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1.
Heart ; 2022 Oct 24.
Article in English | MEDLINE | ID: covidwho-2088827
2.
Russian Journal of Cardiology ; 27(S3):8-15, 2022.
Article in Russian | EMBASE | ID: covidwho-2081128

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has shown the need for the development of telemedicine technologies, especially remote follow-up using vital sign telemonitoring. In the Russian Federation, this approach is also justified by the remoteness factor with a shortage of medical workers in distant areas of the country. Aim. To study the potential of remote monitoring in outpatients discharged after acute decompensated heart failure and acute coronary syndrome. Material and methods. The study included 392 patients randomized to active follow-up groups with remote blood pressure (BP) monitoring (group 1, n=197) and standard management (group 2, n=195). The follow-up period lasted 3 months. Results. During the follow-up period, patients managed with BP and heart rate telemonitoring tended to decrease in systolic BP from 132 (interquartile range (IQR), 121-139) mm Hg up to 125 (IQR, 115-130) mm Hg (p=ns). On the contrary, the 2nd group patients had a slight increase in systolic BP from 127 (IQR, 115-137) mm Hg up to 132 (IQR, 124-142) mm Hg (p=ns). The patients of group 2 were more likely to receive diuretics and nitrates after 3-month follow-up, which can be considered a negative factor. This may indicate no improvement in the course of heart failure and chronic coronary artery disease with the absence of therapy correction over time. During foll ow-up, four patients from group 1 were hospitalized due to decompensated heart failure or an episode of acute coronary syndrome with a total duration of 30 days, compared with 13 hospitalizations for the same reasons in group 2 (p=0,027;OR 3,4;95% CI 1,1-10,8). In total, six patients died during the follow-up period in group 1, and eleven patients died in group 2 (p=0,226;OR 1,9;95% CI 0,7-5,3). At the same time, three patients in the 1st group and one patient from the 2nd group died during the follow-up period due to COVID-19. Thus, cardiovascular mortality consisted of 3 and 10 patients in groups 1 and 2, respectively (p=0,052;OR 3,5;95% CI 0,9-12,9). Conclusion. Three-month remote management of patients after decompensated heart failure or acute coronary syndrome, including BP monitoring, showed a significant reduction in the hospitalization rate and a trend towards a decrease in cardiovascular mortality. Copyright © 2022, Silicea-Poligraf. All rights reserved.

4.
Heart, Vessels and Transplantation ; 6(3), 2022.
Article in English | EMBASE | ID: covidwho-2067558

ABSTRACT

The SARS-CoV2 virus has infected over 545 million people and has claimed over 6 million lives globally by the end of June 2022. The global case fatality rate ranged from 5.5% in Mexico, 2.1-2.5% in South Africa, Brazil, Guatemala, Russia, 1.1-1.5% in the United States, Canada, India and Chile, 0.5-0.9% in Western European countries, 0.3% in Japan, 0.2% in Taiwan to 0.1% in Australia. Among hospitalized COVID-19 patients, the prevalence of pre-existing cardiovascular diseases was approximately 10%. The prevalence of cardiovascular diseases among COVID-19 non-survivors and COVID-19 patients requiring intensive care unit admission were approximately 20-30%. In a multicenter study of 8910 COVID-19 patients from 169 hospitals in Asia, Europe and North America, presence of pre-existing coronary artery disease, chronic heart failure and cardiac arrhythmia was associated with increased mortality of 10.2%, 15.3% and 11.5% respectively, compared with 5-6% mortality in those without the above co-morbidities. The systemic inflammation caused by SARS-CoV-2 could lead to a wide spectrum of cardiovascular complications including acute cardiac injury, acute coronary syndrome, coronary artery dissection, acute myocarditis, cardiomyopathy, chronic heart failure, cardiac arrhythmia, pulmonary embolism, cardiogenic shock, circulatory failure or even cardiac arrest. Copyright © 2022 Heart, Vessels and Transplantation. All right reserved.

5.
Journal of Clinical Outcomes Management ; 29(5):65-71, 2022.
Article in English | EMBASE | ID: covidwho-2067255

ABSTRACT

Objectives: The aim of this study was to describe the characteristics and in-hospital outcomes of patients with acute ST-segment elevation myocardial infarction (STEMI) during the early COVID-19 pandemic at Piedmont Athens Regional (PAR), a 330-bed tertiary referral center in Northeast Georgia. Method(s): A retrospective study was conducted at PAR to evaluate patients with acute STEMI admitted over an 8-week period during the initial COVID-19 outbreak. This study group was compared to patients admitted during the corresponding period in 2019. The primary endpoint of this study was defined as a composite of sustained ventricular arrhythmia, congestive heart failure (CHF) with pulmonary congestion, and/or in-hospital mortality. Result(s): This study cohort was composed of 64 patients with acute STEMI;30 patients (46.9%) were hospitalized during the COVID-19 pandemic. Patients with STEMI in both the COVID-19 and control groups had similar comorbidities, Killip classification score, and clinical presentations. The median (interquartile range) time from symptom onset to reperfusion (total ischemic time) increased from 99.5 minutes (84.8-132) in 2019 to 149 minutes (96.3-231.8;P= .032) in 2020. Hospitalization during the COVID-19 period was associated with an increased risk for combined in-hospital outcome (odds ratio, 3.96;P= .046). Conclusion(s): Patients with STEMI admitted during the first wave of the COVID-19 outbreak experienced longer total ischemic time and increased risk for combined in-hospital outcomes compared to patients admitted during the corresponding period in 2019. Copyright © 2022 Turner White Communications Inc.. All rights reserved.

