Amelanotic Melanoma Invading the Heart.

We present a case of a middle-aged woman who initially presented with shortness of breath but was ultimately found to have a large mass-like lesion in the right atrium of the heart with multi-modality imaging including cardiac computed tomography, cardiac magnetic resonance imaging, and echocardiogram. Biopsy results were positive for amelanotic melanoma. The patient underwent extensive debridement surgery, and she was started on chemotherapy with a close follow-up with an oncologist. In the setting of an aggressive course of disease, unfortunately, the patient passed away secondary to sudden cardiac arrest.  Cardiac melanoma, also known as melanoma of the heart, is an extremely rare type of melanoma that originates in the heart. This case attributes to the professional growth and competency of healthcare providers involved in the care of patients with cardiac melanoma, ultimately aiming to optimize patient outcomes and quality of life. Due to its rarity and the challenges associated with its diagnosis and treatment, prognosis for cardiac melanoma is generally poor. However, advancement in cancer research and treatment may offer hope for improved outcomes in some cases.

Pulmonary Embolism in Patients Admitted With Peripartum Cardiomyopathy: Prevalence, Predictors, and Associated In-Hospital Adverse Events.

Introduction Peripartum cardiomyopathy (PPCM) is defined as an idiopathic left ventricular failure with reduced ejection fraction (EF <45%) that affects women in the last month of pregnancy or in the months after giving birth. The pathophysiology remains elusive, resulting in complications with varied severity; one of the most concerning complications is thromboembolism, specifically pulmonary embolism (PE). The purpose of this study was to characterize and evaluate the real-world prevalence, predictors, and outcomes of PE in PPCM. Methods The data were derived from the National Inpatient Sample (NIS) database from January 2016 to December 2019. The primary outcomes assessed were baseline and hospital admission characteristics and comorbidities for patients with PPCM with or without PE. Outcomes for PPCM patients with PE and predictors of mortality for PPCM were also analyzed. Results PE developed in 105 of 4,582 patients with PPCM (2.3%). Patients with PPCM and PE had longer hospital stays (10.86 days ± 1.4 vs. 5.73 ± 0.2 days, p = 0.001) and total charges ($169,487 ± $39,628 vs. $86,116 ± $3,700, p = 0.001). Patients with PE had a higher burden of coagulopathy (13.3% vs. 3.0%, p = 0.01), intracardiac thrombus (6.7% vs. 1.6%, p = 0.01), and iron deficiency anemia (21.0% vs. 12.6%, p = 0.01). Patients without PE were found to have a higher burden of preeclampsia (14.7% vs. 1.9%, p = 0.01) and obstructive sleep apnea (5.4% vs. 1.0%, p = 0.045). Predictors of mortality in patients with PPCM included cardiogenic shock (aOR 13.42, 95% CI 7.50-24.03, p = 0.05), PE (aOR 6.60, 95% CI 2.506-17.39, p = 0.05), non-ST-elevation myocardial infarction (NSTEMI; aOR 3.57, 95% CI 1.35-9.44, p = 0.05), chronic kidney disease (aOR 3.23, 95% CI 1.68-6.22, p = 0.05), and atrial fibrillation (aOR 2.57; 95% CI 1.25-5.30, p = 0.05). Conclusion Although an uncommon complication, PE in PPCM demonstrates an association with higher mortality and financial burden. Along with PE, we found predictors of mortality in PPCM to include atrial fibrillation, NSTEMI, chronic kidney disease, and cardiogenic shock.

Radial Artery Occlusion After Transradial Access for Coronary Interventions.

Background Transradial access (TRA) is a medical procedure primarily used for percutaneous coronary interventions (PCI) and cardiac catheterization. Based on the recently published Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX (MATRIX) trial, TRA is being used more frequently than transfemoral access (TFA) since it has reduced rates of bleeding and fatality. A structural complication of TRA is radial artery occlusion (RAO), which may cause temporary pain to limit TRA in the future. Objective This study aimed to investigate the onset and risk factors of RAO following TRA for coronary interventions. Material and methods An observational study was conducted at Fauji Foundation Hospital in Peshawar, Pakistan. The study included 1,680 patients recruited between April 2021 to December 2023. Fifty-eight patients were lost to follow-up, while another 95 patients did not come for a visit within the study period. The final study, therefore, included 1,527 patients. Results The mean age of patients was 58.09 ± 8.07 years. Patients were divided into two age groups (greater or less than 60 years). Diagnostic angiograms were completed for 955 patients, while 572 also underwent PCI. The overall RAO onset was 81 (5.3%). There was a significantly higher RAO onset in patients over 60 years old (7.1 vs 3.8%, p = 0.003). Conclusion Overall, the risk of RAO is low following TRA. The risk of RAO is significantly higher in people aged over 60 years.

