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1.
Pharmaceutical Journal ; 309(7965), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2196670
2.
Interventional Neuroradiology ; 28(1 Supplement):252, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2195332

RESUMO

Objective: An epidemic of coronavirus disease 2019 (COVID-19) infection is still ongoing in July 2022. Although preparation for and handling of mechanical thrombectomy for acute ischemic stroke under COVID-19 infection epidemic have ever been reported, in this study, we report that mechanical thrombectomy can be performed safely and effectively without significantly prolonging the time to recanalized occluded vessels by performing rapid RT-PCR at the time of emergency transport, even during COVID-19 outbreak. Material(s) and Method(s): Since April 2022, all patients who were transported to our hospital by ambulance have had their specimens collected in the ambulance and tested for COVID-19 antigens and rapid RT-PCR. Antigen testing results are available 5 min, and those of rapid RT-PCR are available in 40 min. Even if the antigen test was negative, the patient wore a surgical mask, an electrocardiogram and SpO2 monitor, had blood pressure measured, and underwent blood tests and a head MRI scan in our hospital, while waiting for the results of the rapid RT-PCR test Results and Conclusion(s): Until as of July 2022, there were two cases in which the RT-PCR test was positive when the antigen test was negative. By performing the rapid RT-PCR test simultaneously with the antigen test, acute stroke treatment including rt-PA administration and mechanical thrombectomy could be performed safely and effectively without spreading healthcare-associated infection in antigen-negative new coronavirus-positive patients.

3.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2194401

RESUMO

Introduction: Following the inception of the COVID-19 pandemic, chloroquine compounds were proposed as potential therapeutic strategies, at the cost of a potential increase in cardiovascular risk. We aimed to evaluate clinical outcomes of patients with COVID-19, comparing those using chloroquine compounds to individuals without specific treatment. Method(s): Outpatients with suspected COVID-19 in Brazil who had at least 1 ECG transmitted to a Telehealth Network, were prospectively enrolled in 2 arms (G1: treatment with chloroquine compounds and G2: without specific treatment) and G3: registry of other specific treatments. Outcomes were assessed through follow-up phone calls on days 3 and 14, and also administratively collected from national mortality and hospitalization databases. The primary outcome was composed of: hospitalization and all-cause death. The association between treatment groups and the primary outcome was evaluated by logistic regression. Significant variables (p<0.10) were included in 4 multivariate models: 1: unadjusted;2: adjusted for age and sex;3: adjusted for model 2 plus cardiovascular risk factors and 4: adjusted for model 3 plus COVID-19 symptoms (when available from phone contact). Result(s): In 303 days, 712 (10.2%) patients were allocated in G1 (chloroquine), 3623 (52.1%) in G2 (control) and 2622 (37.7%) in G3 (other treatments). Median age was 49 (IQR 38 - 62) years, 57% women. Of these, 1969 had successful phone contacts (G1: 260;G2: 871;G3: 838). The primary outcome was more frequent in groups 1 and 3 compared to the control group, when assessed exclusively by phone (G1: 38,5% vs. G2: 18,0% vs. G3: 34,2%, p<0,001) or combined with administrative data (G1: 19,5% vs. G2: 11,0% vs. G3: 18,2%, p<0,001). In the adjusted models, chloroquine independently associated with a greater chance of the primary outcome: phone contact (model 4): OR=3.24 (95% CI 2.31 - 4.54), p<0.001;phone + administrative data (model 3): OR=1.99 (95% CI 1.61 - 2.44), p<0.001. Chloroquine also independently associated with higher mortality, as assessed by phone + administrative data (model 3): OR=1.67 (95% CI 1.20 - 2.28). Conclusion(s): Chloroquine compounds associated with a higher risk of poor outcomes in outpatients with COVID-19 compared to standard care.

4.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2194390

RESUMO

Background: Hydroxychloroquine (HCQ) was widely used as a potential therapy for COVID-19 infection. We studied the effects of HCQ on electrocardiogram (ECG) intervals. Method(s): We conducted a large-scale retrospective study of COVID-19 patients treated with HCQ admitted between March 1, 2020 and June 1, 2020. Extensive medical chart review was performed. Baseline and on treatment ECG intervals were manually measured by 3 electrophysiologists. The QT interval was corrected using Bazett formula (QTc). The paired t-test was used for the main analysis. Result(s): Paired ECG data from 1890 patients were analyzed. The mean age was 47.0 (+/-12.6) years with a strong male prevalence (85.6%). The commonest comorbidities were hypertension (39.6%) and diabetes mellitus (36.8%). The average duration of HCQ therapy was 6.3 (+/-2.3) days. 404 patients (21.4%) had severe COVID-19 infection and the mortality rate was 3.86%. Intensive care admission and mechanical ventilation was required in 209 (11.1%) and 166 (8.8%) patients, respectively. During therapy, heart rate (HR) decreased from 87.2 +/- 16.8 bpm to 80.6 +/- 14.7 bpm (P<0.001). The mean PR interval increased from 153.2 +/- 21.9 ms to 162.9 +/- 22.8 ms (P<0.001). The mean QRS duration increased from 92.8 +/- 12.6 ms to 97.4 +/- 13 ms (P <0.001). The average QTc increased from 427.4 +/- 25.4 ms to 438.4 +/- 29.9 ms (P<0.001). Conclusion(s): HCQ caused a modest but statistically significant prolongation in PR, QRS and QTc intervals. A reduction in HR was also noted mainly due to clinical improvement. (Figure Presented).

