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1.
Research Journal of Pharmacy and Technology ; 15(12):5909-5918, 2022.
Article in English | EMBASE | ID: covidwho-2207051

ABSTRACT

The great use of telecommunication technology propels new healthcare system of telemedicine through which diagnosis as well as treatment can be done in the remote areas. The ancient Greek language explain the terminology of telemedicine in the phrase of distance healing. As per WHO, Telemedicine is the delivery of health-care services, where distance is a critical factor, by all health-care professionals using information and communications technologies for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and the continuing education of health-care workers, with the aim of advancing the health of individuals and communities. Historically the concept of teleconsultation was evolved in the first half of twentieth century when the data of ECG was communicated through telephone lines, this can be traced as first evidence of this unique healthcare system. Further the introduction of electrical system of telegraph as well as evolution of telephone revolutionized this system of healthcare. when the Technology of telemedicine help both patients as well as service providers in multiple ways involving physicians, surgeons, pharmacists, paramedical staff, IT and electronics engineers, government, hospitals and end user public Location is now a days no problem and therefore there is no limitation of the availability of healthcare facilities to such location or remote location. The biggest role in such development is played by the communication technology which may provide healthcare services to every nook and corner of the location. It can decrease the health staff pressure because in India WHO guidelines ask to maintain the ratio 1:1000 of doctor and Indian public compared to present 0.62:1000 ratio of doctor and public. The great advantage of this system is that in case of epidemic or pandemic like COVID 19 Telemedicine can keep the health staff are well general public free from contagious infection (COVID-19). There are a number of networking communication modes that can be applied, which may improve the patient compliance,dosage regimen can be managed in better fashion thus increase the longevity of person life. Disasters management during pandemics present unique challenges which can be addressed effectively as happened during the lockdown. This technology-based practice can break the infectivity chain of the transmission of communicable diseases This chapter incorporates basic concept of telemedicine, its origin and types, communication technologies, services by telemedicine, types of telemedicine, tools of telemedicine, telemedicine software's and guidelines related to practicingtelemedicine in reference to Indian context. Copyright © RJPT All right reserved.

2.
ARYA Atherosclerosis ; 18:1-8, 2022.
Article in English | EMBASE | ID: covidwho-2206925

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) may lead to myocardial damage and arrhythmia. Patients with ECG changes have shown an increased risk of mortality. OBJECTIVE(S): We aimed to study the changes in the electrocardiogram, which may be of great significance for risk stratification of COVID-19-positive patients. METHOD(S): A retrospective study was conducted to compare electrocardiogram changes and disease severity markers in COVID-19-positive patients admitted to a referral hospital between February 20 and March 20, 2020. RESULT(S): Our study consisted of 201 cases, including 123 males and 78 females. Ages ranged between 16 and 97 years old. Fifty-two (25.9%) cases had a history of ICU admission. Multivariate logistic regression analysis showed that a low O2 saturation level (OR = 0.920, 95% CI 0.868-0.976, p=0.005), several lab tests, ECG changes (OR = 46.84, 95% CI 3.876- 566.287, p =.002) and Age (OR = 1.03, 95% CI 1.000- 1.065, p =.048) were the independent risk factors for predicting mortality rate. In addition, we utilized multivariate logistic regression analysis, demonstrating that LBBB (OR = 4.601, 95% CI: 1.357-15.600, p=0.014) is the only ECG risk factor associated with morbidity in elderly patients with ECG changes. CONCLUSION(S): ECG changes are strong indicators of high mortality rates in elderly COVID-19 patients. ECG interpretations should therefore be used for risk stratification and predicting the need for ICU admission. Copyright © 2022, Isfahan University of Medical Sciences(IUMS). All rights reserved.

