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1.
J Cardiovasc Med (Hagerstown) ; 21(11): 874-881, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32941325

RESUMO

AIMS: The aim of this study was to report the prevalence, clinical features and outcomes of patients with ST-elevation myocardial infarction (STEMI) hospitalized during the Corona-Virus Disease 2019 (COVID-19) outbreak compared with those admitted in a previous equivalent period. METHODS AND RESULTS: Eighty-five patients admitted for STEMI at a high-volume Italian centre were included. Patients hospitalized during the COVID-19 outbreak (21 February-10 April 2020) (40%) were compared with those admitted in pre-COVID-19 period (3 January-20 February 2020) (60%). A 43% reduction in STEMI admissions was observed during the COVID-19 outbreak compared with the previous period. Time from symptom onset to first medical contact (FMC) and time from FMC to primary percutaneous coronary intervention (PPCI) were longer in patients admitted during the COVID-19 period compared with before [148 (79-781) versus 130 (30-185) min; P = 0.018, and 75 (59-148)] versus 45 (30-70) min; P < 0.001]. High-sensitive troponin T levels on admission were also higher. In-hospital mortality was 12% in the COVID-19 phase versus 6% in the pre-COVID-19 period. Incidence of the composite end-point, including free-wall rupture, severe left ventricular dysfunction, left ventricular aneurysm, severe mitral regurgitation and pericardial effusion, was higher during the COVID-19 than the pre-COVID-19 period (19.6 versus 41.2%; P = 0.030; odds ratio = 2.87; 95% confidence interval 1.09-7.58). CONCLUSION: The COVID-19 pandemic had a significant impact on the STEMI care system reducing hospital admissions and prolonging revascularization time. This translated into a worse patient prognosis due to more STEMI complications.


Assuntos
Infecções por Coronavirus , Aneurisma Cardíaco , Ruptura Cardíaca Pós-Infarto/epidemiologia , Pandemias , Intervenção Coronária Percutânea , Derrame Pericárdico , Pneumonia Viral , Infarto do Miocárdio com Supradesnível do Segmento ST , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Testes Diagnósticos de Rotina/estatística & dados numéricos , Feminino , Aneurisma Cardíaco/epidemiologia , Aneurisma Cardíaco/etiologia , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Derrame Pericárdico/epidemiologia , Derrame Pericárdico/etiologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Prevalência , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Tempo para o Tratamento/estatística & dados numéricos
2.
Am Heart J ; 228: 98-108, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32871329

RESUMO

About half of patients with acute ST-segment elevation myocardial infarction (STEMI) present with multivessel coronary artery disease (MVD). Recent evidence supports complete revascularization in these patients. However, optimal timing of non-culprit lesion revascularization in STEMI patients is unknown because dedicated randomized trials on this topic are lacking. STUDY DESIGN: The MULTISTARS AMI trial is a prospective, international, multicenter, randomized, two-arm, open-label study planning to enroll at least 840 patients. It is designed to investigate whether immediate complete revascularization is non-inferior to staged (within 19-45 days) complete revascularization in patients in stable hemodynamic conditions presenting with STEMI and MVD and undergoing primary percutaneous coronary intervention (PCI). After successful primary PCI of the culprit artery, patients are randomized in a 1:1 ratio to immediate or staged complete revascularization. The primary endpoint is a composite of all-cause death, non-fatal myocardial infarction, ischemia-driven revascularization, hospitalization for heart failure, and stroke at 1 year. CONCLUSIONS: The MULTISTARS AMI trial tests the hypothesis that immediate complete revascularization is non-inferior to staged complete revascularization in stable patients with STEMI and MVD.


Assuntos
Vasos Coronários , Intervenção Coronária Percutânea , Complicações Pós-Operatórias , Infarto do Miocárdio com Supradesnível do Segmento ST , Tempo para o Tratamento/normas , Angiografia Coronária/métodos , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Índice de Gravidade de Doença
3.
Indian Heart J ; 72(3): 192-193, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32768020