Immersive Innovations: Exploring the Diverse Applications of Virtual Reality (VR) in Healthcare.

Virtual reality (VR) has experienced a remarkable evolution over recent decades, evolving from its initial applications in specific military domains to becoming a ubiquitous and easily accessible technology. This thorough review delves into the intricate domain of VR within healthcare, seeking to offer a comprehensive understanding of its historical evolution, theoretical foundations, and current adoption status. The examination explores the advantages of VR in enhancing the educational experience for medical students, with a particular focus on skill acquisition and retention. Within this exploration, the review dissects the applications of VR across diverse medical disciplines, highlighting its role in surgical training and anatomy/physiology education. While navigating the expansive landscape of VR, the review addresses challenges related to technology and pedagogy, providing insights into overcoming technical hurdles and seamlessly integrating VR into healthcare practices. Additionally, the review looks ahead to future directions and emerging trends, examining the potential impact of technological advancements and innovative applications in healthcare. This review illuminates the transformative potential of VR as a tool poised to revolutionize healthcare practices.

Cor Adiposum as the Cause of Sudden Cardiac Death: A Case Report and Literature Review.

We present a case of sudden cardiac death in a 65-year-old patient who came to the emergency room with shortness of breath. The gross examination of the heart was significant for extensive left ventricular lipomatosis in association with myocardial fibrosis. Microscopic examination revealed extensive fatty replacement of the myocardial tissue throughout the entire thickness of the ventricular wall (transmural lipomatous myocardial remodeling). We suggest using the term "cor adiposum" to categorize this morphological condition when the transmural lipomatous transformation of the myocardium is present. The fatty replacement of the heart muscle would have led to impaired cardiac function, ultimately resulting in sudden cardiac death in this patient. We also hypothesize that the accumulation of fat in the myocardium might be a compensatory process to preserve ventricular wall compliance.

Generative Artificial Intelligence in Patient Education: ChatGPT Takes on Hypertension Questions.

Introduction Uncontrolled hypertension significantly contributes to the development and deterioration of various medical conditions, such as myocardial infarction, chronic kidney disease, and cerebrovascular events. Despite being the most common preventable risk factor for all-cause mortality, only a fraction of affected individuals maintain their blood pressure in the desired range. In recent times, there has been a growing reliance on online platforms for medical information. While providing a convenient source of information, differentiating reliable from unreliable information can be daunting for the layperson, and false information can potentially hinder timely diagnosis and management of medical conditions. The surge in accessibility of generative artificial intelligence (GeAI) technology has led to increased use in obtaining health-related information. This has sparked debates among healthcare providers about the potential for misuse and misinformation while recognizing the role of GeAI in improving health literacy. This study aims to investigate the accuracy of AI-generated information specifically related to hypertension. Additionally, it seeks to explore the reproducibility of information provided by GeAI. Method A nonhuman-subject qualitative study was devised to evaluate the accuracy of information provided by ChatGPT regarding hypertension and its secondary complications. Frequently asked questions on hypertension were compiled by three study staff, internal medicine residents at an ACGME-accredited program, and then reviewed by a physician experienced in treating hypertension, resulting in a final set of 100 questions. Each question was posed to ChatGPT three times, once by each study staff, and the majority response was then assessed against the recommended guidelines. A board-certified internal medicine physician with over eight years of experience further reviewed the responses and categorized them into two classes based on their clinical appropriateness: appropriate (in line with clinical recommendations) and inappropriate (containing errors). Descriptive statistical analysis was employed to assess ChatGPT responses for accuracy and reproducibility. Result Initially, a pool of 130 questions was gathered, of which a final set of 100 questions was selected for the purpose of this study. When assessed against acceptable standard responses, ChatGPT responses were found to be appropriate in 92.5% of cases and inappropriate in 7.5%. Furthermore, ChatGPT had a reproducibility score of 93%, meaning that it could consistently reproduce answers that conveyed similar meanings across multiple runs. Conclusion ChatGPT showcased commendable accuracy in addressing commonly asked questions about hypertension. These results underscore the potential of GeAI in providing valuable information to patients. However, continued research and refinement are essential to evaluate further the reliability and broader applicability of ChatGPT within the medical field.