5.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2194385

RESUMO

Introduction: Use of mobile cardiac outpatient monitor (MCOT) increased during the COVID-19 pandemic as a substitute for telemetry and monitoring of arrythmias during loading of antiarrhythmic drugs (AAD). However, data comparing difference of QTc interval between a MCOT, and 12 lead ECG is scare. Hypothesis: To assess the accuracy of mobile cardiac outpatient monitor in comparison to 12 lead ECG for QTc monitoring Methods: We prospectively evaluated 24 patients at our institution who received IV sotalol as single day loading dose for initiation of oral sotalol therapy for atrial fibrillation/atrial flutter (AF/AFL). All patients were discharged 6 hours after the IV loading dose with a MCOT for 3 days. All patients had a 12 lead ECG within 12-18 hours of the baseline line MCOT transmission. Variation in heart rate and QTc was assessed. Result(s): A total of 24 patients were included in the study. The mean age was 65+7.3 years, 80% of patients were men. The mean difference between the QTc interval measured on 12 lead ECG and MCOT was 5.1+ 6 milliseconds [450+33 (EKG) - 445+39 (MCOT)], p=0.92. The mean heart rate difference between the two modalities was also not significant, p=0.726 [ 70.4+19 (EKG) -72+ 11.8 (MCOT), DELTAHR=1.6+7.2 beats per minute]. Conclusion(s): MCOT can be considered as a reliable alternate to 12 lead ECG for monitoring of QTc in patients receiving AAD.

6.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2194382

RESUMO

Introduction: Complete heart block (CHB) in association with Covid-19 is uncommon and has been described primarily in the pre-vaccine time period. In the setting of acute Covid-19 infection, decision to treat CHB with permanent pacemaker (PPM) is often uncertain as the CHB may resolve or persist. We present a case of reversible CHB and Covid-19 infection in a vaccinated healthy 28- year-old. Case: A healthy 28-year-old female presented after syncope. She had been vaccinated three times against Covid-19 with Pfizer-BioNTech mRNA vaccine with her third dose four months prior. She had known Covid-19 exposure and developed sore throat three days prior to presenting with syncope. She had no other symptoms. Physical exam was remarkable only for bradycardia. Labs showed positive Covid-19 PCR test and elevated troponin of 0.396 ng/mL. Complete blood counts, metabolic panel, ESR and CRP were normal. Lyme IgM and IgG were negative by Western blot. ECG showed CHB with a rate of 35 beats per minute (Figure 1A). Echocardiogram showed no abnormalities. The patient remained in CHB for 24 hours, at which point PPM was implanted after shared-decision making. Post-PPM ECG showed AV-paced rhythm (Figure 1B). At follow up, PPM interrogation showed that she transitioned to sinus rhythm with right bundle branch block (RBBB) followed by a return to normal sinus rhythm without RBBB 5 days after implantation (Figure 1C). Cardiac MRI two months after PPM implantation showed no abnormalities. Discussion(s): This was a case of Covid-19 associated myocardial injury with CHB in a fullyvaccinated, healthy adult treated with PPM. Despite vaccination, this patient experienced myocardial and conduction system involvement during acute Covid-19 infection. Myocardial injury along with this ECG progression suggested that there was transient inflammation of the myocardial septum resulting in CHB. It may be reasonable to delay PPM implantation in cases of CHB and Covid-19 infection as the CHB may be transient.

