scholarly journals Arrhythmia patterns in patients with COVID-19 infection during and post hospitalization detected via a patch-based mobile cardiac telemetry system

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
O Reynbakh ◽  
E D Braunstein ◽  
M Hsu ◽  
J Ellis ◽  
L Crosson ◽  
...  
Keyword(s):  
Cardiovascular Complications ◽  
Cardiac Monitoring ◽  
Telemetry System ◽  
Monitoring Period ◽  
Funding Sources ◽  
Cardiac Monitor ◽  
Fda Approval ◽  
Daily Frequency ◽  
Coronavirus Infection ◽  
New Onset

Abstract Background Coronavirus infection (COVID-19) is the cause of the current world-wide pandemic. Cardiovascular complications occur in 20–30% of patients with COVID-19 infection including myocardial injury and arrhythmias. Current understanding of specific arrhythmia type and frequency is limited. In response to COVID-19 pandemic and overwhelmed hospital critical care and telemetry recourses, patch-based cardiac monitoring system received emergency Food and Drug Administration (FDA) approval for inpatient monitoring. A patch-based cardiac telemetry system has been shown to be useful for patient management during the COVID-19 pandemic and provides detailed analysis of cardiac rhythms. Purpose To analyze arrhythmia type and frequency in patients with COVID-19 infection, identifying arrhythmia patterns over time during hospitalization and after discharge. Methods A prospective cohort study during the COVID-19 pandemic was performed. We included patients hospitalized with COVID-19 infection who had a patch-based mobile telemetry device placed for cardiac monitoring. A quantitative analysis including type, frequency and duration of detected arrhythmias was performed at the end of the monitoring period. Results A total of 103 patients hospitalized with COVID-19 diagnosis underwent monitoring. Quantitative reports for 59 patients were available for analysis, among those 59% were males, median age 65 (IQR 56–76) yrs. Mean wear time was 6.8±5.0 days. Arrhythmias were detected in 72.9% of patients. Majority of arrhythmias were SVT (59.3% of patients) and AF (22.0%). Episodes of AF duration >30 min were detected in 12 patients. New onset AF was noted in 15.0% of patients and was significantly associated with age (OR 1.4 for 5 yrs difference; 95% CI 1.01–2.05). Brady arrhythmias (2nd degree, 3rd degree AV bock, pause≥3 seconds) were seen in 18.7% of patients. Arrhythmias were consistently detected throughout the monitoring period in 52.9%-89.5% of patients daily (Figure 1). In 9 patients who were discharged with continued patch monitoring, 3 patients (33.3%) had arrhythmic events during their outpatient monitoring period. Conclusion A majority of patients hospitalized with COVID-19 infection had arrhythmias detected by patch cardiac monitor. Arrhythmias were observed throughout hospitalization with a consistent daily frequency. Patients continued to exhibit cardiac arrhythmias after hospital discharge of a type similar to that seen during hospitalization. New onset AF often occurred and was associated with older age. Inpatient application of a patch cardiac telemetry with continued monitoring as outpatient is feasible and effective in detecting occult arrhythmias in patients with COVID-19 infection. FUNDunding Acknowledgement Type of funding sources: None. Daily frequency of arrhythmias detected

The case of comorbidity of sinus node dysfunction and new coronavirus infection with Sjogren’s disease and Thompson’s myotonia

2021 ◽  
Vol 25 (3) ◽  
pp. 35-40
Author(s):  
Maria O. Mohika Estepa ◽  
Nadezhda V. Muzhikina
Keyword(s):  
Respiratory System ◽  
Multidisciplinary Approach ◽  
Sinus Node ◽  
Cardiovascular Complications ◽  
Sinus Node Dysfunction ◽  
Therapeutic Approaches ◽  
Latent Form ◽  
Aged People ◽  
Coronavirus Infection ◽  
Sjögren’S Disease

