Is There a Causal Link Between Acute Myocarditis and COVID-19 Vaccination: An Umbrella Review of Published Systematic Reviews and Meta-Analyses.

Introduction: A few months after the beginning of the coronavirus disease of 2019 (COVID-19) vaccination, several reports of myocarditis secondary to the vaccines were published, sometimes with fulminant cases, but until today there is no proven causal link between these 2 events, but with many hypotheses proposed. Methods: A systematic review of current evidence regarding myocarditis after COVID-19 vaccination was performed by searching several databases including PubMed/Medline and Web of Science. The quality of Meta-analysis was assessed using the AMSTAR-2 tool as well as other qualitative criteria. Results: Our umbrella review appraised 4 Meta-analysis of retrospective studies (range: 5-12), The number of vaccine doses included ranged from 12 to 179 million, with the number of myocarditis cases observed ranging from 343 to 1489. All types of vaccines were evaluated, with no exclusions. The overall incidence ranged from 0.89 to 2.36 cases of myocarditis per 100 000 doses of vaccine received. Heterogeny was assessed in 3 of the Meta-analysis, and was highly significant (>75%) in all included studies, and with a significant P-value (P < .05). Regarding publication bias, 3 of the Meta-analysis conducted the egger and begg regression, with a significant result in only 1. Regarding the assessment of the methodology by the AMSTAR-2 scale indicating that the quality was very critical in 1, low in 2, and moderate in 1 Meta-analysis. Conclusion: The quality of current non-randomized evidence on real causality and incidence of myocarditis after COVID-19 vaccine is still low.

The Impact of Prior Antithrombotic use on Thromboembolic Events in Patients with Cardiovascular Disease and Severe COVID-19 Infection.

OBJECTIVE: Our objective in this study was to determine the predictive factors of thromboembolic complications in patients with previous heart disease and severe covid-19 infection and the impact of previous use of antithrombotics on protection against these complications. METHODS: We conducted a single-center retrospective study of 158 patients with heart disease admitted to an intensive care unit for severe SARS-COV-2 infection. In order to determine the predictive factors, we used logistic regression analysis. RESULTS: Out of 158 patients, 22 were complicated by a thrombo-embolic event (13.9%), mean age of our population 64.03 (SD = 15.27), with a male predominance of 98 (62%). For the predictive factors of thromboembolic complications, and after multivariate analysis, we find the short duration of hospitalization (OR = 0.92; 95%CI (0.863-0.983), P = .014, previous use of antithrombotic drugs ((OR = 0.288, 95%CI (0.091-0.911), P = .034 for antiplatelet agents) and (OR = 0.322, 95% CI (0, 131-0.851), P = .021) for anticoagulants) as protective factors, and admission thrombocytosis as a risk factor (OR = 4.58, 95%CI (1.2-10.627), P = .021). D-dimer was not detected as a risk factor, and this can be explained by the characteristics of our population. Although prior use of antithrombotic drugs protects against thromboembolic complications during severe infection, there was no benefit in mortality. CONCLUSION: Prior use of antithrombotic drugs is a protective factor against thromboembolic complications in patients with a history of heart disease but without effect on mortality.

Pulmonary embolism with junctional tachycardia: A serious complication after COVID-19 vaccination.

Introduction: the association between the development of a thromboembolic event following COVID-19 vaccination is very rare, it represents less than 0.1% of vaccinated cases. Until now this association remains to be discussed. Case presentation: A 49-year-old man presented to the Emergency Department a 7-day after receiving her second dose of BNT162b2 mRNA COVID-19 (Pfizer-BioNTech), and he was diagnosed with pulmonary embolism (PE) with junctional tachycardia on ECG. The biological workup showed an increase in CRP with elevated D-dimer, but no abnormalities in cardiac markers, including troponin and BNP, the COVID-19 testing was negative and absence of thrombocytopenia. The patient was put under curative anticoagulation by rivaroxabon. Discussion: Studies have reported the association of venous thrombosis after administration of the COVID-19 vaccine with negative FP4 antibodies and normal platelet count which is similar with our patient. Moreover, spike proteins generated by mRNA vaccines can produce a pro-inflammatory state, a cascade of events guiding to endothelial dysfunction and afterwards to the development of venous thrombosis. Conclusion: All the same that some studies association COVID-19 immunizations to the development of VTE, we nevertheless recommend COVID-19 vaccination, due to the rarity of these events, compared to the hypercoagulable effects and other serious complications of COVID-19 infection.

Cannabis-induced myocardial infarction in a 27-year-old man: Case report.