7.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2194360

RESUMO

Introduction: Post-sternotomy chest pain (CP) has been widely reported in literature. The etiologies include myocardial infarction, pulmonary embolism, hypersensitivity reactions to foreign material, wound infection, sternal instability and dehiscence, neuropathic pain due to intercoastal nerve damage or sternal wire fracture leading to migration. Here, we report a rare case of a young patient who presented with chronic chest pain after an atrial septal defect (ASD) repair. Case: A 28-year-old male with past medical history significant for an ASD (secundum) repair with autologous pericardial patch, hyperlipidemia, COVID-19 infection, known first degree AV block, and early repolarization changes, presented for a follow-up office visit three years after his ASD repair with complaints of typical anginal symptoms. Diagnosis: Vitals, physical exam, troponin, D-dimer and inflammatory markers were unremarkable. Chest x-ray (Figure 1A) showed sternal wires in place and no fractures of wires. EKG (Figure 1B) was unchanged. Echocardiogram showed LVEF 50% and no wall motion abnormalities. He underwent a coronary CTA which identified intermittent compression on the mid-RCA from the third bottom stainless steel sternal wire (Figure 1C), warranting removal. Treatment: He underwent explantation of all sternal wires and selective right coronary angiography (Figure 1D) was performed, which revealed intact and patent RCA without any complications. He continues to follow-up in our clinic without any CP. Conclusion(s): Chronic CP after any cardiac surgery remains a diagnostic dilemma and a source of anxiety for patients. We recommend comprehensive discussions with patients prior to surgery about these probable complications to alleviate the anxiety. Lastly, from research thus far, removal of sternal wires is a safe, simple, and effective procedure that should be offered to patients with persistent post-sternotomy CP after exclusion of serious complications.

8.
Circulation Conference: American Heart Association's ; 146(Supplement 1), 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2194341

RESUMO

A 25 year old man presented with three days of cough, shortness of breath, and pleuritic chest pain. Initial vital signs in the ED were normal, and exam demonstrated tonsillar erythema without exudate. Labs revealed a leukocytosis of 18.9k/muL, D-dimer of 690 ng/mL, C-reactive protein of 5.7 mg/dL, and lactate elevated to 2.9 mmol/L. High-sensitivity troponin, NT-proBNP, and SARS-CoV-2 RT-PCR were all negative. Presenting electrocardiogram demonstrated PR elevation in aVR with diffuse ST-segment elevation in the inferior and anterolateral leads. Point-of-care echocardiogram demonstrated normal biventricular function without pericardial effusion. CTPA was negative for pulmonary embolism, and he was observed for presumed acute viral pericarditis. Fourteen-hours later, he became febrile to 38.3degreeC, tachycardic to 133 bpm, and hypotensive to 97/65 mmHg with diffuse abdominal pain. Repeat lactate was 9.0 mmol/L. This prompted an emergent CT scan which now showed a new large pericardial effusion and bilateral pleural effusions (Panel A). Repeat echocardiogram confirmed a large circumferential pericardial effusion with early signs of tamponade including right atrial inversion in late diastole (Panel B). Emergent pericardiocentesis yielded 560 mL of brown, purulent fluid (Panel C) with immediate improvement in hemodynamics. Bacterial gram stain and culture grew Haemophilus influenzae (Panel D). Immunodeficiency screening was negative. Transient severe biventricular systolic dysfunction was noted, consistent with sepsis-induced cardiomyopathy. He completed a targeted antibiotic course with partial recovery of his ejection fraction by discharge. Purulent pericarditis is rare in developed countries, and invasive H. influenzae in a young, immunocompetent adult is particularly unusual. This case illustrates the importance of early diagnosis and management of purulent pericarditis given its potential for rapid progression and high mortality. (Figure Presented).

9.
Critical Care Medicine ; 51(1 Supplement):394, 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2190607

RESUMO

INTRODUCTION: Dexmedetomidine is administrated in the ICU to treat adrenergic hyperactivity associated with alcohol withdrawal syndrome (AWS). Reduced ICU bed availability and drug shortages during the COVID-19 pandemic have spurred interest in mitigation strategies. The objective of this study was to develop preliminary data on the safety of dexmedetomidine when administered for AWS in nonintubated patients in order to develop a protocol for its use outside of the ICU. METHOD(S): Patients >=18 years of age admitted to an ICU for AWS and received dexmedetomidine between January 2020 and January 2022 were included. Patients were excluded if they required invasive mechanical ventilation or received dexmedetomidine for indications other than AWS. Bradycardia was defined as a heart rate < 40 beats per minute and hypotension as a systolic blood pressured < 80 mmHg. Heart block was identified using 12-lead electrocardiograms. Need for intervention for adverse drug effects was also recorded. Continuous data are reported as median (IQR) and nominal or categorical data as number (%). RESULT(S): Of the 204 patients screened, 148 (73%) were excluded for invasive mechanical ventilation and 8 (4%) for receipt of dexmedetomidine for non-AWS indications, leaving 48 (24%) evaluable patients. Most were male (n=36, 75%), white (n=43, 90%) and non-Hispanic/ Latino (n=47, 98%). Patients were bedded in the emergency department (n=20;42%), an intermediate care unit (n=11;23%), an outside hospital (n=10;21%), a general medical floor (n=6;12%), or perioperative unit (n=1, 2%) prior to ICU admission. The median initial dexmedetomidine dose was 0.35 (0.1, 0.5) mcg/kg/hr and the maximum dose was 1.2 (0.8, 1.4) mcg/ kg/hr. Time to the maximum dose was 2.2 (0.5, 8.5) hours and the total dexmedetomidine infusion duration was 25 (13, 40) hours. Hypotension occurred in 10 (21%) patients-only 2 (4%) required fluid administration, none received pressors or dose reduction. Bradycardia and heart block were not observed. CONCLUSION(S): Dexmedetomidine administration for AWS in non-intubated ICU patients was safely accomplished in 95% of patients with only 4% of the cohort developing hypotension requiring fluid administration. These results will be used to develop a protocol for dexmedetomidine administration in non-ICU areas for AWS.

