Takotsubo Syndrome and COVID-19: Associations and Implications.

Incidence of cardiovascular complications has increased during the COVID-19 (Coronavirus disease 2019) pandemic, both population-wide and in patients diagnosed with the disease. This increase has presented complications in patient care, leading to increased hospitalizations, adverse outcomes, and medical costs. A condition of interest is takotsubo syndrome, which may be associated with the novel coronavirus. To understand this connection, a narrative review was performed by analyzing primary studies and case reports available. The findings showed increased incidence of takotsubo cardiomyopathy in both the general population and COVID-19 patients. Proposed mechanisms for the linkage include generalized increases in psychological distress, the cytokine storm, increased sympathetic responses in COVID-19 patients, and microvascular dysfunction. Moreover, natural disasters are noted as likely being associated with increases of takotsubo syndrome. As the pandemic continues, treating COVID-19 as a systemic condition is imperative, with the increase in takotsubo syndrome marking a significant impact of the novel coronavirus.

Paradigm Shifts in Cardiac Care: Lessons Learned From COVID-19 at a Large New York Health System.

The coronavirus disease-2019 (COVID-19) pandemic has overwhelmed healthcare systems around the world, resulting in morbidity, mortality, and a dramatic economic downturn In the United States. Urgent responses to the pandemic halted routine hospital workflow in an effort to increase hospital capacity, maintain staffing, and ration protective gear. Most notably, New York saw the largest surge of COVID-19 cases nationwide. Healthcare personnel and physician leaders at Northwell Health, the largest healthcare system in New York, have worked together to successfully implement operational changes resulting in a paradigm shift in cardiac care delivery. In this manuscript, we detail specific protocol adjustments made in our cardiology department, cardiology service line, and healthcare system in the face of the COVID-19 pandemic. We discuss the sustainability of this shift moving forward and the opportunity to optimize care for cardiovascular patients in the post COVID-19 era.

Left Ventricular Assist Devices and the Kidney.

Left ventricular assist devices (LVADs) are common and implantation carries risk of AKI. LVADs are used as a bridge to heart transplantation or as destination therapy. Patients with refractory heart failure that develop chronic cardiorenal syndrome and CKD often improve after LVAD placement. Nevertheless, reversibility of CKD is hard to predict. After LVAD placement, significant GFR increases may be followed by a late return to near baseline GFR levels, and in some patients, a decline in GFR. In this review, we discuss changes in GFR after LVAD placement, the incidence of AKI and associated mortality after LVAD placement, the management of AKI requiring RRT, and lastly, we review salient features about cardiorenal syndrome learned from the LVAD experience. In light of the growing number of patients using LVADs as a destination therapy, it is important to understand the effect of these devices on the kidney. Additional research and long-term data are required to better understand the relationship between the LVAD and the kidney.

Sudden cardiac death in a 20-year-old male swimmer.

In young adults, hypertrophic obstructive cardiomyopathy (HOCM) is an acknowledged risk factor for sudden cardiac death (SCD) in an otherwise healthy and active patient. While the incidence of SCD in young people is not high enough for extensive, wide-scale examinations, the potential for prevention of some deaths via pre-exercise imaging may be beneficial in certain patient populations, such as those with a family history of SCD or professional athletes. We present the case of a healthy 20-year-old man with no past medical history who died while swimming in a river, likely secondary to cardiac arrest in the setting of HOCM.

Successful preterm delivery in a patient with severe mitral stenosis.

We present the case of a 36-year-old woman who was diagnosed with severe mitral stenosis in the 30th week of a pregnancy that was complicated by complete placenta previa and placenta percreta. With medical management, she successfully carried the pregnancy to fetal viability and was delivered by cesarean section before undergoing percutaneous balloon mitral valvuloplasty.