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1.
Pediatr Rheumatol Online J ; 19(1): 29, 2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33726806

RESUMO

BACKGROUND: There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities. METHODS: The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group - KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients' outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS "Burlo Garofolo", Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups. RESULTS: One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p < 0.0001). SARS-CoV-2 assay more often resulted positive in KCG than in KDG (75,5% vs 20%; p < 0.0001). Short-term follow data showed minor complications. Comparing KDG with a KD-Historical Italian cohort (598 patients), no statistical difference was found in terms of clinical manifestations and laboratory data. CONCLUSION: Our study suggests that SARS-CoV-2 infection might determine two distinct inflammatory diseases in children: KD and PIMS-TS. Older age at onset and clinical peculiarities like the occurrence of myocarditis characterize this multi-inflammatory syndrome. Our patients had an optimal response to treatments and a good outcome, with few complications and no deaths.


Assuntos
/fisiopatologia , Doença da Artéria Coronariana/fisiopatologia , Hipotensão/fisiopatologia , Linfopenia/fisiopatologia , Síndrome de Linfonodos Mucocutâneos/fisiopatologia , Miocardite/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/fisiopatologia , Distribuição por Idade , Antirreumáticos/uso terapêutico , Aspirina/uso terapêutico , Proteína C-Reativa/metabolismo , /metabolismo , Criança , Pré-Escolar , Tosse/fisiopatologia , Diarreia/fisiopatologia , Dispneia/fisiopatologia , Feminino , Glucocorticoides/uso terapêutico , Insuficiência Cardíaca/fisiopatologia , Humanos , /fisiopatologia , Imunoglobulinas Intravenosas/uso terapêutico , Fatores Imunológicos/uso terapêutico , Lactente , Unidades de Terapia Intensiva Pediátrica , Proteína Antagonista do Receptor de Interleucina 1/uso terapêutico , Itália/epidemiologia , Masculino , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Síndrome de Linfonodos Mucocutâneos/metabolismo , Síndrome de Linfonodos Mucocutâneos/terapia , Inibidores da Agregação de Plaquetas/uso terapêutico , Choque/fisiopatologia , Síndrome de Resposta Inflamatória Sistêmica/epidemiologia , Síndrome de Resposta Inflamatória Sistêmica/metabolismo , Síndrome de Resposta Inflamatória Sistêmica/terapia , Taquipneia/fisiopatologia , Troponina T/metabolismo , Vômito/fisiopatologia
2.
Harefuah ; 160(2): 94-97, 2021 Feb.
Artigo em Hebraico | MEDLINE | ID: mdl-33760410

RESUMO

INTRODUCTION: Rheumatic fever (RF) is an autoinflammatory disease that is caused by the host response to an infection with group A ß-hemolytic streptococcus. In this case report we describe a 15 years old boy with Down syndrome who had unusual presentation of acute rheumatic fever with a fulminant multisystemic which included heart failure secondary to pancarditis and adult respiratory distress syndrome. The final diagnosis was confirmed after cardiac biopsy that was performed during valve replacement surgery and demonstrated Aschoff bodies - a pathognomonic finding in acute rheumatic fever.


Assuntos
Insuficiência Cardíaca , Doenças das Valvas Cardíacas , Miocardite , Febre Reumática , Adolescente , Adulto , Biópsia , Humanos , Masculino , Febre Reumática/diagnóstico
3.
J Investig Med High Impact Case Rep ; 9: 2324709621999954, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33686899

RESUMO

Severe acute respiratory syndrome coronavirus 2 causes coronavirus disease 2019 (COVID-19), which has become a global pandemic. Apart from the mild features of the disease, long-term complications involve many systems including both endocrine and cardiovascular systems. Myocarditis, secondary to COVID-19, has become a well-known complication of the disease. However, endocrine complications are generally not common, particularly isolated pituitary abnormalities. There is one other report of diabetes insipidus developing as a late sequela of COVID-19. In this article, we report a case of a young male who presented with features of myocarditis but developed diabetes insipidus on day 7 of admission as a long-term complication after recovery from COVID-19 infection. His laboratory test results at the time of developing the complication revealed a high serum sodium level and low urine osmolality. The patient recovered on administration of desmopressin and was discharged after 16 days of hospitalization.