3.
Journal of Pharmaceutical Negative Results ; 13:6927-6942, 2022.
Article in English | EMBASE | ID: covidwho-2206807

ABSTRACT

Cardiovascular inclusion has been accounted for in patients with serious intense respiratory condition Covid 2 contamination, which might be reflected by electrocardiographic changes. Cardiovascular injury is additionally connected with humanity, need for intensive care, and seriousness of illness in patients due to Coronavirus. Some case features cardiovascular contribution as an intricacy related with Coronavirus, even without indications and indications of interstitial pneumonia. Two Coronavirus incidents in our report displayed diverse ECG indications by means of the sickness caused decay. The main case introduced brief SI QIII TIII sound structure followed by changeable almost whole atrioventricular square, and the second exhibited ST-section height joined by choroidal ventricular tachycardiac. The hidden systems of these ECGs irregularities in the serious phase of Coronavirus might be ascribed to hypoxia and incendiary harm brought about by the infection. Since the scourge of Coronavirus pulled in the consideration, hearsays were encompassing ECG variations in the contaminated people. We pointed toward indicative dissimilar noticed ECG discoveries and talking about their experimental importance. This deliberate audit recommends that recognizing ECG designs that may be connected with Coronavirus is fundamental. Given that doctors don't perceive these examples, they may mistakenly hazard the existences of their patients. Moreover, significant medication instigated ECG changes give attention to the medical care laborers on the dangers of potential treatments. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

4.
Arquivos Brasileiros de Cardiologia ; 119(6):1006-1007, 2022.
Article in English, Portuguese | Scopus | ID: covidwho-2206354
5.
Heart, Vessels and Transplantation ; 6(4), 2022.
Article in English | EMBASE | ID: covidwho-2205367

ABSTRACT

The vaccination used for the prevention of COVID-19 could unmask patients with hidden Brugada syndrome even without febrile episodes. We described a case of unmasking or Brugada syndrome in a female patient after vaccination for COVID-19. A possible relationship with sudden death events requires further study. In people with known Brugada syndrome or in their relatives, we recommend serial electrocardiographic monitoring after the administration of the vaccination dose. Copyright © 2022 Heart, Vessels and Transplantation.

6.
Scientific and Technical Journal of Information Technologies, Mechanics and Optics ; 22(6):1166-1177, 2022.
Article in Russian | Scopus | ID: covidwho-2204401

ABSTRACT

Algorithms for prompt automated evaluation of electrocardiogram parameters in the absence of specialized equipment and specialized specialists are considered. The patient's electrocardiogram is recorded on a paper tape, then it is photographed on the primary care doctor's mobile phone and processed by a specialized application. The application digitizes the photographed image of the electrocardiogram, evaluates its main parameters as well as calculates criteria for the differential diagnosis of certain diseases using approximate formulas. In addition, the digitized electrocardiogram image is transmitted to the server and processed using a machine learning system. Algorithms for digitizing and analyzing an electrocardiogram have been developed that make it possible to evaluate its elements that are important for diagnosis, and the average error in determining the position of the most complex (smoothed) peaks — P and T waves — was no more than 0.1 mm. An algorithm for the criteria analysis of an electrocardiogram is proposed to support the differential diagnosis of acute myocardial infarction with ST segment elevation and early ventricular repolarization syndrome which provides accuracy values of 0.85 and F-scores of 0.74. An alternative algorithm based on a deep neural network is proposed which provides the best values — 0.96 and 0.88, respectively, but requires large computing resources and is executed on the server. The algorithms are implemented as a set of library functions. They can be used both independently and as part of a full-scale clinical decision support system for automated evaluation of electrocardiogram parameters based on a client-server architecture. In addition, all calculation results, together with a photograph of the original electrocardiogram, can be promptly transferred to a qualified cardiologist in order to receive an advisory opinion remotely. © 2022, ITMO University. All rights reserved.

7.
Pharmaceutical Journal ; 309(7965), 2022.
Article in English | EMBASE | ID: covidwho-2196670
8.
Interventional Neuroradiology ; 28(1 Supplement):252, 2022.
Article in English | EMBASE | ID: covidwho-2195332

ABSTRACT

Objective: An epidemic of coronavirus disease 2019 (COVID-19) infection is still ongoing in July 2022. Although preparation for and handling of mechanical thrombectomy for acute ischemic stroke under COVID-19 infection epidemic have ever been reported, in this study, we report that mechanical thrombectomy can be performed safely and effectively without significantly prolonging the time to recanalized occluded vessels by performing rapid RT-PCR at the time of emergency transport, even during COVID-19 outbreak. Material(s) and Method(s): Since April 2022, all patients who were transported to our hospital by ambulance have had their specimens collected in the ambulance and tested for COVID-19 antigens and rapid RT-PCR. Antigen testing results are available 5 min, and those of rapid RT-PCR are available in 40 min. Even if the antigen test was negative, the patient wore a surgical mask, an electrocardiogram and SpO2 monitor, had blood pressure measured, and underwent blood tests and a head MRI scan in our hospital, while waiting for the results of the rapid RT-PCR test Results and Conclusion(s): Until as of July 2022, there were two cases in which the RT-PCR test was positive when the antigen test was negative. By performing the rapid RT-PCR test simultaneously with the antigen test, acute stroke treatment including rt-PA administration and mechanical thrombectomy could be performed safely and effectively without spreading healthcare-associated infection in antigen-negative new coronavirus-positive patients.