Coronavirus infection, according to modern data, poses a threat not only to the respiratory system, in more than 15% of patients it can lead to cardiovascular complications, including in young and middle-aged people. COVID-19 is probably the trigger of a detailed clinical picture of chronic diseases occurring in a latent form. The article considers the case of sinus node dysfunction and polyneuropathy in a young patient after coronavirus infection against the background of concomitant diseases such as Sjogrens disease and Thompsons myotonia. To observe the dynamics of the three diseases, the timely organization of a multidisciplinary approach is important. It is necessary to consider all three diseases in the paradigm of the main and concomitant in order to timely and adequate therapy. Further study of the clinical features, therapeutic approaches and complications in patients with COVID-19 is required.

scholarly journals Incidence of and Factors Associated with New-Onset Insomnia Among Lebanese Hospitalised Patients

2021 ◽  
Vol 21 (2) ◽  
pp. e210-220
Author(s):  
Nour Sakr ◽  
Souheil Hallit ◽  
Hanna Mattar
Keyword(s):  
Tertiary Care ◽  
Previous History ◽  
Severity Index ◽  
Cardiac Monitoring ◽  
Sleep Wake Disorders ◽  
Tertiary Care Centre ◽  
Post Discharge ◽  
Hospitalised Patients ◽  
History Of ◽  
New Onset

Objectives: This study aimed to determine the incidence and post-discharge resolution of new-onset insomnia in hospitalised patients with no previous history of insomnia, as well as to define major correlates of in-hospital insomnia. Methods: This prospective observational study was conducted between November 2019 and January 2020 at a tertiary care centre in Lebanon. All hospitalised patients >18 years of age with no history of insomnia were screened for new-onset insomnia using the Insomnia Severity Index (ISI) scale. Subsequently, patients were re-assessed two weeks after discharge to determine insomnia resolution. Results: A total of 75 patients were included in the study. Of these, nine (12%) had no insomnia, 34 (45.3%) had subthreshold insomnia, 22 (29.3%) had moderate insomnia and 10 (13.3%) had severe insomnia. The mean ISI score was 14.95 ± 6.05, with 88% of patients having ISI scores of >7 (95% confidence interval: 0.822–0.965). The frequency of new-onset insomnia was significantly higher among patients who shared a room compared to those in single-bed rooms (95.7% versus 75%; P = 0.011). Other factors were not found to be associated with new-onset insomnia, including the administration of medications known to cause insomnia, in-hospital sedative use, overnight oxygen, cardiac monitoring and self-reported nocturnal toilet use. Overall, insomnia resolution occurred in 78.7% of patients two weeks after discharge. Conclusion: There was a high incidence of acute new-onset insomnia among hospitalised patients at a tertiary centre in Lebanon. Additional research is recommended to further examine inhospital sleep disturbance factors and to seek convenient solutions to limit insomnia. Keywords: Sleep Wake Disorders; Insomnia; Hospitalization; Incidence; Risk Factors; Lebanon.

scholarly journals New onset of generalized myasthenia gravis developed after a new coronavirus infection (COVID-19)

2021 ◽  
Vol 13 (4) ◽  
pp. 127-132
Author(s):  
T. M. Alekseeva ◽  
P. Sh. Isabekova ◽  
M. P. Topuzova ◽  
N. V. Skripchenko
Keyword(s):  
Immune System ◽  
Autoimmune Diseases ◽  
Myasthenia Gravis ◽  
Viral Infection ◽  
Clinical Case ◽  
Neurological Complications ◽  
Medical Society ◽  
Immune Mediated ◽  
Coronavirus Infection ◽  
New Onset

Development of various immune-mediated neurological complications after a viral infection is of particular interest to medical society during a pandemic of COVID-19. It was found that SARS-CoV-2 has the ability to cause hyperstimulation of the immune system, thereby initiating developing of autoimmune diseases. The article describes a clinical case of new onset of generalized myasthenia gravis with thymoma in a patient after previous COVID-19. 

scholarly journals Sinus bradycardia as the initial manifestation of multisystem inflammatory syndrome in children