6.
Revista Argentina de Cardiologia ; 88(5):464-466, 2020.
Article in English | EMBASE | ID: covidwho-2067186
7.
Front Cardiovasc Med ; 9: 912815, 2022.
Article in English | MEDLINE | ID: covidwho-2065488

ABSTRACT

Background: COVID-19 had an adverse impact on the management and outcome of acute coronary syndromes (ACS), but most available data refer to March-April 2020. Aim: This study aims to investigate the clinical characteristics, time of treatment, and clinical outcome of patients at hospitals serving as macro-hubs during the second pandemic wave of SARS-CoV-2 (November 2020-January 2021). Methods and Results: Nine out of thirteen "macro-hubs" agreed to participate in the registry with a total of 941 patients included. The median age was 67 years (IQR 58-77) and ST-elevation myocardial infarction (STEMI) was the clinical presentation in 54% of cases. Almost all patients (97%) underwent coronary angiography, with more than 60% of patients transported to a macro-hub by the Emergency Medical Service (EMS). In the whole population of STEMI patients, the median time from symptom onset to First Medical Contact (FMC) was 64 min (IQR 30-180). The median time from FMC to CathLab was 69 min (IQR 39-105). A total of 59 patients (6.3%) presented a concomitant confirmed SARS-CoV-2 infection, and pneumonia was present in 42.4% of these cases. No significant differences were found between STEMI patients with and without SARS-CoV-2 infection in treatment time intervals. Patients with concomitant SARS-CoV-2 infection had a significantly higher in-hospital mortality compared to those without (16.9% vs. 3.6%, P < 0.0001). However, post-discharge mortality was similar to 6-month mortality (4.2% vs. 4.1%, P = 0.98). In the multivariate analysis, SARS-CoV-2 infection did not show an independent association with in-hospital mortality, whereas pneumonia had higher mortality (OR 5.65, P = 0.05). Conclusion: During the second wave of SARS-CoV-2 infection, almost all patients with ACS received coronary angiography for STEMI with an acceptable time delay. Patients with concomitant infection presented a lower in-hospital survival with no difference in post-discharge mortality; infection by itself was not an independent predictor of mortality but pneumonia was.

8.
Chest ; 162(4):A2508-A2509, 2022.
Article in English | EMBASE | ID: covidwho-2060955

ABSTRACT

SESSION TITLE: Rare Cases with Masquerading Pulmonary Symptoms SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 01:35 pm - 02:35 pm INTRODUCTION: COVID vaccinations have been encouraged by many healthcare providers but many adverse effects have also been reported. The adverse effects of the vaccine can vary based on each individual. Common adverse effects of the vaccine included fatigue, fever, chills, sore throat, muscle pain, headache, rash at injection site. Pleurodynia, also known as Devil's Grip, is a viral myalgia which causes sharp chest pain or the sensation of a grip around one's chest. Pleurodynia treatment is mostly supportive like anti-inflammatories (NSAIDS), pain management, and antibiotics (if bacterial inflammation is suspected). CASE PRESENTATION: We present a case report of a 63-year-old female who presented with complaints of pleuritic chest pain worse with inspiration. She had a history of atrial fibrillation and HTN. Patient had received the Pfizer COVID booster vaccine a few days prior to onset of the pleuritic chest pain. She was obese and had a 40 pack year smoking history. She was on room air saturating 92% with no increased work of breathing. Lung sounds were diminished due to body habitus but clear. Chest x-ray showed low lung volumes with no evidence of acute pulmonary disease. Computed Tomography Angiography (CTA) chest showed no pulmonary embolism and small left partially loculated pleural effusion with peripheral airspace opacities abutting the pleura. Acute coronary syndrome was ruled out and other cardiac workup was negative. COVID PCR was negative. Patient was treated empirically for bacterial infection with ceftriaxone and azithromycin. She was given NSAIDS to decrease inflammation and pain. Patient's symptoms improved significantly with treatment. She was discharged on NSAIDS and advised to follow up outpatient with her primary care and pulmonology. DISCUSSION: Research studies have indicated that the COVID vaccines (like Pfizer) can cause exacerbation of inflammatory or autoimmune conditions. Multiple mechanisms may be responsible for myocarditis, pericarditis, and other inflammatory conditions post vaccines. One mechanism describes that lipid particles of SARS mRNA vaccines can induce inflammation by activating the NLR pyrin domain containing 3 inflammasome of mRNA which are recognized by toll like receptors and cytosolic inflammasome components leading to inflammation. Another mechanism explains that viral proteins can cause immune cross reactivity with self-antigens expressed in the myocardium leading to an inflammatory process. CONCLUSIONS: As per current literature review there are no case reports about pleurodynia post COVID vaccination but pericarditis and myocarditis have been described. Further research studies are indicated to assess the cause and pathophysiology of pleurodynia post COVID vaccine. Physicians should have a high index of clinical suspicion for pleurodynia when assessing a patient with pleuritic chest pain with a recent history of COVID vaccination. Reference #1: 1. Analysis of COVID 19 Vaccine Type and Adverse Effects Following Vaccination. Beatthy, A;Peyser, N;Butcher, X. AMA Netw Open. 2021;4(12):e2140364. doi:10.1001/jamanetworkopen.2021.40364 Reference #2: 1. Association of Group B Coxsackieviruses with Cases of Pericarditis Myocarditis, or Pleurodynia by Demonstration of Immunoglobulin M Antibody. Schmidt, N;Magoffin, R;& Lennette, E. Infection and Immunty Journal. 1973 Sep;8(3): 341–348. PMCID: PMC422854 Reference #3: 3. Autoimmune phenomena following SARS-CoV-2 vaccination. Ishay, Y;Kenig, A;Toren, T;Amer, R;et. al. International Journal of Immuno-pharmacology. 2021 Oct;99: 107970. DISCLOSURES: No relevant relationships by Olufunmilola Ajala No relevant relationships by Arij Azhar No relevant relationships by Louis Gerolemou No relevant relationships by Wael Kalaji No relevant relationships by Steven Miller No relevant relationships by Kunal Nangrani No relevant relationships by Gaurav Parhar No relevant relationships by iran Zaman