9.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194401

ABSTRACT

Introduction: Following the inception of the COVID-19 pandemic, chloroquine compounds were proposed as potential therapeutic strategies, at the cost of a potential increase in cardiovascular risk. We aimed to evaluate clinical outcomes of patients with COVID-19, comparing those using chloroquine compounds to individuals without specific treatment. Method(s): Outpatients with suspected COVID-19 in Brazil who had at least 1 ECG transmitted to a Telehealth Network, were prospectively enrolled in 2 arms (G1: treatment with chloroquine compounds and G2: without specific treatment) and G3: registry of other specific treatments. Outcomes were assessed through follow-up phone calls on days 3 and 14, and also administratively collected from national mortality and hospitalization databases. The primary outcome was composed of: hospitalization and all-cause death. The association between treatment groups and the primary outcome was evaluated by logistic regression. Significant variables (p<0.10) were included in 4 multivariate models: 1: unadjusted;2: adjusted for age and sex;3: adjusted for model 2 plus cardiovascular risk factors and 4: adjusted for model 3 plus COVID-19 symptoms (when available from phone contact). Result(s): In 303 days, 712 (10.2%) patients were allocated in G1 (chloroquine), 3623 (52.1%) in G2 (control) and 2622 (37.7%) in G3 (other treatments). Median age was 49 (IQR 38 - 62) years, 57% women. Of these, 1969 had successful phone contacts (G1: 260;G2: 871;G3: 838). The primary outcome was more frequent in groups 1 and 3 compared to the control group, when assessed exclusively by phone (G1: 38,5% vs. G2: 18,0% vs. G3: 34,2%, p<0,001) or combined with administrative data (G1: 19,5% vs. G2: 11,0% vs. G3: 18,2%, p<0,001). In the adjusted models, chloroquine independently associated with a greater chance of the primary outcome: phone contact (model 4): OR=3.24 (95% CI 2.31 - 4.54), p<0.001;phone + administrative data (model 3): OR=1.99 (95% CI 1.61 - 2.44), p<0.001. Chloroquine also independently associated with higher mortality, as assessed by phone + administrative data (model 3): OR=1.67 (95% CI 1.20 - 2.28). Conclusion(s): Chloroquine compounds associated with a higher risk of poor outcomes in outpatients with COVID-19 compared to standard care.

10.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194390

ABSTRACT

Background: Hydroxychloroquine (HCQ) was widely used as a potential therapy for COVID-19 infection. We studied the effects of HCQ on electrocardiogram (ECG) intervals. Method(s): We conducted a large-scale retrospective study of COVID-19 patients treated with HCQ admitted between March 1, 2020 and June 1, 2020. Extensive medical chart review was performed. Baseline and on treatment ECG intervals were manually measured by 3 electrophysiologists. The QT interval was corrected using Bazett formula (QTc). The paired t-test was used for the main analysis. Result(s): Paired ECG data from 1890 patients were analyzed. The mean age was 47.0 (+/-12.6) years with a strong male prevalence (85.6%). The commonest comorbidities were hypertension (39.6%) and diabetes mellitus (36.8%). The average duration of HCQ therapy was 6.3 (+/-2.3) days. 404 patients (21.4%) had severe COVID-19 infection and the mortality rate was 3.86%. Intensive care admission and mechanical ventilation was required in 209 (11.1%) and 166 (8.8%) patients, respectively. During therapy, heart rate (HR) decreased from 87.2 +/- 16.8 bpm to 80.6 +/- 14.7 bpm (P<0.001). The mean PR interval increased from 153.2 +/- 21.9 ms to 162.9 +/- 22.8 ms (P<0.001). The mean QRS duration increased from 92.8 +/- 12.6 ms to 97.4 +/- 13 ms (P <0.001). The average QTc increased from 427.4 +/- 25.4 ms to 438.4 +/- 29.9 ms (P<0.001). Conclusion(s): HCQ caused a modest but statistically significant prolongation in PR, QRS and QTc intervals. A reduction in HR was also noted mainly due to clinical improvement. (Figure Presented).