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Gonzalez ◽  
I Mendoza Britto ◽  
M Mateu ◽  
E Marcano ◽  
J De Izaguirre ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Sinus Bradycardia ◽  
Case Series ◽  
Intravenous Immunoglobulins ◽  
Cardiovascular Complications ◽  
Laboratory Evaluation ◽  
Initial Manifestation ◽  
Funding Sources ◽  
Coronary Abnormalities ◽  
Inflammatory Syndrome

Abstract Background While cardiovascular complications, including arrhythmias are now a recognized manifestation of Multisystem inflammatory syndrome in children (MIS-C), there are no reports of primary bradycardia preceding the clinical presentation. We sought to describe a case series of sinus bradycardia as an initial manifestation of MIS-C. Methods We included a series of 10 consecutive patients with confirmed COVID-19 who met WHO and CDC criteria for MIS-C, who developed sinus bradycardia with a heart rate measured in the awake state that was below the normal range for age for children, as an initial manifestation of the disease, in a prospective observational multicenter study. Patients underwent clinical, laboratory evaluation, ECG, Holter, telemetry, echocardiogram, chest X Ray, and a chest CT scan. Results Of the 10 patients included, 6 were male, with a mean age of 6.52±5.35 years, range 4 months to 14 years. All cases were Hispanic. Bradycardia was transient and did not merit treatment. Coronary abnormalities were noted in 6 cases; 4 patients had mild coronary ectasia; 9 patients had pericardial effusion with no evidence of tamponade. All patients had a mild clinical course; none had shock, heart failure, the need for mechanical ventilation, or died. All blood markers (Troponin, BNP, Platelet count, C-reactive protein, D-dimer, Ferritin) returned to normal levels by discharge/follow-up with a favorable outcome including resolution of coronary dilatation in all but 2 in which aneurysm persisted. Treatment All patients received steroids and low-weight-molecular heparin 10 patients, 8 aspirin and 8 intravenous immunoglobulins. Conclusion Sinus bradycardia may be the initial manifestation of MIS-C, usually transient and mild. Physicians should be aware of this presentation. FUNDunding Acknowledgement Type of funding sources: None. Kid, MIS-C. Bradycardia/Atrial Rhythm

scholarly journals Myocardial ischaemia of non-obstructive origin as a cause of new onset anginal chest pain in the long COVID syndrome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Espejo ◽  
H Mejia-Renteria ◽  
A Travieso ◽  
N Gonzalo ◽  
S Fernandez ◽  
...  
Keyword(s):  
Chest Pain ◽  
Medical Treatment ◽  
Myocardial Ischaemia ◽  
Treatment Recommendation ◽  
Endothelium Dysfunction ◽  
Funding Sources ◽  
Consensus Document ◽  
Flow Reserve ◽  
Independent Assessment ◽  
New Onset

Abstract Background New-onset chest pain occurs in around 20% of patients with long COVID syndrome (LCS). Being the vascular endothelium one of the targets of the SARS-CoV-2 virus, we hypothesized that new onset anginal symptoms in LCS could be due to endothelium dysfunction and other non-obstructive causes of myocardial ischaemia. Methods We investigated 11 consecutive patients who developed new onset anginal chest pain, suggestive of myocardial ischaemia, after documented SARS-CoV-2 infection. Intracoronary assessment included endothelium-dependent evaluation with acetylcholine testing (Ach), and endothelium-independent assessment with coronary flow reserve (CFR) and microcirculatory resistance (MR). Criteria for positiveness of these tests and medical treatment recommendation were obtained from 2019 ESC guidelines and 2020 EAPCI consensus document on ischaemia with non-obstructive coronary arteries (INOCA). Results Mean patient age was 56 years (SD ± 15); 10 (91%) were female. In the acute COVID-19 phase, 4 patients (36%) had had pulmonary infiltrates and 2 (18%) required hospitalization. Conclusive non-invasive tests were obtained in 7 (64%), showing exercise-related myocardial ischaemia in 6 (86%). Coronary angiography ruled out obstructive epicardial stenoses in all the patients. Ach testing revealed abnormal endothelium-dependent responses in 9 (82%) patients: 5 (56%) had epicardial vessel and 4 (44%) microvascular spasm. Endothelium-independent assessment was abnormal in 6 (54%) cases, with abnormal CFR in 2 (33%), abnormal MR in 2 (33) and both abnormal CFR and MR in 2 (33%) patients. The most frequent endotype was combined endothelium dependent- and independent abnormalities (6/9, 67%). Stratified medical treatment according to endotype led to significant improvement in Seattle Angina Scores for angina frequency (+22 points, p=0.013) and a notable trend towards angina stability (+25 points, p=0.093) at a mean follow-up time of 222 days. Conclusions Myocardial ischaemia of non-obstructive origin is common in patients with chest pain and LCS. Vasomotor abnormalities related to endothelial dysfunction occurred in 82% of patients, frequently associated to impaired microvascular vasodilation or high microvascular resistance. Stratified medical treatment led to significant improvement in angina stability and frequency. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Pretransplant Cardiac Evaluation Using Novel Technology