10.
Open Forum Infectious Diseases ; 9(Supplement 2):S199, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2189617

RESUMO

Background. Early in the coronavirus disease 2019 (COVID-19) pandemic, a low incidence of cardiovascular complications was reported amongst hospitalised patients with COVID-19 in Singapore. Little was known about the trend of cardiovascular complications as the pandemic progressed. As such, we sought to examine the evolving trends in electrocardiographic and cardiovascular manifestations in patients hospitalised for COVID-19 infection. Methods. We examined the first 1781 consecutive hospitalised patients with polymerase chain reaction (PCR) confirmed COVID-19 in a tertiary academic centre. We divided the population based on those who had an abnormal electrocardiogram (ECG) and those who had a normal ECG, comparing the baseline characteristics and outcomes between the 2 groups. Cardiovascular complications such as acute myocardial infarction, stroke, pulmonary embolism, myocarditis and mortality were also examined over time. Results. Of the 261 (14.7%) patients presenting with abnormal ECG, they were more likely to be symptomatic with complaints of breathlessness, palpitations and chest pain. Sinus tachycardia was the most common arrhythmia. Troponin I levels (41.6+/-264.3 vs 97.0+/-482.9, p=0.047) and C-reactive protein levels (20.1+/-50.7 vs 13.9+/-24.1 mumol/L, p=0.003) were significantly higher amongst those with abnormal ECGs at presentation, with a higher prevalence of myocarditis (1.9% vs 0.5%, p=0.021), pulmonary embolism (1.9% vs 0.3%, p=0.009) and acute myocardial infarction (1.1% vs 0.1%, p=0.025). Over time, there was a trend towards a higher proportion of hospitalised patients with cardiovascular complications. Baseline characteristics of hospitalised patients with COVID-19, with or without abnormal ECG at presentation Changes in percentage of hospitalised patients with COVID-19, experiencing cardiovascular events (acute myocardial infarction, stroke, myocarditis, pulmonary embolism and death) over time Conclusion. A baseline ECG at presentation is a simple test that provides valuable information on potential cardiovascular complications in the context of COVID-19. Although the prevalence of abnormal ECGs is relatively low, it appears to be increasing over time amongst hospitalised patients with COVID-19.

11.
Open Forum Infectious Diseases ; 9(Supplement 2):S172, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2189563

RESUMO

Background. MIS-C is a hyper inflammatory condition following SARS-CoV-2 infection. Although COVID-19 infection rates and severity have varied based on circulating SARS-CoV-2 variants, it is unclear if cardiac involvement in MIS-C varies following infection with different SARS-CoV-2 variants. The objective of this study is to describe the severity of cardiac involvement in children with MIS-C following three different waves of SARS-CoV-2 infections. Methods. Children hospitalized with a diagnosis of MIS-C were enrolled in a prospective observational study. Demographic, clinical, laboratory (troponin I and B-type natriuretic peptide (BNP)), electrocardiogram (EKG) and echocardiogram (ECHO) data for children diagnosed between 4/20 and 12/21 and followed at 1- and 6-months was analyzed. The cohort was divided into 3 groups to represent cases that followed infection with the Wuhan (4/20-10/20, group 1), Alpha (B.1.1.7, 11/ 20-7/21, group 2) and Delta (B.1. 617.2, 8/21-12/21, group 3) variants. Cardiac involvement during hospitalization and follow-up was compared between the groups. Results. The cohort includes 131 children with MIS-C (32, 61 and 38 in groups 1, 2 and 3, respectively) with a median age of 10 years. Two-thirds were male (66.4%) and 49.6% were Black. Elevated BNP and troponin I levels were seen in 82% and 52.7% of children at initial diagnosis. A third of the cohort had at least one abnormal EKG finding. The proportion of children with abnormal laboratory and EKG findings was not different between the groups. Decreased left ventricular function on ECHO was seen in 25% (33/131) of the cohort with similar distribution among the three groups (p = 0.79). Trivial-small pericardial effusions were detected in 22% (29/131). Coronary artery abnormalities were detected in 11.45% (15/131), a majority in group 1 (25%;8/ 32). At 1- and 6-monthfollow-up visits, BNP and Troponin I were normal in all children. At the 6-month follow-up visit, EKG was normal in all and ECHO was normal in 37/41 children with trivial to mild valvular regurgitation in four children. Conclusion. In this single center prospective study, while a significant proportion of children with MIS-C had evidence of cardiac involvement at diagnosis, most resolved on follow-up demonstrating good outcomes.

