scholarly journals COVID-19-induced postural orthostatic tachycardia syndrome treated with ivabradine

2021 ◽  
Vol 14 (6) ◽  
pp. e243585
Author(s):  
Jenna Stephanie O'Sullivan ◽  
Andrew Lyne ◽  
Carl J Vaughan
Keyword(s):  
Exercise Tolerance ◽  
Sinus Tachycardia ◽  
Energy Levels ◽  
Symptomatic Improvement ◽  
Substantial Improvement ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Exertional Dyspnoea ◽  
Chest Tightness ◽  
Pharmacological Interventions ◽  
Objective Reduction

A 22-year-old woman was referred with exertional dyspnoea and chest tightness 3 weeks following a diagnosis of COVID-19. Evaluation revealed a resting sinus tachycardia and criteria for postural orthostatic tachycardia syndrome were met. After non-pharmacological interventions failed to yield symptomatic improvement, ivabradine was commenced. This intervention was followed by a substantial improvement in the patient’s exercise tolerance and energy levels and an objective reduction in supine and standing heart rate.

scholarly journals Clinical and Laboratory Improvement in Hyperadrenergic Postural Orthostatic Tachycardia Syndrome (POTS) after COVID-19 Infection

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Rebecca A. Ocher ◽  
Erika Padilla ◽  
Jonathan C. Hsu ◽  
Pam R. Taub
Keyword(s):  
Heart Rate ◽  
Sinus Tachycardia ◽  
Symptomatic Improvement ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Av Block ◽  
Event Monitoring ◽  
Inappropriate Sinus Tachycardia ◽  
History Of ◽  
The Impact ◽  
Catecholamine Levels

A 32-year-old woman with a history of symptomatic supraventricular tachycardia, inappropriate sinus tachycardia, and hyperadrenergic POTS was treated with ivabradine and metoprolol. She then presented with bradycardia and Mobitz II second-degree AV block on event monitoring six weeks after COVID-19 infection. Her post-viral workup revealed normalization of catecholamine levels and significant symptomatic improvement in heart rate. To the authors’ knowledge, this is the first reported case of improvement in POTS after COVID-19 infection. As our understanding of COVID-19 continues to improve, it will be vital to better understand the impact of COVID-19 dysautonomia on cardiac patients.

Bleomycin for orbital and peri-orbital veno-lymphatic malformations – A systematic review

2020 ◽  
pp. 159101992097251
Author(s):  
Khunsa Faiz ◽  
Stephanos Finitsis ◽  
Janice Linton ◽  
Jai Jai Shiva Shankar
Keyword(s):  
Systematic Review ◽  
Pulmonary Fibrosis ◽  
Vascular Malformations ◽  
Symptomatic Improvement ◽  
Low Flow ◽  
Cochrane Database ◽  
Objective Reduction ◽  
Retrospective Cohort Studies ◽  
Subjective Reduction

Background Orbital and peri-orbital venolymphatic malformations (VLM) are low flow vascular malformations. Intralesional bleomycin is now commonly being used to treat such malformations. Objective The purpose of this systematic review is to synthesize evidence on the safety and efficacy of bleomycin/pingyangmycin sclerotherapy for the treatment of orbital and peri-orbital VLM. Methods We searched Medline, Embase, Scopus and Cochrane database for studies reporting outcomes of bleomycin/pingyangmycin sclerotherapy for orbital and peri-orbital VLM between 1974 to April 5th, 2019. Nine retrospective cohort studies enrolling 132 patients were included. Two reviewers independently screened and extracted data and assessed the risk of bias. Predefined outcome measures were subjective and objective reduction of the lesion and associated complications. Results Subjective reduction of the lesions was seen in 96.2% of the studies. Objective reduction of the lesion and symptomatic improvement were reported in 91.6 and 95% of the studies respectively. Non responders were 9.0%. Minor adverse events were reported in 18.1% of the studies. Major complications like pulmonary toxicity or pulmonary fibrosis was not encountered in any of the included studies. Quality of evidence was generally low. Conclusion Bleomycin/pingyangmycin sclerotherapy is very effective and relatively safe for the treatment of orbital and periorbital VLM and is not associated with any major side effects including pulmonary fibrosis. Limitations: The systematic review is limited mainly due to low quality of the included studies with retrospective design.