2019 ◽  
Vol 8 (5) ◽  
pp. 690
Author(s):  
Mohamad Hemu ◽  
Allison Zimmerman ◽  
Dinesh Kalra ◽  
Tochukwu Okwuosa
Keyword(s):  
Cardiac Risk ◽  
Cardiovascular Complications ◽  
Hematopoietic Stem ◽  
Ischemic Disease ◽  
Cardiac Screening ◽  
Novel Technology ◽  
Complex Procedure ◽  
Cardiac Evaluation ◽  
Life Threatening ◽  
New Onset

Hematopoietic stem-cell transplantation (HSCT) is a complex procedure that has been increasingly successful in treating malignant and nonmalignant conditions. Despite its effectiveness, it can be associated with potentially life-threatening adverse effects. New onset heart failure, ischemic disease, and arrhythmias are among the most notable cardiovascular complications post-HSCT. As a result, appropriate cardiac risk stratification prior to transplant could result in decreased morbidity and mortality by identifying patients with a higher probability of tolerating possible toxicities associated with HSCT. In this review, we aim to discuss the utility of cardiac screening using novel modalities of imaging technology in the pre-HSCT phase.

STAI (Studio Ticlopidina Angina Instabile) PROJECT. TICLOPIDINE -IN UNSTABLE ANGINA

1987 ◽  
Author(s):  
F Violi ◽  
C Cimminiello ◽  
S Chierichetti ◽  
M Scatigna ◽  
P Rizzon ◽  
...  
Keyword(s):  
Unstable Angina ◽  
Clinical Symptoms ◽  
Cardiovascular Complications ◽  
Fibrinogen Binding ◽  
Clinical Pictures ◽  
Fatal Myocardial Infarction ◽  
Angina At Rest ◽  
New Onset

The treatment of patients suffering from unstable angina (UA) with antiplatelet drugs is a therapeutic approach that provided interesting results.Patients given aspirin, that inhibits cyclooxigenase pathway (CP) showed a significant reduction of cardiovascularevents.Quite surprisingly sulfinpirazone, that possesses a mechanism of action similar to aspirin, did not influence cardiovascular complications of UA patients.To further investigate the role of platelets in UA patients, we planned to study if ticlopidine (T), that inhibits platelet function by blocking fibrinogen binding to platelets, influences theclinical course of UA.The study will include 1200 randomised patients given conventional therapy with or without T (500 mg/daily).Patients enrolled have to show one ofthe following clinical pictures: 1) angina at rest; 2) "crescendo angina"; 3) new onset angina.Clinical symptoms should be present within 30 days. The follow-up will last6 months.Primary end-point of the study is the incidence of fatal and non-fatal myocardial infarction and of vascular death.Apart from the possible influence of T in the natural course of UA, the study will offer the opportunity to find and incidence pattern of UA cardiovascular complications in Italy.

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