Takotsubo cardiomyopathy caused by emotional stressors in the coronavirus disease 2019 (COVID-19) pandemic era.

The COVID-19 pandemic has had far-reaching consequences beyond the disease itself, including economic, social, political, religious, and psychological implications. This novel coronavirus has been shown to have cardiovascular manifestations in the form of arrhythmias, conduction disturbances, myocarditis, stress cardiomyopathy, myocardial injury and myocardial ischemia or infarction from increased microvascular and/or macrovascular coagulopathy. However, in addition to these direct effects, we are now starting to recognize indirect cardiovascular effects of COVID-19 in the form of increased incidence of Takutsobo cardiomyopathy in patients without any evidence of coronavirus infection presumably due to the increased psychological stress of social isolation and societal turbulence. In this case series, we present two post-menopausal women, presenting with chest pain and acute coronary syndrome, who are finally diagnosed with stress cardiomyopathy, triggered by increased emotional stress-related to the pandemic. There is data from a retrospective cohort analysis showing a fourfold increase in the incidence of acute coronary syndrome resulting from stress cardiomyopathy during the pandemic period compared to similar times periods before the pandemic. Hence, health care providers need to be cognizant of the emotional ramifications of the ongoing pandemic in the form of increased risk of Takotsubo cardiomyopathy. Moreover, urgent measures need to be taken to help the at-risk population cope with the ongoing stressors to help decrease the incidence of this cardiomyopathy.

Coronary artery calcification, serum lipids, lipoproteins, and peripheral inflammatory markers in adolescents and young adults with type 1 diabetes.

OBJECTIVE: To determine whether coronary artery calcification (CAC), elevated fasting lipids, and lipoproteins and peripheral inflammatory markers are present in insulin-dependent diabetic adolescents and young adults several years after diagnosis. STUDY DESIGN: Hispanic insulin-dependent diabetics (n = 32) diagnosed a mean of 7.8 +/- 4.5 years ago (range, 3 to 16 years), with a mean glycosylated hemoglobin concentration at the time of the study of 8.8% +/- 2.3% and a mean chronological age of 16.1 +/- 4.4 years, were evaluated. Healthy patients (n = 15) with a chronological age (CA) of 15.2 +/- 2.2 years served as control subjects. CAC was assessed by multiple slice computed tomography, and total CAC score in Agatston units was calculated. Fasting lipids, C-reactive protein, apolipoprotein (Apo) A, Apo B, and metalloproteinase-9 (MMP-9) concentrations were measured in all subjects. RESULTS: Neither adolescents with type 1 diabetes nor healthy control subjects presented with evidence of CAC. Fasting lipids, Apo A, Apo B, CRP, and MMP-9 concentrations were similar between diabetic subjects and control subjects. However, 34.4% and 25.0% of our type 1 diabetic subjects had elevated total and LDL cholesterol levels (>200 and >130 mg/dL, respectively), whereas 15.6% and 28.1% had elevated triglyceride and Apo B concentrations (>150 mg/dL and >100 mg/dL, respectively). In addition, 28.1% and 34.4% presented with elevated CRP and MMP-9 levels (>2 mg/L and >80 ng/mL, respectively). Total, LDL and HDL cholesterol, triglycerides, Apo B, CRP, and MMP-9 concentrations correlated positively with duration of the disease and with glycosylated hemoglobin levels. CONCLUSIONS: Although the study adolescents with type 1 diabetes did not present any radiologic evidence of CAC at this stage of the disease, they remain a high-risk group for the development of microvascular and macrovascular artery disease, as risk factors such as elevated lipoproteins and proinflammatory markers are already present in a significant percentage of patients studied.

Primera experiencia en el país con un cheatham platinium numed stent (cp stent) para el tratamiento de la coartación de aorta / Firts experience in the country with a cheatham platinium numed stent (cp stent) by the treatment of the coarctation of the aorta

La colocación de "stents" endovascular provee de una fuerza de oposición al retroceso elástico de estenosis vasculares después del fracaso de una angioplastia por balón, además de servir de soporte a la pared del vaso. Por otra parte, permite el crecimiento de la capa endotelial y de esta manera, se reduce el riesgo de trombosis. Múltiples estudios han demostrado la utilidad y efectividad inmediata después de la colocación de "stents" para coartación o re coartación de aorta. Sin embargo, el uso de estructuras rígidas en un niño en crecimiento hace pensar en una importante limitante puesto que se trata de la adquisición de una estenosis por implante de un dispositivo con diámetro fijo. Más aún, estos pacientes pudieran desarrollar gradientes inducidos por ejercicio, a nivel de la lesión puesto que se trata de una estructura no dispensable. Como si esto no fuera suficiente, aún se desconoce el impacto de estos materiales en la vasculatura periférica y en la dinámica de flujo sanguíneo. En contrapartida, estos no son problemas cuando nos enfrentamos con un paciente en la edad adulta puesto que no esperamos realizar una nueva intervención después de haber logrado la completa abertura de malla metálica utilizada. En este artículo reflejamos la primera experiencia en el país con la utilización del "CP Numed stent" para este tipo de patología en una mujer de 26 años de edad. La paciente en cuestión presentaba un gradiente entre la aorta transversal y la aorta decendente de 59 mmHg. Después del procedimiento no se encontró gradiente alguno. El seguimiento de la misma seis meses después, por Doppler, pone de manifiesto estos excelentes resultados (eliminación del gradiente y de la necesidad de drogas antihipertensivas)