Abstract 16727: Cardiac Complications of SARS CoV-2 Associated Multi-System Inflammatory Syndrome in Children (mis-c)

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ashraf S Harahsheh ◽  
Craig A SABLE ◽  
Yue-hin Loke ◽  
Roberta L DeBiasi ◽  
Laura Olivieri ◽  
...  
Keyword(s):  
Acute Phase ◽  
Immune Modulation ◽  
Sinus Bradycardia ◽  
Previous History ◽  
High Rate ◽  
Cardiac Complications ◽  
Av Block ◽  
Pericardial Window ◽  
Long Term Study ◽  
History Of

Introduction: A novel pediatric disease, MIS-C, has emerged during the COVID -19 pandemic. The majority of cases were reported from European and Northeastern US centers. We present our experience of MIS-C with cardiac findings from a large tertiary pediatric cardiac center. Methods: We conducted a retrospective study of all MIS-C patients evaluated and treated from 03/29/2020 to 6/18/2020 at our center. Demographics, clinical, echo and ECG data were extracted from the echo database and EHR. Abnormal cardiac findings during the acute phase were defined as coronary artery abnormality (CAA), decreased ejection fraction (EF) and rhythm abnormality. CAAs were defined as dilation (z-score of > 2 to ≤ 2.49) or aneurysm (2.5 to < 5) as well as reviewed for qualitative changes. Results: 32 children, 17 (53%) males have been treated for MIS-C. The median (IQR) age was 9 (7 - 13) years. Underlying medical conditions were noted in 9 (28%) patients including 2 with cardiac conditions (one with previous history of atypical Kawasaki Disease (KD) and one with previous history of pericardial effusion s/p pericardial window). Ten (31%) patients had abnormal cardiac findings; 4 had isolated CAA, 3 had combined CAA and low EF and 2 had isolated low EF. One patient had aneurysms in all 3 CA’s, 2 patients had abnormalities in 2 CA’s (LMCA and RCA aneurysms in 1 and LMCA aneurysm and LAD dilation in 1 patient), and 4 patients had single CAA (RCA dilation in 1, LAD aneurysm in 1, and LAD dilation in 2 patients). No patient with CAA had morphologic evidence of saccular or fusiform changes. CAA persisted on subsequent echo in 3 patients and normalized in 3 patients. EF normalized on subsequent echo in 3 patients. One of the patients with isolated low EF was also found to have intermittent high grade atrioventricular (AV) block. The 10 th patient had normal echo but 1st degree AV block, sinus bradycardia, and long QTc. No arrhythmia was noted. No mortality occurred and overall length of stay was 13.6±9 days. Conclusion: Our MIS-C patients had a high rate of cardiac findings in the acute phase which exceeded rates historically observed in the setting of KD. Further long term study is needed to assess if the cardiac abnormalities persist, improve with immune modulation or are associated with major cardiac events.

Cardiac echocardiogram findings of severe acute respiratory syndrome coronavirus-2-associated multi-system inflammatory syndrome in children

2021 ◽  
pp. 1-9
Author(s):  
Ashraf S. Harahsheh ◽  
Anita Krishnan ◽  
Roberta L. DeBiasi ◽  
Laura J. Olivieri ◽  
Christopher Spurney ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Pericardial Effusion ◽  
Acute Phase ◽  
Systolic Dysfunction ◽  
Interquartile Range ◽  
High Rate ◽  
Cardiac Complications ◽  
Valvular Regurgitation ◽  
Coronary Artery Abnormalities ◽  
Inflammatory Syndrome