9.
Chest ; 162(4):A288, 2022.
Article in English | EMBASE | ID: covidwho-2060552

ABSTRACT

SESSION TITLE: Cardiovascular Complications in Patients with COVID-19 SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: COVID-19 infection has been shown to exhibit an array of deleterious cardiac effects specifically arrhythmias. While arrhythmias of ventricular origin are less common, direct insult to the myocardium is cited as the most common etiology [1]. Here we present a unique case of hyperthermia induced monomorphic ventricular tachycardia (VT) in the setting of COVID-19 infection. CASE PRESENTATION: A 65-year-old male with medical history of dyslipidemia and hypertension presented with cough, dyspnea and subsequently diagnosed with COVID-19 pneumonia and was noted to be persistently febrile with a peak temperature of 40.1° C, which coincided with the onset of sustained monomorphic VT for approximately 40 minutes. He was treated with amiodarone. He did not have chest pain and troponin levels were normal. Cooling measures were initiated in the ICU. While normothermic, he did not have episodes of VT until the following day when his temperature again peaked at 40.6° C. A lidocaine drip was started to maintain sinus rhythm. However, due to multi-system organ failure, the family decided to proceed with comfort care. DISCUSSION: COVID-19 infection associated with fatal VT has been documented in the literature mainly attributed to ischemia and myocarditis. [1,2]. COVID-19 virus has the potential to trigger a massive inflammatory response causing systemic illness. Classically, the prototypical patient has a scar from previous ischemic heart disease that allows reentry to occur. Our patient had no prior history of structural heart disease, evidence of acute coronary syndrome or myocarditis. Other known causes of VT were ruled out. It became clear that the patient’s induction of VT had a temporal association with hyperthermia. Once the patient’s temperature was above 40° C, VT would ensue and only terminate with resolution of the fever. Temperature has been shown to affect the transmembrane gradient and the flow velocity of ions through myocardial ion gated channels [3]. These physiological changes could lead to increased automaticity or triggered events that induce VT. Therefore, hyperthermia should not be neglected as a potential trigger for VT in an otherwise intact myocardium. CONCLUSIONS: A systemic illness like COVID-19 associated with cytokine storm can drastically influence the thermal regulation of the body. This can cause a shift in the transmembrane gradient and resting membrane potential, which could in turn alter automaticity. Therefore, hyperthermia could be a possible trigger for monomorphic VT in an otherwise intact myocardium. Early recognition and rapid external cooling are crucial to minimize the risk of ventricular dysrhythmias. Reference #1: Manolis, Antonis S et al. "COVID-19 infection and cardiac arrhythmias.” Trends in cardiovascular medicine vol. 30,8 (2020): 451-460. doi:10.1016/j.tcm.2020.08.002 Reference #2: Bhatla, A., Mayer, M., Adusumalli, S., Hyman, M., Oh, E., Tierney, A., Moss, J., Chahal, A., Anesi, G., Denduluri, S., Domenico, C., Arkles, J., Abella, B., Bullinga, J., Callans, D., Dixit, S., Epstein, A., Frankel, D., Garcia, F., Kumareswaram, R., Nazarian, S., Riley, M., Santangeli, P., Schaller, R., Supple, G., Lin, D., Marchlinski, F. and Deo, R., 2020. COVID-19 and cardiac arrhythmias. Heart Rhythm, 17(9), pp.1439-1444. Reference #3: Huckell, V F et al. "Cardiac Manifestations Of Malignant Hyperthermia Susceptibility.". Circulation, vol 58, no. 5, 1978, pp. 916-925. Ovid Technologies (Wolters Kluwer Health), doi:10.1161/01.cir.58.5.916. Accessed 1 June 2021. DISCLOSURES: No relevant relationships by Robert Cacdac No relevant relationships by Nami Moradi

