Fulminant Myocarditis With ST Elevation and Cardiogenic Shock in a SARS-CoV-2 Patient.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first described in patients in Wuhan, China, who presented with flu-like symptoms. Since then, it has spread all over the world and in March 2020 it was labeled as a pandemic by the World Health Organization. Most common presentations include respiratory symptoms that vary from mild cough and shortness of breath to severe acute respiratory distress syndrome. Gastrointestinal symptoms like nausea, vomiting and diarrhea are also common. However, cardiovascular complications have not been reported widely. Patients can present with cardiac complications that include chest pain, heart failure and fulminant myocarditis, which is one of the most serious cardiac manifestations. Primary means of diagnosis are echocardiogram and cardiac magnetic imaging. Treatment is mostly supportive in case of cardiogenic shock and includes ionotropic support with or without mechanical circulatory support and mechanical ventilation. A strong suspicion is required for early diagnosis and aggressive treatment in order to reduce mortality and morbidity.

Bilateral Subarachnoid Hemorrhage and Bilateral Intracranial Hemorrhage With Reversible Cardiomyopathy During Dobutamine Stress Echocardiography.

Dobutamine stress echocardiogram (DSE) is routinely used in the clinical assessment of patients with known or suspected coronary artery disease (CAD). DSE can cause serious complications including cerebrovascular accident (CVA). Even though the incidence of CVA associated with DSE is very low (<0.01%),it can be life-threatening or cause significant morbidity. We present a patient who developed acute multifocal intracranial hemorrhage (ICH) and subarachnoid hemorrhage (SAH) during the DSE.  A 39-year-old female with no prior cardiac history presented to the outpatient echocardiography lab for DSE. She had a blunted heart rate response with increasing dose of dobutamine 30 µg/kg/min and was given one milligram of atropine. The patient complained of frontal headache, nausea, and severe dyspnea. Computed tomography head showed acute multifocal bilateral SAH, and left frontal and right parieto-occipital ICH.  Hypertension is one of the risk factors for ICH and dobutamine infusion can exacerbate severe acute hypertension, which can cause acute intraparenchymal hemorrhage. Even though the risk of ICH associated with DSE is extremely low, there should be increased vigilance if there is development of severe acute hypertension, and the operator should keep a low threshold for further evaluation if the patient develops neurological symptoms.

Cytochrome P450 1B1 Contributes to the Development of Atherosclerosis and Hypertension in Apolipoprotein E-Deficient Mice.

Cytochrome P450 (CYP) 1B1 contributes to vascular smooth muscle cell growth and hypertension in male mice. This study was conducted to determine the contribution of CYP1B1 to the development of atherosclerosis and hypertension and associated pathogenesis in 8-week-old male apolipoprotein E-deficient (ApoE(-/-)/Cyp1b1(+/+)), and ApoE- and CYP1B1-deficient (ApoE(-/-)/Cyp1b1(-/-)) mice fed a normal or atherogenic diet for 12 weeks. A separate group of ApoE(-/-)/Cyp1b1(+/+) mice on an atherogenic diet was injected every third day with the CYP1B1 inhibitor, 2,3',4,5'-tetramethoxystilbene (300 µg/kg), or its vehicle, dimethyl sulfoxide (30 µL, IP); systolic blood pressure was measured by the tail cuff method. After 12 weeks, mice were euthanized, blood collected for lipid analysis, and aortas harvested for measuring lesions and remodeling, and for infiltration of inflammatory cells by histological and immunohistochemical analysis, respectively, and for reactive oxygen species production. Blood pressure, areas of lipids and collagen deposition, elastin breaks, infiltration of macrophages and T lymphocytes, reactive oxygen species generation in the aorta, and plasma lipid levels were increased in ApoE(-/-)/Cyp1b1(+/+) mice on an atherogenic diet; these changes were minimized in mice given 2,3',4,5'-tetramethoxystilbene, and in ApoE(-/-)/Cyp1b1(-/-) mice on an atherogenic diet; absorption/production of lipids remained unaltered in these mice. These data suggest that aortic lesions, hypertension, and associated pathogenesis in ApoE(-/-)/Cyp1b1(+/+) mice on an atherogenic diet are most likely dependent on CYP1B1-generated oxidative stress and increased plasma lipid levels independent of blood pressure and absorption of lipids. CYP1B1 could serve as a novel target for developing drugs to treat atherosclerosis and hypertension caused by hypercholesterolemia.