An Unusual Presentation of Syncope in an Elderly Male Leading to a Diagnosis of an Anomalous Right Coronary Artery.

Various coronary artery anomalies have been identified in modern literature with most being benign in nature. Generally, these anomalous vessels are clinically silent due to their non-obstructive or benign course. It is vital to identify patients with malignant courses of these vessels as their initial presenting symptom might be sudden cardiac death. A 74-year-old male presented to the hospital following an episode of syncope and incontinence. Denying any symptoms of chest pain or shortness of breath, the patient did admit to having a six-month history of intermittent lightheadedness and one prior episode of syncope that was attributed to physical activity. Cardiac nuclear stress testing revealed a large reversible inferior wall defect indicating a defect with the right coronary artery. Cardiac catheterization demonstrated a history of coronary artery disease and revealed an anomalous origin of the right coronary artery. A coronary CT angiogram identified the right coronary artery as having an abnormal origin from the left sinus of Valsalva with a malignant interarterial route. The patient underwent a coronary artery bypass graft to correct the issue. There were no major postoperative complications. Treatment guidelines for patients suffering from malignant coronary artery anomalies are limited. Despite multiple surgical interventions available, data regarding conservative medical management is limited and should be of consideration in future studies.

Efficacy and Safety Profile of Ticagrelor Versus Clopidogrel in Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS): A Systematic Review and Meta-Analysis.

The utilization of individualized anti-platelet therapy is of paramount significance in this era of cardiovascular advancement. This meta-analysis is also aiming to get more information relating to the effectiveness of ticagrelor versus clopidogrel among patients undergoing percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). A comprehensive literature search was done through various databases like PubMed, Google Scholar, EMBASE, Web of Science, and the Cochrane Database Library from January 15, 2023, to February 23, 2023. After careful screening, eight articles with highly significant variables were involved in the synthesis of this meta-analysis. Data analysis was done through Review Manager (RevMan, Version 5.4; The Cochrane Collaboration, Copenhagen, Denmark). In our study, ticagrelor and clopidogrel were evaluated in 10614 and 14662 patients, respectively. Ticagrelor was significantly superior to Clopidogrel in terms of all-cause mortality (RR 0.79, 95% CI 0.69-0.91, p = 0.001), risk of MI (RR 0.74, 95% CI 0.61-0.89, p = 0.001), and stroke (RR 0.64, 95% CI 0.42-0.98, p = 0.04), but a higher risk of bleeding events was observed with Ticagrelor (RR 1.36, 95% CI 1.04-1.79, p = 0.03). The two regimens were comparable in terms of stent thrombosis. Ticagrelor was found to be best in terms of reducing post-PCI myocardial infarction, stroke, stent thrombosis, and all other mortality events in comparison to Clopidogrel. However, the bleeding events were of significant concern for the utilization of ticagrelor and required further investigations.

Meteorological Influence on Atrial Fibrillation and Flutter: A Nationwide Observational Study in South Korea (2010-2022).

Background and rationale The impact of meteorological factors, including atmospheric temperature, humidity, and wind speed, on the incidence of atrial fibrillation and flutter (AF) has been the subject of several studies, but the findings have been inconsistent. Given the complex and multifaceted nature of this relationship, a larger-scale study was necessary to provide sufficient statistical power and elucidate potential associations between them. The aim of this study was, thus, to investigate the potential associations between meteorological factors and the incidence of AF. Methods The South Korean government provides open access to national health insurance and weather data for its citizens; the data was available from January 2010 to July 2022. The national health insurance data includes the monthly number of patients diagnosed with a specific condition, reflecting the incidence and prevalence of the condition. Pearson correlation analyses were performed using the statistical analysis software, SAS® OnDemand for Academics (SAS Institute Inc., Cary, North Carolina, United States), to examine the association between each month's national average climate data and the number of patients diagnosed with AF. Results The number of patients diagnosed with AF in the total population showed a statistically significant correlation only with average wind speed (correlation coefficient (r)=-0.42, 95%CI -0.55 to -0.28, p<0.001) and sunshine duration (r=0.27, 95%CI 0.12 to 0.41, p<0.001). Among females aged 20-24 years, there was a statistically significant association with other variables, including average temperature, precipitation, humidity, and atmospheric pressure (p<0.05). Diurnal temperature variation showed inconsistent associations across different age and sex groups. Conclusion The number of patients diagnosed with AF is negatively correlated with average wind speed and positively correlated with sunshine duration in the general population, particularly among the elderly. There was no significant association between the number of patients diagnosed with AF and average temperature, precipitation, or humidity, except for females aged 20-24 years, who exhibited a significant association with these variables. However, it is important to note that these correlations do not establish causality.

