Cardiac Damage After SARS-CoV2 Infection.

COVID-19 is a viral disease that can manifest acutely in the respiratory tract and other organs. In this study, we aimed to investigate potential long-term damage to the heart from COVID-19. For this study, we divided 97 consecutive unselected COVID-19 patients aged 18-80 years at a cardiology practice in Cologne, Germany, into two groups based on the severity of their infection. We performed a resting ECG and a resting transthoracic echocardiography three and six months after SARS-CoV2 infection. The key discriminator determining disease severity was bed confinement or hospital admission. Group 1 included patients with less severe COVID-19, whereas group 2 contained more severe cases. Heart rate as the primary ECG endpoint was lower by a statistically significant amount for the entire study population (p=0.024), subdivided by gender (pwomen <0.001, pmen <0.001) and in group 1 p =0.003 compared to three months. QTc time and repolarization disturbances as primary ECG endpoints and the echocardiographic primary endpoints, left ventricular ejection fraction, and left ventricular end-diastolic diameter (LVEDD), showed no relevant difference between the subgroups at three and six months or between the measurements taken at each point. In contrast, LVEDD normalized to body surface area was statistically significantly lower at six months in women in group 1 compared to group 2 (p=0.048) and in the overall study population at six months compared with the data after three months (p=0.034). E/E' was statistically lower at six months than at three months in the whole population (p=0.004) and in women (p=0.031). All measured echocardiographic and electrocardiographic mean values were within the normal range in all groups and follow-up controls. Overall, the prospective study conducted showed no significant evidence of long-term cardiac damage from COVID-19 disease, as evidenced by electrocardiographic and echocardiographic examinations at three and six months after infection.

[Progressive multifocal leukoencephalopathy following azathioprine and steroid treatment of pulmonary sarcoid disease]. / Progressive multifokale Leukenzephalopathie. Schwerwiegende Komplikation einer Immunsuppression.

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease of the central nervous system following reactivation of the John-Cunningham-Virus (JVC) in an immunocompromised host. This rare condition is characterized by rapid progressing neurologic symptoms often leading to death. In the following, we report on a rapid evolving deterioration of mental status due to PML in an 53-year-old man during treatment of pulmonary sarcoid disease using azathioprine and steroids. In contrast to reported lethal outcomes, our patient experienced a slow recovery of his cognitive impairment and later on of his palsy following termination of immunosuppression.

Exercised-induced coronary spasm in near normal coronary arteries.

In contrast to effort-induced symptoms in obstructive coronary disease, spasm in normal coronary arteries is characterized by angina at rest. We describe a 44-year-old patient with minor coronary plaques and pure exercised-induced coronary spasm. The case questions the differential pathogenic considerations of variant of the variant as opposed to Prinzmetal's variant angina.

Serial Assessment of Cardiac Function during and following Mitoxantrone Infusion in 30 Consecutive Patients with Multiple Sclerosis.

Immunosuppressive therapy is an established therapeutic option in patients suffering from multiple sclerosis (MS). In an open nonrandomized study we serially assessed cardiac function in 30 consecutive patients with MS before, during, and after mitoxantrone therapy. Mitoxantrone (12 mg/m(2)) was administered intravenously at 3-month intervals. Before each infusion, cardiac function was assessed by history taking, resting electrocardiogram, and echocardiography. Whereas no patient experienced clinical signs of heart failure, left ventricular pump function decreased continuously during mitoxantrone therapy and did not recover after cessation. The presented data suggest a dose-dependent and long-lasting toxic cardiac effect of low-dose mitoxantrone therapy in MS.

Magnetic resonance imaging of carcinoid heart disease.

In a 56-year-old lady, a carcinoid tumor of the terminal ileum metastasized to regional lymph nodes, and the liver was removed by hemicolectomy in 2002. Following a history of cutaneous flushing, diarrhea, and bronchoconstriction 3 years later, a somatostatin therapy was instituted. As flushing and diarrhea resolved and levels of urinary excretion of 5-hydoxyindoleacetic acid decreased, shortness of breath was progressive and prompted a cardiac exam. Despite poor resolution, echocardiography revealed a thickening of the tricuspid valves (TK) with reduced mobility along with right atrial (RA) and right ventricular (RV) dilatation. The pulmonary valve was unobtrusive. Magnetic resonance (MR) imaging revealed extensive fibrous tissue extending from the valvular base to the tip of the tricuspid leaflets. Retraction and immobilization of the TK caused a mild stenosis and a large regurgitant flow. Because medical treatment of tricuspid regurgitation was ineffective, the TK was excised and a Hancock 25-mm bioprosthetic valve was implanted. The postoperative course was uncomplicated, and the patient recuperated and resumed normal daily activities.

[Management of patients with prosthetic heart valves]. / Nachsorge von Patienten mit künstlichen Herzklappen.