RESUMO

There has been a huge impact of the COVID-19 pandemic on global healthcare systems. Advisories across the world have appealed to people to stay at home and observe social distancing to slow down the pandemic. However it is important to realize as to how this is affecting acute cardiovascular care. Recent studies from Europe and USA have reported > 50% reduction in hospital admissions for ACS and declining rates of coronary interventions. The possible reasons for this noticeable reduction in patients with ACS/STEMI during the COVID-19 pandemic are multi-factorial. On one hand, it is due to change in thresholds for referring patients of ACS/STEMI for cardiac catheterization, with fibrinolysis being acceptable for many stable STEMI patients and conservative management being preferred for NSTEMI patients. Theories abound on how "staying at home" strategy may have led to an reduction in acute coronary events due to healthier lifestyle, better compliance and reduced stress. Realistically however, a more disquieting reason would be a "pseudo-reduction" ie. the incidence of ACS/STEMI is actually the same, but these patients are staying away from hospitals due to fear of contracting the infection. Lockdown restrictions have also limited transport options for patients seeking to reach hospitals in time. Healthcare systems need to be prepared for an anticipated downstream deluge of such untreated patients who may present with sequelae like heart failure, reinfarction, arrhythmias, mechanical complications etc. Scientific societies should have proactive campaigns to alleviate patient concerns, and encourage them to seek timely medical attention despite the COVID-19 pandemic.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Infecções por Coronavirus/epidemiologia , Hospitalização/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/organização & administração , Europa (Continente) , Feminino , Saúde Global , Humanos , Incidência , Controle de Infecções/métodos , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Medição de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Estados Unidos
5.
BMJ Case Rep ; 13(8)2020 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-32843473

RESUMO

The current COVID-19 crisis has significantly impacted healthcare systems worldwide. There has been a palpable increase in public avoidance of hospitals, which has interfered in timely care of critical cardiovascular conditions. Complications from late presentation of myocardial infarction, which had become a rarity, resurfaced during the pandemic. We present two such encounters that occurred due to delay in seeking medical care following myocardial infarction due to the fear of contracting COVID-19 in the hospital. Moreover, a comprehensive review of literature is performed to illustrate the potential factors delaying and decreasing timely presentations and interventions for time-dependent medical emergencies like ST-segment elevation myocardial infarction (STEMI). We emphasise that clinicians should remain vigilant of encountering rare and catastrophic complications of STEMI during this current era of COVID-19 pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência , Medo , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pneumonia Viral/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Tempo para o Tratamento , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
6.
Am J Cardiol ; 131: 1-6, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32732010

RESUMO

There is limited information regarding clinical characteristics and outcomes of patients with SARS-CoV-2 (COVID-19) disease presenting with ST-segment elevation myocardial infarction (STEMI). In this multicenter retrospective study, we reviewed charts of patients admitted with symptomatic COVID-19 infection and STEMI to a total of 4 hospitals spanning Italy, Lithuania, Spain and Iraq from February 1, 2020 to April 15, 2020. A total of 78 patients were included in this study, 49 (63%) of whom were men, with a median age of 65 [58, 71] years, and high comorbidity burden. During hospitalization, 8 (10%) developed acute respiratory distress syndrome, and 14 (18%) required mechanical ventilation. 19 (24%) patients were treated with primary Percutaneous Coronary Intervention (PCI) and 59 (76%) were treated with fibrinolytic therapy. 13 (17%) patients required cardiac resuscitation, and 9 (11%) died. For the 19 patients treated with primary PCI, 8 (42%) required intubation and 8 (42%) required cardiac resuscitation; stent thrombosis occurred in 4 patients (21%). A total of 5 patients (26%) died during hospitalization. 50 (85%) of the 59 patients initially treated with fibrinolytic therapy had successful fibrinolysis. The median time to reperfusion was 27 minutes [20, 34]. Hemorrhagic stroke occurred in 5 patients (9%). Six patients (10%) required invasive mechanical ventilation; 5 (9%) required cardiac resuscitation, and 4 (7%) died. In conclusion, this is the largest case series to-date of COVID-19 positive patients presenting with STEMI and spans 4 countries. We found a high rate of stent thrombosis, indicating a possible need to adapt STEMI management for COVID-19 patients.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Fibrinolíticos/uso terapêutico , Intervenção Coronária Percutânea/métodos , Pneumonia Viral/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Terapia Trombolítica/métodos , Idoso , Angiografia Coronária , Infecções por Coronavirus/epidemiologia , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Espanha/epidemiologia , Taxa de Sobrevida/tendências , Resultado do Tratamento
7.
PLoS One ; 15(8): e0236866, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760080