Takotsubo Cardiomyopathy Induced by Stress From Amyotrophic Lateral Sclerosis and a Mechanical Fall.

Named after the Japanese octopus trap, Takotsubo cardiomyopathy is an acute myocardial condition characterized by a reversible ventricular dysfunction with ballooning of the left ventricle (LV) during systole. A catecholamine surge is likely the primary mechanism responsible for myocardial damage in this condition. The association between amyotrophic lateral sclerosis (ALS) and Takotsubo cardiomyopathy has not been well established. We present a unique case of Takotsubo cardiomyopathy diagnosed in a patient with ALS who presented after a fall with shortness of breath, generalized weakness, and hypotension. She was found to have troponinemia, elevated brain natriuretic peptide, and Osborn waves without ST-segment changes noted on electrocardiography (EKG). The diagnosis of Takotsubo cardiomyopathy was confirmed via transthoracic echocardiography (TTE), which revealed reduced left ventricular ejection fraction, apical ballooning of the LV, akinesis of the ventricular apex, and hyperkinesis of the base of the heart. Coronary angiography revealed no coronary artery disease. She was managed medically and was hemodynamically stable at the time of discharge.

Late Presentation of Acute Coronary Syndrome Complicated by Ventricular Septal Rupture.

Acquired ventricular septal rupture (VSR) is a rare but potentially fatal complication of late-presenting myocardial infarction (MI). In the era of revascularization and reperfusion therapy, the incidence of VSR has significantly decreased. Ruptures occur predominantly in patients with late-presenting ST elevation MI. Patients may present with a wide variety of symptoms ranging from chest pain and mild hemodynamic instability to profound cardiogenic shock. Inotropes, vasopressors, and mechanical support with intra-aortic balloon pumps and extracorporeal membrane oxygenation can be used to bridge patients to surgery. Despite treatment with ventricular septal repair, postsurgical mortality remains high. There is a wide variety of complications that can occur in the postoperative period. A multidisciplinary approach is vital in these patients who develop VSR. Improving awareness among healthcare professionals regarding the symptoms of acute coronary syndrome can hopefully help prevent delayed presentation of patients to healthcare facilities.

T-wave Inversions in Precordial Leads: A Case Study of Arrhythmogenic Right Ventricular Cardiomyopathy in a Patient With Recurrent Syncope.

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare sudden cardiac death (SCD) syndrome characterized by ventricular arrhythmias of right ventricular (RV) origin. This case follows the presentation of ARVC in an otherwise healthy 26-year-old male. The patient was observed for one week after being admitted from the emergency department secondary to pre-syncope with pathognomonic findings on his electrocardiogram (EKG), echocardiogram, and cardiac imaging. The patient was started on beta-blockers, which ultimately he could not tolerate due to bradycardia, and the recommendation of an automatic implantable cardioverter-defibrillator (AICD) was refused. He was discharged without any complications or ventricular arrhythmias on telemetry while hospitalized.

Sodium-Glucose Cotransporter-2 (SGLT-2) Inhibitors in Heart Failure: An Umbrella Review.

Heart failure remains a leading cause of hospitalization and death, and presents a significant challenge for healthcare providers despite the advancements in its management. This umbrella review aimed to pool the results of meta-analyses on the use of sodium-glucose cotransporter-2 (SGLT-2) inhibitors in the treatment of heart failure patients. A literature search was done on five databases: PubMed, Cochrane Library, Scopus, Global Index Medicus, and Science Direct for articles with full texts available online. Meta-analyses of five or more randomized controlled trials (RCTs) were included; the assessment of multiple systematic reviews (AMSTAR) was used to assess the quality of included studies. A systematic search identified 10 relevant meta-analyses of RCTs, with primary analyses including outcome data from 171,556 heart failure patients. A pooled review showed that SGLT-2 inhibitors significantly reduced the risk of heart failure hospitalization, cardiovascular death, mortality, serious adverse events, and improved quality of life. SGLT-2 inhibitors are likely safe and effective in managing patients with heart failure especially considering the acute outcomes.

Unmasking a Silent Killer and Understanding Sudden Cardiac Death in Brugada Syndrome: A Traditional Review.

