Prevalence and Characteristics of Hyperthyroidism Among Patients With Sarcoidosis in the United States.

OBJECTIVE: We aimed to determine the prevalence and clinical characteristics of self-reported hyperthyroidism in patients with sarcoidosis. METHODS: A national registry-based study investigating 3836 respondents to the Sarcoidosis Advanced Registry for Cures questionnaire in the period between June 2014 and August 2019 was conducted. This registry is generated from a web-based questionnaire that is self-reported by patients with sarcoidosis. We compared patients with sarcoidosis who had hyperthyroidism with those who did not. We used multivariate logistic regression analysis to study the association between hyperthyroidism and different cardiac manifestations in patients with sarcoidosis. RESULTS: Three percent of the study respondents self-reported having hyperthyroidism and were generally middle-aged Caucasian women. Compared with patients without hyperthyroidism, patients with hyperthyroidism had more sarcoidosis-related comorbidities (59% vs 43%, P = .001) and more steroid-related comorbidities (56% vs 44%, P = .01), but there was no difference in the sarcoidosis-specific treatments they received, which included corticosteroids. Patients with hyperthyroidism reported sarcoidosis involvement of the heart (26.6% vs 14.9%, P = .005), kidneys (14.9% vs 8%, P = .033) and sinuses (17.7% vs 10.2%, P = .030) more frequently. Cardiac manifestations that were more frequently reported in patients with hyperthyroidism included atrial arrhythmias (11.3% vs 6.3%, P = .046), ventricular arrhythmias (17.2% vs 7.5%, P < .001), congestive heart failure (10.4% vs 5%, P = .017), and heart block (9.4% vs 4.7%, P = .036). CONCLUSION: Hyperthyroidism is infrequent in patients with sarcoidosis but is potentially associated with different cardiac manifestations. We suggest considering routine screening for hyperthyroidism in patients with sarcoidosis, especially in those with cardiac involvement. Further studies are needed to investigate the impact of identifying and treating hyperthyroidism in patients with sarcoidosis.

Perspectives on Heyde's Syndrome and Calcific Aortic Valve Disease.

Heyde's syndrome is a multisystem disorder describing the association between calcified aortic stenosis, gastrointestinal tract bleeding from arteriovenous malformations, and acquired von Willebrand syndrome. Several studies have reported an increase in prevalence of gastrointestinal arteriovenous malformation in patients with aortic stenosis and vice versa; however, the incidence of Heyde's syndrome remains controversial. In general, the syndrome is prevalent in the elderly population. The pathogenesis and management remain controversial as well. Our review, provides a unique case to highlight the diagnosis and management of Heyde's syndrome while also briefly describing the prevalence, etiology, diagnosis, and management of calcific aortic valve disease in general.

Atypical Presentation of Infective Endocarditis With Native Aortic Valve Involvement Secondary to Staphylococcus aureus Bacteremia in the Setting of Non-Hodgkin Lymphoma.

Infective endocarditis (IE) is a condition that can involve endocardial tissue and possibly lead to valvular disease. Not only is it important to recognize the clinical presentation difference between acute and subacute IE, but physicians should understand that underlying risk factors, such as immunosuppression secondary to non-Hodgkin lymphoma (NHL), can alter an acute presentation into that of a subacute one. We report an NHL patient, who presented with subacute clinical symptoms of IE, but had a clinical test workup that showed evidence of acute IE rather than subacute.

Cardiac Myosin Activation in the Treatment of Congestive Heart Failure: New Therapeutic Options and Review of Literature.

Congestive heart failure (HF) remains a major cause of cardiac-related morbidity and mortality, despite major therapeutic advancements. A newer class of medications has recently been developed which targets the root cause of HF, which is reduced myocardial contractility. This article aims to highlight the cardiac myosin activator class of drugs and the trials to date highlighting their effects on HF outcomes.

COVID-19 Coagulopathy: Current knowledge and guidelines on anticoagulation.

COVID-19-associated coagulopathy (CAC) is a feature of COVID-19 that can lead to various thrombotic complications and death. In this review, we briefly highlight possible etiologies, including direct cytotoxicity caused by the SARS-CoV-2 virus, and the activation of proinflammatory molecules such as cytokines, underlying coagulopathy. Endothelial dysfunction has been highlighted as pivotal, irrespective of the mechanism involved in CAC. Specific features of CAC distinguishing it from disseminated intravascular coagulopathy and sepsis or ARDS-associated coagulopathy have been discussed. We have also highlighted some hematological parameters, such as elevated d-dimers and partial prothrombin and prothrombin times prolongation, which can guide the use of anticoagulation in critically ill patients. We conclude by highlighting the importance of prophylactic anticoagulation in all COVID-19 hospitalized patients and reiterate the need for institution-specific guidelines for anticoagulation COVID-19 patients since individual institutions have different patient populations.

Update on the Cardiovascular Benefits of Sodium-Glucose Co-Transporter-2 Inhibitors: Mechanism of Action, Available Agents and Comprehensive Review of Literature.

Despite the currently established treatment for heart failure (HF), HF remains a growing public healthcare problem with an increasing burden. Therefore, novel therapeutic innovations are needed to overcome this issue and improve HF prognosis. Sodium-glucose co-transporter-2 inhibitors (SGLT2i) are state-of-the-art in type 2 diabetes mellitus management. They inhibit the reabsorption of glucose from the proximal renal tubules, leading to increased glycosuria and decreased plasma glucose levels. SGLT2i use is growing significantly, especially after recent clinical trials demonstrating favorable cardiovascular and renal protective effects independently of blood glucose-lowering. The mechanisms by which SGLT2i demonstrate their cardio-renal protective effects remain incompletely understood but are thought to be related to potential diuretic and natriuretic effects along with other mechanisms that will be discussed in this article. Over the past few years, there has been significant research on the safety, efficacy, and quality of this class of medications. Here, we review the current guideline-directed medical therapy for HF, focus on SGLT2i mechanism of action and potential role in HF patients, and finally summarize the cardiovascular clinical trials with SGLT2.