Cardiovascular impact of COVID-19: an array of presentations.

The novel coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) dominantly infects the lungs, causing interstitial pneumonitis and severe acute respiratory distress syndrome (ARDS) however the cardiovascular implications of the infection are particularly significant, especially in their contribution to disease morbidity and mortality. SARS-CoV-2 enters the cardiovascular system by binding to the angiotensin-converting enzyme 2 (ACE2) receptor. The pathogenic cardiovascular mechanism of the virus involves systemic inflammation via a cytokine storm and direct myocardial injury. The most frequently reported cardiovascular complications of COVID-19 include acute myocardial injury, myocarditis, myocardial infarction, heart failure, cardiomyopathy, arrhythmias, and venous thromboembolic events. Also, pre-existing cardiovascular disease in COVID-19 patients is a prime marker for attaining severe disease and is associated with high mortality rates.  Lastly, the medications under investigation for COVID-19 may have their individual cardiovascular adverse effects. We hereby present a concise literature review that summarizes recent peer-reviewed and pre-print articles published on the cardiovascular implications of COVID-19. The information on the subject is being updated frequently therefore latest literature needs to be added in newly published reports for a better understanding of the topic.

Early Restenosis of Sirolimus-eluting Stent: An Unusual Case of a Hyperthyroid Patient.

The presentation of atherosclerosis with concomitant hyperthyroidism is not uncommon. Hyperthyroidism predisposes to worse cardiovascular pathologies like systolic hypertension, atrial fibrillation, and hypercoagulability. Drug-eluting stents, on the other hand, have emerged as a miracle treatment choice for patients having atherogenic conditions. They have the highest success rates when it comes to minimizing in-stent restenosis (ISR) during short-term follow-up. There is scarce literature that assesses the correlation of multinodular goiter (MNG) to ISR, especially in Pakistan, and thus any probable association between the two is left untouched. We report a case of a 57-year-old female who is a known hyperthyroid with a massive MNG, presenting with worsening chest pain. She had undergone sirolimus-eluting stent (SES) implantation in left anterior descending artery (LAD) six months back. Cardiac catheterization confirmed restenosis of the SES in the LAD, along with the occlusion of left circumflex and right coronary artery, accompanied by grade I diastolic dysfunction and mild aortic regurgitation on echocardiography.