RESUMO

INTRODUCTION: Influenza may precipitate cardiovascular disease, but influenza typically peaks in winter, coinciding with other triggers of myocardial infarction (MI) such as low air temperature, high wind velocity, low atmospheric pressure, and short sunshine duration. OBJECTIVE: We aimed to determine the relationship of week-to-week variation in influenza cases and acute MI, controlling for meteorological factors in a nationwide population. METHODS: Weekly laboratory-confirmed influenza case reports were obtained from the Public Health Agency of Sweden from 2009 to 2016 and merged with the nationwide SWEDEHEART MI registry. Weekly incidence of MI was studied with regard to number of influenza cases stratified into tertiles of 0-16, 17-164, and >164 cases/week. Incidence rate ratios (IRR) were calculated using a count regression model for each category and compared to a non-influenza period as reference, controlling for air temperature, atmospheric pressure, wind velocity, and sunshine duration. RESULTS: A total of 133562 MI events was reported to the registry during the study period. Weeks with influenza cases were associated with higher incidence of MI than those without in unadjusted analysis for overall MI, ST-elevation MI and non ST-elevation MI independently. During the influenza season, weeks with 0-16 reported cases/week were not associated with MI incidence after adjusting for weather parameters, adjusted IRR for MI was 1.03 (95% CI 1.00-1.06, P = 0.09). However, weeks with more cases reported were associated with MI incidence: 17-163 reported cases/week, adjusted IRR = 1.05 (95% CI 1.02-1.08, P = 0.003); and for ≥164 cases/week, the IRR = 1.06 (95% CI 1.02-1.09, P = 0.002). Results were consistent across a large range of subgroups. CONCLUSIONS: In this nationwide observational study, we found an association of incidence of MI with incidence of influenza cases beyond what could be explained by meteorological factors.


Assuntos
Influenza Humana/diagnóstico , Infarto do Miocárdio/diagnóstico , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Incidência , Influenza Humana/complicações , Influenza Humana/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Sistema de Registros , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Suécia/epidemiologia
8.
S Afr Med J ; 110(4): 327-331, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32657746

RESUMO

BACKGROUND: ST-segment elevation myocardial infarction (STEMI) is one of the main contributors to morbidity and mortality in South Africa (SA). Timeous intervention by means of percutaneous coronary intervention (PCI) or fibrinolysis can significantly improve the outcome of STEMI. OBJECTIVES: To determine the median time interval between diagnosis and fibrinolysis in patients presenting to centres within the drainage area of Tygerberg Hospital, Cape Town, SA, and compare it with the European Society of Cardiology (ESC) recommendation of 10 minutes. METHODS: A retrospective medical record review of patients presenting to the abovementioned centres between 1 March 2017 and 28 February 2018 was performed. The primary presenting centre, time between diagnosis and fibrinolysis and discharge medication were recorded, in addition to other relevant demographic information. RESULTS: A total of 492 patients were identified, of whom 447 were included in the study. Three hundred and eighteen patients received fibrinolysis, of whom 18 (5.7%) were treated within 10 minutes of diagnosis. The median time interval between diagnosis and fibrinolysis was 67 (interquartile range (IQR) 32.5 -122.5) minutes. CONCLUSIONS: Most patients received fibrinolysis >10 minutes after diagnosis, which indicates suboptimal therapy when compared with the ESC guidelines. Future studies should investigate the factors prolonging this therapeutic delay.


Assuntos
Instituições de Assistência Ambulatorial , Hospitais de Distrito , Hospitais Privados , Transferência de Pacientes , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Centros de Atenção Terciária , Terapia Trombolítica/métodos , Tempo para o Tratamento/estatística & dados numéricos , Centros Médicos Acadêmicos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , África do Sul
9.
Arch Cardiovasc Dis ; 113(6-7): 443-447, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32636131

RESUMO

BACKGROUND: How coronavirus 2019 (COVID-19) is affecting management of myocardial infarction is a matter of concern, as medical resources have been massively reorientated and the population has been in lockdown since 17 March 2020 in France. AIMS: To describe how lockdown has affected the evolution of the weekly rate of myocardial infarctions (non-ST-segment and ST-segment elevation) hospital admissions in Lyon, the second largest city in France. To verify the trend observed, the same analysis was conducted for an identical time window during 2018-2019 and for an unavoidable emergency, i.e. birth. METHODS: Based on the national hospitalisation database [Programme de médicalisation des systèmes d'information (PMSI)], all patients admitted to the main public hospitals for a principal diagnosis of myocardial infarction or birth during the 2nd to the 14th week of 2020 were included. These were compared with the average number of patients admitted for the same diagnosis during the same time window in 2018 and 2019. RESULTS: Before lockdown, the number of admissions for myocardial infarction in 2020 differed from that in 2018-2019 by less than 10%; after the start of lockdown, it decreased by 31% compared to the corresponding time window in 2018-2019. Conversely, the numbers of births remained stable across years and before and after the start of lockdown. CONCLUSION: This study strongly suggests a decrease in the number of admissions for myocardial infarction during lockdown. Although we do not have a long follow-up to determine whether this trend will endure, this is an important warning for the medical community and health authorities.