Abstract Background: A novel paediatric disease, multi-system inflammatory syndrome in children, has emerged during the 2019 coronavirus disease pandemic. Objectives: To describe the short-term evolution of cardiac complications and associated risk factors in patients with multi-system inflammatory syndrome in children. Methods: Retrospective single-centre study of confirmed multi-system inflammatory syndrome in children treated from 29 March, 2020 to 1 September, 2020. Cardiac complications during the acute phase were defined as decreased systolic function, coronary artery abnormalities, pericardial effusion, or mitral and/or tricuspid valve regurgitation. Patients with or without cardiac complications were compared with chi-square, Fisher’s exact, and Wilcoxon rank sum. Results: Thirty-nine children with median (interquartile range) age 7.8 (3.6–12.7) years were included. Nineteen (49%) patients developed cardiac complications including systolic dysfunction (33%), valvular regurgitation (31%), coronary artery abnormalities (18%), and pericardial effusion (5%). At the time of the most recent follow-up, at a median (interquartile range) of 49 (26–61) days, cardiac complications resolved in 16/19 (84%) patients. Two patients had persistent mild systolic dysfunction and one patient had persistent coronary artery abnormality. Children with cardiac complications were more likely to have higher N-terminal B-type natriuretic peptide (p = 0.01), higher white blood cell count (p = 0.01), higher neutrophil count (p = 0.02), severe lymphopenia (p = 0.05), use of milrinone (p = 0.03), and intensive care requirement (p = 0.04). Conclusion: Patients with multi-system inflammatory syndrome in children had a high rate of cardiac complications in the acute phase, with associated inflammatory markers. Although cardiac complications resolved in 84% of patients, further long-term studies are needed to assess if the cardiac abnormalities (transient or persistent) are associated with major cardiac events.

A study of deliberate self-poisoning in a Dublin hospital 1986 – 1990

1994 ◽  
Vol 11 (2) ◽  
pp. 70-72 ◽  
Author(s):  
Fergus Coakley ◽  
Catherine Hayes ◽  
John Fennell ◽  
Zachary Johnson
Keyword(s):  
Past History ◽  
Dublin Hospital ◽  
Psychiatric Inpatient ◽  
Previous History ◽  
Psychiatric Hospitals ◽  
High Rate ◽  
Medical Complication ◽  
Motivating Factors ◽  
History Of ◽  
Low Threshold

AbstractObjective: The study was undertaken to determine the current demographic and clinical features of cases of deliberate self-poisoning (DSP) presenting to an acute general hospital and to compare the findings with previous work in Ireland and elsewhere. Method: Four hundred and sixty seven consecutive admissions for DSP presenting to a Dublin hospital between 1986 and 1990 inclusive were identified retrospectively and the case notes reviewed. Data was collected on age, sex, marital status, past history, date of DSP, drugs used, motivating factors and outcome. Results: The peak age of DSP was 15-24 years. The female:male ratio was 1.5:1. There was an increased incidence of DSP in women in July and August. In 32% there was a previous history of DSP. Benzodiazepines, antidepressants and analgesics/anti-inflammatories were the commonest drugs taken. There was a significant medical complication in 10.5% of cases, but no fatalities. Twenty-five percent of patients were subsequently admitted to psychiatric inpatient care. Conclusions: DSP is an ongoing problem. The summer peak in females may be related to the parenting burden during the summer recess. The high rate of repetition suggests a significant reduction could be achieved with successful strategies for secondary prevention. The high rate of psychiatric in-patient referral may be related to a low threshold for admissions to Irish psychiatric hospitals.

scholarly journals Rapidly Progressive Atrioventricular Block in a Patient with Sarcoidosis

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Nagham Saeed Jafar ◽  
Warkaa Al Shamkhani ◽  
Sunil Roy Thottuvelil Narayanan ◽  
Anil Kumar Rajappan
Keyword(s):  
Cardiac Sarcoidosis ◽  
Previous History ◽  
Pacemaker Implantation ◽  
Young Patients ◽  
Young Male ◽  
Pulmonary Involvement ◽  
Av Block ◽  
History Of ◽  
Exercise Induced ◽  
Cardiac Manifestations

