Myocarditis in COVID-19 presenting with cardiogenic shock: a case series.

BACKGROUND: SARS-CoV2, also known as COVID-19, is a specific strain of coronavirus that is responsible for an ongoing global pandemic. COVID-19 primarily targets the respiratory system via droplet transmission, causing symptoms similar to influenza, including fever, cough, and shortness of breath. It is now known to impact other organ systems, causing significant cardiovascular and gastrointestinal illness, among others. CASE SUMMARY: We describe two cases of COVID-19 induced myocarditis presenting with cardiogenic shock. These cases highlight the importance of understanding the lethal cardiac complications of COVID-19 infection, as well as its presentation, diagnosis, pathophysiology, and potential treatment options. These two cases involve patients without underlying cardiovascular disease risk factors who experienced prolonged symptoms of COVID-19 infection. Both patients presented with cardiogenic shock more than one week after symptom onset and diagnosis. These cases demonstrate the late presentation of myocarditis and cardiogenic shock, treated with corticosteroids and inotropes, with subsequent recovery of cardiac function. DISCUSSION: The cases highlight the importance of recognizing late presentation viral myocarditis secondary to COVID-19 infection, even in patients without underlying cardiac disease.

The impact of deployment on COPD in active duty military personnel.

PURPOSE: To identify trends in chronic obstructive pulmonary disease (COPD) diagnoses among active duty U.S. military personnel based on deployment history and whether International Classification of Disease, 9th edition (ICD-9) coding meet criteria for the diagnosis of COPD. METHODS: A retrospective chart review using the electronic medical system was conducted for military personnel diagnosed with COPD based on ICD-9 codes for emphysema or chronic obstructive lung disease with at least three qualifying outpatient COPD-coded encounters. Clinical symptoms, smoking history, pulmonary function testing, and radiographs obtained during the diagnostic workup were reviewed. The established diagnosis of COPD was analyzed in relation to deployment. RESULTS: A total of 371 patients were identified during the study period (2005-2009). Of these patients, 194 (52.3%) deployed, whereas 177 (47.7%) did not deploy to Southwest Asia since 2003. Thirty-four percent had no documented smoking history despite the diagnosis of COPD. Airway obstruction was identified by spirometry in only 67% of individuals diagnosed with COPD. No statistically significant differences in pulmonary function testing values were identified between those deployed and nondeployed individuals. CONCLUSION: Despite evidence of increased respiratory symptoms in deployed military personnel, the impact of deployment on increased diagnosis of COPD or severity of disease appears minimal.

Correlation of airway hyper-responsiveness with obstructive spirometric indices and FEV(1) > 90% of predicted.

BACKGROUND: Current published guidelines on spirometry interpretation suggest an elevated FVC and FEV(1) > 100% of predicted with an obstructive ratio may represent a physiological variant. There is minimal evidence whether this finding can be indicative of symptomatic airways obstruction. METHODS: Pulmonary function testing databases for a 4-year period were retrospectively reviewed. All technically adequate spirometry studies were included, based on these criteria: FEV(1) > 90% of predicted, and FEV(1)/FVC below the lower limit of normal, based on 95th percentile confidence intervals. Clinical indications for testing were noted. Testing for post-bronchodilator response, lung volumes, and methacholine challenge tests were reviewed for evidence of airway hyper-responsiveness (AHR). Comparisons were made between symptomatic versus asymptomatic individuals and FEV(1) values less than or greater than 100% of predicted. RESULTS: A total of 280 studies were analyzed. During their clinical evaluation, 192 patients (69%) had post-bronchodilator spirometry recorded, 63 patients (23%) had lung volumes, and 36 patients (11%) completed methacholine challenge testing. Indications for spirometry included 193 symptomatic patients and 87 asymptomatic patients. Nearly 28% of patients with post-bronchodilator testing met criteria for AHR. No differences in AHR were found between the symptomatic and asymptomatic groups. The majority of patients (77%) with AHR had an FEV(1) < 100%, when compared to patients with an FEV(1) ≥ 100%. CONCLUSIONS: A normal FEV(1) > 90% of predicted with obstructive indices may not represent a normal physiological variant, as 28% of patients were found to have underlying AHR. These findings suggest that clinicians should evaluate for AHR, especially in symptomatic patients, even if the FEV(1) is > 90% of predicted.