Assuntos
Infecções por Coronavirus/epidemiologia , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Admissão do Paciente/tendências , Pneumonia Viral/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , França/epidemiologia , Humanos , Incidência , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Prognóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Fatores de Tempo , Virulência
12.
Clin Med (Lond) ; 20(5): e170-e172, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32719037

RESUMO

During the current SARS-CoV-2 pandemic the restructure of healthcare services to meet the huge increase in demand for hospital resource and capacity has led to the proposal that where necessary ST elevation myocardial infarction (STEMI) could be managed by intravenous thrombolysis in the first instance as a means of reducing the workforce requirements of a primary angioplasty service run at a heart attack centre. Our modelling, based on data from the UK, shows that contrary to reducing demand, the effect on both mortality and bed occupancy would be negative with 158 additional deaths per year for each 10% reduction in primary angioplasty and at a cost of ~8,000 additional bed days per year for the same reduction. Our analysis demonstrates that specialist services such as heart attack pathways should be protected during the COVID crisis to maximise the appropriate use of resource and prevent unnecessary mortality.


Assuntos
Ocupação de Leitos/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Terapia Trombolítica/estatística & dados numéricos , Idoso , Infecções por Coronavirus/prevenção & controle , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Pandemias/prevenção & controle , Intervenção Coronária Percutânea/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Medição de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Síndrome Respiratória Aguda Grave/epidemiologia , Síndrome Respiratória Aguda Grave/prevenção & controle , Terapia Trombolítica/métodos , Reino Unido
13.
Angiology ; 71(10): 894-902, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32643400

RESUMO

The prevalence of coronary artery disease is increasing in young adults. We evaluated the outcomes of different types of acute coronary syndrome in 917 patients undergoing coronary angiography aged ≤45 years. Male sex, smoking, dyslipidemia were the most important risk factors. ST-elevation myocardial infarction (STEMI; 54.8%) predominated. The STEMI patients had higher risk of hospital mortality (3.6% vs 0.6%; P = .004) and major adverse cardiac and cerebrovascular events (MACCE; 13.8% vs 3.3%; P < .001, hazard ratio [HR], 4.65; 95% CI, 2.45-8.82). Presentation heart rate, blood pressure, heart failure, shock, arrhythmia, ejection fraction (EF), diabetes, contrast-induced nephropathy (CIN), and elevated troponin were associated with hospital mortality and MACCE. But only heart failure (HR, 5.816; 95% CI, 2.254-15.008) and CIN (HR, 6.241; 95% CI, 2.340-16.641) were independent risk factors for hospital MACCE. There was no difference in long-term mortality between the 2 groups, but non-STEMI patients had higher risk for MACCE after 3 years (14.4% vs 9.9%, P = .033). Although shock (HR, 0.814; 95% CI, 0.699-0.930), Killip class ≥2 (HR, 0.121; 95% CI, 0.071-0.170), CIN (HR, 0.323; 95% CI, 0.265-0.380), and EF (HR, 0.917; 95% CI, 0.854-0.984) were independent predictors of hospital death, only EF was the independent predictor of long-term mortality (HR, 0.897; 95% CI, 0.852-0.944).


Assuntos
Síndrome Coronariana Aguda/complicações , Síndrome Coronariana Aguda/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Síndrome Coronariana Aguda/mortalidade , Adulto , Fatores Etários , Angiografia Coronária , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
14.
Can J Cardiol ; 36(8): 1326.e9-1326.e11, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32599017

