scholarly journals Characteristics of Patients Referred to a Cardiovascular Disease Clinic for Post-Acute Sequelae of SARS-CoV-2 Infection

2021 ◽  
Author(s):  
Stephen Y. Wang ◽  
Philip Adejumo ◽  
Claudia See ◽  
Oyere K. Onuma ◽  
Edward J. Miller ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chest Pain ◽  
Exercise Intolerance ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Gadolinium Enhancement ◽  
Disease Clinic ◽  
Lower Severity ◽  
Myocardial Involvement ◽  
Male Patients ◽  
New Diagnosis

ABSTRACTThere is limited literature on the cardiovascular manifestations of post-acute sequelae of SARS-CoV-2 infection (PASC). We aimed to describe the characteristics, diagnostic evaluations, and cardiac diagnoses in patients referred to a cardiovascular disease clinic designed for patients with PASC from May 2020 to September 2021. Of 126 patients, average age was 46 years (range 19-81 years), 43 (34%) were male. Patients presented on average five months after COVID-19 diagnosis. 30 (24%) patients were hospitalized for acute COVID-19. Severity of acute COVID-19 was mild in 37%, moderate in 41%, severe in 11%, and critical in 9%. Patients were also followed for PASC by pulmonology (53%), neurology (33%), otolaryngology (11%), and rheumatology (7%). Forty-three patients (34%) did not have significant comorbidities. The most common symptoms were dyspnea (52%), chest pain/pressure (48%), palpitations (44%), and fatigue (42%), commonly associated with exertion or exercise intolerance. The following cardiovascular diagnoses were identified: nonischemic cardiomyopathy (5%); new ischemia (3%); coronary vasospasm (2%); new atrial fibrillation (2%), new supraventricular tachycardia (2%); myocardial involvement (15%) by cardiac MRI, characterized by late gadolinium enhancement (LGE; 60%) or inflammation (48%). The remaining 97 patients (77%) exhibited common symptoms of fatigue, dyspnea on exertion, tachycardia, or chest pain, which we termed “cardiovascular PASC syndrome.” Three of these people met criteria for postural orthostatic tachycardia syndrome. Lower severity of acute COVID-19 was a significant predictor of cardiovascular PASC syndrome. In this cohort of patients referred to cardiology for PASC, 23% had a new diagnosis, but most displayed a pattern of symptoms associated with exercise intolerance.

scholarly journals Diagnostic Yield of Electroanatomic Voltage Mapping in Guiding Endomyocardial Biopsies

Circulation ◽  
2020 ◽  
Vol 142 (13) ◽  
pp. 1249-1260 ◽  
Author(s):  
Michela Casella ◽  
Antonio Dello Russo ◽  
Marco Bergonti ◽  
Valentina Catto ◽  
Edoardo Conte ◽  
...  
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Sensitivity And Specificity ◽  
Low Voltage ◽  
Diagnostic Yield ◽  
Gadolinium Enhancement ◽  
Promising Tool ◽  
Voltage Mapping ◽  
Few Data ◽  
New Diagnosis ◽  
Complications Rate

Background: Electroanatomic voltage mapping (EVM) is a promising modality for guiding endomyocardial biopsies (EMBs). However, few data support its feasibility and safety. We now report the largest cohort of patients undergoing EVM-guided EMBs to show its diagnostic yield and to compare it with a cardiac magnetic resonance (CMR)–guided approach. Methods: We included 162 consecutive patients undergoing EMB at our institution from 2010 to 2019. EMB was performed in pathological areas identified at EVM and CMR. CMR and EVM sensitivity and specificity regarding the identification of pathological substrates of myocardium were evaluated according to EMB results. Results: Preoperative CMR showed late gadolinium enhancement in 70% of the patients, whereas EVM identified areas of low voltage in 61%. Right (73%), left (19%), or both ventricles (8%) underwent sampling. EVM proved to have sensitivity similar to CMR (74% versus 77%), with specificity being 70% and 47%, respectively. In 12 patients with EMB-proven cardiomyopathy, EVM identified pathological areas that had been undetected at CMR evaluation. Sensitivity of pooled EVM and CMR was as high as 95%. EMB analysis allowed us to reach a new diagnosis, different from the suspected clinical diagnosis, in 39% of patients. The complications rate was low, mostly related to vascular access, with no patients requiring urgent management. Conclusions: EVM proved to be a promising tool for targeted EMB because of its sensitivity and specificity for identification of myocardial pathological substrates. EVM was demonstrated to have accuracy similar to CMR. EVM and CMR together conferred a positive predictive value of 89% on EMB.

