The Role of Heparin in Postural Orthostatic Tachycardia Syndrome and Other Post-Acute Sequelae of COVID-19.

The therapeutic management and short-term consequences of the coronavirus disease 2019 (COVID-19) are well known. However, COVID-19 post-acute sequelae are less known and represent a public health problem worldwide. Patients with COVID-19 who present post-acute sequelae may display immune dysregulation, a procoagulant state, and persistent microvascular endotheliopathy that could trigger microvascular thrombosis. These elements have also been implicated in the physiopathology of postural orthostatic tachycardia syndrome, a frequent sequela in post-COVID-19 patients. These mechanisms, directly associated with post-acute sequelae, might determine the thrombotic consequences of COVID-19 and the need for early anticoagulation therapy. In this context, heparin has several potential benefits, including immunomodulatory, anticoagulant, antiviral, pro-endothelial, and vascular effects, that could be helpful in the treatment of COVID-19 post-acute sequelae. In this article, we review the evidence surrounding the post-acute sequelae of COVID-19 and the potential benefits of the use of heparin, with a special focus on the treatment of postural orthostatic tachycardia syndrome.

Effectiveness of a cardiac rehabilitation program on biomechanical, imaging, and physiological biomarkers in elderly patients with heart failure with preserved ejection fraction (HFpEF): FUNNEL + study protocol.

BACKGROUND: Patients with heart failure with preserved ejection fraction (HFpEF) have a low functional status, which in turn is a risk factor for hospital admission and an important predictor of survival in HFpEF. HFpFE is a heterogeneous syndrome and recent studies have suggested an important role for careful, pathophysiological-based phenotyping to improve patient characterization. Cardiac rehabilitation has proven to be a useful tool in the framework of secondary prevention in patients with HFpEF. Facilitating decision-making and implementing cardiac rehabilitation programs is a challenge in public health systems for HFpEF management. The FUNNEL + study proposes to evaluate the efficacy of an exercise and education-based cardiac rehabilitation program on biomechanical, physiological, and imaging biomarkers in patients with HFpEF. METHODS: A randomised crossover clinical trial is presented among people older than 70 years with a diagnosis of HFpEF. The experimental group will receive a cardiac rehabilitation intervention for 12 weeks. Participants in the control group will receive one educational session per week for 12 weeks on HFpEF complications, functional decline, and healthy lifestyle habits. VO2peak is the primary outcome. Biomechanical, imaging and physiological biomarkers will be assessed as secondary outcomes. Outcomes will be assessed at baseline, 12 weeks, and 24 weeks. DISCUSSION: Identifying objective functional parameters indicative of HFpEF and the subsequent development of functional level stratification based on functional impairment ("biomechanical phenotypes") may help clinicians identify cardiac rehabilitation responders and non-responders and make future clinical decisions. In this way, future pharmacological and non-pharmacological interventions, such as exercise, could be improved and tailored to improve quality of life and prognosis and reducing patients' hospital readmissions, thereby reducing healthcare costs. TRIAL REGISTRATION: NCT05393362 (Clinicaltrials.gov).

Myocarditis Related to COVID-19 and SARS-CoV-2 Vaccination.

The coronavirus disease of 2019 (COVID-19) has been a cause of significant morbidity and mortality worldwide. Among the short- and long-term consequences of COVID-19, myocarditis is a disease to be taken into consideration. Myocarditis, in general, is related to a poor prognosis. However, the epidemiology and prognosis of myocarditis related to COVID-19 are currently unknown. While vaccination against COVID-19 is of great benefit at a public health level, the risk of myocarditis should be considered in the context of the global benefits of vaccination. In this narrative review, we will summarize the etiopathogenic bases, the epidemiology, the clinical manifestations, the course, diagnosis, prognosis, and the treatment of myocarditis related to SARS-CoV-2, as well as myocarditis secondary to mRNA vaccines.

Reincorporación laboral de trabajadores con cardiopatía, según el tipo de trabajo y la realización de un programa de rehabilitación cardiaca en Málaga / Return to work of workers with heart disease according to the type of work and attendance to a cardia rehabilitation program in Málaga

Justificación y objetivos: Las enfermedades más comunes asociadas al trabajo son los trastornos músculo-esqueléticos, las enfermedades dermatológicas y la alergia ocupacional. No obstante, las enfermedades cardiovasculares provocan la cuarta parte de accidentes de trabajo mortales que se producen en los centros de trabajo(1). Además son causas importantes de incapacidad laboral permanente, en pacientes con edad comprendida entre los 40 y 65 años, es decir, en pleno auge profesional. Los programas de rehabilitación cardiaca (PRC) han demostrado con creces su beneficio(2) en favor de una reincorporación laboral temprana y segura(3). El presente estudio pretende conocer la prevalencia de reincorporación laboral tras un evento cardia co, según el trabajo que desempeñan, en población laboral de Málaga; además del posible beneficio que aportan los PRC que siguen muchos de los pacientes que acuden por este motivo a unos de los dos grandes hospitales de la capital malagueña, y manifestar las posibles diferencias en reincorporación con pacientes similares y de la de la misma población pero que no tienen la oportunidad de participar en un PRC. Conclusiones: La reincorporación laboral, sobre todo en pacientes con riesgo medio-alto, fue mayor en el grupo que siguió un PRC, aunque la diferencia no resultó estadísticamente significativa. En cambio, sí hubo asociación entre reincorporación laboral y otras variables incluidas en el estudio, relacionadas con la enfermedad, factores socioeconómicos y características del trabaj (AU)

Justification and objetives: Most common diseases at work are skeletal muscle disorder, dermatological diseases and occupational allergy. However, cardiovascular diseases cause 25% of the mortal accidents in the companies during working hours(1). Besides, they are important causes of permanent labour disability, for patients who are 40-65 years old (i.e., during their highest professional time). Cardiac rehabilitation programs (CRP) have been proven as very benefitial(2) for a quick and safe labour reincorporation(3). This analysis tries to find out the prevalence of labour reincorporation after a cardiac event over the working population of Málaga (depending upon their roles at work) as well as the potential benefits given by the CRP followed by most of the patients assisted in one of the largest hospital in the city, and manifest the potential differences in reincorporation with similar patients from the same place who have no opportunity to participate in a CRP. Conclusions: Labour reincorporation, especially on medium to high risk patients, was higher in the group that followed a CRP although the difference was not significant enough. On the other hand, there was a link between labour reincorporation and other variables used in the analysis which were related to disease, socio-economic factors and job characteristics (AU)