12.
European Heart Journal, Supplement ; 24(Supplement K):K143, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2188681

RESUMO

Background and aims: Relative Bradycardia (RB) is a poorly understood condition that refers to inappropriately low heart rate response to a given increase in body temperature. Dysfunctional crosstalk between the immune system and the autonomous nervous system has been advocated. It is most often observed in intracellular gram negative and parasitic infections, with a prevalence ranging between 15% and 20%. The aim of this study was to identify the prevalence, clinical determinants and significance of RB in patients hospitalized for SARS-CoV-2 infection and to evaluate its prognostic value for long-covid syndrome during follow-up. Method(s): We enrolled consecutive patients hospitalized for SARS-CoV-2 infection from March 2020 to April 2021. We collected clinical parameters including clinostatic and orthostatic blood pressure (BP) and heart rate (HR) at 1,3 and 5 minutes, oxygen saturation, body temperature (BT), routine blood tests, 12-lead ECG, and 48-h Holter ECG. At follow up, clinical symptoms were investigated by novel Malmo POTS Symptoms (MAPS) questionnaire. Result(s): Total population included 269 inpatients (mean age 67+/-17 years, 59% male).Of these, 30 (11%) presented with sinus bradycardia and 37 (14%) RB. RB was more frequently observed in younger male patients with higher BT and heightened CRP levels. There were no significant correlations between BP and HR orthostatic changes and BR during hospital admission or during follow-up. No clinically relevant arrhythmias were revealed during 48-hour ECG monitoring. After mean16-month follow-up, MAPS score was higher in patients with RB (30+/-19) compared to those without RB (18+/-21, p=0.001) during index hospital admission. Dizziness, palpitations and fatigue were more frequently reported in patients with RB(p<0.001). Conclusion(s): RB is not an uncommon condition during acute COVID-19. SARS-CoV-2 inpatients who presented RB during index hospitalization showed a higher symptom burden during follow-up, as recorded by MAPS score. Further studies are needed to clarify the clinical significance of RB and its value to predict post-acute sequelae of COVID-19. (Figure Presented).

13.
European Heart Journal, Supplement ; 24(Supplement K):K138, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2188667

RESUMO

Background: Cardiovascular abnormalities have been largely reported in patients with COVID-19. Among these, myocardial injury and rhythm disorders represent one of the most important complications in patients affected by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Moreover, a poorer prognosis has been documented in COVID-19 patients when complicated by arrhythmias, independently by age and sex. Objective(s): The aims of the present study were to identify some of non-cardiac and cardiac comorbidities and some myocardial electrical features (including QT dispersion) associated with arrhythmia in hospitalized COVID-19 patients. Moreover, another objective was to contribute in analyzing the impact of arrhythmias on outcome in this setting of patients. Method(s): At admission, each patient underwent cardiac telemetry monitoring through entire hospitalization period. In all the subjects, laboratory analyses, standard 12-lead electrocardiogram (both at admission and on discharge), and lung imaging examination (by means of both ultrasound scans and computed tomography) were performed. Patients exhibiting arrhythmia during in-hospital period were divided into three groups: i, with brady-arrhythmias;ii, with tachy-arrhythmias;and, iii, with tachy- and brady-arrhythmias. Result(s): Two-hundred patients completed the study (males, 123;mean age, 70.1 years);of these, 80 patients (40%) exhibited rhythm disorders on cardiac telemetry. Patients with arrhythmia resulted to be older (p<0.0001) than patients without arrhythmia. Moreover, patients with arrhythmia showed: i, greater number of comorbidities (p<0.0001);ii, higher values of creatinine (p=0.007), B-type natriuretic peptide (p<0.0001), troponin (p<0.0001), c-reactive protein (p=0.01), ferritin (p=0.001), d-dimer (p<0.0001), and procalcitonin (p=0.0008);iii, QT interval (p=0.002), QTc interval (p=0.04), and QTc dispersion (p=0.01);and, iiii, lower values of sodium (p=0.03), magnesium (p=0.04), glomerular filtration rate (p<0.0001), and hemoglobin (p=0.008) as compared to patients without arrhythmia. By comparing the three subgroups of patients, no significant differences were found. Multivariate analysis showed that age (OR=1.14 [95% CI: 1.07-1.22];p=0.0004), coronary artery disease (OR=12.7 [95% CI: 2.38-68.01];p=0.005), and circulating troponin (OR=1.05 [95% CI: 1.003-1.10];p=0.04) represented risk factors independently associated with arrhythmia. By analyzing allcause in-hospital mortality, it resulted a ~forty-fold higher among patients with arrhythmia (OR=39.66 [95% CI: 5.20-302.51];p=0.0004) when compared to patients without rhythm disorders. Conclusion(s): In the present study, arrhythmias have been to be associated with ageing, coronary artery disease, subtle myocardial injury, hyperinflammatory status, coagulative unbalance, and abnormalities in myocardial electrical impulse propagation in patients affected by SARS-CoV-2 infection. In alignment with previous reports, the presence of arrhythmia seems to be associated with a worse in-hospital prognosis. Given its usefulness, routinary use of cardiac telemetric monitoring should be encouraged in COVID wards.

