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1.
Semin Cardiothorac Vasc Anesth ; 25(1): 5-10, 2021 03.
Artículo en Inglés | MEDLINE | ID: covidwho-1069519
2.
BMJ Case Rep ; 14(1)2021 Jan 18.
Artículo en Inglés | MEDLINE | ID: covidwho-1066840

RESUMEN

The ongoing SARS-CoV-2 (COVID-19) pandemic has presented many difficult and unique challenges to the medical community. We describe a case of a middle-aged COVID-19-positive man who presented with pulmonary oedema and acute respiratory failure. He was initially diagnosed with acute respiratory distress syndrome. Later in the hospital course, his pulmonary oedema and respiratory failure worsened as result of severe acute mitral valve regurgitation secondary to direct valvular damage from COVID-19 infection. The patient underwent emergent surgical mitral valve replacement. Pathological evaluation of the damaged valve was confirmed to be secondary to COVID-19 infection. The histopathological findings were consistent with prior cardiopulmonary autopsy sections of patients with COVID-19 described in the literature as well as proposed theories regarding ACE2 receptor activity. This case highlights the potential of SARS-CoV-2 causing direct mitral valve damage resulting in severe mitral valve insufficiency with subsequent pulmonary oedema and respiratory failure.


Asunto(s)
/complicaciones , Insuficiencia de la Válvula Mitral/etiología , Enfermedad Aguda , Fibrilación Atrial/complicaciones , Fibrilación Atrial/fisiopatología , Cuerdas Tendinosas/diagnóstico por imagen , Ecocardiografía , Electrocardiografía , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/fisiopatología , Insuficiencia de la Válvula Mitral/cirugía , Edema Pulmonar/etiología , Edema Pulmonar/fisiopatología , Edema Pulmonar/terapia , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/fisiopatología , Insuficiencia Respiratoria/terapia , Índice de Severidad de la Enfermedad , Choque Cardiogénico/etiología , Choque Cardiogénico/fisiopatología
3.
BMC Infect Dis ; 21(1): 122, 2021 Jan 28.
Artículo en Inglés | MEDLINE | ID: covidwho-1054804

RESUMEN

BACKGROUND: SARS-CoV-2 virus which targets the pulmonary vasculature is supposed to induce an intrapulmonary right to left shunt with an increased pulmonary blood flow. Such vascular injury is difficult to observe because it is hidden by the concomitant lung injury. We report here what may be, to the best of our knowledge, the first case of a pure Covid-19 related Acute Vascular Distress Syndrome (AVDS). CASE PRESENTATION: A 43-year-old physician, tested positive for Covid-19, was addressed to the emergency unit for severe dyspnoea and dizziness. Explorations were non informative with only a doubt regarding a sub-segmental pulmonary embolism (no ground-glass lesions or consolidations related to Covid-19 disease). Dyspnoea persisted despite anticoagulation therapy and normal pulmonary function tests. Contrast-enhanced transthoracic echocardiography was performed which revealed a moderate late right-to-left shunt. CONCLUSIONS: This case report highlights the crucial importance of the vascular component of the viral disease. The intrapulmonary shunt induced by Covid-19 which remains unrecognized because generally hidden by the concomitant lung injury, can persist for a long time. Contrast-enhanced transthoracic echocardiography is the most appropriate test to propose in case of persistent dyspnoea in Covid-19 patients.


Asunto(s)
/fisiopatología , /patogenicidad , Adulto , /patología , Disnea/diagnóstico por imagen , Ecocardiografía , Humanos , Pulmón/diagnóstico por imagen , Pulmón/patología , Pulmón/fisiopatología , Masculino , /patología
5.
Open Heart ; 8(1)2021 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1052327