scholarly journals 189 Prevalence of comorbidities and the incidence of cardiovascular disease in those with non-cardiac chest pain

2021 ◽  
Author(s):  
Sai Ramesh ◽  
Kayleigh Mason ◽  
James Bailey ◽  
Mamas Mamas ◽  
Kelvin Jordan
Keyword(s):  
Cardiovascular Disease ◽  
Chest Pain

Abstract 222: Nerve Conduction Study in Postural Orthostatic Tachycardia Syndrome

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Chandralekha Ashangari ◽  
Samreen F Asghar ◽  
Sadaf Syed ◽  
Amna A Butt ◽  
Amer Suleman
Keyword(s):  
Heart Rate ◽  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Clinical Symptoms ◽  
Orthostatic Intolerance ◽  
Tibial Nerve ◽  
Sensory Nerves ◽  
Exercise Intolerance ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Medical Diagnostic

Background: Postural orthostatic tachycardia syndrome (POTS) is an autonomic disturbance characterized by the clinical symptoms of orthostatic intolerance, mainly light headedness, fatigue, sweating, tremor, anxiety, palpitation, exercise intolerance and near syncope on upright posture. These are relieved on lying down. Patients also have a heart rate >120 beats/min (bpm) on standing or increase their heart rate by 30 bpm from a resting heart rate after standing for 10 min. A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. The aim of this study is to demonstrate median, ulnar, peroneal, tibial nerve conduction results POTS patients. Methods: 177 patients were selected randomly from our clinic with POTS. Nerve conduction results of median, ulnar, peroneal, tibial nerves were reviewed from electronic medical records. Results: Out of 177 patients, 151 patients are females (85%, n=151, age 32.07±11.10), 26 patients are males (15%, n=26, age 29.08±17.40).Median nerve conduction results are 57.83 m/sec ±7.58 m/sec, Ulnar nerve conduction results are 56.62 m/sec ±6.85 m/sec, Peroneal nerve conduction results are 49.96 m/sec ±6.85 m/sec, Tibial nerve conduction results are 50.70 m/sec ±6.86 m/sec. Conclusion: The nerve conduction velocities tend to be within normal range in Postural Orthostatic Tachycardia Syndrome (POTS) patients.

Abstract 46: Study of Symptoms Variation in the Morning and Evening in Postural Orthostatic Tachycardia Syndrome (POTS)

2016 ◽  
Vol 119 (suppl_1) ◽  
Author(s):  
Muhammad M Ahsan ◽  
Tara Thompson ◽  
Chandralekha Ashangari ◽  
Amer Suleman
Keyword(s):  
Chest Pain ◽  
Orthostatic Intolerance ◽  
Early Morning ◽  
P Value ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Shortness Of Breath ◽  
Blurred Vision ◽  
Excessive Sweating ◽  
Study Results ◽  
Daily Function

Background: Postural Orthostatic Tachycardia Syndrome (POTS) is a form of dysautonomia that is estimated to impact between 1,000,000 and 3,000,000 Americans and millions more around the world. Patients chronically have symptoms that are worse with upright posture and that improve with recumbence. Symptoms often include orthostatic intolerance such as dizziness, fatigue, excessive sweating and many others. The aim of this study is to determine the variation of symptoms early morning after wake up and evening at 4 PM. Methods: The Autonomic nervous system questionnaire consisting of eight POTS symptoms palpitations, headaches, dizziness, shortness of breath(SOB), chest pain, weakness, blurred vision and heaviness of feet was handover to the patients at our clinic. 42 POTS patients participated in the study, participated patients had been asked to scale their symptoms early morning after wake up and evening at 4 PM. Symptoms were defined 0 as Never,1 as mild,2 as moderate,3 as severe ,4 as extreme and 5 impairing daily function and living. Results: Out of 42 POTS patients 90% are female (38/42, age 31.74±10.67) and 10% are males (4/42, age 30.75±13.20), symptoms were scaled early morning after wake up vs symptoms scaled evening at 4 pm results in mean±SD and Anova P value. Palpitations 1.69±1.32 vs 2.45±1.38 (P =0.01), Dizziness 2.40±1.38 vs 2.67±1.46 (P =0.40), Chest pain 0.93±1.02 vs 1.52±1.27 (P=0.02), SOB 1.36±1.32 vs 1.81±1.40 (P=0.13), Weakness 2.79±1.37 vs 3.12±1.38 (P=0.27), Blurred vision 1.38±1.29 vs 1.48±1.27 (P=0.73), Headaches 1.74±1.36 vs 2.52±1.38 (P =0.01), Heaviness of feet 0.95±1.19 vs 1.43±1.53 (P =0.11). Conclusion: Our study results demonstrated that the patients with POTS had significant variation in symptoms Palpitations, Chest pain, Headaches in evenings when compared to early morning after wake up.

