Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 49
Filter
1.
BMJ Open ; 12(4): e055123, 2022 04 19.
Article in English | MEDLINE | ID: covidwho-1868733

ABSTRACT

INTRODUCTION: Identifying and excluding coronary artery disease (CAD) in patients with atypical angina pectoris (AP) and non-specific thoracic complaints is a challenge for general practitioners (GPs). A diagnostic and prognostic tool could help GPs in determining the likelihood of CAD and guide patient management. Studies in outpatient settings have shown that the CT-based coronary calcium score (CCS) has high accuracy for diagnosis and exclusion of CAD. However, the CT CCS test has not been tested in a primary care setting. In the COroNary Calcium scoring as fiRst-linE Test to dEtect and exclude coronary artery disease in GPs patients with stable chest pain (CONCRETE) study, the impact of direct access of GPs to CT CCS will be investigated. We hypothesise that this will allow for early diagnosis of CAD and treatment, more efficient referral to the cardiologist and a reduction of healthcare-related costs. METHODS AND ANALYSIS: CONCRETE is a pragmatic multicentre trial with a cluster randomised design, in which direct GP access to the CT CCS test is compared with standard of care. In both arms, at least 40 GP offices, and circa 800 patients with atypical AP and non-specific thoracic complaints will be included. To determine the increase in detection and treatment rate of CAD in GP offices, the CVRM registration rate is derived from the GPs electronic registration system. Individual patients' data regarding cardiovascular risk factors, expressed chest pain complaints, quality of life, downstream testing and CAD diagnosis will be collected through questionnaires and the electronic GP dossier. ETHICS AND DISSEMINATION: CONCRETE has been approved by the Medical Ethical Committee of the University Medical Center of Groningen. TRIAL REGISTRATION NUMBER: NTR 7475; Pre-results.


Subject(s)
Coronary Artery Disease , General Practitioners , Angina Pectoris/complications , Angina Pectoris/diagnosis , Calcium , Chest Pain/diagnosis , Chest Pain/etiology , Coronary Angiography/methods , Coronary Artery Disease/complications , Coronary Artery Disease/diagnosis , Humans , Multicenter Studies as Topic , Pragmatic Clinical Trials as Topic , Predictive Value of Tests , Quality of Life , Randomized Controlled Trials as Topic
2.
Chest ; 161(5): e299-e304, 2022 May.
Article in English | MEDLINE | ID: covidwho-1866966

ABSTRACT

CASE PRESENTATION: A 31-year-old Asian male never-smoker living in the upper Midwest with a past medical history of congenital bilateral hearing loss sought treatment with a 1-week history of fever, fatigue, right-sided pleuritic chest pain, shortness of breath, productive cough with mild intermittent hemoptysis, night sweats, and unintentional 10-lb weight loss over 4 weeks. He was adopted from South Korea as an infant, and thus the family history was unknown. He worked in the heating, ventilation, and air conditioning business, performing installations and repairs. There was no known exposure to animals, caves, rivers, lakes, or wooded areas. He travelled to South Korea and New Hampshire approximately 9 months previously. He did not take any medication.


Subject(s)
Chest Pain , Mediastinal Diseases , Chest Pain/diagnosis , Chest Pain/etiology , Cough/diagnosis , Diagnosis, Differential , Dyspnea/diagnosis , Fever/diagnosis , Fever/etiology , Humans , Male , Mediastinal Diseases/diagnosis
3.
JCI Insight ; 7(10)2022 May 23.
Article in English | MEDLINE | ID: covidwho-1861744

ABSTRACT

Shortness of breath, chest pain, and palpitations occur as postacute sequelae of COVID-19, but whether symptoms are associated with echocardiographic abnormalities, cardiac biomarkers, or markers of systemic inflammation remains unknown. In a cross-sectional analysis, we assessed symptoms, performed echocardiograms, and measured biomarkers among adults more than 8 weeks after confirmed SARS-CoV-2 infection. We modeled associations between symptoms and baseline characteristics, echocardiographic findings, and biomarkers using logistic regression. We enrolled 102 participants at a median of 7.2 months following COVID-19 onset; 47 individuals reported dyspnea, chest pain, or palpitations. Median age was 52 years, and 41% of participants were women. Female sex, hospitalization, IgG antibody against SARS-CoV-2 receptor binding domain, and C-reactive protein were associated with symptoms. Regarding echocardiographic findings, 4 of 47 participants (9%) with symptoms had pericardial effusions compared with 0 of 55 participants without symptoms; those with effusions had a median of 4 symptoms compared with a median of 1 symptom in those without effusions. There was no strong evidence for a relationship between symptoms and echocardiographic functional parameters or other biomarkers. Among adults more than 8 weeks after SARS-CoV-2 infection, SARS-CoV-2 RBD antibodies, markers of inflammation, and, possibly, pericardial effusions are associated with cardiopulmonary symptoms. Investigation into inflammation as a mechanism underlying postacute sequelae of COVID-19 is warranted.


