Pre-Existing Atrial Fibrillation in Hospitalized Patients with COVID-19: Insights from the CARDIO COVID 19-20 Registry.

Pre-existing (chronic) atrial fibrillation (AF) has been identified as a risk factor for cardiovascular complications and mortality in patients with COVID-19; however, evidence in Latin America (LATAM) is scarce. This prospective and multicenter study from the CARDIO COVID 19-20 database includes hospitalized adults with COVID-19 from 14 countries in LATAM. A parsimonious logistic regression model was used to identify the main factors associated with mortality in a simulated case-control setting comparing patients with a history of AF to those without. In total, 3260 patients were included, of which 115 had AF. The AF group was older, had a higher prevalence of comorbidities, and had greater use of cardiovascular medications. In the model, AF, chronic kidney disease, and a respiratory rate > 25 at admission were associated with higher in-hospital mortality. The use of corticosteroids did not reach statistical significance; however, an effect was seen through the confidence interval. Thus, pre-existing AF increases mortality risk irrespective of other concomitant factors. Chronic kidney disease and a high respiratory rate at admission are also key factors for in-hospital mortality. These findings highlight the importance of comorbidities and regional characteristics in COVID-19 outcomes, in this instance, enhancing the evidence for patients from LATAM.

Cardiac paraganglioma: implications and impacts of a rare disease-a case report †.

Background: Tumour-producing catecholamines arise in the adrenal medulla (pheochromocytomas), as well as in extra-adrenal chromaffin cells (paragangliomas). The origin can be from any location; however, it is very rare in the heart. Case summary: A 43-year-old woman with a history of arterial hypertension presented with dyspnoea on moderate exertion, New York Class Association (NYHA) functional classes III and IV, and oedema in the lower extremities. Medical and laboratory evaluation revealed an NT-proBNP of 6046 pg/mL, a left ventricular ejection fraction (LVEF) of 15%, longitudinal strain of -7%, and a mass located on the inner surface of the left atrioventricular groove. Surgical intervention was performed, and the tumour was resected. Pathological report showed an extra-adrenal paraganglioma without neoplastic involvement in the margins of the vena cava. After surgery, the patient showed clinical improvement with NYHA functional class I, LVEF of 56%, and longitudinal strain of -20% on transthoracic echocardiography 4 months after treatment. Discussion: Paragangliomas are tumours that are rarely found in the heart, and their diagnosis is difficult. However, early detection and treatment can improve the quality of life of affected patients.

COVID-19 fulminant myocarditis: a case report.

BACKGROUND: Fulminant myocarditis is a catastrophic disease with high mortality and complications. A viral aetiology is frequent and the implication of SARS-CoV-2 is not yet known. CASE SUMMARY: A 38-year-old woman who recently arrived from Spain presented with palpitations that started suddenly 3 days prior to presentation and were associated with haemodynamic instability, without dyspnoea or chest pain. We found features of myopericarditis on the electrocardiogram and severe systolic dysfunction on the echocardiogram. The chest tomography showed findings which suggested COVID-19 infection, and PCR for SARS-CoV-2 was positive. The cardiac magnetic resonance image showed Lake Louise criteria for myocarditis. The patient was treated with immunomodulatory, steroid, and immunoglobulin therapy, with a favourable clinical response. DISCUSSION: The importance of this case lies in highlighting the severe cardiac involvement in a young patient, without previous risk factors, positive for COVID-19, and the favourable response to the medical treatment given.

Trombosis venosa profunda en un paciente con hipertiroidismo de novo. Presentación de caso / A case of deep venous thrombosis in a patient with de novo hyperthyroidism

La trombosis venosa es una condición clínica en la cual un trombo se genera y ocluye la luz de un vaso venoso con el consecuente riesgo de embolia pulmonar. La fisiopatología se relaciona con estados de hipercoagulabilidad, alteraciones del flujo sanguíneo y lesiones vasculares endoteliales, conocida como la triada de Virchow. Dentro de los factores de riesgo se encuentran el cáncer, la estancia hospitalaria prolongada, la cirugía mayor, el trauma mayor y las trombofilias; sin embargo en el 25-50% de los casos es imposible identificar el factor etiológico. Presentamos el caso de un hombre con clínica y diagnóstico de trombosis venosa profunda en manejo extrainstitucional con cumínicos, que acude al Hospital Infantil Universitario de San José por incremento de los signos inflamatorios en el miembro inferior derecho. Al ingreso hay aumento de la extensión de la trombosis venosa y niveles subterapéuticos de INR, a pesar de dosis óptimas de cumínicos. La evolución trascurrió con taquicardia y episodios de diaforesis. Se documenta y realiza el diagnóstico de hipertiroidismo asociado con elevación del factor viii de coagulación. Conclusión: Se considera que la trombosis venosa profunda está favorecida por un estado de hipercoagulación determinado por hipertiroidismo.

Venous thrombosis is a clinical condition that occurs when a thrombus forms and obstructs the lumen of a vein constituting a risk for pulmonary embolism. Pathophysiology features Virchow's triad, that is, hypercoagulability, blood flow alterations and vascular endothelial damage. Risk factors include, cancer, prolonged length of hospital stay, major surgery, major trauma and thrombophilias, although, identifying the etiological factor is impossible in 25 to 50% of all cases. A case is presented in a man with clinical presentation and diagnosis of deep venous thrombosis who had been managed with coumarin before consulting to our institution. He came to Hospital Infantil Universitario de San José for presenting an increase of the inflammatory signs on his right leg. At admission, a greater areawas affected by venous thrombosis and subtherapeutic INR values were evidenced despite patient had received optimal doses of coumarin derivatives. He presented tachycardia and episodes of diaphoresis during his hospital stay. A diagnosis of hyperthyroidism associated with high concentrations of coagulation factor VIII was documented. Conclusion: It is considered that DVT is favored by hypercoagulable states determined by hyperthyroidism.