Abstract 439: Gender Bias in Prehospital Chest Pain Management: Do female Paramedics Under-treat patients With Chest Pain?

Hypertension ◽  
2012 ◽  
Vol 60 (suppl_1) ◽  
Author(s):  
Nabil El Sanadi ◽  
Todd Leduc ◽  
David Erdman ◽  
Jason Mansour ◽  
Gabriel Thornton
Keyword(s):  
Chest Pain ◽  
Pain Score ◽  
Gender Bias ◽  
Pain Tolerance ◽  
Coronary Insufficiency ◽  
Female Patients ◽  
Patient Gender ◽  
Score Difference ◽  
Injury Patient ◽  
Male Patients

Introduction: Patients with possible coronary insufficiency should undergo aggressive treatment to minimize the pain, since chest pain is a correlate of myocardial ischemia and injury. Patient gender should not affect the intensity of therapy. METHODS: A retrospective run-sheet review from a large prehospital system (684 paramedics E.M.S. approximately 17,000 runs/year) was done to determine the gender of the lead paramedic, the gender of the patient and the chest pain score difference pre-and post-treatment. Treatment included standard therapy of oxygen, nitroglycerin and morphine. A pain score of 0-10 was used. All runs with “chest pain” as the chief complaint were reviewed from 4/2007 to 7/2008. 225 cases were found. 2 sample poison test was used to analyze the data. Results: When female E.M.T.P’s treat female patients vs. Treating male patients, the pain score difference is 1.77 (p=0.010) When male E.M.T.P’s treat male patients vs. Female patients the pain score difference is 0.57 (p=0.063) Conclusions: Female FF/EMTP treat female patients more aggressively for chest pain than when they treat male patients. This may be due to gender bias and expectation of pain tolerance by male patients. Male FF/EMTP treats male and female patients with the same intensity.

Drugs

ESC CardioMed ◽  
2018 ◽  
pp. 1030-1035
Author(s):  
Mike Kirby ◽  
Jonny Coxon
Keyword(s):  
Quality Of Life ◽  
Cardiovascular Disease ◽  
Erectile Dysfunction ◽  
Negative Effects ◽  
Phosphodiesterase Type 5 Inhibitors ◽  
Cardiac Condition ◽  
Male Patients ◽  
Phosphodiesterase Type ◽  
The Impact

It should not be presumed that male patients with cardiovascular disease are less sexually active than others, but they are more likely to have erectile dysfunction. It is therefore crucial to consider the impact on sexual function of medications commonly used to treat cardiovascular disease, because negative effects on erectile dysfunction can lead to problems with compliance and quality of life. Cardiovascular implications of phosphodiesterase type 5 inhibitors used to treat erectile dysfunction should be borne in mind. Effective treatment of the cardiac condition should always take priority.

scholarly journals Is it time to change? Portable echocardiography demonstrates high prevalence of abnormalities in self-presenting members of a rural community in Kyrgyzstan

2018 ◽  
Vol 7 ◽  
pp. 204800401877973
Author(s):  
Anthony James Barron ◽  
Turgunbai Aijigitov ◽  
Aigul Baltabaeva
Keyword(s):  
Cardiovascular Disease ◽  
Heart Disease ◽  
Rural Communities ◽  
Rural Community ◽  
Severe Disease ◽  
Remote Access ◽  
Lv Function ◽  
Valvular Regurgitation ◽  
Mild Disease ◽  
New Diagnosis