14.
European Heart Journal, Supplement ; 24(Supplement K):K137, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2188663

RESUMO

Background: Myopericarditis following coronavirus disease-2019 (COVID-19) vaccine is a described entity, but its evolution is still unclear. Method(s): Patients with a diagnosis of myopericarditis after mRNA COVID-19 vaccine represented our population. Clinical evaluation, laboratory tests and non-invasive cardiac tests were performed at baseline and at six months. Result(s): Between January and August 2021, we identified 7 patients with myopericarditis following mRNA vaccination. The median age was 29 years (IQR: 25.5-53.5 years) and all patients were males. The median time from vaccine administration to symptoms onset was 5 days (IQR: 4-7 days);five patients received BNT162b2, two mRNA-1273 and only one patient developed symptoms after first dose of vaccine. The most common symptoms at presentation were chest pain (100%) and fatigue (71.4%). Left Ventricular Ejection Fraction (LVEF) was preserved in 6 of them while was mildly reduced in one (median LVEF: 61.3% [IQR: 60-62.9%]). Late Gadolinium Enhancement was detected at Cardiac Magnetic Resonance in the 42.9% of cases. Treatment was conservative for all patients except one;a pericardiocentesis was necessary due to massive pericardial effusion. At six months follow-up all patients were asymptomatic with normal troponin level, electrocardiogram and echocardiogram confirming the complete healing of the inflammatory process. Two patients received a COVID-19 vaccine booster dose without evidence of myopericardial involvement. Conclusion(s): Myopericarditis associated with mRNA COVID19 vaccination is more frequent in young males and is usually characterized by a benign evolution. (Figure Presented).

15.
European Heart Journal, Supplement ; 24(Supplement K):K76, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2188659

RESUMO

Aims: The atrial septal pouch (ASP) is an incomplete fusion between septum primum (SP) and septum secundum (SS), resulting in a kangaroo pouch, that has a high prevalence in general populations (47%) and it is a potential site of blood stasis and thrombosis. After the novel coronavirus disease (COVID19) -related thrombotic complications, immunothrombosis has been widely investigated and proposed as key pathogenic mechanism linking coagulation and inflammation, leading sometimes to intracardiac thrombosis. In this paper we describe a case of thrombus in the ASP interestingly developed after COVID19 and made a literature review. Methods and Results: A 85 years old woman with a history of hypertension and chronic atrial fibrillation (AF) in therapy with dabigatran, was admitted to our hospital for dyspnea, atypical chest pain and fever. Laboratory exams showed only mild leukocytosis and elevated levels of d-dimer;EKG confirmed AF with a normal ventricular rate and CT scan excluded pulmonary embolism. Transthoracic and transesophageal echocardiogram (TEE) (Figure 1) showed a mobile ovoid mass (13x26 mm) attached to a left-sided ASP mimicking a myxoma, no mass was seen in the left atrial appendage (LAA). Four months earlier she had been hospitalized for idiopathic thrombocytopenia and concurrent COVID19 infection with mild symptoms, therefore dabigatran was discontinued for a month. The patient underwent surgery and histopathology confirmed it was a thrombus. In the PubMed search we conducted for reports demonstrating ASP masses, or alleged thromboembolism (TE) from this site, we found 25 reports, whose characteristics are briefly summarized in Table 1. Interestingly mild thrombocytopenia was described just in one case. Conclusion(s): In addition to the LAA, the atrial septal pouch is a newly described, common anatomic entity of the interatrial septum, that potentially serves as a site of stasis and thrombus formation. Despite its high prevalence, the finding of a thrombus in this site is very rare. According to Virchow triad, we assume that in this case an endothelial injury and hypercoagulability could have played a pivotal role, since the concomitant thrombocytopenia and high levels of d-dimer. This could be the first case of a thrombus in the ASP associated with COVID19-immunothrombosis. (Table Presented).