11.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194385

ABSTRACT

Introduction: Use of mobile cardiac outpatient monitor (MCOT) increased during the COVID-19 pandemic as a substitute for telemetry and monitoring of arrythmias during loading of antiarrhythmic drugs (AAD). However, data comparing difference of QTc interval between a MCOT, and 12 lead ECG is scare. Hypothesis: To assess the accuracy of mobile cardiac outpatient monitor in comparison to 12 lead ECG for QTc monitoring Methods: We prospectively evaluated 24 patients at our institution who received IV sotalol as single day loading dose for initiation of oral sotalol therapy for atrial fibrillation/atrial flutter (AF/AFL). All patients were discharged 6 hours after the IV loading dose with a MCOT for 3 days. All patients had a 12 lead ECG within 12-18 hours of the baseline line MCOT transmission. Variation in heart rate and QTc was assessed. Result(s): A total of 24 patients were included in the study. The mean age was 65+7.3 years, 80% of patients were men. The mean difference between the QTc interval measured on 12 lead ECG and MCOT was 5.1+ 6 milliseconds [450+33 (EKG) - 445+39 (MCOT)], p=0.92. The mean heart rate difference between the two modalities was also not significant, p=0.726 [ 70.4+19 (EKG) -72+ 11.8 (MCOT), DELTAHR=1.6+7.2 beats per minute]. Conclusion(s): MCOT can be considered as a reliable alternate to 12 lead ECG for monitoring of QTc in patients receiving AAD.

12.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194382

ABSTRACT

Introduction: Complete heart block (CHB) in association with Covid-19 is uncommon and has been described primarily in the pre-vaccine time period. In the setting of acute Covid-19 infection, decision to treat CHB with permanent pacemaker (PPM) is often uncertain as the CHB may resolve or persist. We present a case of reversible CHB and Covid-19 infection in a vaccinated healthy 28- year-old. Case: A healthy 28-year-old female presented after syncope. She had been vaccinated three times against Covid-19 with Pfizer-BioNTech mRNA vaccine with her third dose four months prior. She had known Covid-19 exposure and developed sore throat three days prior to presenting with syncope. She had no other symptoms. Physical exam was remarkable only for bradycardia. Labs showed positive Covid-19 PCR test and elevated troponin of 0.396 ng/mL. Complete blood counts, metabolic panel, ESR and CRP were normal. Lyme IgM and IgG were negative by Western blot. ECG showed CHB with a rate of 35 beats per minute (Figure 1A). Echocardiogram showed no abnormalities. The patient remained in CHB for 24 hours, at which point PPM was implanted after shared-decision making. Post-PPM ECG showed AV-paced rhythm (Figure 1B). At follow up, PPM interrogation showed that she transitioned to sinus rhythm with right bundle branch block (RBBB) followed by a return to normal sinus rhythm without RBBB 5 days after implantation (Figure 1C). Cardiac MRI two months after PPM implantation showed no abnormalities. Discussion(s): This was a case of Covid-19 associated myocardial injury with CHB in a fullyvaccinated, healthy adult treated with PPM. Despite vaccination, this patient experienced myocardial and conduction system involvement during acute Covid-19 infection. Myocardial injury along with this ECG progression suggested that there was transient inflammation of the myocardial septum resulting in CHB. It may be reasonable to delay PPM implantation in cases of CHB and Covid-19 infection as the CHB may be transient.