More than 15,000 valve replacements are annually performed in Germany resulting in a significant improvement of function, symptoms and prognosis. Nevertheless, prosthetic heart valves bear a small risk of serious complications and these patients remain cardiac patients all their life. Therefore, cardiologic checkups are recommended at regular intervals and, if needed, also on a short-term appointment. Despite the presence of unspecific symptoms most patients do not reveal problems concerning their prosthetic valves, which can be quickly determined using the standard examination techniques of a cardiologist. The routine "basic examination" should be extended to an "advanced examination" in case of abnormal findings (in the "basic examination"). Apart from history taking, physical examination, ECG and laboratory tests, echocardiography (either transthoracic or, if necessary, transesophageal) is the most important method for evaluation of prosthetic valves. Occasionally, complementary stress tests, right/left heart catheterization or MRI are needed. Common complications include valve thrombosis with or without embolization, endocarditis, structural failure, hemolysis and paravalvular regurgitation which can be reliably detected and treated by the cardiologist. Furthermore, it is the cardiologist's responsibility to define the patients' antithrombotic treatment regimen and to guide the patients through special situations like gravidity or before and after an operation. With some restrictions, patients with prosthetic heart valves can be fully rehabilitated in respect of professional life and sports.

Ambulatory electrical cardioversion of atrial fibrillation.

Elective electrical cardioversion of atrial fibrillation is an effective and safe cardiac procedure in selected patients. It is most often performed during a short hospital stay or in an outpatient setting of a hospital. In a retrospective analysis, we report our experience on electrical cardioversions in private practice without a hospital stand-by performed by a cardiologist and an anesthesiologist in concert. Sixty patients with a mean age of 66+/-8 years and a typical spectrum of cardiac diseases in stable condition were chosen for the ambulatory procedure. The immediate success rate of electrical cardioversion was 83%. Within the next 3 months, a relapse of atrial fibrillation occurred in 46%. Following 87 procedures in 60 patients, 3 complications requiring a hospital admission occurred. One of these three patients had suffered from a short syncope without other deficits potentially due to cerebral embolism. Apart from these complications, no patient suffered a thromboembolic complication or a cerebral problem following electrical cardioversion. We conclude that elective electrical cardioversion of atrial fibrillation can be performed safely, effectively and comfortable for patient and physician following a preceding evaluation and counseling by a cardiac specialist.

Non-invasive imaging of a coronary bypass stenosis using CT angiography in a patient with negative stress testing.

In patients with a low or intermediate probability of a coronary artery disease, ultrafast computer tomography (CT) of the coronary arteries and bypass grafts offer a novel approach for the evaluation of the coronary anatomy. The presented case impressively demonstrated the capability of ultrafast CT to show precisely the extent and localisation of a bypass artery stenosis in a patient with mild chest discomfort but negative stress testing. However, widespread screening of coronary artery disease with non-invasive imaging modalities can not be recommended until validated in larger studies that a complete visualization of all coronary arteries and bypass grafts can be achieved.

Klippel-Feil syndrome associated with aortic coarctation.

Aortic coarctation was diagnosed in a 27-year-old man with Klippel-Feil syndrome, an inborn skeletal defect of the vertebral column associated with anomalies of various organs. The presented findings are discussed in the context to the theory of vascular artery supply disruption sequence during embryogenisis as a potential explanation for the pathogenesis of morphological defects of Klippel-Feil and associated syndromes.

Metoprolol treatment to prevent restenosis following percutaneous transluminal coronary angioplasty.

This study tested the hypothesis that metoprolol reduces the restenosis rate after percutaneous transluminal coronary angioplasty (PTCA) in native coronary arteries as compared to placebo. Apart from prognostic clinical effects in the treatment of patients with coronary heart disease, several in vivo and ex vivo studies have demonstrated antiproliferative and antiatherogenic effects of beta-blockers. In the present study, 192 male patients were randomized in a double-blind fashion to metoprolol sustained-release treatment or placebo starting at least 1 day before angioplasty. Lesion diameters and restenosis rates were evaluated using automatic edge detection systems. The study endpoint was the angiographic restenosis rate 4 months after PTCA. Ninety-seven randomized patients had a control angiography a mean of 4.5 months after PTCA. Dropouts were evenly distributed between the metoprolol and placebo groups. Lumen loss in the target lesion was 0.36 mm in the metoprolol group and 0.32 mm in the placebo group. Restenosis rates averaged 57.5% in the metoprolol group and 44.2% in the placebo group using conventional restenosis criteria. Taking metoprolol serum levels above 50 mmol/l as an indication of definite compliance with the metoprolol treatment, the restenosis rate was 58.3%. In conclusion, 95 mg of sustained-release metoprolol failed to reduce the restenosis rate following angioplasty in native coronary arteries.