10.
Chest ; 162(4):A285, 2022.
Article in English | EMBASE | ID: covidwho-2060550

ABSTRACT

SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Beyond conventional risk factors, studies suggest acute viral infections, including influenza, are a potential risk factor for development of acute cardiovascular (CV) related events such as acute coronary syndrome (ACS) and stroke. On Mar 31st, 2020, the Texas state governor instated a shelter-in-place or quarantine order. With social distancing and masking the exposure respiratory viral illnesses dropped. This study seeks to evaluate the impact of reduced viral infections on CV related events. METHODS: A retrospective chart review of patients admitted to 18 affiliated Baylor Scott & White Texas hospitals in north and central Texas from January 20th, 2020 to Jun 1st, 2020 and between January 20th, 2019 to Jun 1st, 2019. We defined the pre-quarantine period as January 20, 2020 – March 31, 2020. The quarantine period was defined as April 1, 2020 – Jun 1st, 2020. We investigated ACS and stroke risk associated with lab-confirmed respiratory virus panel- PCR (RVP) positivity using a self-controlled case series. RVP positivity was reviewed to determine the presence or absence of increased risk interval. Risk intervals were identified as 7 days after respiratory specimen collection and associated control intervals were one year before and one year after the risk intervals. RESULTS: There were 3,782 patients who had ACS or stroke from January 20th, 2020 to June 1st, 2020. Average monthly rate of positive viral infection was significantly lower during the state mandate social distancing period than before social distancing mandate (5.5 ± 4.6 vs 19.7 ± 4.2, p<0.0001). During the prequarantine period, for stroke, there was a significant difference in positive RVP between the prequarantine and quarantine period (10.8% vs 0%, P=0.009). For ACS, there was a significant difference in positive RVP between the prequarantine and quarantine period (16.2% vs 1%, P<0.001). Rhinovirus infections accounted for 67% of patients of stroke prequarantine. Influenza accounted for 40% of infections in patients with ACS. Admissions for CV related events were higher in the pre-quarantine period compared to the quarantine period (893 vs 695 strokes;1,227 vs 967 ACS). Patients in the pre-quarantine and quarantine were similar in age and gender. For stroke, there was no significant difference in the type of stroke between the two time periods with ischemic stroke occurring in 67% of patients. For ACS, there was no significant difference in type with non ST-elevation MI occurring in 44% of patients. There was no statistical difference of survival to discharge or readmission at 30 days between the two periods. CONCLUSIONS: In our multicenter study, we note significant decline in cardiovascular events due to viral illness. This study strengthens the association between viral infections and cardiovascular events. CLINICAL IMPLICATIONS: This study reveals implications of cardiovascular events following viral illness. DISCLOSURES: No relevant relationships by Tayler Acton no disclosure on file for Alex Arroliga;No relevant relationships by Jason Ettlinger No relevant relationships by Shekhar Ghamande No relevant relationships by Mufaddal Mamawala No relevant relationships by Abirami Subramanian No relevant relationships by Heath White

11.
Chest ; 162(4):A283, 2022.
Article in English | EMBASE | ID: covidwho-2060549

ABSTRACT

SESSION TITLE: Cardiovascular Complications in Patients with COVID-19 SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Spontaneous coronary artery dissection (SCAD) is a rare cardiac phenomenon associated with autoimmune and inflammatory conditions seen often in young women with few conventional atherosclerotic risk factors. The presentation is indistinguishable from acute coronary syndrome and can lead to acute myocardial infarction, arrhythmias, and sudden death. We share a thought-provoking case of SCAD in a COVID-19 positive patient. CASE PRESENTATION: 51-year-old physically fit female with BMI of 22.46kg/m2, non-diabetic with recent unremarkable lipid panel and history of anxiety, postpartum cardiomyopathy 15 years prior with recovered ejection fraction presented with complaints of midsternal chest pain at rest, 9/10 intensity, radiating to the right shoulder associated with dyspnea, lasting for 3 hours until relieved by nitroglycerine patch. Initial workup revealed troponin of 3.08 and EKG consistent with acute ischemic changes without STEMI. She was incidentally found positive for SARS-CoV-2. Echocardiogram showed dyskinetic apex with normal ejection fraction. The following day, while she was on aspirin and heparin drip, she developed chest discomfort with EKG revealing dynamic T wave inversions and troponin trending up to 14.79. The patient was taken for an emergent cardiac catheterization which revealed patent coronaries with concern for distal left anterior descending artery dissection. Subsequently, the patient was continued on a heparin drip with an improvement of her symptoms. Troponin declined to 7.97 with no other COVID-19 related concerns. She was deemed medically stable and discharged home after completing her isolation. Furthermore, she underwent a cardiac and coronary artery CT angiogram 2 weeks later, showing patent coronaries and a calcium score of 0 and no findings of coronary artery disease. DISCUSSION: SCAD is an emergent condition closely associated with inflammatory conditions, systemic arteriopathy, emotional stress triggers, fibromuscular dysplasia, and pregnancy. It is not iatrogenic, traumatic or associated with atherosclerosis. The mainstay of detection of SCAD is coronary angiography. In our patient, since it was a distal LAD disease, the echo findings of dyskinetic apex helped established the diagnosis of SCAD. Management is mainly supportive usually carrying a good prognosis. In our case report, the connecting factor to SCAD was the presence of SARS-CoV-2. Our patient was without traditional risk factors for coronary artery disease, which reinforced the likelihood of SCAD instead of acute coronary syndrome. CONCLUSIONS: Thus, as the manifestations, complications, and sequelae of COVID-19 continue to emerge, we believe SCAD needs to remain a top differential in COVID -19 positive patients presenting with symptoms of the acute coronary syndrome. To better elucidate the pathophysiology of SCAD in SARS-CoV-2 patients, we encourage further vigilance of this phenomenon. Reference #1: Hayes, S. N. et al (2018, February 22). Spontaneous coronary artery dissection: Current state of the science: A scientific statement from the American Heart Association. Circulation. Retrieved April 1, 2022, from https://www.ahajournals.org/doi/10.1161/cir.0000000000000564 Reference #2: Ahmed, T., Jeudy, J., & Srivastava, M. C. (2020). Imaging modalities to delineate sequelae of spontaneous coronary artery dissection managed with percutaneous coronary intervention. Cureus. https://doi.org/10.7759/cureus.7591 DISCLOSURES: No relevant relationships by Hareesh Lal No relevant relationships by Jennaire Lewars No relevant relationships by Avani Mohta