RESUMO

A wide spectrum of cardiovascular manifestations has been documented in patients suffering from coronavirus disease-2019 (COVID-19). Usually associated with a poor prognoses, these manifestations include thromboembolic events, acute coronary syndrome, heart failure, and cardiogenic shock. We describe a patient with COVID-19 who presented with subacute myocardial infarction, biventricular thrombi, and bilateral pulmonary emboli. Biventricular thrombi are rare, and their presence raises concern for an underlying prothrombotic condition.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Aneurisma Cardíaco , Ventrículos do Coração , Pandemias , Pneumonia Viral , Embolia Pulmonar , Infarto do Miocárdio com Supradesnível do Segmento ST , Trombose , Anticoagulantes/administração & dosagem , Reanimação Cardiopulmonar/métodos , Deterioração Clínica , Angiografia Coronária/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/fisiopatologia , Evolução Fatal , Feminino , Aneurisma Cardíaco/diagnóstico , Aneurisma Cardíaco/etiologia , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/patologia , Humanos , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Trombose/diagnóstico , Trombose/tratamento farmacológico , Trombose/etiologia , Tomografia Computadorizada por Raios X/métodos , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologia
15.
G Ital Cardiol (Rome) ; 21(7): 502-508, 2020 Jul.
Artigo em Italiano | MEDLINE | ID: mdl-32555565

RESUMO

During the early phase of the lockdown following the COVID-19 pandemic, an alarm on the impact on cardiology admissions for cardiac causes, particularly in the field of acute coronary syndromes (ACS), has emerged. In order to evaluate this trend, we analyzed the literature data published since the beginning of the COVID-19 pandemic to date, in addition to our intensive cardiac care unit (ICCU) experience. This analysis showed (i) a reduction of the overall ICCU admissions up to 50%; (ii) a 40-50% reduction of ACS admissions, greater for non-ST-elevation myocardial infarction (NSTEMI) than for ST-elevation myocardial infarction (STEMI); (iii) a reduction greater than 50% of coronary angiography and percutaneous coronary angioplasty; (iv) a higher time delay of STEMI; and (v) a higher number of ICCU admissions for non-primarily cardiac problems. In conclusion, the lockdown imposed due to the spread of COVID-19 infection has led to a change in the number and type of cardiology admissions. It seems therefore necessary that patients, especially for time-dependent diseases such as ACS, continue to refer to hospital care; that contemporary standard of care for acute cardiac disease should be guaranteed, and that intensivist cardiologists acquire specific skills for the treatment of patients with clinical conditions normally treated by other specialists.


Assuntos
Síndrome Coronariana Aguda/terapia , Angioplastia Coronária com Balão/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Síndrome Coronariana Aguda/diagnóstico , Idoso , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Feminino , Mortalidade Hospitalar , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Itália , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Medição de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Análise de Sobrevida
17.
Crit Pathw Cardiol ; 19(2): 49-54, 2020 06.
Artigo em Inglês | MEDLINE | ID: covidwho-158057

RESUMO

Novel coronavirus-19 disease (COVID-19) is an escalating, highly infectious global pandemic that is quickly overwhelming healthcare systems. This has implications on standard cardiac care for ST-elevation myocardial infarctions (STEMIs). In the setting of anticipated resource scarcity in the future, we are forced to reconsider fibrinolytic therapy in our management algorithms. We encourage clinicians to maintain a high level of suspicion for STEMI mimics, such as myopericarditis which is a known, not infrequent, complication of COVID-19 disease. Herein, we present a pathway developed by a multidisciplinary panel of stakeholders at NewYork-Presbyterian/Columbia University Irving Medical Center for the management of STEMI in suspected or confirmed COVID-19 patients.


Assuntos
Infecções por Coronavirus/diagnóstico , Procedimentos Clínicos/normas , Controle de Infecções/normas , Pneumonia Viral/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Efeitos Psicossociais da Doença , Assistência à Saúde/normas , Humanos , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde
20.
Crit Pathw Cardiol ; 19(2): 49-54, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32356955

RESUMO

Novel coronavirus-19 disease (COVID-19) is an escalating, highly infectious global pandemic that is quickly overwhelming healthcare systems. This has implications on standard cardiac care for ST-elevation myocardial infarctions (STEMIs). In the setting of anticipated resource scarcity in the future, we are forced to reconsider fibrinolytic therapy in our management algorithms. We encourage clinicians to maintain a high level of suspicion for STEMI mimics, such as myopericarditis which is a known, not infrequent, complication of COVID-19 disease. Herein, we present a pathway developed by a multidisciplinary panel of stakeholders at NewYork-Presbyterian/Columbia University Irving Medical Center for the management of STEMI in suspected or confirmed COVID-19 patients.


Assuntos
Infecções por Coronavirus/diagnóstico , Procedimentos Clínicos/normas , Controle de Infecções/normas , Pneumonia Viral/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Efeitos Psicossociais da Doença , Assistência à Saúde/normas , Humanos , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde
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