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1.
Tex Heart Inst J ; 48(3)2021 07 01.
Article in English | MEDLINE | ID: covidwho-1355273

ABSTRACT

During the coronavirus disease 2019 (COVID-19) pandmic, more patients are presenting with complications late after acute myocardial infarction. We report the case of a 71-year-old man who delayed seeking medical care for 2 weeks, despite progressive shortness of breath, cough, and tactile fever, for fear of contracting COVID-19 in the hospital. Clinical and echocardiographic evaluation revealed a ventricular septal rupture secondary to acute myocardial infarction. The patient underwent urgent cardiac catheterization, followed by successful saphenous vein grafting to the left anterior descending coronary artery and open surgical repair of the ventricular septal rupture with a bovine pericardial patch. This case highlights a potential long-lasting negative effect that the COVID-19 pandemic will have on the care-seeking behavior and health of patients with acute cardiovascular disease.


Subject(s)
COVID-19 , Cardiac Catheterization/methods , Coronary Artery Bypass/methods , Fear , Patient Acceptance of Health Care/psychology , ST Elevation Myocardial Infarction , Ventricular Septal Rupture , Aged , COVID-19/epidemiology , COVID-19/psychology , Coronary Angiography/methods , Echocardiography/methods , Electrocardiography/methods , Humans , Male , SARS-CoV-2 , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/surgery , Time-to-Treatment/trends , Treatment Outcome , Ventricular Septal Rupture/diagnosis , Ventricular Septal Rupture/etiology , Ventricular Septal Rupture/physiopathology , Ventricular Septal Rupture/surgery
2.
J Am Heart Assoc ; 10(12): e019635, 2021 06 15.
Article in English | MEDLINE | ID: covidwho-1249490

ABSTRACT

Background Public health emergencies may significantly impact emergency medical services responses to cardiovascular emergencies. We compared emergency medical services responses to out-of-hospital cardiac arrest (OHCA) and ST-segment‒elevation myocardial infarction (STEMI) during the 2020 COVID-19 pandemic to 2018 to 2019 and evaluated the impact of California's March 19, 2020 stay-at-home order. Methods and Results We conducted a population-based cross-sectional study using Los Angeles County emergency medical services registry data for adult patients with paramedic provider impression (PI) of OHCA or STEMI from February through May in 2018 to 2020. After March 19, 2020, weekly counts for PI-OHCA were higher (173 versus 135; incidence rate ratios, 1.28; 95% CI, 1.19‒1.37; P<0.001) while PI-STEMI were lower (57 versus 65; incidence rate ratios, 0.87; 95% CI, 0.78‒0.97; P=0.02) compared with 2018 and 2019. After adjusting for seasonal variation in PI-OHCA and decreased PI-STEMI, the increase in PI-OHCA observed after March 19, 2020 remained significant (P=0.02). The proportion of PI-OHCA who received defibrillation (16% versus 23%; risk difference [RD], -6.91%; 95% CI, -9.55% to -4.26%; P<0.001) and had return of spontaneous circulation (17% versus 29%; RD, -11.98%; 95% CI, -14.76% to -9.18%; P<0.001) were lower after March 19 in 2020 compared with 2018 and 2019. There was also a significant increase in dead on arrival emergency medical services responses in 2020 compared with 2018 and 2019, starting around the time of the stay-at-home order (P<0.001). Conclusions Paramedics in Los Angeles County, CA responded to increased PI-OHCA and decreased PI-STEMI following the stay-at-home order. The increased PI-OHCA was not fully explained by the reduction in PI-STEMI. Field defibrillation and return of spontaneous circulation were lower. It is critical that public health messaging stress that emergency care should not be delayed.