12.
Chest ; 162(4):A254, 2022.
Article in English | EMBASE | ID: covidwho-2060546

ABSTRACT

SESSION TITLE: Infections In and Around the Heart Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Acute bacterial myocarditis due to Salmonella bacteremia is a rare cause of ST-segment elevation that can manifest as acute decompensated heart failure, life threatening arrhythmias, and sudden cardiac death. CASE PRESENTATION: A 62-year-old male with a past medical history of HTN, HLD, DM2, and TIA presented with nausea, vomiting, nonbloody diarrhea, and right upper quadrant pain for five days. He quickly decompensated in the ED, becoming increasingly hypotensive, tachycardic, and lethargic concerning for sepsis. Broad spectrum antibiotics and IV fluids were initiated. Chest X-ray revealed multifocal pneumonia. Labs revealed a metabolic acidosis consistent with acute hypoxic respiratory failure warranting emergent intubation. CTA chest showed multifocal pneumonia and Covid-19 antigen testing was negative. Troponin I was elevated at.211 ng/mL (n <.08) and ECG showed new onset atrial fibrillation, for which cardiology was consulted. On admission to the ICU, repeat labs showed acute renal failure and he was anuric warranting hemodialysis initiation. Despite medical optimization, his Troponin I trended up to 1.458 ng/mL, and repeat ECG showed 2:1 atrial flutter with new ST-elevations in leads II, III, and aVF, consistent with an acute inferior STEMI. Labs did not show hyperkalemia nor hypercalcemia. Transthoracic echocardiography revealed normal systolic and diastolic function, with a left ventricle ejection fraction of 65-70%. A heparin infusion was started and he was taken for a cardiac catheterization which showed no evidence of occlusive CAD. His blood cultures revealed Salmonella enteritidis for which he was switched to ciprofloxacin. Abdominal ultrasound appeared benign, but CT abdomen with contrast showed findings of cholecystitis, which was confirmed on HIDA scan. Gastroenterology and Surgery were consulted who recommended a cholecystostomy tube placement, with a delayed laparoscopic cholecystectomy (LC) when stable. Repeat ECG following the LC showed complete resolution of the previous STEMI. He was discharged to a rehabilitation facility where he made a full recovery. DISCUSSION: Acute bacterial myocarditis can mimic acute coronary syndromes and warrants a high index of suspicion in the setting of Salmonella bacteremia. Our patient presented with signs of acute cholecystitis and an ECG concerning for acute STEMI. Bacterial etiologies of myocarditis are less reported in the literature compared to viral infections, and are seen more often in patients with severe sepsis such as our patients. Common findings associated with Salmonella myocarditis include ST-segment elevation on ECG and elevated troponin levels. Serial ECG findings can distinguish myocarditis from acute myocardial infarction. Early diagnosis is essential to improve outcomes and reduce mortality. CONCLUSIONS: Acute bacterial myocarditis can mimic acute coronary syndromes. Reference #1: Villablanca P, Mohananey D, Meier G, Yap JE, Chouksey S, Abegunde AT. Salmonella Berta myocarditis: Case report and systematic review of non-typhoid Salmonella myocarditis. World J Cardiol. 2015;7(12):931-937. doi:10.4330/wjc.v7.i12.931 Reference #2: Sundbom P, Suutari AM, Abdulhadi K, Broda W, Csegedi M. Salmonella enteritidis causing myocarditis in a previously healthy 22-year-old male. Oxf Med Case Reports. 2018;2018(12):omy106. Published 2018 Nov 26. doi:10.1093/omcr/omy106 Reference #3: Majid A, Bin Waqar SH, Rehan A, Kumar S. From Gut to Heart: Havoc in a Young Patient with Typhoid-associated Cardiomyopathy. Cureus. 2019;11(7):e5049. Published 2019 Jul 1. doi:10.7759/cureus.5049 DISCLOSURES: No relevant relationships by Mohamed Faher Almahmoud No relevant relationships by JONATHAN BROWN No relevant relationships by Hytham Rashid No relevant relationships by Syed Raza