Assuntos
/complicações , Diabetes Insípido/etiologia , Miocardite/virologia , Adulto , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , Concentração Osmolar , Sódio/sangue , Tomografia Computadorizada por Raios X , Urina/química
5.
Medicine (Baltimore) ; 100(8): e24552, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663062

RESUMO

ABSTRACT: Although myocarditis can be a severe cardiac complication of COVID-19 patients, few data are available in the literature about the incidence and clinical significance in patients affected by SARS-CoV-2. This study aims to describe the prevalence and the clinical features of suspected myocarditis in 3 cohorts of patients hospitalized for COVID-19. We retrospectively evaluated all the consecutive patients admitted for COVID-19 without exclusion criteria. Suspect myocarditis was defined according to current guidelines. Age, sex, in-hospital death, length of stay, comorbidities, serum cardiac markers, interleukin-6, electrocardiogram, echocardiogram, and therapy were recorded. Between March 4 to May 20, 2020, 1169 patients with COVID-19 were admitted in 3 Italian Medicine wards. 12 patients (1%) had suspected acute myocarditis; 5 (41.7%) were men, mean age was 76 (SD 11.34; median 78.5 years); length of stay was 38 days on average (SD 8, median value 37.5); 3 (25%) patients died. 8 (66.7%) had a history of cardiac disease; 7 (58.33%) patients had other comorbidities like diabetes, chronic obstructive pulmonary disease, or renal insufficiency. Myocarditis patients had no difference in sex prevalence, rate of death, comorbidities, elevations in serum cardiac markers as compared with patients without myocardial involvement. Otherwise, there was a significantly higher need for oxygen-support and a higher prevalence of cardiac disease in the myocarditis group. Patients with suspected myocarditis were older, had a higher frequency of previous cardiac disease, and significantly more prolonged hospitalization and a lower value of interleukin-6 than other COVID-19 patients. Further studies, specifically designed on this issue, are warranted.


Assuntos
/complicações , Miocardite/etiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , /fisiopatologia , Comorbidade , Eletrocardiografia , Feminino , Mortalidade Hospitalar , Humanos , Interleucina-6/sangue , Itália/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Miocardite/fisiopatologia , Oxigenoterapia , Estudos Retrospectivos , Fatores Sexuais
7.
Recenti Prog Med ; 112(3): 191-194, 2021 03.
Artigo em Italiano | MEDLINE | ID: mdl-33687357

RESUMO

Observational studies of cardiac magnetic resonance imaging in people with recent covid-19, including young asymptomatic athletes, have documented variable amounts of myocardial findings deemed suggestive of myocarditis. Despite a critical appraisal of the current literature points toward an insufficient evidence base about the existence of a peculiar association between covid-19 and myocarditis, the concern for unrecognized myocarditis and its potential consequences has led several sports medicine organizations to recommend a variety of cardiac tests to enable return to play in athletes with previous covid-19. We argue that some of these recommendations may lead to unnecessary tests or treatments, especially for asymptomatic SARS-CoV-2 positive people and for those with previous mild disease, and that sports participation may even be discouraged. As a response to current uncertainty, we advocate both for randomized studies that analyse the outcomes of different diagnostic strategies and for a prolonged follow-up of these people.