Brugada syndrome (BrS) is an intricate and heterogeneous genetic disorder that engenders a formidable risk of life-threatening ventricular arrhythmias (VAs). While initially regarded as an electrophysiological aberration, emergent studies have illuminated the presence of underlying structural anomalies in select BrS cases. Although mutations in the SCN5A gene encoding the α-subunit of the cardiac sodium channel were originally identified as a primary causative factor; they account for only a fraction of the syndrome's multifaceted complexity pointing at genetic heterogeneity as a contributing factor. Remarkably, BrS has been linked to a higher incidence of fatal arrhythmic incidents and sudden cardiac death (SCD) with about 4% of SCD cases thought to be caused by BrS. Patients who spontaneously exhibit type one Brugada ECGs are more likely to experience cardiac events, emphasizing the importance of early risk stratification. To aid in risk stratification, the Shanghai score; a multifactorial risk stratification scoring system that incorporates ECG, clinical history, family history, and genetic test results; is utilized to identify those most susceptible to SCD. Beyond single ECGs, evaluation of arrhythmic findings from 24-hour Holter monitoring, ECG variables, electrophysiologic study (EPS) status in the temporal domain, and EPS data collected over time are all critical factors in risk classification. Among management options avoidance of triggers, early risk stratification, and implantation of an Implantable Cardioverter-Defibrillator (ICD) are recommended for asymptomatic patients. For symptomatic patients, pharmacotherapy and ICD implantation are available, with the latter being a highly effective choice for treating and preventing lethal arrhythmias in BrS.

Transesophageal Echocardiogram Before Cardioversion in Atrial Fibrillation Patients.

Transesophageal echocardiography (TEE) offers an invaluable, non-invasive avenue for diagnosing and managing various cardiac conditions, including atrial fibrillation (AF). As the most common cardiac arrhythmia, AF affects millions and can lead to severe complications. Cardioversion, a procedure to restore the heart's normal rhythm, is frequently conducted on AF patients resistant to medication. Due to inconclusive data, TEE's utility prior to cardioversion in AF patients remains ambiguous. Understanding TEE's potential benefits and limitations in this population could significantly influence clinical practice. This review aims to scrutinize the current literature on the use of TEE before cardioversion in AF patients. The principal objective is to understand TEE's potential benefits and limitations comprehensively. The study seeks to offer a clear understanding and practical recommendations for clinical practice, thereby improving the management of AF patients before cardioversion using TEE. A literature search of databases was conducted using the keywords "Atrial Fibrillation," "Cardioversion" and "Transesophageal echocardiography," resulting in 640 articles. These were narrowed to 103 following title and abstract reviews. After applying exclusion and inclusion criteria with a quality assessment, 20 papers were included: seven retrospective studies, 12 prospective observational studies, and one randomized controlled trial (RCT). Stroke risk associated with direct-current cardioversion (DCC) potentially results from post-cardioversion atrial stunning. Thromboembolic events occur post cardioversion, with or without prior atrial thrombus or cardioversion complications. Generally, cardiac thrombus localizes in the left atrial appendage (LAA), a clear contraindication to cardioversion. Atrial sludge without LAA thrombus in TEE is a relative contraindication. TEE before electrical cardioversion (ECV) in anticoagulated AF individuals is uncommon. In AF patients planned for cardioversion, contrast enhancement facilitates thrombus exclusion in TEE images, reducing embolic events. Left atrial thrombus (LAT) frequently occurs in AF patients, necessitating TEE examination. Despite the increased use of pre-cardioversion TEE, thromboembolic events persist. Notably, patients with post-DCC thromboembolic events had no LA thrombus or LAA sludge. The use of TEE-guided DCC has grown due to its ability to detect atrial thrombi pre-cardioversion, aiding risk stratification. Thrombus in the left atrium also signals an elevated risk of future thromboembolic events in AF patients. While atrial stunning post cardioversion detected by TEE is a significant risk factor for future thromboembolic events, further evidence is required. Therapeutic anticoagulation is essential during and post cardioversion, even if no atrial thrombus is detected. Current data recommends cardioversion guided by TEE, particularly in outpatient settings.

Misdiagnosed Seizure-Like Activity in a Patient With Postural Orthostatic Tachycardia Syndrome: A Case Report.

Postural orthostatic tachycardia is a syndrome characterized by an elevated heart rate in response to standing. This syndrome typically presents in late adolescence and early adulthood, with a higher percentage occurring in females. This syndrome is often seen following a viral infection, pregnancy, surgery, or intense psychological stress. This condition presents a wide range of symptoms that vary depending on its unclear etiology. We present the case of a 21-year-old woman with convulsions associated with postural orthostatic tachycardia syndrome after being misdiagnosed with a psychiatric condition for many years.