Objectives Cardiovascular disease accounts for 42% of male and 51% of female mortality within Europe. Kyrgyzstan, population of almost 6 million, has amongst the highest rates within Europe, second only to Uzbekistan for female cardiovascular disease mortality (588 per 100,000). We attempted to identify established cardiovascular disease prevalence within a rural community in Kyrgyzstan using portable echocardiography. Design Free open access echocardiography (VIVID-I, GE, USA) was offered to all adults in Batken district. Routine echocardiographic views were obtained and analysis performed using EchoPac Clinical Workstation (GE, USA). Mild valvular regurgitation, mild LV hypertrophy, patent foramen ovales and mild atrial enlargement were considered mild abnormalities; compensated ischaemic or valvular heart disease – moderate abnormalities, and decompensated congenital, ischaemic or valvular disease – severe abnormalities. Results One hundred and twenty five adults (48 male, 77 female), mean age 53 ± 16 years, underwent echocardiography. Only 16% of participants had no significant abnormality, 46% had mild disease, 25% moderate, compensated disease and 13% had severe disease. Nine percent had congenital heart disease including one tetralogy of Fallot and one Ebstein’s anomaly. Average LV function was normal, however, 19 participants had EF < 50%. Forty percent of participants had a new diagnosis warranting formal follow-up, 12% a new diagnosis of heart failure. Conclusion Using portable echocardiography, we identify a higher than reported prevalence of cardiovascular disease in rural Kyrgyzstan. Absence of portable tools and specialists for early diagnosis might lead to presentation in an advanced stage of disease when little can be done to improve mortality. Embracing remote access diagnostics is essential for disease identification within rural communities.

Leber’s hereditary optic neuropathy associated with a multiple-sclerosis-like picture in a man

2011 ◽  
Vol 17 (6) ◽  
pp. 763-766 ◽  
Author(s):  
Antonella La Russa ◽  
Rita Cittadella ◽  
Virginia Andreoli ◽  
Paola Valentino ◽  
Francesca Trecroci ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Spinal Cord ◽  
Optic Neuropathy ◽  
Brain Mri ◽  
Resonance Imaging ◽  
Gadolinium Enhancement ◽  
Demyelinating Lesions ◽  
Male Patients ◽  
Magnetic Resonance Imaging Mri ◽  
Symptoms And Signs

A 35-year-old young man displayed Leber’s optic neuropathy (LHON) due to T14484C and multiple sclerosis (MS) phenotype that was dominated by symptoms and signs of spinal cord impairment. Magnetic resonance imaging (MRI) revealed demyelinating lesions extending from D6 to D11 in the spinal cord with gadolinium enhancement, while only three linear demyelinating lesions were seen on brain MRI. In the literature, a major involvement of the spinal cord was already reported in three of four male patients with the 14484 LHON mutation who developed MS, but the reasons of this peculiar association remain unknown, and further research in this area is needed.

scholarly journals Primary care use and cardiovascular disease risk in Russian 40–69 year olds: a cross-sectional study

2020 ◽  
pp. jech-2019-213549
Author(s):  
Jakob Petersen ◽  
Anna Kontsevaya ◽  
Martin McKee ◽  
Erica Richardson ◽  
Sarah Cook ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Care ◽  
Chest Pain ◽  
Russian Federation ◽  
General Health ◽  
Cross Sectional Study ◽  
Health Check ◽  
Sectional Study ◽  
Cvd Risk ◽  
Cross Sectional

BackgroundThe Russian Federation has very high cardiovascular disease (CVD) mortality rates compared with countries of similar economic development. This cross-sectional study compares the characteristics of CVD-free participants with and without recent primary care contact to ascertain their CVD risk and health status.MethodsA total of 2774 participants aged 40–69 years with no self-reported CVD history were selected from a population-based study conducted in Arkhangelsk and Novosibirsk, Russian Federation, 2015–2018. A range of co-variates related to socio-demographics, health and health behaviours were included. Recent primary care contact was defined as seeing primary care doctor in the past year or having attended a general health check under the 2013 Dispansarisation programme.ResultsThe proportion with no recent primary care contact was 32.3% (95% CI 29.7% to 35.0%) in males, 16.3% (95% CI 14.6% to 18.2%) in females, and 23.1% (95% CI 21.6% to 24.7%) overall. In gender-specific age-adjusted analyses, no recent contact was also associated with low education, smoking, very good to excellent self-rated health, no chest pain, CVD 10-year SCORE risk 5+%, absence of hypertension control, absence of hypertension awareness and absence of care-intensive conditions. Among those with no contact: 37% current smokers, 34% with 5+% 10-year CVD risk, 32% untreated hypertension, 20% non-anginal chest pain, 18% problem drinkers, 14% uncontrolled hypertension and 9% Grade 1–2 angina. The proportion without general health check attendance was 54.6%.ConclusionPrimary care and community interventions would be required to proactively reach sections of 40–69 year olds currently not in contact with primary care services to reduce their CVD risk through diagnosis, treatment, lifestyle recommendations and active follow-up.

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