Subject(s)
COVID-19 , Pericardial Effusion , Adult , Antibodies, Viral , Biomarkers , COVID-19/complications , COVID-19/diagnostic imaging , Chest Pain/etiology , Cross-Sectional Studies , Echocardiography , Female , Humans , Inflammation , Male , Middle Aged , SARS-CoV-2
4.
J Investig Med High Impact Case Rep ; 10: 23247096221092291, 2022.
Article in English | MEDLINE | ID: covidwho-1808263

ABSTRACT

Viral infections are a common cause of acute myocarditis. However, vaccines including influenza and smallpox have also been rarely implicated. Recently, the coronavirus disease 2019 (COVID-19) vaccines have been associated with acute myocarditis. We describe a case of acute myocarditis in a 19-year-old male 2 days after the initial dose of the COVID-19 mRNA-1273 vaccine. He presented with chest pain radiating to his left arm and bilateral shoulders. COVID, influenza, coxsackie, respiratory syncytial virus polymerase chain reaction (PCR) tests were negative. Electrocardiogram revealed diffuse ST-segment elevation. Initial Troponin was 15.7 ng/mL. A coronary angiogram revealed patent coronary arteries and no wall motion abnormality. A transthoracic echocardiogram showed diffuse hypokinesis with an ejection fraction of 49%. Cardiac magnetic resonance scan was aborted after 2 attempts due to severe claustrophobia. His chest pain resolved following initiation of aspirin, tylenol, colchicine, lisinopril, and metoprolol.


Subject(s)
COVID-19 , Influenza, Human , Myocarditis , Adult , COVID-19 Vaccines/adverse effects , Chest Pain/etiology , Humans , Influenza, Human/complications , Male , Myocarditis/complications , Vaccination/adverse effects , Young Adult
5.
J Womens Health (Larchmt) ; 31(5): 620-630, 2022 05.
Article in English | MEDLINE | ID: covidwho-1758608

ABSTRACT

Background: Sex differences have been demonstrated in the acute phase of coronavirus disease 2019 (COVID-19). Women (F) were found to be less prone to develop a severe disease than men (M), but few studies have assessed sex-differences in Long-COVID-19 syndrome. Methods: The aim of this prospective/retrospective study was to characterize the long-term consequences of this infection based on sex. For this purpose, we enrolled 223 patients (89 F and 134 M) who were infected by SARS-CoV-2. In the acute phase of the illness, F reported the following symptoms more frequently than M: weakness, dysgeusia, anosmia, thoracic pain, palpitations, diarrhea, and myalgia-all without significant differences in breathlessness, cough, and sleep disturbance. Results: After a mean follow-up time of 5 months after the acute phase, F were significantly more likely than M to report dyspnea, weakness, thoracic pain, palpitations, and sleep disturbance but not myalgia and cough. At the multivariate logistic regression, women were statistically significantly likely to experience persistent symptoms such as dyspnea, fatigue, chest pain, and palpitations. On the contrary, myalgia, cough, and sleep disturbance were not influenced by sex. Conclusion: We demonstrated that F were more symptomatic than M not only in the acute phase but also at follow-up. Sex was found to be an important determinant of Long-COVID-19 syndrome because it is a significant predictor of persistent symptoms in F, such as dyspnea, fatigue, chest pain, and palpitations. Our results suggest the need for long-term follow-up of these patients from a sex perspective to implement early preventive and personalized therapeutic strategies.


Subject(s)
COVID-19 , Sleep Wake Disorders , COVID-19/complications , COVID-19/epidemiology , Chest Pain/etiology , Cough/complications , Dyspnea/etiology , Fatigue , Female , Humans , Male , Myalgia/complications , Myalgia/etiology , Prospective Studies , Retrospective Studies , SARS-CoV-2 , Sex Characteristics , Sleep Wake Disorders/complications , Sleep Wake Disorders/epidemiology , Syndrome
6.
Cardiovasc Revasc Med ; 38: 43-44, 2022 05.
Article in English | MEDLINE | ID: covidwho-1693820
8.
Sci Rep ; 11(1): 23959, 2021 12 14.
Article in English | MEDLINE | ID: covidwho-1585800

