Does Cardiac Arrhythmia Predict Worse Outcome in Mild or Moderate Covid-19 Infection?

Covid-19 is a multisystem disease with the lungs being predominantly affected. Cardiac involvement is mostly seen as a rise in troponins, arrhythmias, and ventricular dysfunction. This study aimed to estimate the incidence of arrhythmias seen in Covid-19 infection and assess if arrhythmias predict worsening or mortality. Prospective observational study involving patients with mild to moderate Covid illness admitted in a tertiary care centre. Among the 85 patients (Mean age 45.8 + 14.1 years; 75.31% men), worsening of Covid-19 illness was seen in 29 (34.1%) patients. New onset arrhythmias were detected on Holter in 9 (10.5%) patients. Supraventricular tachycardia was seen in 7 (8.2%) patients of whom 6 showed worsening which was statistically significant (p-value-0.006). Risk factors associated with worsening on univariate analysis were male gender (OR [95%CI] = 6.93(1.49-32.31), p-value - 0.014), new onset supraventricular tachycardia (OR [95% CI] = 14.35 [1.64-125.94], p-value - 0.016) and D-dimer elevation (OR [95% CI] = 1.00(1.00-1.01), p-value - 0.02). On multivariate analysis D-dimer (OR [95% CI] = 1.00(1.00-1.01; p-value 0.046) and supraventricular arrhythmias (OR [95% CI] = 11.12 (1.22-101.14); p-value - 0.033) were independently associated with worsening. Covid-19 infection can lead to cardiac arrhythmias. The development of supraventricular tachycardia in patients with Covid-19 infection predicts higher morbidity and worsening.

Longest Surviving Patient with Ebstein's Anomaly in Indian Subcontinent.

Ebstein's anomaly accounts for 0.3% to 0.7% of all cases of congenital heart disease. The condition is characterized by abnormal tricuspid valve and right ventricle with apical displacement of tricuspid valve leading to atrialization of right ventricle. There have been case reports of patients surviving up to ninth decade. It is unusual for these patients to be asymptomatic in adulthood for long duration. We describe a patient with Ebstein's anomaly in the ninth decade with coronary artery disease.

Long-term Mortality in Patients with Permanent Pacemaker Implantation.

INTRODUCTION: The development of implantable technology for cardiac rhythm management remains one of the seminal achievements of the second half of the 20th century. The development of artificial pacemakers for the electrical control of the cardiac rhythm has greatly enhanced the physician's ability to treat cardiac dysrhythmias. An ageing population and the extension of indications will in all probability result in an increasing number of cardiac device implantations. OBJECTIVE OF STUDY: To study mortality and morbidity in patients with permanent pacemaker implantation at a tertiary care hospital in North India. MATERIAL ANDF METHODS: This was a two year prospective observational study conducted in the Department of Cardiology of Christian Medical College and Hospital, Ludhiana. This included a retrospective period of ten years from 1st July 2002 to 30th June 2012, and a prospective period of two years from 1st July 2012 to 31st July 2014. All patients admitted to Christian Medical College and Hospital, Ludhiana, who received a permanent pacemaker for bradyarrhythmias were included in the study. A detailed analysis of demographic profile, indications, complications and mortality data was performed. RESULTS: A total of 323 patients were included in the study of which more than 75% of the patients receiving the pacemaker were in the age group 56-85 yrs. Males received more pacemakers than females. The commonest presenting symptom was syncope. Complete heart block was the commonest ECG finding. Acquired A-V block was the most common indication of pacing. VVI was the commonest mode of pacemaker implantation. Complications were seen in 3.72% patients. During the entire study period death occurred in 7.1% patients. CONCLUSIONS: Permanent pacemaker implantation is a relatively safe procedure with low complication rates and low mortality particularly in patients who have been on a regular follow up.

Bilateral Coronary Artery Fistula.

Coronary artery anomalies include anomalies of origin, termination, structure or course. Coronary artery fistulae (CAF) are classified as abnormalities of termination and are considered a major congenital anomaly. A coronary artery fistula involves a sizable communication between a coronary artery, bypassing the myocardial capillary bed and entering either a chamber of the heart (coronary-cameral fistula) or a great vessel. Bilateral coronary artery fistula, are a rare variant. We describe a bilateral CAF with angina and significant coronary artery disease requiring percutaneous coronary intervention.