduced ejection fraction. Right heart catheterization confirmed cardiogenic shock and nitroprusside and milrinone were started to help reduce afterload and improve contractility. Workup to exclude COVID induced myocarditis lead to the diagnosis of tachycardia induced cardiomyopathy and atrial tachycardia ablation was performed. Conclusion: We report a case of cardiogenic shock with workup diagnosing tachycardia induced cardiomyopathy induced from a combination of excessive monster energy drinks and coffee. She was treated successfully with afterload reduction, inotrope support, and atrial tachycardia ablation.

18.
JACC Case Rep ; 4(10): 567-575, 2022 May 18.
Article in English | MEDLINE | ID: covidwho-1763790

ABSTRACT

A 60-year-old woman with a past medical history of asthma presented with fulminant myocarditis 9 days after testing positive for SARS-CoV-2 and 16 days after developing symptoms consistent with COVID-19. Her hospital course was complicated by the need for veno-arterial extracorporeal membrane oxygenation, ventricular arrhythmias, and pseudomonas bacteremia. She ultimately recovered and was discharged to home with normal left ventricular systolic function. Thereafter, she developed symptomatic ventricular tachycardia, for which she received an implantable cardioverter-defibrillator and antiarrhythmic drug therapy.

19.
Journal of the American College of Cardiology ; 79(9):3220, 2022.
Article in English | EMBASE | ID: covidwho-1757982

ABSTRACT

Background: Primary causes of tricuspid regurgitation (TR) account for 8-10% of cases, whereas secondary causes account for >90%. Given this disparity, there is paucity of data to help guide treatment. Case: A 55-year-old man presented with DOE, fatigue, and diarrhea. He initially presented to urgent care to be tested for COVID-19, however, was found to have a pulsatile neck and was sent to the emergency department. Further history significant for lethargy, bilateral lower extremity swelling, and PND. On presentation, he was normotensive and tachycardic to 110 bpm. Pertinent physical exam findings included facial erythema, severe jugular venous distention with prominent C-V waves, a holosystolic murmur without radiation, and 2+ lower extremity pitting edema. Pertinent laboratory studies include NT-Pro-BNP of 802 pg/mL (reference range, 15 - 125 pg/mL). Infectious workup was positive for SARS-CoV-2. Transthoracic echocardiogram (TTE) demonstrated preserved ejection fraction of 55-60%, dilation of the right atrium and ventricle with normal function, and a small pericardial effusion. Evaluation of the tricuspid valve showed wide-open regurgitation with thickened and restricted leaflets. Decision-making: Given concern for carcinoid valvular disease, oncologic workup was performed that revealed a serum serotonin of 1493 ng/mL (reference range, 21-321 ng/mL), 24-hour urine serotonin of >300 mg/24 hr (reference range, 0.0-14.9 mg/24 hr), and chromogranin A of 806.7 ng/mL (reference range, 0.0-101.8 ng/mL). PET/CT demonstrated Dotatate uptake within the liver and mesenteric lymph nodes. Percutaneous liver biopsy confirmed metastatic well-differentiated neuroendocrine tumor, grade 1. He was started on octreotide and furosemide for symptomatic management. Currently, he is pending endoscopic tricuspid valve replacement which will be guided by decreased tumor progression. Conclusion: Carcinoid heart disease, while rare, represents an important etiology of valvular dysfunction. Despite a well-recognized clinical entity, establishing a diagnosis and making an individualized treatment plan remains a significant challenge utilizing several subspecialties.

20.
Journal of the American College of Cardiology ; 79(9):2694, 2022.
Article in English | EMBASE | ID: covidwho-1757979

ABSTRACT

Background: Hemorrhagic pericardial effusion (HPE) is an infrequently encountered entity. We present here a challenging case of HPE. Case: A 67-year-old woman with history of hypothyroidism presented with dyspnea, chest discomfort, chills since 2 weeks. She had received mRNA-1273 vaccine 7 days prior to presentation. Vitals were notable for a heart rate of 136/min, otherwise she was hemodynamically stable. Physical exam was notable for muffled heart sounds. Decision-making: Labs showed a hemoglobin of 9.6 g/dL, C reactive protien(CRP) of 93.80 mg/L, normal thyroid profile and troponin, and a negative COVID-19 PCR. ECG was suggestive of sinus tachycardia. An Echocardiogram showed ejection fraction of 55-60% and large pericardial effusion with tamponade physiology. Emergent pericardiocentesis was done, removing 940 mL of sanguineous fluid. Pericardial fluid showed predominantly red blood cells;cytology was negative for malignant cells. Infectious workup for fungal, viral, tuberculosis and bacterial infections, and antibody testing as a part of rheumatologic workup was negative. A CT of the chest, abdomen and pelvis did not show any evidence of malignancy. She remained hemodynamically stable and was discharged on colchicine and ibuprofen. The patient did well on follow up at one month. Conclusion: Despite extensive workup, underlying etiology of HPE was not identified. As the symptoms preceded vaccination, the likelihood of vaccine-induced pericarditis and HPE was deemed low. [Formula presented]

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