13.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194360

ABSTRACT

Introduction: Post-sternotomy chest pain (CP) has been widely reported in literature. The etiologies include myocardial infarction, pulmonary embolism, hypersensitivity reactions to foreign material, wound infection, sternal instability and dehiscence, neuropathic pain due to intercoastal nerve damage or sternal wire fracture leading to migration. Here, we report a rare case of a young patient who presented with chronic chest pain after an atrial septal defect (ASD) repair. Case: A 28-year-old male with past medical history significant for an ASD (secundum) repair with autologous pericardial patch, hyperlipidemia, COVID-19 infection, known first degree AV block, and early repolarization changes, presented for a follow-up office visit three years after his ASD repair with complaints of typical anginal symptoms. Diagnosis: Vitals, physical exam, troponin, D-dimer and inflammatory markers were unremarkable. Chest x-ray (Figure 1A) showed sternal wires in place and no fractures of wires. EKG (Figure 1B) was unchanged. Echocardiogram showed LVEF 50% and no wall motion abnormalities. He underwent a coronary CTA which identified intermittent compression on the mid-RCA from the third bottom stainless steel sternal wire (Figure 1C), warranting removal. Treatment: He underwent explantation of all sternal wires and selective right coronary angiography (Figure 1D) was performed, which revealed intact and patent RCA without any complications. He continues to follow-up in our clinic without any CP. Conclusion(s): Chronic CP after any cardiac surgery remains a diagnostic dilemma and a source of anxiety for patients. We recommend comprehensive discussions with patients prior to surgery about these probable complications to alleviate the anxiety. Lastly, from research thus far, removal of sternal wires is a safe, simple, and effective procedure that should be offered to patients with persistent post-sternotomy CP after exclusion of serious complications.

14.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Article in English | EMBASE | ID: covidwho-2194341

ABSTRACT

A 25 year old man presented with three days of cough, shortness of breath, and pleuritic chest pain. Initial vital signs in the ED were normal, and exam demonstrated tonsillar erythema without exudate. Labs revealed a leukocytosis of 18.9k/muL, D-dimer of 690 ng/mL, C-reactive protein of 5.7 mg/dL, and lactate elevated to 2.9 mmol/L. High-sensitivity troponin, NT-proBNP, and SARS-CoV-2 RT-PCR were all negative. Presenting electrocardiogram demonstrated PR elevation in aVR with diffuse ST-segment elevation in the inferior and anterolateral leads. Point-of-care echocardiogram demonstrated normal biventricular function without pericardial effusion. CTPA was negative for pulmonary embolism, and he was observed for presumed acute viral pericarditis. Fourteen-hours later, he became febrile to 38.3degreeC, tachycardic to 133 bpm, and hypotensive to 97/65 mmHg with diffuse abdominal pain. Repeat lactate was 9.0 mmol/L. This prompted an emergent CT scan which now showed a new large pericardial effusion and bilateral pleural effusions (Panel A). Repeat echocardiogram confirmed a large circumferential pericardial effusion with early signs of tamponade including right atrial inversion in late diastole (Panel B). Emergent pericardiocentesis yielded 560 mL of brown, purulent fluid (Panel C) with immediate improvement in hemodynamics. Bacterial gram stain and culture grew Haemophilus influenzae (Panel D). Immunodeficiency screening was negative. Transient severe biventricular systolic dysfunction was noted, consistent with sepsis-induced cardiomyopathy. He completed a targeted antibiotic course with partial recovery of his ejection fraction by discharge. Purulent pericarditis is rare in developed countries, and invasive H. influenzae in a young, immunocompetent adult is particularly unusual. This case illustrates the importance of early diagnosis and management of purulent pericarditis given its potential for rapid progression and high mortality. (Figure Presented).