Cardiac sarcoidosis is a major cause of death in patients with systemic sarcoidosis. Cardiac manifestations are seen in 2.3% of the patients. Atrioventricular (AV) block is one of the common manifestations of cardiac sarcoidosis. Other presentations of cardiac involvement include congestive heart failure, ventricular arrhythmias, and sudden cardiac death. The presence of AV block in young patients should raise the suspicion of sarcoidosis. AV block may be the only manifestation and patients may not have clinical evidence of pulmonary involvement. Here we describe a young male presented with exercise induced AV block rapidly progressing to complete heart block with recurrent syncope needing urgent pacemaker implantation. Factors that suggested an infiltrative process included his young age, rapidly progressive conduction abnormalities in the ECG in the absence of coronary disease, and previous history of cutaneous sarcoidosis.

scholarly journals Volvulus of the liver with intrathoracic herniation

2014 ◽  
Vol 96 (7) ◽  
pp. e27-e29 ◽  
Author(s):  
G Moussa ◽  
PM Thomson ◽  
A Bohra
Keyword(s):  
Abdominal Pain ◽  
Transverse Colon ◽  
Abdominal Cavity ◽  
Liver Perfusion ◽  
Previous History ◽  
Interesting Case ◽  
Oval Window ◽  
Uneventful Recovery ◽  
Pericardial Window ◽  
History Of

Introduction We present a rare case of a liver volvulus, stomach and transverse colon herniating through the diaphragm. This scenario has not been reported previously. We discuss the presentation and management of this interesting case. Case history A 65-year-old woman with a history of sarcoidosis and recurrent pericardial effusions, treated previously with a subxiphoid pericardial oval window fenestration, presented with acute upper abdominal pain radiating to the chest. High contrast computed tomography showed a volvulus of the liver with consequent venous congestion, and herniation of the liver, stomach and transverse colon through an anterior diaphragmatic defect. With liver perfusion threatened, an urgent laparoscopic repair was performed. The stomach and transverse colon were reduced, and the twisted left lobe of the liver was unrotated and reduced into the abdominal cavity. A double-sided synthetic mesh was used to repair the defect. The patient made an uneventful recovery. Conclusions This is a novel complication of a patient presenting with abdominal pain with a previous history of pericardial window fenestration. A laparoscopic reduction and repair can be performed safely with excellent postoperative results.

Subacute post-operative atrial fibrillation after valvular surgery in patients undergoing cardiac rehabilitation: predictive factors

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Maranta ◽  
A Bonaccorso ◽  
V Rizza ◽  
S Pellegrino ◽  
C Meloni ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Mitral Valve ◽  
Hospital Stay ◽  
Acute Phase ◽  
Previous History ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
History Of