Subject(s)
COVID-19/prevention & control , Electric Countershock , Emergency Medical Services , Out-of-Hospital Cardiac Arrest/therapy , Patient Acceptance of Health Care , ST Elevation Myocardial Infarction/therapy , COVID-19/transmission , Cross-Sectional Studies , Humans , Incidence , Los Angeles/epidemiology , Out-of-Hospital Cardiac Arrest/diagnosis , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/physiopathology , Physical Distancing , Registries , Return of Spontaneous Circulation , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/physiopathology , Time Factors , Treatment Outcome
4.
Circ J ; 85(10): 1701-1707, 2021 09 24.
Article in English | MEDLINE | ID: covidwho-1110060

ABSTRACT

BACKGROUND: Coronavirus Disease-2019 (COVID-19) may impair outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The extent of this phenomenon and its mechanisms are unclear.Methods and Results:This study prospectively included 50 consecutive STEMI patients admitted to our center for primary percutaneous coronary intervention (PCI) at the peak of the Italian COVID-19 outbreak. At admission, a COVID-19 test was positive in 24 patients (48%), negative in 26 (52%). The primary endpoint was in-hospital all-cause mortality. Upon admission, COVID-19 subjects had lower PO2/FiO2 (169 [100-425] vs. 390 [302-477], P<0.01), more need for oxygen support (62.5% vs. 26.9%, P=0.02) and a higher rate of myocardial dysfunction (ejection fraction <30% in 45.8% vs. 19.2%, P=0.04). All patients underwent emergency angiography. In 12.5% of COVID-19 patients, no culprit lesions were detected, thus PCI was performed in 87.5% and 100% of COVID-19 positive and negative patients, respectively (P=0.10). Despite a higher rate of obstinate thrombosis in the COVID-19 group (47.6% vs. 11.5%, P<0.01), the PCI result was similar (TIMI 2-3 in 90.5% vs. 100%, P=0.19). In-hospital mortality was 41.7% and 3.8% in COVID-19 positive and negative patients, respectively (P<0.01). Respiratory failure was the leading cause of death (80%) in the COVID-19 group, frequently associated with severe myocardial dysfunction. CONCLUSIONS: In-hospital mortality of COVID-19 patients with STEMI remains high despite successful PCI, mainly due to coexisting severe respiratory failure. This may be a critical factor in patient management and treatment selection.


Subject(s)
COVID-19/physiopathology , Lung/physiopathology , Percutaneous Coronary Intervention , Respiration , Respiratory Insufficiency/physiopathology , ST Elevation Myocardial Infarction/therapy , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/mortality , COVID-19/virology , Cause of Death , Female , Hospital Mortality , Humans , Lung/virology , Male , Middle Aged , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Prospective Studies , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/mortality , Respiratory Insufficiency/virology , Risk Assessment , Risk Factors , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/physiopathology , Time Factors , Treatment Outcome
5.
J Emerg Med ; 60(1): 103-106, 2021 01.
Article in English | MEDLINE | ID: covidwho-1065310

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 induces a marked prothrombotic state with varied clinical presentations, including acute coronary artery occlusions leading to ST-elevation myocardial infarction (STEMI). However, while STEMI on electrocardiogram (ECG) is not always associated with acute coronary occlusion, this diagnostic uncertainty should not delay cardiac catheterization. CASE REPORTS: We present 2 cases of patients with COVID-19 that presented with STEMI on ECG. While both patients underwent cardiac catheterization, a delay in time to intervention in the patient found to have acute coronary artery occlusion may have contributed to a poor outcome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: These cases highlight the fact that while not all COVID-19 patients with STEMI on ECG will have acute coronary artery occlusions, there is continued need for prompt percutaneous coronary intervention during the severe acute respiratory syndrome coronavirus 2 pandemic.


Subject(s)
Diagnosis, Differential , ST Elevation Myocardial Infarction/diagnosis , Aged , COVID-19/physiopathology , COVID-19/prevention & control , Electrocardiography/methods , Humans , Male , Middle Aged , ST Elevation Myocardial Infarction/physiopathology
6.
Open Heart ; 8(1)2021 02.
Article in English | MEDLINE | ID: covidwho-1066931

