Sometimes Late Is Better Than Never: Implantation of a Cardioverter Defibrillator Years after an Acute Myocardial Infarction - Case Report

Sustained ventricular arrhythmias that occur early post-myocardial infarction (MI) are generally considered epiphenomena of the MI and are not consistently associated with long-term prognosis. The lack of association with long-term prognosis is more clearly established for early ventricular fibrillation (VF) and polymorphic ventricular tachycardia (PVT). Sustained monomorphic ventricular tachycardia (SMVT), even when it occurs early, however, may reflect a permanent arrhythmic substrate1. Patients with COVID-19 have a high risk of thromboembolic events, and the virus has also been shown to have extensive effects on the cardiovascular system2,3,4. A 62-year-old woman, recently hospitalized for COVID-19 pneumonia, was brought to the emergency department with pulseless SMVT having been successfully resuscitated in the prehospital setting. The patient has a history of an old MI treated with thrombolysis and percutaneous coronary intervention (PCI) that was complicated with early SMVT, but with preserved left ventricular function and without heart failure. The patient underwent implantation of a cardioverter defibrillator (ICD). During the hospitalization, she developed dyspnea and was diagnosed with minor pulmonary embolism. It may be appropriate to consider early SMVT as a predictor of adverse late outcomes that would necessitate rigorous follow-up and maybe an early invasive primary prevention strategy. This case also reflects the possibility of long-term cardiac involvement and increased thromboembolic risk in patients recovering from COVID-19. © 2022 Maria Zamfirescu et al., published by Sciendo.

To Retest or Not to Retest the Experience of a Cardiology Emergency Clinic During the COVID-19 Pandemic

Acute cardiovascular pathology can frequently resemble the clinical and paraclinical picture of SARS-CoV-2 infection. The present paper aims to present the experience of a cardiology clinic during this pandemic and describe the way in which the clinical station was organized in order to limit in-hospital transmission of the virus. Methods. Patients admitted to an emergency cardiology department between May 1, 2020 and December 31, 2020 were retrospectively identified and divided into two groups: (1) those positive for SARS-CoV2 infection and (2) those with an initial negative test, but high suspicion for the infection, who were tested at least twice by RT-PCR. We followed the motivation for retesting as well as possible correlations between clinical and paraclinical parameters and the decision to retest. Results. A number of 334 patients were identified, 51 with a first positive RT-PCR test for SARS-CoV2 infection, and 276 who were tested for infection at least twice. The most common reasons for retesting were lung imaging and existence of subfever. The best predictive model for the outcome of the second RT-PCR test included the presence of lymphopenia, subpleural condensation, highest temperature during hospitalization, and the presence of at least two COVID-19 symptoms. Conclusion. The balance between prompt detection of patients with high suspicion of SARS-CoV2 infection (through PCR re-testing) and misuse of material resources should be guided by clinical algorithms. © 2022 MediaMed Publicis. All rights reserved.