ABSTRACT

Evidence that patients may avoid healthcare facilities for fear of COVID-19 infection has heightened the concern that true rates of myocardial infarctions have been under-ascertained and left untreated. We analyzed data from the National Emergency Medical Services Information System (NEMSIS) and incident COVID-19 infections across the United States (US) between January 1, 2020 and April 30, 2020. Grouping events by US Census Division, multivariable adjusted negative binomial regression models were utilized to estimate the relationship between COVID-19 and EMS cardiovascular activations. After multivariable adjustment, increasing COVID-19 rates were associated with less activations for chest pain and non-ST-elevation myocardial infarctions. Simultaneously, increasing COVID-19 rates were associated with more activations for cardiac arrests, ventricular fibrillation, and ventricular tachycardia. Although direct effects of COVID-19 infections may explain these discordant observations, these findings may also arise from patients delaying or avoiding care for myocardial infarction, leading to potentially lethal consequences.


Subject(s)
Arrhythmias, Cardiac/epidemiology , COVID-19/epidemiology , Chest Pain/epidemiology , Arrhythmias, Cardiac/etiology , COVID-19/complications , Chest Pain/etiology , Humans , Models, Theoretical , Non-ST Elevated Myocardial Infarction/epidemiology , Non-ST Elevated Myocardial Infarction/genetics , United States/epidemiology
9.
Pan Afr Med J ; 38: 74, 2021.
Article in English | MEDLINE | ID: covidwho-1547719

ABSTRACT

Boerhaave's syndrome is an uncommon syndrome characterized by spontaneous rupture of the oesophagus with a high mortality rate. While excessive alcohol intake and binge-eating are the classic precipitants of this syndrome, medication-induced vomiting causing Booerhave's is quite uncommon. Traditionally managed operatively, conservative management is being increasingly reported in selected cases. We report the case of 21-year-old male with who developed sudden onset chest pain and dyspnoea after pentazocine induced vomiting. He was referred after lack of response to initial treatment for acute severe asthma. A chest CT scan showed pneumomediastinum, subcutaneous emphysema and oesophageal tear. He was managed conservatively with oxygen therapy, nil per mouth and antibiotics with improvement of symptoms and discharge after 8 days.


Subject(s)
Esophageal Perforation/diagnostic imaging , Mediastinal Diseases/diagnostic imaging , Pentazocine/adverse effects , Vomiting/complications , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Anti-Bacterial Agents/administration & dosage , Asthma/physiopathology , Asthma/therapy , Chest Pain/etiology , Dyspnea/etiology , Esophageal Perforation/etiology , Esophageal Perforation/therapy , Humans , Male , Mediastinal Diseases/etiology , Mediastinal Diseases/therapy , Oxygen Inhalation Therapy , Pentazocine/administration & dosage , Tomography, X-Ray Computed , Vomiting/chemically induced , Young Adult
11.
Am J Nurs ; 121(10): 16, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1434515

ABSTRACT

Patients report a wide range of symptoms as researchers work to pinpoint their cause.


Subject(s)
COVID-19/complications , COVID-19/physiopathology , Chest Pain/etiology , Fatigue/etiology , Fever/etiology , Headache/etiology , Humans , Longitudinal Studies
14.
Emerg Med J ; 38(7): 361-363, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1376518

ABSTRACT

A short cut review was carried out to establish the diagnostic characteristics of alveolar dead space fraction (AVDSf) in the diagnosis of pulmonary embolism (PE). This is calculated from the arterial and end-tidal CO2 Three papers were selected to answer the clinical question. The author, study type, relevant outcomes, results and weaknesses are tabulated. It is concluded that there is good evidence to support the use of AVDSf within a clinical prediction model to exclude a PE in patients when there is a low pretest probability. However, the specificity is not sufficient to support it as a 'rule in' test.


Subject(s)
COVID-19/complications , Capnography/methods , Carbon Dioxide/analysis , Pulmonary Embolism/diagnosis , Aged , COVID-19/diagnosis , Capnography/instrumentation , Carbon Dioxide/blood , Chest Pain/etiology , Cough/etiology , Dyspnea/etiology , Fever/etiology , Humans , Male , Pulmonary Embolism/blood , Pulmonary Embolism/physiopathology
15.
Cardiol Young ; 32(1): 146-149, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1283658

ABSTRACT

Two adolescent males presented within 3 days after the first and second dose of the BNT162b2 vaccine with chest pain. Elevated troponin levels, ST segment elevation, and enhancement of the myocardium in cardiac MRI suggested myocarditis. Left ventricular function remained normal, symptoms resolved, and patients were discharged in 4 days. BNT162b2 vaccine may be associated with self-limited myocarditis in youth.