ABSTRACT

OBJECTIVE: Although there are regional reports that the COVID-19 pandemic is associated with a reduction in acute myocardial infarction presentations and primary percutaneous coronary intervention (PCI) procedures, little is known about the impact of the COVID-19 pandemic on mechanical complications resulting from ST-segment elevation myocardial infarction (STEMI) and mortality. METHODS: This single-centre retrospective cohort study analysed presentations, incidence of mechanical complications, and mortality in patients with STEMI before and after a state of emergency was declared due to the COVID-19 pandemic by the Japanese government on 7 April 2020. RESULTS: We analysed 359 patients with STEMI hospitalised before the declaration and 63 patients hospitalised after the declaration. The proportion of patients with late presentation was significantly higher after the declaration than before (25.4% vs 14.2%, p=0.03). The incidence of late presentation was significantly higher during the COVID-19 pandemic than before (incidence rate ratio (IRR), 2.41; 95% CI, 1.37 to 4.05; p=0.001, even after adjusting for month (IRR, 2.61; 95% CI, 1.33 to 5.13; p<0.01). Primary PCI was performed significantly less often after the declaration than before (68.3% vs 82.5%, p=0.009). The mechanical complication resulting from STEMI occurred in 13 of 359 (3.6%) patients before the declaration and 9 of 63 (14.3%) patients after the declaration (p<0.001). However, the incidence of in-hospital death (before, 6.2% vs after, 6.4%, p=0.95) was comparable. CONCLUSIONS: Following the COVID-19 pandemic, an increased incidence of mechanical complications resulting from STEMI was observed. Instructing people to stay at home, without effectively educating them to immediately seek medical attention when suffering symptoms of a heart attack, may worsen outcomes in patients with STEMI.


Subject(s)
COVID-19 , Patient Acceptance of Health Care , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction/therapy , Time-to-Treatment , Aged , Aged, 80 and over , Female , Hospital Mortality , Hospitalization , Humans , Japan , Male , Middle Aged , Percutaneous Coronary Intervention/adverse effects , Percutaneous Coronary Intervention/mortality , Registries , Retrospective Studies , Risk Assessment , Risk Factors , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/physiopathology , Time Factors , Treatment Outcome
7.
Multimed Man Cardiothorac Surg ; 20202020 Dec 23.
Article in English | MEDLINE | ID: covidwho-1007098

ABSTRACT

We describe the insertion of the Impella 5.0, a peripherally placed mechanical cardiovascular microaxial pump, in a patient with ischemic left ventricular dysfunction. The Impella is a 7 Fr device capable of achieving a flow of 4.0-5.0 L/min; its use necessitates an open arterial cut-down. A subclavicular incision is used to access the right or left axillary artery. A 10-mm tube graft is anastomosed to the artery through which the Impella 5.0 is inserted. The device traverses the tube graft and is advanced via the aorta, across the aortic valve, to its final position (inflow toward the ventricular apex and outflow above the aorta). The device may remain in situ for 10 days until recovery or until further supports are instituted. Our goal is to demonstrate the insertion of the Impella 5.0 device in a patient with cardiogenic shock whose situation was further complicated by coronavirus disease 2019.


Subject(s)
Assisted Circulation , COVID-19 , Heart-Assist Devices , Prosthesis Implantation , ST Elevation Myocardial Infarction , Shock, Cardiogenic , Adult , Assisted Circulation/instrumentation , Assisted Circulation/methods , COVID-19/complications , COVID-19/therapy , Cardiac Catheterization/methods , Humans , Male , Prone Position/physiology , Prosthesis Implantation/instrumentation , Prosthesis Implantation/methods , SARS-CoV-2/isolation & purification , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/physiopathology , Shock, Cardiogenic/etiology , Shock, Cardiogenic/physiopathology , Shock, Cardiogenic/surgery , Treatment Outcome
9.
J Int Med Res ; 48(10): 300060520966151, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-894958

ABSTRACT

OBJECTIVE: No data are available to develop uniform recommendations for reperfusion therapies in ST-segment elevation myocardial infarction (STEMI) during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to fill the evidence gap regarding STEMI reperfusion strategy during the COVID-19 era. METHODS: Clinical characteristics and outcomes for 17 patients with STEMI who received fibrinolysis during the COVID-19 pandemic were compared with 20 patients who received primary percutaneous coronary intervention (PPCI), and were further compared with another 41 patients who received PPCI in the pre-COVID-19 period. RESULTS: In patients with STEMI, fibrinolysis achieved a comparable in-hospital and 30-day primary composite end point, as compared with those who received PPCI during the COVID-19 pandemic. No major bleeding was detected in either group. Compared patients with STEMI who received PPCI in the pre-COVID-19 period, we found a remarkable extension of chest pain onset-to-first medical contact (FMC) and FMC-to-wire crossing times, significantly increased number and length of stents, and much worse thrombolysis in myocardial infarction flow in patients with STEMI who received PPCI during the COVID-19 pandemic. CONCLUSION: Owing to its considerable efficacy and safety and advantages in conserving medical resources, we recommend fibrinolysis as a reasonable alternative for STEMI care during the COVID-19 pandemic.