16.
Journal of Electrocardiology ; 73:8, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2180405

RESUMO

Background: Effortless and contactless monitoring technologies enable the collection of vital signs in a remote fashion without the need for physical contact with the patients. Videoplethysmography (VPG) is a technique developed to measure the pulse rate of an individual using facial video recorded by the video cameras embedded into smart devices and personal computers. It is an innovative solution to the challenges associated with the new healthcare delivery system under the SARS-CoV-1/2 pandemic. Despite these advantages, there is a knowledge gap around the performance of such technologies, especially in cardiac patients using the technology in various lighting conditions. In this work, we aim to assess the performance of the VPG technology when acquiring indoor pulse rates in patients with a history of atrial fibrillation (AF). Method(s): We evaluated the VPG technology in measuring the pulse rate in AF patients at low illumination levels. We performed an experiment in which AF patients were asked to stare at the screen of multiple devices while their VPG recordings were acquired for 25 s. We tested the VPG technology when running on 3 types of devices: an S10 smartphone (SP), a Tab3 tablet (TB), and a laptop with a Logitech C920 webcam (PC). We used a single-lead Holter ECG recorder to collect the ECG and measure heart rate (HR) at the time of the facial video. We evaluated the accuracy of measurements across a cohort of AF patients after collecting VPG signals from the three devices in various illumination conditions: 50 (dark surrounding area) to 500 (indoor office) lux, and two types of lights (LED and incandescent). We used the Bland-Altman (BA) method to measure the level of agreement between VPG- and ECG-based measurements of HR under various conditions. Finally, we measured the rates of rejection of recordings associated with each level of illumination and source of lights. Result(s): We present the results for the cohort of AF patients enrolled in this IRB-approved study from June to September 2021. Seventeen subjects were enrolled (12 men, 68+/-11 yrs). The BA plots shown in figure below do not show any bias. Furthermore, the mean difference in heart rate from VPG and ECG was inferior to 0.7 bpm across the 3 devices with confidence intervals ranging from 3 to 12 BPM (PC device showing the largest CI). The rate of rejection of VPG signal for too low quality was 60% at 50 lx, and 23% at 500 lx. The precision of heart rate measurements was higher under LED lights than under incandescent lights: measurement error+/-CI were (0.2+/-3 bpm) vs. (0.3+/-10 bpm), respectively. Conclusion(s): This VPG technology enables accurate measurements of pulse rates in patients with a history of AF when acquired in in-door conditions (low and normal illumination levels). The proposed method ensures a consistent level of accuracy even at low illumination (50 lx). This video-cardiac monitoring method represents a unique solution for physicians to measure their patient's heart rate during telemedicine visits. [Formula presented] Copyright © 2022

17.
Journal of Electrocardiology ; 73:7, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2180404

RESUMO

Background: The technological advances in electrocardiography have been substantially accelerated due to COVID-19. Furthermore, the progress in the (ECG) became possible with the introduction of integrated circuitry and wireless technologies for communication of mobile and cloud computing and of a variety of novel materials for ECG sensors. There are a number of wearables which are able to capture, monitor, record and/or remotely transmit ECG signals. Some of these devices enable non-invasive capture and storage of ECGs over a longer time period when compared to standard Holter recorders, or to acquire the ECG on demand but without the need for wet electrodes attached to the skin. Method(s): The objective of this study is to validate the ECG performance of the HeartKey Vital Signs Monitor (VSM) Watch, a dry electrode wrist wearable, against a wet electrode system whilst inducing motion noise reflective of a real-life use case. Data from each recording device was compared with the criterion in each stage of the protocol through a comparison of heart rate (HR) data. A beat rejection analysis was performed to provide insight into the degree of high frequency noise in ECG recorded from the HeartKey VSM Watch. Data from a HeartKey Reference Wrist Worn Device validation was used to compare the HeartKey VSM Watch to another wrist-based ECG wearable device. Result(s): Bland Altman analysis showed that the VSM Watch, when using HeartKey technology, had an overall mean absolute HR difference of 0.74, 1.21 and 0.80 bpm from the criterion device during the sitting, walking and standing stage respectively and within the +/-10% or +/- 5 bpm range as is recommended by ANSI EC13. ECG from the HeartKey VSM Watch had a higher beat rejection rate (8.5% vs ~0%), due to excessive high frequency noise, during the non-motion and motion-based protocol when compared to the HeartKey Chest Module. Conclusion(s): This study suggests that the HeartKey VSM Watch demonstrates medical grade HR performance when processing Lead I, dry electrode ECG data during both non-motion and motion-based testing. Further ECG signal chain development may be required to allow full usability of HeartKey Health and Wellness algorithms in a diverse population, particularly those with high skin wrist impedance. Copyright © 2022