RESUMEN

AIMS: It was predicted internationally that transthoracic echocardiography (TTE) would be vital during the SARS-CoV-2 outbreak. We therefore, designed a study to report the demand for TTE in two large District General Hospitals during the rise in the first wave of the SARS-CoV-2 pandemic in the UK. A primary clinical outcome of 30-day mortality was also assessed. METHODS: The TTE service across two hospitals was reconfigured to maximise access to inpatient scanning. All TTEs of suspected or confirmed SARS-CoV-2 patients over a 3-week period were included in the study. All patients were followed up until at least day 30 after their scan at which point the primary clinical outcome of mortality was recorded. Comparative analysis based on mortality was conducted for all TTE results, biochemical markers and demographics. RESULTS: 27 patients with confirmed SARS-CoV-2 had a TTE within the inclusion window. Mortality comparative analysis showed the deceased group were significantly older (mean 68.4, SD 11.9 vs 60.5, SD 13.0, p=0.03) and more commonly reported fatigue in their presenting symptoms (29.6% vs 71.4%, p=0.01). No other differences were identified in the demographic or biochemical data. Left ventricular systolic dysfunction was noted in 7.4% of patients and right ventricular impairment or dilation was seen in 18.5% patients. TTE results were not significantly different in mortality comparative analysis. CONCLUSION: This study demonstrates an achievable approach to TTE services when under increased pressure. Data analysis supports the limited available data suggesting right ventricular abnormalities are the most commonly identified echocardiographic change in SARS-CoV-2 patients. No association can be demonstrated between mortality and TTE results.


Asunto(s)
/mortalidad , Enfermedades Cardiovasculares/mortalidad , Ecocardiografía/métodos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , /diagnóstico por imagen , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/fisiopatología , Enfermedades Cardiovasculares/virología , Ecocardiografía/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reino Unido/epidemiología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/epidemiología , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/epidemiología , Disfunción Ventricular Derecha/fisiopatología
6.
Am J Case Rep ; 22: e928852, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: covidwho-1032431

RESUMEN

BACKGROUND Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the lungs but can involve any organ. The medical community is struggling to cope with the critical illness associated with the disease. On top of that, patients who have recovered from COVID-19 have presented with complications such as thrombotic episodes in various organs both during and after being infected with SARS-CoV-2. A COVID-19-associated prothrombotic state has been mentioned in multiple recent research articles. The role of anticoagulants is debatable, because even after receiving them prophylactically, many patients have experienced thrombotic episodes. The situation, therefore, represents a challenge to the medical community. CASE REPORT We report on a COVID-19-associated prothrombotic state in a 65-year-old man with no history of comorbid illness. Initially, he presented with right-sided weakness and was found to have had an acute ischemic stroke. Urgent imaging after the stroke revealed changes on electrocardiography that were remarkable for left bundle branch block. The patient's elevated cardiac enzyme levels correlated with a silent acute myocardial infarction (MI). His echocardiogram revealed a left ventricular (LV) thrombus. He was managed with a multidisciplinary approach involving Neurology, Cardiology, and Medicine. CONCLUSIONS COVID-19-associated prothrombotic episodes involving arterial and venous systems have been reported in the literature. But concomitant stroke, acute MI, and LV thrombus rarely have been documented. The role of prophylactic or therapeutic anticoagulation is still unclear because even when patients are on these drugs, they continue to develop thrombotic episodes. Indeed, further studies are required to develop a standard management plan for what can be a fatal situation.


Asunto(s)
/complicaciones , Infarto del Miocardio/virología , Trombosis/virología , Anciano , Bloqueo de Rama/diagnóstico , Bloqueo de Rama/virología , Ecocardiografía , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Infarto del Miocardio/diagnóstico , Trombosis/diagnóstico por imagen , Tomografía Computarizada por Rayos X
7.
BMJ Open ; 11(1): e042098, 2021 01 13.
Artículo en Inglés | MEDLINE | ID: covidwho-1030410

RESUMEN

INTRODUCTION: COVID-19 can cause severe acute respiratory failure requiring management in intensive care unit with invasive ventilation and a 40% mortality rate. Cardiovascular manifestations are common and studies have shown an increase in right ventricular (RV) dysfunction associated with mortality. These studies, however, comprise heterogeneous patient groups with few requiring invasive ventilation. This study will investigate the prevalence and prognostic significance of RV dysfunction in ventilated patients with COVID-19 which may lead to targeted interventions to improve patient outcomes. METHODS AND ANALYSIS: This prospective multicentre observational cohort study will perform transthoracic echocardiography (TTE) in 150 patients with COVID-19 requiring invasive ventilation for more than 48 hours. RV dysfunction will be defined as TTE evidence of RV dilatation along with the presence of septal flattening. Baseline demographics, disease severity data and clinical information relating to proposed aetiological mechanisms of RV dysfunction (acute respiratory distress syndrome (ARDS), disordered coagulation, direct myocardial injury and ventilation) will be collected and analysed.Primary outcome measures include the prevalence of RV dysfunction and its association with 30-day mortality. Exploratory outcome measures will investigate the association of the proposed aetiological mechanisms of RV dysfunction to the primary outcomes.Prevalence of RV dysfunction will be determined along with 95% Clopper-Pearson CIs and 30-day survival will be analysed using logistic regression adjusting for patient demographics, phase of disease and baseline severity of illness. The role of potential aetiological factors (ARDS, disordered coagulation, direct myocardial injury and ventilation) in relation to the primary outcomes will be analysed using logistic regression. ETHICS AND DISSEMINATION: Approval was gained from Scotland A Research Ethics Committee (REC reference 20/SS/0059). Findings will be disseminated by various methods including webinars, international presentations and publication in peer-reviewed journals.