Cannabis smoking has been reported as one of the risk factors for coronary heart disease, which can trigger in rare cases, an acute coronary syndrome (ACS). In this report, we present a case of a 27-year-old man presented with acute myocardial infarction (AMI) following cannabis consumption. The patient developed ST-segment elevation on the anterior and inferior leads. Coronary angiogram demonstrated a significant stenosis of the left anterior descending coronary artery (LAD). A Percutaneous Coronary Intervention (PCI) of the LAD, was realized with the implantation of a new generation-stent with good clinical evolution status. Healthcare professionals should consider cannabis consumption as a possible etiology of acute myocardial infarction, particularly in young patients with a susceptible social profile (drug-using patients with coronary heredity as a cardiovascular risk factor), and should educate patients regarding this emerging public health issue.

Submitral aneurysm: An unusual localization of aneurysm complicating a myocardial infarction: A case report.

INTRODUCTION: and importance: Submitral aneurysms are an uncommon heart condition that is widespread among young black Africans, congenital etiology is the most common, when SMA is found in patients of other races, other etiologies must be sought, especially ischemic. CASE PRESENTATION: We present the case of a 65-year-old male patient admitted for wide complex tachycardia at a rate of 198 bpm, in whom transthoracic echocardiography revealed a submitral aneurysm and coronary angiography revealed an occlusion of the left circumflex artery. CLINICAL DISCUSSION: Submitral left ventricular aneurysm is a rare cardiac pathology with a variety of causes including inflammation, infection, traumatic illness, or, in rare cases, ischemic heart disease; it can be caused by a congenital defect in the posterior portion of the mitral annulus, which is more common in African population. Clinical manifestations are frequently serious and alarming, such as ventricular tachycardia, cardiogenic shock or an embolic phenomenon; however, asymptomatic cases are possible. CONCLUSION: What we can retain from our case is that SMA can be the cause or consequence of coronary ischemia, so we must be vigilant in patients with an atypical clinical presentation.

Shone syndrome revealed by treatment-resistant hypertension.

INTRODUCTION: and importance: Shone complex is a congenital heart defect consisting of four obstructive defects in the left heart: a mitral supravalvular ring, sub-aortic stenosis, parachute mitral valve, and coarctation of the aorta (CoA), which affects only a small minority of people. CASE PRESENTATION: We report the case of a 25-year-old woman with a past medical history of moderate mitral stenosis, since she was 10-year-old with uncontrolled high blood pressure, treated with nicardipine. admitted to our emergency department with high blood pressure: 190/80 mmhg, in whom The transthoracic echocardiography (TTE) revealed: sub-mitral membrane, with a single sub-papillary muscle, and coarctation of the aorta and the CT scan showed narrowed aortic arch and a left superior vena cava allowing to retain shone syndrome as the main diagnosis. The patient was treated with an antihypertensive treatment combining (perindopril/indapamide/amlodipine) while waiting for surgery. CLINICAL DISCUSSION: In this mini-review, we aim to describe this rare pathological condition its pathophysiological thoughts, and the way to diagnosis this complex early. CONCLUSION: Treatment required the coordinated efforts of a team of specialists. It could be either surgical with different method or by Trans catheter treatments.

D-dimer Level and Diabetes in the COVID-19 Infection.

INTRODUCTION: Diabetes is the most common of comorbidity in patients with SARS-COV-2 pneumonia. Coagulation abnormalities with D-dimer levels are increased in this disease. OBJECTIFS: We aimed to compare the levels of D-dimer in diabetic and non-diabetic patients with COVID 19. A link between D-dimer and mortality has also been established. MATERIALS: A retrospective study was carried out at the University Hospital Center of Oujda (Morocco) from November 01st to December 01st, 2020. Our study population was divided into two groups: a diabetic group and a second group without diabetes to compare clinical and biological characteristics between the two groups. In addition, the receiver operator characteristic curve was used to assess the optimal D-dimer cut-off point for predicting mortality in diabetics. RESULTS: 201 confirmed-COVID-19-patients were included in the final analysis. The median age was 64 (IQR 56-73), and 56% were male. Our study found that D-dimer levels were statistically higher in diabetic patients compared to non-diabetic patients. (1745 vs 845 respectively, P = 0001). D-dimer level > 2885 ng/mL was a significant predictor of mortality in diabetic patients with a sensitivity of 71,4% and a specificity of 70,7%. CONCLUSION: Our study found that diabetics with COVID-19 are likely to develop hypercoagulation with a poor prognosis.

Severe Myocardial Infarction Caused by Excessive Cannabis Consumption.

The cardiovascular effects of cannabis are not well known. Cannabis use has been shown to cause arrhythmia, including ventricular tachycardia, sudden death, and increase in the risk of myocardial infarction (MI). We report a 62-year-old woman with chronic cannabis abuse inducing MI complicated by cardiogenic shock, chronic dilated cardiomyopathy, and atrial fibrillation.