13.
Chest ; 162(4):A156, 2022.
Article in English | EMBASE | ID: covidwho-2060541

ABSTRACT

SESSION TITLE: Infections In and Around the Heart Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Due to the novelty of COVID-19 virus, complications of this severe respiratory infection are continually emerging. The inflammatory response to the virus carries a high mortality rate and can lead to a variety of cardiothoracic complications such as acute coronary syndrome, thromboembolism, and heart failure [1]. Here, we present a case of a young female who suffered cardiac tamponade (CT) from a pericardial effusion (PEEF) attributed to COVID-19 infection, which has only been described a handful of times in the literature. CASE PRESENTATION: A 33-year-old female with a history of Down syndrome and morbid obesity presented with worsening dyspnea and fever for one week. Her initial oxygen saturation was 50% on room air, and bilevel noninvasive ventilatory support was initiated. Her viral PCR was positive for COVID-19. A computed tomography angiogram of the chest revealed small bilateral pulmonary emboli, diffuse ground-glass consolidations, and small bilateral pleural effusions. Her respiratory status continued to decompensate and she was placed on mechanical ventilation. She became hypotensive requiring vasopressor support. The following morning, an echocardiogram (TTE) revealed an ejection fraction of 40-45% and a new PEEF with early right ventricular diastolic collapse consistent with CT physiology. She underwent emergent pericardiocentesis, and 220 mL of bloody fluid was drained. PEEF studies revealed a glucose level of 186 mg/dL, LDH of 1380 U/L, and protein of 3.0 g/dL. Total nucleated count was 16,545/uL with 68% neutrophils. Gram stain showed a few white blood cells without organisms, and final bacterial, fungal, and acid-fast cultures were negative. A pericardial drain was left in place, but the procedure was complicated by a pneumothorax and a chest tube was placed. A follow-up TTE the next day revealed improvement of the PEEF without signs of CT. A repeat chest x-ray showed resolution of the pneumothorax. Unfortunately, the patient’s oxygenation and hemodynamic status continued to worsen. She eventually suffered cardiac arrest with pulseless electrical activity and succumbed to her illness. DISCUSSION: New knowledge regarding complications of COVID-19 infection is continually emerging. According to a February 2022 systematic review, only 30 cases of severe PEEFs with CT secondary to COVID-19 have been recorded. The mechanism by which PEEFs form is unclear. It is proposed that the entry of the virus into inflammatory cells causes a release of cytokines such as TNF-alpha, IL-1, IL-6, and IL-8. This resulting cytokine storm allows rapid inflammation and infiltration of fluid into the pericardial sac [1]. CONCLUSIONS: In a decompensated patient with COVID-19, a stat TTE should be obtained to rule out PEEF. Physicians must be cognizant of this uncommon yet highly fatal complication in unstable COVID-19 patients, as cardiac tamponade is a potentially reversible cause of cardiac arrest. Reference #1: Kermani-Alghoraishi, M., Pouramini, A., Kafi, F., & Khosravi, A. (2022). Coronavirus Disease 2019 (COVID-19) and Severe Pericardial Effusion: From Pathogenesis to Management: A Case Report Based Systematic Review. Current problems in cardiology, 47(2), 100933. https://doi.org/10.1016/j.cpcardiol.2021.100933 DISCLOSURES: No relevant relationships by Amanda Cecchini No relevant relationships by Arthur Cecchini No relevant relationships by Kevin Cornwell No relevant relationships by Krupa Solanki

14.
Journal of Arrhythmia. ; 2022.
Article in English | EMBASE | ID: covidwho-2059535

ABSTRACT

Background: Patients with coronavirus disease 2019 (COVID-19) can develop cardiac injury resulting in cardiac arrhythmias, myocarditis, and acute coronary syndrome (ACS). In this study, we aimed to investigate whether COVID-19 infection affects ventricular repolarization parameters such as Tpeak-Tend interval (Tp-e), QT interval, corrected QT (QTc), Tp-e/QT, and Tp-e/cQT in patients with ACS. Method(s): The study consisted of two groups. The first group included patients with ACS and COVID-19 (Group 1) (n = 50). Polymerase chain reaction test positive patients were enrolled. The second group included patients with only ACS (Group 2) (n = 100). The risk of ventricular arrhythmias was evaluated on the basis of the measured electrocardiographic Tp-e and QT interval, and QTc, Tp-e/QT, and Tp-e/QTc values. Result(s): Tp-e interval, QTc, and Tp-e/QTc were significantly higher in the group1 than group 2 (p <.001, p <.018, and p <.001, respectively). Significant positive correlations were found between Tp-e, D-dimer level, and C-reactive protein (CRP) level in the group1 (p =.002, p = 0.03, and p =.021, respectively). Univariate and multivariate regression analyses revealed that Tp-e was one of the independent predictor of length of stay in the intensive care unit (ICU). (B = 1.662, p =.006 and B = 1.804, p =.021, respectively). Conclusion(s): In the patients with ACS, COVID-19 infection caused increases in QTc, Tp-e, and Tp-e/QTc ratio. In addition, age and prolonged Tp-e were found to be independent predictors of prolonged ICU stay. Copyright © 2022 The Authors. Journal of Arrhythmia published by John Wiley & Sons Australia, Ltd on behalf of Japanese Heart Rhythm Society.

15.
Tuberculosis and Lung Diseases ; 100(7):41-46, 2022.
Article in Russian | Scopus | ID: covidwho-2056743

ABSTRACT

The objective: to define hemogram parameters in smokers with COVID-19 and acute coronary syndrome when they are admitted to hospital. Subjects and Methods. 62 male smokers hospitalized due to acute coronary syndrome (ACS) were enrolled into a case-control study. Group 1 (n = 31) had ASC and COVID-19, Group 2 (n = 31) had ACS and no COVID-19. The groups were adjusted by age, body mass index and the date of hospitalisation. According to the current routing procedures, from September to December 2020, the subjects were referred to different hospitals in Sverdlovsk Region depending on COVID-19 status. Inpatient medical records were used to collect the data. Blood parameters were examined by Mindray BC-5150 (China) automatic hematological analyzer performing complete clinical blood count and differentiating 5 leukocyte subpopulations. Statistical processing was performed using Statistica 13.0. The significance of differences was taken at p < 0.05. Results. Smoking men with COVID-19 and ACS unlike those GOVID-19 negative had a lower level of diastolic blood pressure, significantly more often were diagnosed with low degrees of hypertension, higher BPD with the same frequency of detection and functional characteristics of chronic heart failure and chronic obstructive pulmonary disease. The hemogram showed a lower level of the number of leukocytes, the percentage of neutrophils, erythrocytes, hemoglobin, hematocrit, the average concentration of hemoglobin in the erythrocyte;a higher level of monocytes, erythrocyte sedimentation rate, and average platelet volume. The above changes can be associated with spesific features of the COVID-19 course. © 2022 New Terra Publishing House. All rights reserved.