Subject(s)
COVID-19 , Myocarditis , Adolescent , COVID-19 Vaccines , Chest Pain/diagnosis , Chest Pain/etiology , Humans , Male , Myocarditis/diagnosis , Myocarditis/etiology , Vaccination/adverse effects , Vaccines, Synthetic
16.
JAMA Cardiol ; 6(10): 1202-1206, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1286093

ABSTRACT

Importance: Myocarditis has been reported with COVID-19 but is not clearly recognized as a possible adverse event following COVID-19 vaccination. Objective: To describe myocarditis presenting after COVID-19 vaccination within the Military Health System. Design, Setting, and Participants: This retrospective case series studied patients within the US Military Health System who experienced myocarditis after COVID-19 vaccination between January and April 2021. Patients who sought care for chest pain following COVID-19 vaccination and were subsequently diagnosed with clinical myocarditis were included. Exposure: Receipt of a messenger RNA (mRNA) COVID-19 vaccine between January 1 and April 30, 2021. Main Outcomes and Measures: Clinical diagnosis of myocarditis after COVID-19 vaccination in the absence of other identified causes. Results: A total of 23 male patients (22 currently serving in the military and 1 retiree; median [range] age, 25 [20-51] years) presented with acute onset of marked chest pain within 4 days after receipt of an mRNA COVID-19 vaccine. All military members were previously healthy with a high level of fitness. Seven received the BNT162b2-mRNA vaccine and 16 received the mRNA-1273 vaccine. A total of 20 patients had symptom onset following the second dose of an appropriately spaced 2-dose series. All patients had significantly elevated cardiac troponin levels. Among 8 patients who underwent cardiac magnetic resonance imaging within the acute phase of illness, all had findings consistent with the clinical diagnosis of myocarditis. Additional testing did not identify other etiologies for myocarditis, including acute COVID-19 and other infections, ischemic injury, or underlying autoimmune conditions. All patients received brief supportive care and were recovered or recovering at the time of this report. The military administered more than 2.8 million doses of mRNA COVID-19 vaccine in this period. While the observed number of myocarditis cases was small, the number was higher than expected among male military members after a second vaccine dose. Conclusions and Relevance: In this case series, myocarditis occurred in previously healthy military patients with similar clinical presentations following receipt of an mRNA COVID-19 vaccine. Further surveillance and evaluation of this adverse event following immunization is warranted. Potential for rare vaccine-related adverse events must be considered in the context of the well-established risk of morbidity, including cardiac injury, following COVID-19 infection.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Military Personnel/statistics & numerical data , Myocarditis/etiology , Vaccination/adverse effects , Adult , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , COVID-19 Vaccines/administration & dosage , Cardiac Imaging Techniques/methods , Chest Pain/etiology , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Military Health Services/standards , Myocarditis/diagnosis , Myocarditis/epidemiology , Retrospective Studies , SARS-CoV-2/genetics , Troponin/blood , United States/epidemiology , Vaccination/statistics & numerical data
17.
JAMA Cardiol ; 6(10): 1196-1201, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1286092

ABSTRACT

Importance: Vaccine-associated myocarditis is an unusual entity that has been described for the smallpox vaccine, but only anecdotal case reports have been described for other vaccines. Whether COVID-19 vaccination may be linked to the occurrence of myocarditis is unknown. Objective: To describe a group of 7 patients with acute myocarditis over 3 months, 4 of whom had recent messenger RNA (mRNA) COVID-19 vaccination. Design, Setting, and Participants: All patients referred for cardiovascular magnetic resonance imaging at Duke University Medical Center were asked to participate in a prospective outcomes registry. Two searches of the registry database were performed: first, to identify patients with acute myocarditis for the 3-month period between February 1 and April 30 for 2017 through 2021, and second, to identify all patients with possible vaccine-associated myocarditis for the past 20 years. Once patients with possible vaccine-associated myocarditis were identified, data available in the registry were supplemented by additional data collection from the electronic health record and a telephone interview. Exposures: mRNA COVID-19 vaccine. Main Outcomes and Measures: Occurrence of acute myocarditis by cardiovascular magnetic resonance imaging. Results: In the 3-month period between February 1 and April 30, 2021, 7 patients with acute myocarditis were identified, of which 4 occurred within 5 days of COVID-19 vaccination. Three were younger male individuals (age, 23-36 years) and 1 was a 70-year-old female individual. All 4 had received the second dose of an mRNA vaccine (2 received mRNA-1273 [Moderna], and 2 received BNT162b2 [Pfizer]). All presented with severe chest pain, had biomarker evidence of myocardial injury, and were hospitalized. Coincident testing for COVID-19 and respiratory viruses provided no alternative explanation. Cardiac magnetic resonance imaging findings were typical for myocarditis, including regional dysfunction, late gadolinium enhancement, and elevated native T1 and T2. Conclusions and Relevance: In this study, magnetic resonance imaging findings were found to be consistent with acute myocarditis in 7 patients; 4 of whom had preceding COVID-19 vaccination. Further investigation is needed to determine associations of COVID-19 vaccination and myocarditis.