Subject(s)
Coronavirus Infections/epidemiology , Fibrinolytic Agents/therapeutic use , Pandemics , Pneumonia, Viral/epidemiology , ST Elevation Myocardial Infarction/drug therapy , Urokinase-Type Plasminogen Activator/therapeutic use , Aged , Aspirin/therapeutic use , COVID-19 , Clopidogrel/therapeutic use , Female , Fibrinolysis , Heparin/therapeutic use , Humans , Male , Middle Aged , Myocardial Reperfusion/methods , Percutaneous Coronary Intervention/methods , Recombinant Proteins/therapeutic use , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/surgery , Stents , Survival Analysis , Treatment Outcome
10.
J Am Heart Assoc ; 9(19): e017126, 2020 10 20.
Article in English | MEDLINE | ID: covidwho-852817

ABSTRACT

Background After the coronavirus disease 2019 outbreak, social isolation measures were introduced to contain infection. Although there is currently a slowing down of the infection, a reduction of hospitalizations, especially for myocardial infarction, was observed. The aim of our study is to evaluate the impact of the infectious disease on ST-segment-elevation myocardial infarction (STEMI) care during the coronavirus disease 2019 pandemic, through the analysis of recent cases of patients who underwent percutaneous coronary intervention. Methods and Results Consecutive patients affected by STEMI from March 1 to 31, 2020, during social restrictions of Italian government, were collected and compared with patients with STEMI treated during March 2019. During March 2020, we observed a 63% reduction of patients with STEMI who were admitted to our catheterization laboratory, when compared with the same period of 2019 (13 versus 35 patients). Changes in all time components of STEMI care were notably observed, particularly for longer median time in symptom-to-first medical contact, spoke-to-hub, and the cumulative symptom-to-wire delay. Procedural data and in-hospital outcomes were similar between the 2 groups, whereas the length of hospitalization was longer in patients of 2020. In this group, we also observed higher levels of cardiac biomarkers and a worse left ventricular ejection fraction at baseline and discharge. Conclusions The coronavirus disease 2019 outbreak induced a reduction of hospital access for STEMI with an increase in treatment delay, longer hospitalization, higher levels of cardiac biomarkers, and worse left ventricular function.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Heart Ventricles/physiopathology , Pneumonia, Viral/epidemiology , ST Elevation Myocardial Infarction/epidemiology , Aged , COVID-19 , Comorbidity , Echocardiography, Doppler, Color , Electrocardiography , Female , Follow-Up Studies , Heart Ventricles/diagnostic imaging , Hospital Mortality/trends , Hospitalization/trends , Humans , Incidence , Italy/epidemiology , Male , Middle Aged , Pandemics , Percutaneous Coronary Intervention/methods , Prognosis , Retrospective Studies , SARS-CoV-2 , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/surgery , Stroke Volume/physiology , Survival Rate/trends
11.
Arch Cardiol Mex ; 90(Supl): 33-35, 2020.
Article in English | MEDLINE | ID: covidwho-596948

ABSTRACT

The communications accumulated in the last weeks make it clear that there is no agreement to define the best treatment strategy in patients with acute coronary syndrome (SICA). In patients presenting with an acute myocardial infarction with ST-segment elevation (IAMCESST), it has been suggested to favor fibrinolysis (FL) over primary percutaneous coronary intervention (PCI), reserving ICP for cases of failed FL1,2; however, some societies have maintained the indication of the ICPp as the repercussion method of choice3. In SICAs without ST segment elevation (SICASESST) the recommendations are very similar, favoring medical treatment over percutaneous coronary intervention in this subgroup of patients1. Several companies consider the contagion status, particularly in the SICASESST, to decide which repercussion follow3. Anticipating that the epidemiological curve in Mexico will be similar to that observed in most countries, we recommend continuing the care of patients with SICA, the catheterization rooms must maintain their operation.