16.
Cardiovascular Therapy & Prevention ; 21(9):75-84, 2022.
Article in Russian | Academic Search Complete | ID: covidwho-2056570

ABSTRACT

An important place in the structure of cardiovascular morbidity is occupied by myocardial infarction (MI), especially complicated MI, including complicated by the formation of left ventricular (LV) aneurysm. The latter is a very formidable complication and leads to such life-threatening conditions as ventricular arrhythmias, heart failure, thromboembolism. The purpose of the review is to analyze the publications of foreign and Russian authors on risk factors, outcomes and treatment of patients with postinfarction LV aneurysm. Attention is paid to the role of registers in the study of this problem, as well as the analysis of literature data on the prevalence of such a complication as MI during the COVID-19 pandemic (COrona VIrus Disease 2019). It is shown that the registers of acute coronary syndrome, as a rule, do not contain separate data on patients with a formed LV aneurysm, risk factors for its development and outcomes in this group of patients. Postinfarction LV aneurysm can form only after transmural MI;therefore, it is important to keep records of patients diagnosed with transmural MI, primarily in the form of a register. (English) [ FROM AUTHOR] Важное место в структуре сердечно-сосудистой заболеваемо- сти занимает инфаркт миокарда (ИМ), особенно ИМ осложнен- ного течения, в т.ч. осложненный формированием аневризмы левого желудочка (ЛЖ). Последняя является весьма грозным осложнением и приводит к таким жизнеугрожающим состоя- ниям, как желудочковые нарушения ритма, сердечная недоста- точность, тромбоэмболии. Целью обзора является анализ пу- бликаций зарубежных и российских авторов о факторах риска, исходах и лечении пациентов с постинфарктной аневризмой ЛЖ. Уделено внимание роли регистров в изучении данной проблемы, а также проведен анализ литературных данных о распространен- ности такого осложнения как ИМ в период пандемии COVID-19 (COrona VIrus Disease 2019). Показано, что в регистрах остро- го коронарного синдрома, как правило, не содержится отдель- ных данных о пациентах со сформировавшейся аневризмой ЛЖ, факторах риска ее развития и исходах у этой группы пациентов. Постинфарктная аневризма ЛЖ может сформироваться только после трансмурального ИМ, поэтому представляется важным вести учет больных с диагнозом трансмуральный ИМ, в первую очередь в виде регистра. (Russian) [ FROM AUTHOR] Copyright of Cardiovascular Therapy & Prevention is the property of Silicea-Poligraf LLC and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

17.
Am J Med Sci ; 364(4): 481-491, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2048874

ABSTRACT

Synthetic cannabinoids cannot be detected on a standard urine drug screen (UDS), making them a convenient drug of abuse. We report the first case of ST elevation myocardial infarction (STEMI) in a young patient due to coronary artery thrombosis secondary to synthetic cannabinoid use and concurrent COVID-19 infection. A 38-year-old previously healthy male developed severe chest pain and was found to have anterior STEMI and COVID-19 infection. Coronary angiography showed acute thrombotic occlusion of the mid-left anterior descending artery that was managed with thrombectomy and stent placement. He only required supportive care for COVID-19. A comprehensive literature search revealed 34 additional cases of STEMI with synthetic cannabinoid use; majority were males (97%) with mean age of 29 years. 29 patients (85.3%) underwent coronary angiography and majority had left anterior descending artery (LAD) involvement (55%), with 13 (44.8%) undergoing stent placement. We highlight STEMI as a potentially lethal complication of synthetic cannabinoids; prompt angiography may be lifesaving.


Subject(s)
COVID-19 , Cannabinoids , Coronary Thrombosis , ST Elevation Myocardial Infarction , Adult , Cannabinoids/adverse effects , Coronary Angiography , Coronary Thrombosis/complications , Female , Humans , Male , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/surgery
18.
J Clin Med ; 11(18)2022 Sep 14.
Article in English | MEDLINE | ID: covidwho-2033031

ABSTRACT

COVID-19 causes thromboembolic complications that affect the patient's prognosis. COVID-19 vaccines significantly improve the prognosis for the course of the infection. The aim of this study was to evaluate the impacts of patient characteristics, including COVID-19 vaccinations, on perioperative mortality in acute coronary syndrome in Poland during the pandemic. We analyzed the data of 243,515 patients from the National Registry of Invasive Cardiology Procedures (Ogólnopolski Rejestr Procedur Kardiologii Inwazyjnej [ORPKI]). In this group, 7407 patients (21.74%) had COVID-19. The statistical analysis was based on a neural network that was verified by the random forest method. In 2020, the most significant impact on prognosis came from a diagnosis of unstable angina, a short period (<2 h) from pain occurrence to first medical contact, and a history of stroke. In 2021, the most significant factors were pre-hospital cardiac arrest, female sex, and a short period (<2 h) from first medical contact to coronary angiography. After adjusting for a six-week lag, a diagnosis of unstable angina and psoriasis were found to be relevant in the data from 2020, while in 2021, it was the time from the pain occurrence to the first medical contact (2-12 h) in non-ST segment elevation myocardial infarction and the time from first contact to balloon inflation (2-12 h) in ST-segment elevation myocardial infarction. The number of vaccinations was one of the least significant factors. COVID-19 vaccination does not directly affect perioperative prognosis in patients with acute coronary syndrome.