Exploring the Potential of Energy-Based Therapeutics (Photobiomodulation/Low-Level Laser Light Therapy) in Cardiovascular Disorders: A Review and Perspective.

Based on the review of the literature, this article examines the potential therapeutic benefits of photobiomodulation therapy (PBMT) or low-level laser therapy (LLLT) for the treatment of cardiovascular disorders. The methodology involved searching PubMed, Google Scholar, and Central databases for relevant articles published from inception till date. The articles included in this review were preclinical and clinical studies investigating the effects of PBMT and LLLT on the heart. The article summarizes the findings of nineteen studies investigating the effects of PBMT and LLLT on various parameters related to heart failure (HF) and myocardial infarction (MI), including inflammation, oxidative stress, angiogenesis, cardiac function, and remodeling. The studies suggest that PBMT and LLLT have potential therapeutic benefits for the treatment of cardiovascular diseases and could be used in combination with traditional pharmacological therapies to enhance their effects or as a stand-alone treatment for patients who are not responsive to or cannot tolerate traditional therapies. In conclusion, this review article highlights the promising potential of PBMT for the treatment of HF and MI and the need for further research to fully understand its mechanisms of action and optimize treatment protocols.

Peripartum Cardiomyopathy: A Case Series Emphasizing the Significance of Left Ventricular Global Longitudinal Strain Imaging.

Peripartum cardiomyopathy (PPCM) poses diagnostic and management challenges, while left ventricular global longitudinal strain (LV GLS) provides crucial insights into myocardial function. This case series explores the significance of LV GLS imaging in diagnosing and managing PPCM. Three distinct cases of varying severity highlight the significance of LV-GLS in assessing myocardial function during the peripartum period. Each case exhibited varying degrees of cardiac impairment, with LV GLS serving as a sensitive indicator of dysfunction. Treatment response, closely monitored through LV GLS changes, emphasizes the importance of this imaging technique in evaluating therapy efficacy. The discussion underscores deviations from traditional management approaches, emphasizing the need for personalized strategies in PPCM. Nonetheless, the study's limitations stress the need for broader research to validate these findings across diverse populations and settings, as well as long-term follow-up of the patients who had persistence of abnormal global longitudinal strain values despite recovery of left ventricular ejection fraction.

A Rent in the Left Ventricle: A Sea-Saw Between Life and Death.

Penetrating injuries to the precordium are life-threatening and require early detection and immediate intervention. We present a case of penetrating cardiac injury who presented with a definitive airway and hemodynamically unstable. During the primary survey, the patient had a cardiac arrest with pulseless ventricular tachycardia. The patient was resuscitated as per advanced cardiac life support (ACLS) and advanced trauma life support (ATLS) guidelines with manual digital compression at the penetrating site leading to a return of spontaneous circulation (ROSC). After ROSC, he was shifted for emergency explorative median sternotomy. During the sternotomy, we found a clotted rent in the anterior wall of the left ventricle, which was repaired. Aggressive resuscitation and appropriate management strategy in the emergency department (ED) resulted in a successful outcome, and he was discharged after 10 days of hospital stay. Our case highlights the importance of early diagnosing and managing penetrating cardiac trauma.

A Systematic Review of Post-COVID Electrocardiographic Changes in Young Athletes.

Post-coronavirus disease (COVID) syndrome involves the presentation of various new, returning, or ongoing symptoms, more than four weeks after COVID-19 infection. Post-infectious myocarditis is a potential sequela, associated with greater arrhythmogenic potential. Thus, it is an outcome that should be considered in athletes. An undiagnosed heart condition associated with adrenergic stimulus caused by high-intensity exercises can lead to sudden cardiac death. Electrocardiography (ECG) plays a role in cardiac screening for potential cardiac changes associated with myocarditis. Therefore, this study aimed to evaluate the occurrence of electrocardiographic alterations in athletes during the post-COVID period. A systematic review of longitudinal observational studies in the PubMed, LILACS, and CENTRAL databases that evaluated athletes in the post-COVID period with ECG was performed. A total of four articles involving 5371 patients were included in the analysis. The athletes mostly presented with mild asymptomatic or symptomatic COVID-19. A low prevalence of electrocardiographic alterations suggestive of cardiac involvement by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified in this population. Electrocardiographic abnormalities indicative of myocarditis are uncommon in young athletes throughout the post-COVID era. However, anomalies that may signify and need further cardiovascular testing were found.