15.
Critical Care Medicine ; 51(1 Supplement):394, 2023.
Article in English | EMBASE | ID: covidwho-2190607

ABSTRACT

INTRODUCTION: Dexmedetomidine is administrated in the ICU to treat adrenergic hyperactivity associated with alcohol withdrawal syndrome (AWS). Reduced ICU bed availability and drug shortages during the COVID-19 pandemic have spurred interest in mitigation strategies. The objective of this study was to develop preliminary data on the safety of dexmedetomidine when administered for AWS in nonintubated patients in order to develop a protocol for its use outside of the ICU. METHOD(S): Patients >=18 years of age admitted to an ICU for AWS and received dexmedetomidine between January 2020 and January 2022 were included. Patients were excluded if they required invasive mechanical ventilation or received dexmedetomidine for indications other than AWS. Bradycardia was defined as a heart rate < 40 beats per minute and hypotension as a systolic blood pressured < 80 mmHg. Heart block was identified using 12-lead electrocardiograms. Need for intervention for adverse drug effects was also recorded. Continuous data are reported as median (IQR) and nominal or categorical data as number (%). RESULT(S): Of the 204 patients screened, 148 (73%) were excluded for invasive mechanical ventilation and 8 (4%) for receipt of dexmedetomidine for non-AWS indications, leaving 48 (24%) evaluable patients. Most were male (n=36, 75%), white (n=43, 90%) and non-Hispanic/ Latino (n=47, 98%). Patients were bedded in the emergency department (n=20;42%), an intermediate care unit (n=11;23%), an outside hospital (n=10;21%), a general medical floor (n=6;12%), or perioperative unit (n=1, 2%) prior to ICU admission. The median initial dexmedetomidine dose was 0.35 (0.1, 0.5) mcg/kg/hr and the maximum dose was 1.2 (0.8, 1.4) mcg/ kg/hr. Time to the maximum dose was 2.2 (0.5, 8.5) hours and the total dexmedetomidine infusion duration was 25 (13, 40) hours. Hypotension occurred in 10 (21%) patients-only 2 (4%) required fluid administration, none received pressors or dose reduction. Bradycardia and heart block were not observed. CONCLUSION(S): Dexmedetomidine administration for AWS in non-intubated ICU patients was safely accomplished in 95% of patients with only 4% of the cohort developing hypotension requiring fluid administration. These results will be used to develop a protocol for dexmedetomidine administration in non-ICU areas for AWS.

16.
Open Forum Infectious Diseases ; 9(Supplement 2):S199, 2022.
Article in English | EMBASE | ID: covidwho-2189617

ABSTRACT

Background. Early in the coronavirus disease 2019 (COVID-19) pandemic, a low incidence of cardiovascular complications was reported amongst hospitalised patients with COVID-19 in Singapore. Little was known about the trend of cardiovascular complications as the pandemic progressed. As such, we sought to examine the evolving trends in electrocardiographic and cardiovascular manifestations in patients hospitalised for COVID-19 infection. Methods. We examined the first 1781 consecutive hospitalised patients with polymerase chain reaction (PCR) confirmed COVID-19 in a tertiary academic centre. We divided the population based on those who had an abnormal electrocardiogram (ECG) and those who had a normal ECG, comparing the baseline characteristics and outcomes between the 2 groups. Cardiovascular complications such as acute myocardial infarction, stroke, pulmonary embolism, myocarditis and mortality were also examined over time. Results. Of the 261 (14.7%) patients presenting with abnormal ECG, they were more likely to be symptomatic with complaints of breathlessness, palpitations and chest pain. Sinus tachycardia was the most common arrhythmia. Troponin I levels (41.6+/-264.3 vs 97.0+/-482.9, p=0.047) and C-reactive protein levels (20.1+/-50.7 vs 13.9+/-24.1 mumol/L, p=0.003) were significantly higher amongst those with abnormal ECGs at presentation, with a higher prevalence of myocarditis (1.9% vs 0.5%, p=0.021), pulmonary embolism (1.9% vs 0.3%, p=0.009) and acute myocardial infarction (1.1% vs 0.1%, p=0.025). Over time, there was a trend towards a higher proportion of hospitalised patients with cardiovascular complications. Baseline characteristics of hospitalised patients with COVID-19, with or without abnormal ECG at presentation Changes in percentage of hospitalised patients with COVID-19, experiencing cardiovascular events (acute myocardial infarction, stroke, myocarditis, pulmonary embolism and death) over time Conclusion. A baseline ECG at presentation is a simple test that provides valuable information on potential cardiovascular complications in the context of COVID-19. Although the prevalence of abnormal ECGs is relatively low, it appears to be increasing over time amongst hospitalised patients with COVID-19.