Assuntos
Medicina , Miocardite , Médicos , Atletas , Humanos , Miocardite/diagnóstico , Miocardite/terapia , Volta ao Esporte
9.
Handb Clin Neurol ; 177: 111-123, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33632429

RESUMO

Myocarditis, a nonischemic acquired cardiomyopathy, is an uncommon condition with multiple presentation patterns which may be initially difficult to recognize and may simulate other conditions such as acute myocardial infarction, pericarditis, septicemia, etc. There are four distinct clinical presentation patterns that include: (1) low-grade nonspecific symptoms such as fatigue; (2) symptoms that resemble an acute myocardial infarction, especially in younger individuals; (3) a heart failure presentation which may be acute, subacute, or chronic and may be associated with cardiac conduction system defects and arrhythmias; and (4) an arrhythmia presentation that may produce sudden cardiac death, especially in young athletes with minimal or no prodromal symptoms. This chapter will provide a brief overview of various myocarditis etiologies and diagnostic modalities. The ultimate focus will be directed toward neurologic manifestations of myocarditis and its subtypes, complications of specific therapies including extracorporeal membrane oxygenation (ECMO) for refractory heart failure, and review the current literature regarding the appropriate use of therapeutic anticoagulation in myocarditis and heart failure for stroke prevention. Covid-19 infection has been discovered to cause myocarditis. The emerging science will be discussed. Nuances of brain death (BD) determination in patients receiving venoarterial ECMO for heart failure refractory to standard medical therapies will be discussed.


Assuntos
/complicações , Miocardite/complicações , Doenças do Sistema Nervoso/etiologia , Oxigenação por Membrana Extracorpórea , Humanos , Miocardite/etiologia , Miocardite/terapia , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/terapia
11.
Rev Soc Bras Med Trop ; 54: e07892020, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33533821

RESUMO

Covid-19 is a novel infectious disease whose spectrum of presentation ranges from absence of symptoms to widespread interstitial pneumonia associated with severe acute respiratory syndrome (SARS), leading to significant mortality. Given the systemic pattern of Covid-19, there are many factors that can influence patient's functional capacity after acute infection and the identification of such factors can contribute to the development of specific rehabilitation strategies. Pulmonary impairment is the primary cause of hospitalization due to Covid-19, and can progress to SARS as well as increase length of hospitalization. Moreover, cardiac involvement is observed in approximately 30% of hospitalized patients, with an increased risk of acute myocarditis, myocardial injury, and heart failure, which may compromise functional capacity in the long-term. Thromboembolic complications have also been reported in some patients with Covid-19 and are associated with a poor prognosis. Musculoskeletal complications may result from long periods of hospitalization and immobility, and can include fatigue, muscle weakness and polyneuropathy. Studies that address the functional capacity of patients after Covid-19 infection are still scarce. However, based on knowledge from the multiple systemic complications associated with Covid-19, it is reasonable to suggest that most patients, especially those who underwent prolonged hospitalization, will need a multiprofessional rehabilitation program. Further studies are needed to evaluate the functional impact and the rehabilitation strategies for patients affected by Covid-19.


Assuntos
Insuficiência Cardíaca , Miocardite , Hospitalização , Humanos
14.
Stem Cell Res ; 51: 102168, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33485182

RESUMO

COVID-19 caused by a novel coronavirus named SARS-CoV-2, can elites severe acute respiratory syndrome, severe lung injury, cardiac injury, and even death and became a worldwide pandemic. SARS-CoV-2 infection may result in cardiac injury via several mechanisms, including the expression of angiotensin-converting enzyme 2 (ACE2) receptor and leading to a cytokine storm, can elicit an exaggerated host immune response. This response contributes to multi-organ dysfunction. As an emerging infectious disease, there are limited data on the effects of this infection on patients with underlying cardiovascular comorbidities. In this review, we summarize the early-stage clinical experiences with COVID-19, with particular focus on patients with cardiovascular diseases and cardiopulmonary injuries, and explores potential available evidence regarding the association between COVID-19, and cardiovascular complications.