Abstract Background Postoperative atrial fibrillation (POAF) is the most frequent arrhythmic complication following cardiac surgery (occurring in up to one third of patients). It may develop between the second and fourth postoperative days (acute POAF) as well as later, within 30 days after surgery (subacute). Episodes of atrial fibrillation in the subacute phase (sPOAF) are associated with an increase in morbidity, length of hospital stay and several complications both in the mid- and long- term. Therefore, POAF is not just an acute event but it may impact on long term clinical outcomes. Aim of the study The aim of this study was to identify the clinical predictors of postoperative atrial fibrillation in the subacute phase (sPOAF) in patients performing Cardiovascular Rehabilitation (CR) after cardiac surgery. Materials and methods A retrospective study was conducted on 737 post-surgical valvular patients (median age 62 years; 55,4% male) hospitalised in our Unit for in-patient CR program. During all the hospital stay patients received continuous monitoring with 12-lead ECG telemetry. We evaluated the predictive value of anamnestic data, the type of cardiac surgery intervention, the clinical course in the Cardiac Surgery Unit and in the CR Unit, the 6 minutes-walking tests (6MWT) parameters and main blood tests on sPOAF onset. Results SPOAF was documented in 170 patients (23,1%). Those who developed sPOAF were older [median 66 (56–74) years vs median 61 (50–70) years; p&lt;0,001), had a history of atrial fibrillation prior to surgery (29,4% vs 16,2%; p&lt;0,001), had a worse functional result at the 6MWT at the admission in CR Unit [median 250 (180–320) vs median 275 (210–370); p=0,015], had higher values of neutrophil-lymphocite ratio at baseline [median 2,33 (1,84–3,27) vs median 2,17 (1,64 - 2,87); p=0,027] when compared to those who did not develop POAF. At the multivariable logistic regression analysis, the occurrence of POAF in the acute phase (OR 2,916; 95% CI 2,011–4,228; p&lt;0,001), advanced age (OR 1,027; 95% CI 1,01–1,044; p=0,002), previous history of atrial fibrillation (OR 1,652; 95% CI 1,068–2,555; p=0,024), higher values of NLR at baseline (OR 1,144; 95% CI 1,028–1,272; p=0,013) and mitral valve surgery (OR 1,632, 95% CI 1,075–2,480; p=0,022) were found to be independent predictors of sPOAF after cardiac surgery. Conclusions Atrial fibrillation is a common complication after cardiac surgery with great clinical relevance. Advanced age, previous history of AF, higher values of NLR at baseline, mitral valve surgery and the occurrence of POAF in the acute phase were shown to be predictors of sPOAF in a cardiac surgery population during the rehabilitation period. Funding Acknowledgement Type of funding source: None

scholarly journals Worldwide Survey of COVID-19 Associated Arrhythmias

2021 ◽  
Author(s):  
Ellie J. Coromilas ◽  
Stephanie Kochav ◽  
Isaac Goldenthal ◽  
Angelo Biviano ◽  
Hasan Garan ◽  
...  
Keyword(s):  
Cardiac Arrhythmias ◽  
Regional Differences ◽  
Ventricular Arrhythmias ◽  
Sinus Bradycardia ◽  
Cardiac Complications ◽  
Prior History ◽  
High Morbidity ◽  
Mechanically Ventilated ◽  
History Of ◽  
Artery Disease

Background - COVID-19 has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic. Methods - We conducted a retrospective analysis of patients hospitalized with COVID-19 infection worldwide with and without incident cardiac arrhythmias. Patients with documented atrial fibrillation (AF), atrial flutter (AFL), supraventricular tachycardia (SVT), non-sustained or sustained ventricular tachycardia (VT), ventricular fibrillation (VF), atrioventricular block (AVB), or marked sinus bradycardia (HR<40bpm) were classified as having arrhythmia. De-identified data was provided by each institution and analyzed. Results - Data was collected for 4,526 patients across 4 continents and 12 countries, 827 of whom had an arrhythmia. Cardiac comorbidities were common in patients with arrhythmia: 69% had hypertension, 42% diabetes mellitus, 30% had heart failure and 24% coronary artery disease. Most had no prior history of arrhythmia. Of those who did develop an arrhythmia, the majority (81.8%) developed atrial arrhythmias, 20.7% developed ventricular arrhythmias, and 22.6% had bradyarrhythmia. Regional differences suggested a lower incidence of AF in Asia compared to other continents (34% vs. 63%). Most patients in in North America and Europe received hydroxychloroquine, though the frequency of hydroxychloroquine therapy was constant across arrhythmia types. Forty-three percent of patients who developed arrhythmia were mechanically ventilated and 51% survived to hospital discharge. Many institutions reported drastic decreases in electrophysiology procedures performed. Conclusions - Cardiac arrhythmias are common and associated with high morbidity and mortality among patients hospitalized with COVID-19 infection. There were significant regional variations in the types of arrhythmias and treatment approaches.

scholarly journals Corneal Langerhans Cell And Endothelium Changes In Patients With Herpetic Keratitis During Acute Phase Of The Disease And After 6 Months