17.
Open Forum Infectious Diseases ; 9(Supplement 2):S172, 2022.
Article in English | EMBASE | ID: covidwho-2189563

ABSTRACT

Background. MIS-C is a hyper inflammatory condition following SARS-CoV-2 infection. Although COVID-19 infection rates and severity have varied based on circulating SARS-CoV-2 variants, it is unclear if cardiac involvement in MIS-C varies following infection with different SARS-CoV-2 variants. The objective of this study is to describe the severity of cardiac involvement in children with MIS-C following three different waves of SARS-CoV-2 infections. Methods. Children hospitalized with a diagnosis of MIS-C were enrolled in a prospective observational study. Demographic, clinical, laboratory (troponin I and B-type natriuretic peptide (BNP)), electrocardiogram (EKG) and echocardiogram (ECHO) data for children diagnosed between 4/20 and 12/21 and followed at 1- and 6-months was analyzed. The cohort was divided into 3 groups to represent cases that followed infection with the Wuhan (4/20-10/20, group 1), Alpha (B.1.1.7, 11/ 20-7/21, group 2) and Delta (B.1. 617.2, 8/21-12/21, group 3) variants. Cardiac involvement during hospitalization and follow-up was compared between the groups. Results. The cohort includes 131 children with MIS-C (32, 61 and 38 in groups 1, 2 and 3, respectively) with a median age of 10 years. Two-thirds were male (66.4%) and 49.6% were Black. Elevated BNP and troponin I levels were seen in 82% and 52.7% of children at initial diagnosis. A third of the cohort had at least one abnormal EKG finding. The proportion of children with abnormal laboratory and EKG findings was not different between the groups. Decreased left ventricular function on ECHO was seen in 25% (33/131) of the cohort with similar distribution among the three groups (p = 0.79). Trivial-small pericardial effusions were detected in 22% (29/131). Coronary artery abnormalities were detected in 11.45% (15/131), a majority in group 1 (25%;8/ 32). At 1- and 6-monthfollow-up visits, BNP and Troponin I were normal in all children. At the 6-month follow-up visit, EKG was normal in all and ECHO was normal in 37/41 children with trivial to mild valvular regurgitation in four children. Conclusion. In this single center prospective study, while a significant proportion of children with MIS-C had evidence of cardiac involvement at diagnosis, most resolved on follow-up demonstrating good outcomes.

18.
European Heart Journal, Supplement ; 24(Supplement K):K143, 2022.
Article in English | EMBASE | ID: covidwho-2188681

ABSTRACT

Background and aims: Relative Bradycardia (RB) is a poorly understood condition that refers to inappropriately low heart rate response to a given increase in body temperature. Dysfunctional crosstalk between the immune system and the autonomous nervous system has been advocated. It is most often observed in intracellular gram negative and parasitic infections, with a prevalence ranging between 15% and 20%. The aim of this study was to identify the prevalence, clinical determinants and significance of RB in patients hospitalized for SARS-CoV-2 infection and to evaluate its prognostic value for long-covid syndrome during follow-up. Method(s): We enrolled consecutive patients hospitalized for SARS-CoV-2 infection from March 2020 to April 2021. We collected clinical parameters including clinostatic and orthostatic blood pressure (BP) and heart rate (HR) at 1,3 and 5 minutes, oxygen saturation, body temperature (BT), routine blood tests, 12-lead ECG, and 48-h Holter ECG. At follow up, clinical symptoms were investigated by novel Malmo POTS Symptoms (MAPS) questionnaire. Result(s): Total population included 269 inpatients (mean age 67+/-17 years, 59% male).Of these, 30 (11%) presented with sinus bradycardia and 37 (14%) RB. RB was more frequently observed in younger male patients with higher BT and heightened CRP levels. There were no significant correlations between BP and HR orthostatic changes and BR during hospital admission or during follow-up. No clinically relevant arrhythmias were revealed during 48-hour ECG monitoring. After mean16-month follow-up, MAPS score was higher in patients with RB (30+/-19) compared to those without RB (18+/-21, p=0.001) during index hospital admission. Dizziness, palpitations and fatigue were more frequently reported in patients with RB(p<0.001). Conclusion(s): RB is not an uncommon condition during acute COVID-19. SARS-CoV-2 inpatients who presented RB during index hospitalization showed a higher symptom burden during follow-up, as recorded by MAPS score. Further studies are needed to clarify the clinical significance of RB and its value to predict post-acute sequelae of COVID-19. (Figure Presented).