Assuntos
/patologia , Doenças Cardiovasculares/complicações , Cardiopatias/complicações , Animais , /transmissão , Síndrome da Liberação de Citocina/etiologia , Cardiopatias/prevenção & controle , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/prevenção & controle , Humanos , Miocardite/complicações , Miocardite/prevenção & controle , /isolamento & purificação
15.
Arterioscler Thromb Vasc Biol ; 41(3): 1019-1031, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33472401

RESUMO

Drug-induced cardiotoxicity is a significant clinical issue, with many drugs in the market being labeled with warnings on cardiovascular adverse effects. Treatments are often prematurely halted when cardiotoxicity is observed, which limits their therapeutic potential. Moreover, cardiotoxicity is a major reason for abandonment during drug development, reducing available treatment options for diseases and creating a significant financial burden and disincentive for drug developers. Thus, it is important to minimize the cardiotoxic effects of medications that are in use or in development. To this end, identifying patients at a higher risk of developing cardiovascular adverse effects for the drug of interest may be an effective strategy. The discovery of human induced pluripotent stem cells has enabled researchers to generate relevant cell types that retain a patient's own genome and examine patient-specific disease mechanisms, paving the way for precision medicine. Combined with the rapid development of pharmacogenomic analysis, the ability of induced pluripotent stem cell-derivatives to recapitulate patient-specific drug responses provides a powerful platform to identify subsets of patients who are particularly vulnerable to drug-induced cardiotoxicity. In this review, we will discuss the current use of patient-specific induced pluripotent stem cells in identifying populations who are at risk to drug-induced cardiotoxicity and their potential applications in future precision medicine practice. Graphic Abstract: A graphic abstract is available for this article.


Assuntos
Cardiotoxicidade/etiologia , Cardiotoxinas/toxicidade , Células-Tronco Pluripotentes Induzidas/efeitos dos fármacos , Arritmias Cardíacas/induzido quimicamente , Avaliação Pré-Clínica de Medicamentos/métodos , Marcadores Genéticos , Humanos , Células-Tronco Pluripotentes Induzidas/patologia , Células-Tronco Pluripotentes Induzidas/fisiologia , Contração Miocárdica/efeitos dos fármacos , Miocardite/induzido quimicamente , Miócitos Cardíacos/efeitos dos fármacos , Miócitos Cardíacos/patologia , Miócitos Cardíacos/fisiologia , Testes Farmacogenômicos/métodos , Polimorfismo de Nucleotídeo Único , Medicina de Precisão/métodos , Fatores de Risco
17.
J Med Case Rep ; 15(1): 31, 2021 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-33494822

RESUMO

BACKGROUND: Previous reports have shown various cardiac complications to be associated with COVID-19 including: myocardial infarction, microembolic complications, myocardial injury, arrythmia, heart failure, coronary vasospasm, non-ischemic cardiomyopathy, stress (Takotsubo) cardiomyopathy, pericarditis and myocarditis. These COVID-19 cardiac complications were associated with respiratory symptoms. However, our case illustrates that COVID-19 myopericarditis with cardiac tamponade can present without respiratory symptoms. CASE PRESENTATION: A 58-year-old Caucasian British woman was admitted with fever, diarrhoea and vomiting. She developed cardiogenic shock and Transthoracic echocardiogram (TTE) found a pericardial effusion with evidence of cardiac tamponade. A nasopharyngeal swab showed a COVID-19 positive result, despite no respiratory symptoms on presentation. A pericardial drain was inserted and vasopressor support required on intensive treatment unit (ITU). The drain was removed as she improved, an antibiotic course was given and she was discharged on day 12. CONCLUSIONS: Our case demonstrates that patients without respiratory symptoms could have COVID-19 and develop cardiac complications. These findings can aid timely diagnosis of potentially life-threatening COVID-19 myopericarditis with cardiac tamponade.


