Emerging spectrum of post-COVID-19 syndrome.

'Post-COVID-19 syndrome' refers to symptoms in the convalescent phase following initial COVID-19 infection. This term encompasses a wide array of presentation involving lungs, heart and the neuromuscular system. Pulmonary manifestations include post-COVID-19 fibrosis, which is akin to post acute respiratory distress syndrome fibrosis and may reflect the permanent damage to the lungs following an initial bout of infection. Cardiovascular system is often involved, and the presentation can be in terms of acute coronary syndrome, myocarditis and heart failure. Clinical manifestations are often varied and non-specific, which entails a detailed workup and a multidisciplinary approach. Post-COVID-19 syndrome adds to the overall disease morbidity and leads to a prolonged hospital stay, greater healthcare utilisation and loss of productivity marring the country's dwindling economy. Thus, it is imperative that post-COVID-19 syndrome be prevented and identified early followed by a prompt treatment.

Very late stent thrombosis associated with COVID-19 infection: a case report and review of the literature.

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 has varied manifestation with multisystem involvement. Acute coronary syndrome in COVID-19 as a result of stent thrombosis is an uncommon entity and is often due to hypercoagulable state. A 40-year-old male was referred to us with acute onset chest pain. He also reported fever, sore throat and dry cough for six days which mandated testing for COVID-19 which turned out to be positive. He had a prior history of coronary artery disease with a drug eluting stent implanted two years back. An electrocardiogram was suggestive of acute anterior wall myocardial infarction while echocardiogram revealed hypokinesia of left anterior descending (LAD) artery territory. Coronary angiogram revealed non-occlusive thrombus in proximal LAD stent. A Thrombolysis in Myocardial Infarction (TIMI) III flow was restored following balloon angioplasty with a non-compliant balloon and use of glycoprotein (GP) IIb-IIIa receptor antagonist. A diagnosis of very late stent thrombosis subsequent to COVID-19 was made.

Cardiovascular system and COVID-19: perspectives from a developing country.

A novel coronavirus, SARS-CoV-2, thought to have originated from bats causes COVID-19 infection which was first reported from Wuhan, China in December 2019. This virus has a high infectivity rate and has impacted a significant chunk of the population worldwide. The spectrum of disease ranges from mild to severe with respiratory system being the most commonly affected. Cardiovascular system often gets involved in later stages of the disease with acute cardiac injury, heart failure and arrhythmias being the common complications. In addition, the presence of cardiovascular co-morbidities such as hypertension, coronary artery disease in these patients are often associated with poor prognosis. It is still not clear regarding the exact mechanism explaining cardiovascular system involvement in COVID-19. Multiple theories have been put forward however, more robust studies are required to fully elucidate the "heart and virus" link. The disease has already made its presence felt on the global stage and its impact in the developing countries is going to be profound. These nations not only have a poorly developed healthcare system but there is also a huge burden of cardiovascular diseases. As a result, COVID-19 would adversely impact the already overburdened healthcare network leading to impaired cardiovascular care delivery especially for acute coronary syndrome and heart failure patients.

Bronchial artery embolization: A gratifying life-saving procedure.

BACKGROUND: Bronchial artery embolization (BAE) is an urgent life-saving procedure in patients with massive hemoptysis. MATERIAL AND METHODS: This was a single center observational study wherein patients presenting with hemoptysis were evaluated and underwent BAE. Initially, a descending thoracic aortogram was performed to identify culprit vessels followed by selective catheterization of the involved vessels. Abnormal bronchial artery morphology included hypertrophied and tortuous bronchial artery (BA), focal hyperemia and hypervascularity, shunting into pulmonary artery or vein, extravasation of contrast into the lung parenchyma/cavity and BA aneurysms. Selective embolization was done using either gelfoam or polyvinyl alcohol particles. Post-procedure, follow-up was done at one month and six months with outcomes defined in terms of recurrence of hemoptysis. RESULTS: A total of 187 patients underwent BAE with post-tubercular sequalae being the most common diagnosis in 157 (84%) followed by idiopathic bronchiectasis in 19 (10.2%) and aspergilloma in 7 (3.7%). A total of 246 vessels were embolized with right sided BA being more commonly involved as compared to left [143 (76.5%) vs. 35 (18.7%); P < 0.0001]. Complete resolution was observed in 183 (97.8%) 24 hours post procedure. Recurrence was reported in 34 (18.2%) patients with higher frequency in diabetics, patients with active tuberculosis and presence of aspergillomas. Multi-variate logistic regression analysis showed that diabetes, presence of an aspergilloma and feeding vessels from internal mammary artery were independent predictors of recurrent hemoptysis. Most of the complications were minor except paraparesis observed in two patients. CONCLUSION: BAE is a safe and effective procedure for the treatment of hemoptysis of different etiologies.

Cardiovascular complications and its impact on outcomes in COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has led to a widespread morbidity and mortality. Limited data exists regarding the involvement of cardiovascular system in COVID-19 patients. We sought to evaluate the cardiovascular (CV) complications and its impact on outcomes in symptomatic COVID-19 patients. METHODS: This was a single center observational study among symptomatic COVID-19 patients. Data regarding clinical profile, laboratory investigations, CV complications, treatment and outcomes were collected. Cardiac biomarkers and 12 lead electrocardiograms were done in all while echocardiography was done in those with clinical indications for the same. Corrected QT-interval (QTc) at baseline and maximum value during hospitalization were computed. RESULTS: Of the 108 patients, majority of them were males with a mean age of 51.2 ± 17.7 years. Hypertension (38%) and diabetes (32.4%) were most prevalent co-morbidities. ECG findings included sinus tachycardia in 18 (16.9%), first degree AV block in 5 (4.6%), VT/VF in 2 (1.8%) and sinus bradycardia in one (0.9%). QTc prolongation was observed in 17.6% subjects. CV complications included acute cardiac injury in 25.9%, heart failure, cardiogenic shock and acute coronary syndrome in 3.7% each, "probable" myocarditis in 2.8% patients. Patients with acute cardiac injury had higher mortality than those without (16/28 [57.1%] vs 14/78 [17.5%]; P < 0.0001). Multivariate logistic regression analysis showed that acute cardiac injury (OR: 11.3), lymphopenia (OR: 4.91), use of inotropic agents (OR: 2.46) and neutrophil-lymphocyte ratio (OR:1.1) were independent predictors of mortality. CONCLUSIONS: CV complications such as acute cardiac injury is common in COVID-19 patients and is associated with worse prognosis.

Awareness, treatment adherence and risk predictors of uncontrolled hypertension at a tertiary care teaching hospital in Western India.

INTRODUCTION: Hypertension still remains poorly controlled. RESULT: Adequate BP control was achieved in 37.4% of patients and significant attributes for poor control were BMI, marital status, literacy, socioeconomic status, smoking, medication adherence, absence of side effects, number of drugs, number of years on drug therapy and co-morbid conditions.