19.
European Heart Journal, Supplement ; 24(Supplement K):K138, 2022.
Article in English | EMBASE | ID: covidwho-2188667

ABSTRACT

Background: Cardiovascular abnormalities have been largely reported in patients with COVID-19. Among these, myocardial injury and rhythm disorders represent one of the most important complications in patients affected by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Moreover, a poorer prognosis has been documented in COVID-19 patients when complicated by arrhythmias, independently by age and sex. Objective(s): The aims of the present study were to identify some of non-cardiac and cardiac comorbidities and some myocardial electrical features (including QT dispersion) associated with arrhythmia in hospitalized COVID-19 patients. Moreover, another objective was to contribute in analyzing the impact of arrhythmias on outcome in this setting of patients. Method(s): At admission, each patient underwent cardiac telemetry monitoring through entire hospitalization period. In all the subjects, laboratory analyses, standard 12-lead electrocardiogram (both at admission and on discharge), and lung imaging examination (by means of both ultrasound scans and computed tomography) were performed. Patients exhibiting arrhythmia during in-hospital period were divided into three groups: i, with brady-arrhythmias;ii, with tachy-arrhythmias;and, iii, with tachy- and brady-arrhythmias. Result(s): Two-hundred patients completed the study (males, 123;mean age, 70.1 years);of these, 80 patients (40%) exhibited rhythm disorders on cardiac telemetry. Patients with arrhythmia resulted to be older (p<0.0001) than patients without arrhythmia. Moreover, patients with arrhythmia showed: i, greater number of comorbidities (p<0.0001);ii, higher values of creatinine (p=0.007), B-type natriuretic peptide (p<0.0001), troponin (p<0.0001), c-reactive protein (p=0.01), ferritin (p=0.001), d-dimer (p<0.0001), and procalcitonin (p=0.0008);iii, QT interval (p=0.002), QTc interval (p=0.04), and QTc dispersion (p=0.01);and, iiii, lower values of sodium (p=0.03), magnesium (p=0.04), glomerular filtration rate (p<0.0001), and hemoglobin (p=0.008) as compared to patients without arrhythmia. By comparing the three subgroups of patients, no significant differences were found. Multivariate analysis showed that age (OR=1.14 [95% CI: 1.07-1.22];p=0.0004), coronary artery disease (OR=12.7 [95% CI: 2.38-68.01];p=0.005), and circulating troponin (OR=1.05 [95% CI: 1.003-1.10];p=0.04) represented risk factors independently associated with arrhythmia. By analyzing allcause in-hospital mortality, it resulted a ~forty-fold higher among patients with arrhythmia (OR=39.66 [95% CI: 5.20-302.51];p=0.0004) when compared to patients without rhythm disorders. Conclusion(s): In the present study, arrhythmias have been to be associated with ageing, coronary artery disease, subtle myocardial injury, hyperinflammatory status, coagulative unbalance, and abnormalities in myocardial electrical impulse propagation in patients affected by SARS-CoV-2 infection. In alignment with previous reports, the presence of arrhythmia seems to be associated with a worse in-hospital prognosis. Given its usefulness, routinary use of cardiac telemetric monitoring should be encouraged in COVID wards.

20.
European Heart Journal, Supplement ; 24(Supplement K):K137, 2022.
Article in English | EMBASE | ID: covidwho-2188663

ABSTRACT

Background: Myopericarditis following coronavirus disease-2019 (COVID-19) vaccine is a described entity, but its evolution is still unclear. Method(s): Patients with a diagnosis of myopericarditis after mRNA COVID-19 vaccine represented our population. Clinical evaluation, laboratory tests and non-invasive cardiac tests were performed at baseline and at six months. Result(s): Between January and August 2021, we identified 7 patients with myopericarditis following mRNA vaccination. The median age was 29 years (IQR: 25.5-53.5 years) and all patients were males. The median time from vaccine administration to symptoms onset was 5 days (IQR: 4-7 days);five patients received BNT162b2, two mRNA-1273 and only one patient developed symptoms after first dose of vaccine. The most common symptoms at presentation were chest pain (100%) and fatigue (71.4%). Left Ventricular Ejection Fraction (LVEF) was preserved in 6 of them while was mildly reduced in one (median LVEF: 61.3% [IQR: 60-62.9%]). Late Gadolinium Enhancement was detected at Cardiac Magnetic Resonance in the 42.9% of cases. Treatment was conservative for all patients except one;a pericardiocentesis was necessary due to massive pericardial effusion. At six months follow-up all patients were asymptomatic with normal troponin level, electrocardiogram and echocardiogram confirming the complete healing of the inflammatory process. Two patients received a COVID-19 vaccine booster dose without evidence of myopericardial involvement. Conclusion(s): Myopericarditis associated with mRNA COVID19 vaccination is more frequent in young males and is usually characterized by a benign evolution. (Figure Presented).

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