Assuntos
/complicações , Tamponamento Cardíaco/etiologia , Miocardite/etiologia , Pericardite/etiologia , Feminino , Humanos , Pessoa de Meia-Idade
18.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431479

RESUMO

Here we present the case of a 37-year-old previously healthy man who developed fever, headache and a unilateral, painful neck swelling while working offshore. He had no known contact with anyone with COVID-19; however, due to the ongoing pandemic, a nasopharyngeal swab was performed, which was positive for the virus. After transfer to hospital for assessment his condition rapidly deteriorated, requiring admission to intensive care for COVID-19 myocarditis. One week after discharge he re-presented with unilateral facial nerve palsy. Our case highlights an atypical presentation of COVID-19 and the multifaceted clinical course of this still poorly understood disease.


Assuntos
Alcalose Respiratória/sangue , Paralisia de Bell/fisiopatologia , Miocardite/fisiopatologia , Adulto , Alcalose Respiratória/etiologia , Gasometria , Proteína C-Reativa/metabolismo , /terapia , Ecocardiografia , Edema/etiologia , Eletrocardiografia , Humanos , Hipotensão/etiologia , Hipotensão/fisiopatologia , Linfadenite/etiologia , Linfadenite/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Miocardite/sangue , Miocardite/diagnóstico por imagem , Miocardite/terapia , Peptídeo Natriurético Encefálico/sangue , Pescoço , Oxigenoterapia , Fragmentos de Peptídeos/sangue , Pró-Calcitonina/sangue , Recuperação de Função Fisiológica , Troponina T/sangue , Vasoconstritores/uso terapêutico
19.
BMJ Case Rep ; 14(1)2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33436362

RESUMO

SARS-CoV-2 is primarily a respiratory disease; however, there have been multiple reports of associated myocarditis. In our 463 bedded, district general hospital, we noted an influx of young patients with myocarditis shortly after the peak of the outbreak. We report two cases presenting with myocarditis, both of whom tested negative for the virus despite clinical and biochemical evidence of recent infection. Diagnosis was made based on positive transthoracic echocardiogram (TTE) findings and a raised troponin, not in the context of suspected acute coronary syndrome. We recommend that patients with negative coronavirus tests should still be considered at risk of potential sequelae from the disease. There should be a low threshold for performing basic cardiac investigations: ECG, troponin and TTE as well as seeking a cardiology opinion. Colchicine is a recognised treatment for viral pericarditis and should be considered as adjunctive treatment; however, further research is required specific to SARS-CoV-2.


Assuntos
Miocardite , Adulto , Infecções Assintomáticas , /diagnóstico , Diagnóstico Diferencial , Humanos , Masculino , Miocardite/diagnóstico , Miocardite/etiologia , Miocardite/terapia
20.
Curr Probl Cardiol ; 46(4): 100782, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33412348

RESUMO

The accelerated growth of commercial flights has resulted in a huge upswing of air travelers over the last few decades, including passengers with a wide range of cardiovascular conditions. Notwithstanding the ongoing COVID-19 pandemic that has set back the aviation industry for the next 1-2 years, air travel is expected to rebound fully by 2024. Guidelines and evidence-based recommendations for safe air travel in this group vary, and physicians often encounter situations where opinions and assessments on fitness for flights are sought. This article aims to provide an updated suite of recommendations for the aeromedical disposition of passenger with uncommon cardiovascular conditions, such as congenital heart diseases, inflammatory cardiac conditions (endocarditis/pericarditis/myocarditis), pulmonary hypertension, and venous thromboembolism. In addition, the article also aims to provide practical general guidance for the aeromedical examiner in evaluating, preparing, and optimizing the cardiac status of the patient with cardiovascular ailments for air travel.


Assuntos
Viagem Aérea , Doenças Cardiovasculares , Endocardite , Cardiopatias Congênitas , Hipertensão Pulmonar , Miocardite , Pericardite , Tromboembolia Venosa/prevenção & controle , Medicina Aeroespacial , Cardiologia , Humanos , Encaminhamento e Consulta , Índice de Gravidade de Doença , Trombose Venosa/prevenção & controle
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