18.
SN Comprehensive Clinical Medicine ; 5(1) (no pagination), 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2175591

RESUMO

Hemiplegic migraine (HM) is a rare, heterogenous form of migraine characterized by unilateral weakness. This motor aura can present with reversible visual, sensory, and language deficits. HM can be difficult to diagnose due to overlapping presentation with other complex conditions such as multiple sclerosis, seizure disorders, and transient ischemic attack (TIA). We describe a case of a 40-year-old female with asymptomatic COVID-19 infection who presented after a motor vehicle collision caused by HM consistent with left-sided weakness and loss of consciousness. To date, this is the first description of a patient with known complex migraines to have a motor vehicle collision as a result of HM. The risk of HM-associated neurologic symptoms while driving poses a significant public safety concern. We suggest driving restrictions be considered in patients with HM when migraine aura is present. This case presents support to examine active infection with SARS-CoV-2 as a trigger for HM. Copyright © 2022, The Author(s), under exclusive licence to Springer Nature Switzerland AG.

19.
3rd International Workshop on New Approaches for Multidimensional Signal Processing, NAMSP 2022 ; 332 SIST:81-92, 2023.
Artigo em Inglês | Scopus | ID: covidwho-2173955

RESUMO

COVID-19 is one of the greatest pandemics that threaten individuals, especially the elders. It was first reported in Wuhan, China in 2019. It was discovered recently that COVID-19 disease can be detected using three main protocols. The first protocol is based on Polymerase Chain reaction (PCR), while the second protocol is based on lung chest (ultrasound, X-ray, and CT-Scan), and the final protocol is based on the ECG image reports. This review aims to present a survey on the methodologies and algorithms applied for the detection of COVID disease using electrocardiogram (ECG). In this study, various papers were presented for determining how the COVID can be diagnosed using ECG image reports relying on symptoms and changes in the ECG peaks and intervals. In addition to this, other studies are presented on techniques applied to the ECG reports for the detection of COVID. Also, the main limitations and future works are illustrated. It can be concluded that COVID can be detected with high accuracy using ECG reports and it is even more efficient than other protocols. Finally, based on the performance of the studies it can be shown that the ECG image report is close to an acceptable level in the detection of COVID disease. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

20.
JACCP Journal of the American College of Clinical Pharmacy ; 5(12):1392-1393, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2173034

RESUMO

Introduction: The clinical benefits of remdesivir in the treatment of coronavirus disease 2019 (COVID-19) are well documented. The safety profile, however, is less characterized with a possible association between remdesivir and bradycardia now emerging. Research Question or Hypothesis: What is the temporal relation between remdesivir administration and episodes of profound bradycardia in patients with COVID-19? Study Design: Single-center, retrospective case series. Method(s): We searched our health-system's patient safety alert (PSA) reporting database to identify PSAs involving remdesivir and bradycardia submitted between August 1 and November 31, 2021. Electronic medical records were reviewed to verify remdesivir administration followed by profound bradycardia, defined as a heart rate less than 50 beats per minute, which occurred within 24 hours. Subsequent data collection followed manually. Result(s): A total of 15 patients were identified as potentially experiencing remdesivir-induced bradycardia. Patients were a median age of 54 years (interquartile range [IQR], 42 - 63.5 yrs) and mostly female (n=8;53.3%). Baseline electrocardiograms were collected on 11 patients (73.3%) with no evidence of existing sinus bradycardia. Five patients (33.3%) experienced bradycardia following the first administration, and prior to the fourth scheduled dose, the majority of patients had experienced at least one instance of profound bradycardia (n=14, 93.3%). Profound bradycardia occurred at a median of 7 hours (IQR, 3.5 - 17 hrs) following the most recent administration. Remdesivir was discontinued before completion of the full 5-day regimen in eight patients;doses were held in another two patients. Two patients died during their hospital course. Conclusion(s): Results suggest that bradycardia generally presents early in the remdesivir treatment course and often continues or recurs with subsequent administrations. This bradycardia can be clinically meaningful and interrupt remdesivir therapy. Findings are limited by potential bias in the spontaneous reporting of PSAs. Future research should assess whether these findings are reproducible in a larger cohort.

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