Subject(s)
COVID-19 Vaccines/adverse effects , COVID-19/prevention & control , Myocarditis/etiology , Vaccination/statistics & numerical data , Acute Disease , Adult , Aged , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , COVID-19 Vaccines/administration & dosage , Cardiac Imaging Techniques/methods , Chest Pain/diagnosis , Chest Pain/etiology , Female , Gadolinium/administration & dosage , Gadolinium/metabolism , Hospitalization , Humans , Magnetic Resonance Imaging/methods , Male , Myocarditis/diagnosis , Myocarditis/epidemiology , Outcome Assessment, Health Care , Prospective Studies , Registries , SARS-CoV-2/genetics , Vaccination/methods , Vaccination/trends
18.
Emerg Med J ; 38(7): 361-363, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1280440

ABSTRACT

A short cut review was carried out to establish the diagnostic characteristics of alveolar dead space fraction (AVDSf) in the diagnosis of pulmonary embolism (PE). This is calculated from the arterial and end-tidal CO2 Three papers were selected to answer the clinical question. The author, study type, relevant outcomes, results and weaknesses are tabulated. It is concluded that there is good evidence to support the use of AVDSf within a clinical prediction model to exclude a PE in patients when there is a low pretest probability. However, the specificity is not sufficient to support it as a 'rule in' test.


Subject(s)
COVID-19/complications , Capnography/methods , Carbon Dioxide/analysis , Pulmonary Embolism/diagnosis , Aged , COVID-19/diagnosis , Capnography/instrumentation , Carbon Dioxide/blood , Chest Pain/etiology , Cough/etiology , Dyspnea/etiology , Fever/etiology , Humans , Male , Pulmonary Embolism/blood , Pulmonary Embolism/physiopathology
19.
Medicine (Baltimore) ; 100(24): e26371, 2021 Jun 18.
Article in English | MEDLINE | ID: covidwho-1269625

ABSTRACT

ABSTRACT: Most patients with coronavirus disease 2019 (COVID-19) have mild to moderate illness not requiring hospitalization. However, no study has detailed the evolution of symptoms in the first month of illness.At our institution, we conducted remote (telephone and video) visits for all adult outpatients diagnosed with COVID-19 within 24 h of a positive nasopharyngeal polymerase chain test for SARS-CoV-2. We repeated regular video visits at 7, 14, and 28 days after the positive test, retrospectively reviewed the prospective data collected in the remote visits, and constructed a week by week profile of clinical illness, through week 4 of illness.We reviewed the courses of 458 symptomatic patients diagnosed between March 12, 2020, and June 22, 2020, and characterized their weekly courses. Common initial symptoms included fever, headache, cough, and chest pain, which frequently persisted through week 3 or longer. Upper respiratory or gastrointestinal symptoms were much shorter lived, present primarily in week 1. Anosmia/ageusia peaked in weeks 2 to 3. Emergency department visits were frequent, with 128 visits in the 423 patients who were not hospitalized and 48 visits among the 35 outpatients (7.6%) who were eventually hospitalized (2 subsequently died). By the fourth week, 28.9% said their illness had completely resolved. After the 4-week follow up, 20 (4.7%) of the 423 nonhospitalized patients had further medical evaluation and management for subacute or chronic COVID-19 symptoms.Mild to moderate outpatient COVID-19 is a prolonged illness, with evolving symptoms commonly lasting into the fourth week of illness.


Subject(s)
Ambulatory Care , COVID-19/complications , COVID-19/therapy , Adolescent , Adult , Aged , Aged, 80 and over , Anosmia/etiology , COVID-19/diagnosis , Chest Pain/etiology , Cough/etiology , Dyspnea/etiology , Emergency Service, Hospital , Fatigue/etiology , Female , Fever/etiology , Humans , Male , Middle Aged , Myalgia/etiology , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index , Treatment Outcome , Young Adult
SELECTION OF CITATIONS
SEARCH DETAIL