NORMOCARDIA – CORRECT HEART RHYTHM

2020 ◽  
Vol 2 (55) ◽  
pp. 34-38
Author(s):  
Przemysław Mitkowski
Keyword(s):  
Sinus Tachycardia ◽  
Heart Rhythm ◽  
Postural Orthostatic Tachycardia Syndrome ◽  
Inappropriate Sinus Tachycardia ◽  
P Waves ◽  
Sinus Rate ◽  
Pr Interval ◽  
Esc Guidelines ◽  
The Difference ◽  
Rate Limit

Sinus rhythm is diagnosed based on 12-lead ecg recording. Diagnostic criteria are as follows: positive P waves in limb lead I and II and negative in aVR; PR interval of at least 120 ms; the difference of consecutive P-P interval should be less than 120 ms. A sinus rate limit is between 50-100/min. Numerous factors: physiologic, pathologic, medications, drugs and stimulants could increase sinus rate. Sinus tachycardia is also observed in inappropriate sinus tachycardia and postural orthostatic tachycardia syndrome. ESC guidelines related to latter two syndrome are summarized.

scholarly journals Effect of Compaction Energy on Engineering Properties of Expansive Soil

2017 ◽  
Vol 3 (8) ◽  
pp. 610 ◽  
Author(s):  
Sadam Hussain
Keyword(s):  
Expansive Soils ◽  
Energy Levels ◽  
Expansive Soil ◽  
Substantial Improvement ◽  
Engineering Properties ◽  
Engineering Structures ◽  
Expansive Clays ◽  
Swell Potential ◽  
Compaction Energy ◽  
Strength And Deformation

Swelling of expansive clays is one of the great hazards, a foundation engineer encounters. Each year expansive soils cause severe damage to residences, buildings, highways, pipelines, and other civil engineering structures. Strength and deformation parameters of soils are normally related to soil type and moisture. However, surprisingly limited focus has been directed to the compaction energy applied to the soil. Study presented herein is proposed to examine the effect of varying compaction energy of the engineering properties i.e. compaction characteristics, unconfined compressive strength, California bearing ratio and swell percentage of soil. When compaction energy increased from 237 KJ/m3 to 1197 KJ/m3, MDD increased from 1.61 g/cm3 to 1.75 g/cm3, OMC reduced from 31.55 percent to 21.63 percent, UCS increased from 110.8 to 230.6 KPa, and CBR increased from mere 1 percent to 10.2 percent. Results indicate substantial improvement in these properties. So, compacting soil at higher compaction energy levels can provide an effective approach for stabilization of expansive soils up to a particular limit. But if the soil is compacted more than this limit, an increase in swell potential of soil is noticed due to the reduction in permeability of soil.

scholarly journals Chronic non-granulomatous supraglottitis of a male adolescent and its successful management with azathioprine

2019 ◽  
Vol 12 (4) ◽  
pp. e227458
Author(s):  
Aaron Kovacs ◽  
Shankar Haran ◽  
Paul Paddle
Keyword(s):  
Symptomatic Improvement ◽  
Sleep Apnoea ◽  
Male Adolescent ◽  
Exertional Dyspnoea ◽  
Successful Management ◽  
Intravenous Steroid ◽  
Obstructive Sleep ◽  
Oral Steroids ◽  
Supraglottic Larynx ◽  
Steroid Sparing

Chronic non-granulomatous supraglottitis (CNGS) is a rare disorder of the supraglottic larynx, characterised by chronic supraglottic inflammation in the absence of granulomata, vasculitis, neoplasia, autoimmune disease or infective changes on histology. We present the case of a male adolescentwho attended with progressively worsening exertional dyspnoea, stridor and symptoms of obstructive sleep apnoea. Flexible nasendoscopy revealed marked supraglottic subepithelial thickening sparing the glottis and subglottis, confirmed on microlaryngoscopy. MRI of the head and neck demonstrated diffuse, homogenous supraglottic oedema. At the peak of his symptomology, the patient was admitted for further investigations and intravenous steroid therapy, and switched to prolonged oral steroids on discharge. Tracheostomy was avoided. After 3 months, he was successfully weaned from steroids to azathioprine with gradual symptomatic improvement. This case represents the first successful use of a steroid-sparing agent in the management of CNGS.

Severe exertional dyspnoea in COPD: Implications for exercise tolerance and survival

2021 ◽  
Author(s):  
J. Alberto Neder ◽  
Juan Pablo De Torres ◽  
M. A. Martin-Palmero ◽  
Danilo C Berton ◽  
Philips Devin ◽  
...  
Keyword(s):  
Exercise Tolerance ◽  
Exertional Dyspnoea
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