2019 ◽  
Author(s):  
Vilija Danileviciene ◽  
Reda Zemaitiene ◽  
Vilte Marija Gintauskiene ◽  
Irena Nedzelskiene ◽  
Dalia Zaliuniene
Keyword(s):  
Cell Density ◽  
Acute Phase ◽  
Previous History ◽  
Langerhans Cell ◽  
Eye Disease ◽  
Prospective Clinical Study ◽  
Ophthalmological Examination ◽  
Healthy Controls ◽  
Herpes Labialis ◽  
History Of

Abstract Purpose. To describe corneal morphological changes by evaluating Langerhans cell (LC) and endothelium cell density using in vivo laser scanning confocal microscopy (LSCM) in herpes simplex virus (HSV) keratitis during acute phase of the disease and after 6 months, to compare with contralateral eyes, controls with previous history of herpes labialis and healthy controls. Methods A prospective clinical study included 79 patients with herpetic eye disease, 101 healthy patients with previous history of herpes labialis but no history of herpetic eye disease, and 89 patients with no history of any HSV diseases. All patients underwent a complete ophthalmological examination including LSCM of the central cornea, using the Heidelberg Retina Tomograph III Rostock Cornea Module. After 6 months, the same ophthalmological examination was performed for patients with herpetic eye disease. Serology tests of the serum to detect HSV 1/2 IgG and IgM using Virion Serion ELISA classic kit were performed. Results HSV affected eyes showed an increase in LC density when compared with contralateral eyes, herpes labialis, and healthy control groups (357.9±308.7 vs. 197.1±258.5 vs. 62.9±72.6 vs. 81.7±88.3) (p<0.05). Higher LC density and less density of corneal sub-basal nerve parameters were found (p<0.05). Endothelium density in HSV affected eyes did not differ from the contralateral eyes, but it was lower when comparing with herpes labialis patients and healthy controls (2300.7±530.6 vs. 2343.3±543.7 vs. 2672.9±268.1 vs. 2620.9±347.1) (p<0.05). After 6 months, LC density in HSV affected eyes decreased but did not reach those of healthy controls (p<0.05). Conclusions LSCM reveals a significant increase of LC and decrease of endothelium cell density in HSV affected corneas. The decrease in LC density is a clear, indirect sign of recovery, which can be used in clinical practice.

scholarly journals Profile of Caesarean Section in Kirtipur Hospital

2014 ◽  
Vol 9 (2) ◽  
pp. 51-54
Author(s):  
P Pradhan ◽  
S Shrestha ◽  
P K Rajbhandari ◽  
G Dangal
Keyword(s):  
Caesarean Section ◽  
Previous History ◽  
Fetal Distress ◽  
Fetal Outcome ◽  
High Rate ◽  
Age Group ◽  
Acceptable Range ◽  
Operative Complications ◽  
History Of ◽  
Case Files

Aims: This study was done to find out the incidence and outcome of caesarean sections done at Kirtipur Hospital. Methods: This was a retrospective study conducted from 1st January 2009 to 31st December 2013. Case files of 660 patients who underwent caesarean section for various indications were analyzed for incidence, indication of caesarean section, booking status, parity, and maternal and fetal outcomes. Results: Out of 1295 deliveries, 50.9% (n=660) had caesarean section. Most of the caesarean section was done for fetal distress (40.2%; n=265) and on account of previous history of caesarean section (13.5%; n=89). Majority of caesarean section (44.4%, n=293) was done in age group of 25-29 years. Among them, 65.9% (n=435) were nulliparous. There were 35.3% (n=563) booked cases. Emergency caesarean sections were performed in 62.4% (n=412) cases. Maternal morbidity was less (7.2%, n=48). Conclusions: The study showed high rate of caesarean section. The most common indication was fetal distress. Post-operative complications and fetal outcome were within acceptable range. DOI: http://dx.doi.org/10.3126/njog.v9i2.11763  

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