Las comunicaciones acumuladas en las últimas semanas dejan claro que no existe un acuerdo para definir la mejor estrategia de tratamiento en los pacientes con un síndrome coronario agudo (SICA). En los pacientes que se presentan con un infarto agudo del miocardio con elevación del segmento ST (IAMCESST) se ha sugerido privilegiar la fibrinólisis (FL) sobre la intervención coronaria percutánea primaria (ICPp), reservando el ICP para los casos de FL fallidar1,2; sin embargo algunas sociedades han mantenido la indicación de la ICPp como el método de repercusión de elecciónr3. En los SICA sin elevación del segmento ST (SICASESST) las recomendaciones son muy similares, favoreciendo el tratamiento medico sobre el intervencionismo coronario percutáneo, en este subgrupo de pacientes1. Varias sociedades consideran el estado de contagio, en particular en los SICASESST, para decidir que estrategia de repercusión seguir3. Anticipando que la curva epidemiológica en México será similar a la observada en la mayoría de los países, recomendamos continuar la atención de los pacientes con SICA, las salas de cateterismo deben mantener su funcionamiento.


Subject(s)
Acute Coronary Syndrome/therapy , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Acute Coronary Syndrome/physiopathology , COVID-19 , Cardiac Catheterization , Coronavirus Infections/prevention & control , Disease Outbreaks , Humans , Mexico/epidemiology , Non-ST Elevated Myocardial Infarction/physiopathology , Non-ST Elevated Myocardial Infarction/therapy , Pandemics/prevention & control , Percutaneous Coronary Intervention/methods , Pneumonia, Viral/prevention & control , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/therapy
12.
Can J Cardiol ; 36(8): 1326.e9-1326.e11, 2020 08.
Article in English | MEDLINE | ID: covidwho-620915

ABSTRACT

A wide spectrum of cardiovascular manifestations has been documented in patients suffering from coronavirus disease-2019 (COVID-19). Usually associated with a poor prognoses, these manifestations include thromboembolic events, acute coronary syndrome, heart failure, and cardiogenic shock. We describe a patient with COVID-19 who presented with subacute myocardial infarction, biventricular thrombi, and bilateral pulmonary emboli. Biventricular thrombi are rare, and their presence raises concern for an underlying prothrombotic condition.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Heart Aneurysm , Heart Ventricles , Pandemics , Pneumonia, Viral , Pulmonary Embolism , ST Elevation Myocardial Infarction , Thrombosis , Anticoagulants/administration & dosage , COVID-19 , Cardiopulmonary Resuscitation/methods , Clinical Deterioration , Coronary Angiography/methods , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Fatal Outcome , Female , Heart Aneurysm/diagnosis , Heart Aneurysm/etiology , Heart Arrest/etiology , Heart Arrest/therapy , Heart Ventricles/diagnostic imaging , Heart Ventricles/pathology , Humans , Middle Aged , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pulmonary Embolism/diagnosis , Pulmonary Embolism/etiology , SARS-CoV-2 , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/therapy , Thrombosis/diagnosis , Thrombosis/drug therapy , Thrombosis/etiology , Tomography, X-Ray Computed/methods , Ventricular Dysfunction, Left/diagnosis , Ventricular Dysfunction, Left/etiology
13.
Can J Cardiol ; 36(6): 966.e1-966.e4, 2020 06.
Article in English | MEDLINE | ID: covidwho-100580

ABSTRACT

Cardiac involvement has been reported in patients with COVID-19, which may be reflected by electrocardiographic (ECG) changes. Two COVID-19 cases in our report exhibited different ECG manifestations as the disease caused deterioration. The first case presented temporary SIQIIITIII morphology followed by reversible nearly complete atrioventricular block, and the second demonstrated ST-segment elevation accompanied by multifocal ventricular tachycardia. The underlying mechanisms of these ECG abnormalities in the severe stage of COVID-19 may be attributed to hypoxia and inflammatory damage incurred by the virus.


Subject(s)
Arrhythmias, Cardiac , Coronavirus Infections , Electrocardiography/methods , Extracorporeal Membrane Oxygenation/methods , Hypoxia , Pandemics , Pneumonia, Viral , ST Elevation Myocardial Infarction , Aged , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/physiopathology , Arrhythmias, Cardiac/therapy , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Critical Illness/therapy , Female , Humans , Hypoxia/etiology , Hypoxia/physiopathology , Hypoxia/therapy , Male , Pneumonia, Viral/complications , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Respiration, Artificial/methods , SARS-CoV-2 , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/therapy , Treatment Outcome
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