Asunto(s)
/complicaciones , Ecocardiografía/métodos , Proyectos de Investigación , Respiración Artificial , Disfunción Ventricular Derecha/complicaciones , Disfunción Ventricular Derecha/diagnóstico por imagen , /terapia , Estudios de Cohortes , Estudios Prospectivos , Escocia , Índice de Severidad de la Enfermedad
8.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: covidwho-1020900

RESUMEN

Here we present the case of a 37-year-old previously healthy man who developed fever, headache and a unilateral, painful neck swelling while working offshore. He had no known contact with anyone with COVID-19; however, due to the ongoing pandemic, a nasopharyngeal swab was performed, which was positive for the virus. After transfer to hospital for assessment his condition rapidly deteriorated, requiring admission to intensive care for COVID-19 myocarditis. One week after discharge he re-presented with unilateral facial nerve palsy. Our case highlights an atypical presentation of COVID-19 and the multifaceted clinical course of this still poorly understood disease.


Asunto(s)
Alcalosis Respiratoria/sangre , Parálisis de Bell/fisiopatología , Miocarditis/fisiopatología , Adulto , Alcalosis Respiratoria/etiología , Análisis de los Gases de la Sangre , Proteína C-Reactiva/metabolismo , /terapia , Ecocardiografía , Edema/etiología , Electrocardiografía , Humanos , Hipotensión/etiología , Hipotensión/fisiopatología , Linfadenitis/etiología , Linfadenitis/fisiopatología , Imagen por Resonancia Magnética , Masculino , Miocarditis/sangre , Miocarditis/diagnóstico por imagen , Miocarditis/terapia , Péptido Natriurético Encefálico/sangre , Cuello , Terapia por Inhalación de Oxígeno , Fragmentos de Péptidos/sangre , Polipéptido alfa Relacionado con Calcitonina/sangre , Recuperación de la Función , Troponina T/sangre , Vasoconstrictores/uso terapéutico
9.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artículo en Inglés | MEDLINE | ID: covidwho-1020898

RESUMEN

A 34-year-old woman was seen in the emergency department for shortness of breath and chest pain. During a pandemic, it is easy to 'think horses and not zebras', and with a patient presenting with the classic coronavirus symptoms it would have been easy to jump to that as her diagnosis. After a careful history and examination, it became clear that there was another underlying diagnosis. Chest X-ray, echocardiogram and CT scan revealed marked right ventricular dilatation and pulmonary hypertension, alongside a persistent left superior vena cava (PLSVC). Further investigation with cardiac MRI and coronary angiography at a tertiary centre demonstrated that she not only have a PLSVC but also a partial anomalous pulmonary venous drainage and sinus venosus atrial septal defect. This case highlights the importance of considering all differentials and approaching investigations in a logical manner.


Asunto(s)
/diagnóstico , Dolor en el Pecho/fisiopatología , Disnea/fisiopatología , Defectos del Tabique Interatrial/diagnóstico por imagen , Hipertensión Pulmonar/diagnóstico por imagen , Hipertrofia Ventricular Derecha/diagnóstico por imagen , Síndrome de Cimitarra/diagnóstico por imagen , Adulto , Cateterismo Cardíaco , Dolor en el Pecho/etiología , Angiografía por Tomografía Computarizada , Angiografía Coronaria , Diagnóstico Diferencial , Dilatación Patológica/complicaciones , Dilatación Patológica/diagnóstico por imagen , Dilatación Patológica/fisiopatología , Disnea/etiología , Ecocardiografía , Electrocardiografía , Femenino , Defectos del Tabique Interatrial/complicaciones , Defectos del Tabique Interatrial/fisiopatología , Humanos , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/fisiopatología , Hipertrofia Ventricular Derecha/complicaciones , Hipertrofia Ventricular Derecha/fisiopatología , Imagen por Resonancia Magnética , /fisiopatología , Síndrome de Cimitarra/complicaciones , Síndrome de Cimitarra/fisiopatología , Tomografía Computarizada por Rayos X , Presión Ventricular
10.
Crit Care ; 24(1): 702, 2020 12 24.
Artículo en Inglés | MEDLINE | ID: covidwho-992527

RESUMEN

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.


