Acute Triple Coronary Artery Occlusion Leading to Cardiogenic Shock and Cardiac Arrest Emphasizing the Role of Mechanical Circulatory Support (Escalate before It's Too Late).

We report a case of cardiac arrest in a 38-year-old male with no past medical history who presented as a case of ST-segment elevation myocardial infarction, and coronary angiography showed triple coronary artery thrombosis complicated with cardiogenic shock (CS) that warrants starting on inotropic support and insertion of intra-aortic balloon pump. CS diagnosis with a high likelihood of deterioration was established based on hemodynamics assessment; hence, an early prompt decision for escalation of mechanical circulatory support to Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was made, which helped to prevent the patient's further deterioration and organ damage. The patient had uneventful VA-ECMO decannulation and was transferred to the ward and discharged after 28 days in stable condition on oral medical therapy and was following up regularly in the cardiology clinic. Therefore, early hemodynamics assessment in acute myocardial infarction CS cases will help predict rapid worsening, which may require prompt escalation of mechanical circulatory support and perhaps improve the outcome.

Isolation Unit: A New Way to Practice at Heart Hospital, Qatar during the Corona Virus -2019 Pandemic.

BACKGROUND: The novel coronavirus disease-2019 (COVID-19) spread rapidly around the world and was declared as the second pandemic of the 21st century. The first case was detected in Qatar on February 29, 2020. In order to protect patients and staff in Heart Hospital, the only tertiary cardiac center in Qatar, new measures were implemented to reduce the spread of infection in our hospital. METHODOLOGY: A 13-bed high dependency isolation unit was allocated to receive cardiac patients with appreciate infection control measures. Another isolation unit was also established in coronary care unit for critical patients. All patients admitted to Heart Hospital were tested for COVID-19 on admission. Patients were transferred out of isolation, if result was negative. Patients with positive results were either transferred to a COVID facility before or after planned cardiac procedure depending on their cardiovascular disease risk. RESULTS: Six hundred and seven patients were admitted to both the isolation units, most of them were men (89%). Forty-four percent were diagnosed with ST elevation myocardial infarction, 22% were non-STEMI or unstable angina, 17% were decompensated heart failure, 7% were elective cases for coronary angiography or electrophysiology procedures, 8% for other diagnosis, and 1% for both cardiac arrest and post cardiac surgery. 85.2% of the patients admitted to isolation units were tested negative and transferred to normal wards to complete their treatment. Eighty percent of the patients tested positive or reactive for COVID-19 had epidemiological risk, 8.4% had suggestive symptoms, and 11.6% had abnormal chest X-ray. CONCLUSION: This study demonstrated the importance of the isolation unit with infection control measures in controlling the transmission of COVID-19 in a hospital setting such as the Heart Hospital. Epidemiological risk factors including recent travel, close contact with suspected or confirmed cases within 14 days or less, living in shared accommodation or living in lockdown area were the main risk factors for spreading COVID-19 infection which can be managed by minimizing social activities.