19.
Farmatsiya ; 71(6):12-18, 2022.
Article in Russian | Academic Search Complete | ID: covidwho-2026431

ABSTRACT

Introduction. Clopidogrel bisulfate (Clopidogrel) is one of the main drugs for the treatment of various cardiovascular diseases (acute coronary syndrome, ischemic stroke, transient ischemic attack, peripheral artery disease, etc.). Especially, this drug is very relevant in the treatment of COVID-19. Clopidogrel has repeatedly been the cause of lethal poisoning, and cases of clopidogrel being used for suicide are very common in China. According to the studied literature data, the analysis of this drug in the biological material is not presented. Objective: The aim of the research was to establish the distinctive ability of conventional methods of isolating medicinal substances from biological material in relation to clopidogrel in chemical and toxicological analysis (CTA). Material and methods. The study was carried out with model samples of pig liver that had not undergone putrefactive changes, which contained the studied drug. Detection and quantification of clopidogrel in extracts were carried out using thin-layer chromatography (TLC) and UV spectrophotometry. Results. The isolation efficiency of clopidogrel according to the method of A.A. Vasilyeva was 57.75±5.08%, according to the method of V.P. Kramarenko – 64.23±5.44%. When using the isolation method of A.A. Vasilyeva, the detection limit of clopidogrel was 1.04%, according to the method of V.P. Kramarenko – 1.09%. The limit of quantitative determination of clopidogrel according to the method of A.A. Vasilyeva is 3.31%, according to the method of V.P. Kramarenko – 3.34%, respectively. Conclusion. For analytical diagnostics in case of clopidogrel poisoning, TLC screening and UV spectrophotometric determination must be carried out with preliminary TLC purification. Isolation of clopidogrel with water acidified with ethyl alcohol (the Stas-Otto method) does not work. The effectiveness of isolating the drug by the method of V.P. Kramarenko is 64.23±5.44%. The greatest selectivity of the UV spectrophotometric method for determining clopidogrel in biological material in relation to matrix components was provided by the method of isolation with water acidified with sulfuric acid (V.P. Kramarenko's method). (English) [ FROM AUTHOR] Введение. Клопидогрела бисульфат (клопидогрел) является одним из основных лекарственных препаратов для лечения различных сердечно-сосудистых заболеваний (острый коронарный синдром, ишемический инсульт, транзиторная ишемическая атака, заболевания переферических артерий и др.). Данный препарат особенно актуален при лечении СОVID-19. Неоднократно клопидогрел был причиной летальных отравлений, например, в Китае очень часто встречаются случаи использования клопидо- грела в целях самоубийства. Анализа данного препарата в биологическом материале по литературным данным не представлено. Целью исследований явилось установление отличительной способности клопидогрела, общепринятой в химико-токсико- логическом анализе методов изолирования лекарственных веществ из биологического материала. Материал и методы. Исследование проводили с модельными пробами свиной печени, не претерпевшей гнилостных изме- нений, которые содержали исследуемый препарат. Обнаружение и количественное определение клопидогрела в экстрактах проводили с помощью тонкослойной хроматографии (ТСХ) и УФ-спектрофотометрии. Результаты. Эффективность изолирования клопидогрела по методу А.А. Васильевой составила 57,75±5,08%, по методу В.П. Крамаренко – 64,23±5,44%. При использовании метода изолирования А.А. Васильевой предел обнаружения клопидогрела составлял 1,04%, по методу В.П. Крамаренко – 1,09%. Предел количественного определения клопидогрела по методу А.А. Васильевой – 3,31%, по методу В.П. Крамаренко – 3,34%. Заключение. Для проведения аналитической диагностики при отравлении клопидогрелом ТСХ-скрининг и УФ-спектрофотометрическое определение необходимо проводить с предварительной ТСХ-очисткой. Изолирование клопидо- грела водой, подкисленной этиловым спиртом (метод Стаса–Отто), не происходит. Наибольшую селективность УФ-спектрофотометрического метода определения клопидогрела в биологическом материале по отношению к матричным компонентам обеспечивал метод изолирования водой, подкисленной серной кислотой (метод В.П. Крамаренко). Эффективность изолирования препарата по методу В.П. Крамаренко составляет 64,23±5,44%. (Russian) [ FROM AUTHOR] Copyright of Farmatsiya (Pharmacy) is the property of Russian Physician Public House Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

20.
Meditsinskiy Sovet ; 2022(14):16-22, 2022.
Article in Russian | Scopus | ID: covidwho-2026183

ABSTRACT

In the conditions of the existing pandemic, that affects both the physical and psychological health of people, it can be pre-dicted with a high degree of probability an outbreak in mental disorders and stress-associated mental illnesses, including depression. The problem of the relationship between depression and cardiac diseases, in particular coronary heart disease (CHD), has been studied by native and foreign scientists for several decades. Various mechanisms have been found and con-tinue to be studied, indicating that the presence of depression can affect more or less on the course of coronary heart disease and even become a predictor of new cardiac events. Dysfunction of the autonomic nervous system with changes in heart rate variability, hyperactivity of the hypothalamic-pituitary-adrenal axis and associated hypercortisolemia, disorders of serotonergic signal transmission pathways, high aggregation response and increased platelet activity, continuous increase of proinflamma-tory cytokines ((IL17A, IL6, TNFa and IL12p70) in patients’ plasma – such mechanisms probably underlie the correlation between depression and an increased risk of cardiovascular complications and cardiac death. The review includes some features of depression and its influence on various forms of coronary heart disease, particularly in different age and gender groups. In view of the ongoing COVID-19 pandemic, this theme seems to be relevant and requires targeted study. Probably it is necessary to conduct clinical researches, to create registers for a detailed assessment of the mutual influence of depression and coronary heart disease in existing conditions. Perhaps, the results of such work will contribute not only to the early detec-tion and treatment of depression, but also to the development of new ways in primary and secondary prevention of coronary heart disease and its acute forms. © 2022, Remedium Group Ltd. All rights reserved.

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