Decrease in acute coronary syndrome presentations during the COVID-19 pandemic in upstate New York.

The COVID-19 virus is a devastating pandemic that has impacted the US healthcare system significantly. More than one study reported a significant decrease in acute coronary syndrome admissions during that pandemic which is still due to unknown reasons. METHODS: This is a retrospective non-controlled multi-centered study of 180 patients (117 males and 63 females) with acute coronary syndrome (STEMI and NSTEMI) admitted during March/April of 2019 and March/April 2020 in Upstate New York. RESULTS: A total of 113 patients (61.9% males, 38.1% females) with a mean age of 72.3 ±â€¯14.2 presented during March/April 2019 with ACS (STEMI + NSTEMI) while only 67 (70.1% males, 29.9% females) COVID-19 negative patients with a mean age of 65.1 ±â€¯14.5 presented during the same period (March/April) in 2020. This is a drop by 40.7% (P < .05) of total ACS cases during the COVID-19 pandemic. In NSTEMI patients, 36.4% presented late (>24 hours of symptoms) during the COVID-19 pandemic in comparison with 2019 (27.1%, P = .033). CONCLUSION: The COVID-19 pandemic led to a substantial drop by 40.7% (P < .05) of total ACS admissions in our area. This decrease in hospital admissions and late presentations can be a worrisome sign for an increase in future complications of myocardial infarctions.

Superior Vena Cava Syndrome in Conjunction with Pulmonary Vasculature Compromise: A Case Study and Literature Review.

BACKGROUND Superior vena cava (SVC) syndrome can result from external compression or invasion of the vessel from structural pathology within the mediastinum. Here we present a case of a patient that had no airway compromise, but who had hemodynamic instability due to pulmonary vasculature compression requiring urgent intervention. CASE REPORT A 61-year-old male who presented with severe dyspnea was found to have newly diagnosed small cell carcinoma of the right lung. The carcinoma compressed the SVC as well as the right pulmonary artery (PA) as seen on computed tomography scanning. He became critically hypoxic and was emergently intubated. Due to the lack of airway compromise, this instance of SVC syndrome was not emergently treated with radiation or chemotherapy. However, he received appropriate treatment while on mechanical ventilatory support and eventually recovered. CONCLUSIONS SVC syndrome is considered an emergent condition in the setting of airway compromise. With the addition of PA compression, a case's acuity should be reconsidered. Our case highlights the fact that SVC syndrome can be associated with compression of the right PA, due to its close proximity to the SVC. This can lead to rapid hemodynamic deterioration, thereby increasing the acuity when evaluating a patient with SVC syndrome. We recommend emergent intervention to be taken when a patient develops this combination of SVC syndrome and PA compromise.