Asunto(s)
/diagnóstico por imagen , Consenso , Ecocardiografía/normas , Testimonio de Experto/normas , Internacionalidad , Sistemas de Atención de Punto/normas , /terapia , Ecocardiografía/métodos , Testimonio de Experto/métodos , Humanos , Pulmón/diagnóstico por imagen , Tromboembolia/diagnóstico por imagen , Tromboembolia/terapia , Triaje/métodos , Triaje/normas , Ultrasonografía/normas
13.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artículo en Inglés | MEDLINE | ID: covidwho-963649

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a public health emergency and a pandemic of international concern. As of April 31st,  the reported cases of COVID-19 are three million in 186 countries. Reported case fatality has crossed 200 thousand among which more than fifty thousand has been in the USA. Most patients present with symptoms of fever, cough, and shortness of breath following exposure to other COVID-19 patients. Respiratory manifestations predominate in patients with mild, moderate, severe illness. Imaging of patients with COVID-19 consistently reports various pulmonary parenchymal involvement. In this article we wanted to reinforce and review the various reported imaging patterns of cardiac and mediastinal involvement in COVID-19 patients. Among patients with COVID 19 who underwent various imaging of chest various cardiac findings including pericardial effusion, myocarditis, cardiomegaly has been reported. Most of these findings have been consistently reported in patients with significant acute myocardial injury, and fulminant myocarditis. Acute biventricular dysfunction has also been reported with subsequent improvement of the same following clinical improvement. Details of cardiac MRI is rather limited. In a patient with clinical presentation of acute myocarditis, biventricular myocardial interstitial edema, diffuse biventricular hypokinesia, increased ventricular wall thickness, and severe LV dysfunction has been reported. Among patients with significant clinical improvement in LV structure and function has also been documented. With increasing number of clinical cases, future imaging studies will be instrumental in identifying the various cardiac manifestations, and their relation to clinical outcome.


Asunto(s)
Cardiomegalia/diagnóstico por imagen , Infecciones por Coronavirus/diagnóstico por imagen , Corazón/diagnóstico por imagen , Isquemia Miocárdica/diagnóstico por imagen , Miocarditis/diagnóstico por imagen , Derrame Pericárdico/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Betacoronavirus , Cardiomegalia/fisiopatología , Angiografía Coronaria , Infecciones por Coronavirus/fisiopatología , Ecocardiografía , Edema/diagnóstico por imagen , Edema/fisiopatología , Corazón/fisiopatología , Humanos , Imagen por Resonancia Magnética , Isquemia Miocárdica/fisiopatología , Miocarditis/fisiopatología , Pandemias , Derrame Pericárdico/fisiopatología , Neumonía Viral/fisiopatología , Radiografía Torácica , Recuperación de la Función , Tomografía Computarizada por Rayos X , Disfunción Ventricular/diagnóstico por imagen , Disfunción Ventricular/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología
14.
Herz ; 45(8): 715-718, 2020 Dec.
Artículo en Alemán | MEDLINE | ID: covidwho-932491

RESUMEN

Since its first appearance in December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world at a rapid pace causing the coronavirus disease 2019 (COVID-19). Originating from the Chinese province Hubei, more than 29.4 million people globally have now been confirmed to have contracted the coronavirus and more than 930,000 patients have died so far from COVID-19 (situation as of 15 September 2020). The virus is mainly spread during close contact by small droplets and aerosols. During the close contact in medical examinations, such as echocardiography, the risk of contracting the virus is increased. Therefore, the use of personal protective equipment is recommended for the protection of patients and medical personnel alike. This article summarizes the current recommendations of international societies and describes the local implementation in Austria.


