RESUMO
AIM: Studies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India. METHODS & RESULTS: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We included 41,832 consecutive adults with AMI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India. The weekly average decrease in AMI admissions in 2020 correlated negatively with the number of COVID cases (r = -0·48; r2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. CONCLUSIONS: The magnitude of reduction in AMI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing AMI during the pandemic.
Assuntos
COVID-19 , Infarto do Miocárdio , Infarto do Miocárdio sem Supradesnível do Segmento ST , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Idoso , COVID-19/epidemiologia , Controle de Doenças Transmissíveis , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/terapia , Pandemias , Volume Sistólico , Função Ventricular EsquerdaRESUMO
Ticagrelor is a potent reversible P2Y12 inhibitor with proven superiority over clopidogrel. Ticagrelor increases the tissue concentration of adenosine, thereby leading to bradyarrhythmia. This complication is reported to occur very early after initiating the drug. A randomized controlled trial reported that ticagrelor-induced pauses have an early onset without much clinical impact. However, our patient developed ticagrelor-induced hemodynamically significant sinus arrest 10 months after coronary artery stenting, which improved after stopping the drug. Ticagrelor should be considered as one of the uncommon reasons for late-onset sinus pause or bradyarrhythmia.
Assuntos
Inibidores da Agregação Plaquetária , Antagonistas do Receptor Purinérgico P2Y , Parada Sinusal Cardíaca , Ticagrelor , Adenosina , Clopidogrel , Humanos , Inibidores da Agregação Plaquetária/efeitos adversos , Antagonistas do Receptor Purinérgico P2Y/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Parada Sinusal Cardíaca/induzido quimicamente , Ticagrelor/efeitos adversosRESUMO
Straight back syndrome is characterized by loss of the normal upper thoracic kyphosis, leading to a reduced anteroposterior diameter and squashing of the heart. Most patients are asymptomatic; if symptomatic, chest pain and palpitations are most common. On examination, the abnormal clinical findings simulate organic heart disease that needs to be ruled out by echocardiography and cardiac catheterization. A lateral chest radiograph is diagnostic. This condition is commonly associated with mitral valve prolapse and bicuspid aortic valve. We describe an interesting case of straight back syndrome with all the classic and rarely reported clinical findings.
Assuntos
Prolapso da Valva Mitral/complicações , Doenças da Coluna Vertebral/complicações , Vértebras Torácicas/anormalidades , Dor no Peito/etiologia , Diagnóstico Diferencial , Eletrocardiografia , Sopros Cardíacos , Hemodinâmica , Humanos , Masculino , Prolapso da Valva Mitral/diagnóstico , Prolapso da Valva Mitral/fisiopatologia , Valor Preditivo dos Testes , Radiografia , Doenças da Coluna Vertebral/diagnóstico , Síndrome , Vértebras Torácicas/diagnóstico por imagem , Adulto JovemAssuntos
Vasos Coronários/diagnóstico por imagem , Ponte Miocárdica/diagnóstico por imagem , Angiografia Coronária , Vasos Coronários/fisiopatologia , Diagnóstico Diferencial , Ecocardiografia , Humanos , Masculino , Pessoa de Meia-Idade , Ponte Miocárdica/complicações , Ponte Miocárdica/diagnósticoAssuntos
Angiografia Coronária , Vasos Coronários/diagnóstico por imagem , Ponte Miocárdica/diagnóstico por imagem , Antagonistas Adrenérgicos beta/administração & dosagem , Adulto , Vasos Coronários/efeitos dos fármacos , Humanos , Masculino , Ponte Miocárdica/tratamento farmacológico , Valor Preditivo dos TestesRESUMO
Balloon mitral valvotomy is a commonly performed procedure for mitral stenosis. This procedure can lead to complications such as left ventricular perforation with tamponade, mitral regurgitation and stroke. Here we report a case of left ventricular pseudoaneurysm following balloon mitral valvotomy. It was a consequence of adherent pericardium secondary to open mitral valvotomy performed earlier. It was surgically corrected by pseudoaneurysm repair and mitral valve replacement. We believe that this is the first such reported case.