Asunto(s)
Infecciones por Coronavirus , Coronavirus , Pandemias , Neumonía Viral , Austria , Betacoronavirus , Ecocardiografía , Humanos
16.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artículo en Inglés | MEDLINE | ID: covidwho-918289

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a public health emergency and a pandemic of international concern. As of April 31st,  the reported cases of COVID-19 are three million in 186 countries. Reported case fatality has crossed 200 thousand among which more than fifty thousand has been in the USA. Most patients present with symptoms of fever, cough, and shortness of breath following exposure to other COVID-19 patients. Respiratory manifestations predominate in patients with mild, moderate, severe illness. Imaging of patients with COVID-19 consistently reports various pulmonary parenchymal involvement. In this article we wanted to reinforce and review the various reported imaging patterns of cardiac and mediastinal involvement in COVID-19 patients. Among patients with COVID 19 who underwent various imaging of chest various cardiac findings including pericardial effusion, myocarditis, cardiomegaly has been reported. Most of these findings have been consistently reported in patients with significant acute myocardial injury, and fulminant myocarditis. Acute biventricular dysfunction has also been reported with subsequent improvement of the same following clinical improvement. Details of cardiac MRI is rather limited. In a patient with clinical presentation of acute myocarditis, biventricular myocardial interstitial edema, diffuse biventricular hypokinesia, increased ventricular wall thickness, and severe LV dysfunction has been reported. Among patients with significant clinical improvement in LV structure and function has also been documented. With increasing number of clinical cases, future imaging studies will be instrumental in identifying the various cardiac manifestations, and their relation to clinical outcome.


Asunto(s)
Cardiomegalia/diagnóstico por imagen , Infecciones por Coronavirus/diagnóstico por imagen , Corazón/diagnóstico por imagen , Isquemia Miocárdica/diagnóstico por imagen , Miocarditis/diagnóstico por imagen , Derrame Pericárdico/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Betacoronavirus , Cardiomegalia/fisiopatología , Angiografía Coronaria , Infecciones por Coronavirus/fisiopatología , Ecocardiografía , Edema/diagnóstico por imagen , Edema/fisiopatología , Corazón/fisiopatología , Humanos , Imagen por Resonancia Magnética , Isquemia Miocárdica/fisiopatología , Miocarditis/fisiopatología , Pandemias , Derrame Pericárdico/fisiopatología , Neumonía Viral/fisiopatología , Radiografía Torácica , Recuperación de la Función , Tomografía Computarizada por Rayos X , Disfunción Ventricular/diagnóstico por imagen , Disfunción Ventricular/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología
20.
J Am Coll Cardiol ; 76(18): 2043-2055, 2020 11 03.
Artículo en Inglés | MEDLINE | ID: covidwho-887081

RESUMEN

BACKGROUND: Myocardial injury is frequent among patients hospitalized with coronavirus disease-2019 (COVID-19) and is associated with a poor prognosis. However, the mechanisms of myocardial injury remain unclear and prior studies have not reported cardiovascular imaging data. OBJECTIVES: This study sought to characterize the echocardiographic abnormalities associated with myocardial injury and their prognostic impact in patients with COVID-19. METHODS: We conducted an international, multicenter cohort study including 7 hospitals in New York City and Milan of hospitalized patients with laboratory-confirmed COVID-19 who had undergone transthoracic echocardiographic (TTE) and electrocardiographic evaluation during their index hospitalization. Myocardial injury was defined as any elevation in cardiac troponin at the time of clinical presentation or during the hospitalization. RESULTS: A total of 305 patients were included. Mean age was 63 years and 205 patients (67.2%) were male. Overall, myocardial injury was observed in 190 patients (62.3%). Compared with patients without myocardial injury, those with myocardial injury had more electrocardiographic abnormalities, higher inflammatory biomarkers and an increased prevalence of major echocardiographic abnormalities that included left ventricular wall motion abnormalities, global left ventricular dysfunction, left ventricular diastolic dysfunction grade II or III, right ventricular dysfunction and pericardial effusions. Rates of in-hospital mortality were 5.2%, 18.6%, and 31.7% in patients without myocardial injury, with myocardial injury without TTE abnormalities, and with myocardial injury and TTE abnormalities. Following multivariable adjustment, myocardial injury with TTE abnormalities was associated with higher risk of death but not myocardial injury without TTE abnormalities. CONCLUSIONS: Among patients with COVID-19 who underwent TTE, cardiac structural abnormalities were present in nearly two-thirds of patients with myocardial injury. Myocardial injury was associated with increased in-hospital mortality particularly if echocardiographic abnormalities were present.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Corazón/diagnóstico por imagen , Miocardio/patología , Neumonía Viral/diagnóstico por imagen , Disfunción Ventricular/virología , Anciano , Betacoronavirus , Biomarcadores/sangre , Angiografía Coronaria , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/mortalidad , Ecocardiografía , Electrocardiografía , Femenino , Corazón/fisiopatología , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Ciudad de Nueva York/epidemiología , Pandemias , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Estudios Retrospectivos
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