Abstract 16929: Right Heart Strain on Presenting 12-Lead Electrocardiogram Predicts Critical Illness in COVID-19

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Mohamad Raad ◽  
Sachin Parikh ◽  
Gurjit Singh
Keyword(s):  
Respiratory Failure ◽  
Cardiac Injury ◽  
Cost Effective ◽  
Cardiovascular Complications ◽  
Cor Pulmonale ◽  
Right Heart ◽  
Institutional Review ◽  
Life Threatening ◽  
Clinical Tools ◽  
Almost All

Introduction: The world has been facing the COVID-19 pandemic. Primarily a pulmonary illness, most deaths have been caused by respiratory failure. Emerging information has revealed that cardiovascular complications, including cardiac injury and cor pulmonale, can also be life-threatening consequences of COVID-19. Hypothesis: Signs of right heart strain on presenting 12-lead ECG predicts mortality in patients admitted with COVID-19. Methods: We retrospectively evaluated 480 patients consecutively admitted with COVID-19. ECGs from the emergency department (ED) were read by G.S. and S.P. who were blinded to data and outcomes. Right heart strain (RHS) was defined by any new right axis deviation, S1Q3T3 pattern, incomplete or complete right bundle branch block, or ST Depressions with T-wave inversions in leads V1-3 or II, III, aVF. This study was approved by the Institutional Review Board (IRB# 13774). Results: ECGs from the ED were available for 314 patients who were included in the analysis. Almost all patients were in sinus rhythm with sinus tachycardia being the most frequent dysrhythmia. RHS findings were present in 12.7% of cases. RHS was significantly associated with mortality and was the strongest predictor even after multivariate regression for mortality [OR 18.3 (6.1-55.3), p<0.001] (figure 1, table 1). Conclusions: Among available clinical tools, ECGs are easily performed, cost-effective, and widely available. Patients with evidence of RHS on initial ECG had significantly higher rates of mortality which has not been previously reported. Given that respiratory failure is the most common cause of death in patients with COVID-19, this information is valuable.

scholarly journals COVID-19 and the Cardiovascular System: How the First PostModern Pandemic ‘Weakened’ our Hearts

2020 ◽  
Vol 3 ◽  
pp. e15
Author(s):  
Syeda Tasneem Towhid ◽  
◽  
Nadira Naznin Rakhi ◽  
ASM Shamsul Arefin ◽  
Otun Saha ◽  
...  
Keyword(s):  
Cardiovascular System ◽  
Cardiac Injury ◽  
Age Groups ◽  
Signs And Symptoms ◽  
Holistic Approach ◽  
Cardiovascular Complications ◽  
Cardiac Complications ◽  
Cardiovascular Damage ◽  
Preventative Measures ◽  
Life Threatening

The global spread of SARS-CoV-2 with its diverse signs and symptoms manifested in COVID-19 patients across different age groups and geographic locations perplexed the clinicians and public health experts. Emerging variants of SARS-CoV-2 through continuous mutation with a limited arsenal of treatment made the study of viral pathogenesis and factors associated with disease outcomes in a holistic approach inevitable, among which pre-existing cardiovascular complications were found to be significantly associated with adverse outcome of COVID-19. In addition, COVID-19 has already been reported to cause cardiac injury and different cardiovascular complications in patients irrespective of preexisting cardiovascular complications, which highlights the importance of recognizing the complications at the onset, although these arising complications might be an indirect effect of SARS-CoV-2 induced cytokine storm or hypoxia rather the virus itself. Also, the drugs used for the clinical management of the patients may have an impact on the induced cardiac complications. Thus, the effect of SARS-CoV-2 on the cardiovascular system needs to be investigated in order to predict the clinical outcome and to devise a proper treatment strategy. Besides, the interaction of vaccines or therapeutics to be approved with the cardiovascular system needs to be evaluated to avoid confounding effects leading to cardiovascular complications followed by post-approval retraction. However, potential biomarkers (eg. troponin, D-dimers, fibrin) associated with cardiac injury may be potentially useful in predicting life-threatening conditions early enough to save lives. In conclusion, this review summarizes the molecular pathogenesis of cardiovascular damage caused by SARS-CoV-2 in COVID-19 patients, as well as prescribed treatment and preventative measures.

Application of Natural Dye Obtained from Sweet Indrajao on Fabrics

2020 ◽  
Vol 6 (3) ◽  
pp. 180-191
Author(s):  
Kavitha Chandrasekaran
Keyword(s):  
Potassium Dichromate ◽  
Bacterial Pathogens ◽  
Ultrasonic Method ◽  
Ferrous Sulphate ◽  
Fine Powder ◽  
Cost Effective ◽  
Metal Salts ◽  
Cow Dung ◽  
Long Run ◽  
Almost All

Background:: In the long run, synthetic tints were found to be harmful to the chemicals. As a result natural tints have come to be used for their many intrinsic values. The main reason being, then availability of local plants as the main source of natural colorants. Their easy availability in the country being zero cost – effective and planted for other purposes are the main reasons for utilizing them as natural tints. Almost all the parts of the plants, namely stem, leaves, fruits, seeds, barks etc. are used for extracting natural colour. In addition, they are antimicrobial antifungal, insect – repellant deodorant, disinfectant having medicinal values. Methods:: Sweet Indrajao leaves were cleaned by washing with water and dried under direct sunlight and ground as fine powder. A fine strainer was used to remove the wastages. After all these processes, 1-kilogram leaves weighed 318 grams. Then, it is put in 75% ethanol 25% water and heated in a breaker which in kept over a water bath for 2 hours. After this, the contents were filtered and kept in a separate beaker. Bleached fleece draperies stained with stain extract were made to become wet and put into different stain baths which contain the required amount of stain extract and water. Acetic acid was added to it after 20 minutes. The fleece drapery was stained for about one hour at 60oC. The draperies thus stained were removed, squeezed, and put to treatment with metal salts without washing. Different metal salts were used for the treatment using 3% of any one of the chemical mordants like alum, stannous chloride, potassium dichromate, ferrous sulphate, nickel sulphate, copper sulphate and natural mordants such as myrobolan, turmeric, cow dung, Banana sap juice at 60oC for 30 minutes with MLR of 1:30. The stained draperies were washed repeatedly in all the three methods in water and dried in air. At last, the stained draperies were put to soap with soap solution at 60oC for 10 minutes. The draperies were repeatedly washed in water and dried under the sun. Results:: Sweet Indrajao leaves discharged colour easily in alcoholic water. The fleece draperies were stained with chemical and natural mordants. It was observed that the stain uptake was found to be good in post-mordanting method. Ultrasonication has clearly improved the stainability of the draperies at pH 3 and 3.5 values. The pH decreases the stain ability under both Conventional and Ultrasonic conditions. The colour strength increases with an increase in staining temperature in both cases of US and CH methods. Conclusion:: Sweet Indrajao.L has been found to have good ultrasonic potential as a stain plant. The stain uptake as well as the fastness properties of the fleece drapery were found to enhance when metal mordant was used in conjugation with ultra-sonication for the extract of Sweet Indrajao. It was also found that the enhancement of staining ability was better without mordant draperies. The dye extract showed good antibacterial activity against the three bacterial pathogens. Among the three bacterial pathogens, dye extract showed more effective against Escherichia coli pathogens and dye extract showed more effective against Aspergillus pathogens. Hence, the ultrasonic method of drapery staining may be appropriate and beneficial for society at large in future.

scholarly journals Right Heart Thrombus and Pulmonary Embolism in Patients with Life-Threatening Bleeding: Management of a Complex Condition

2021 ◽  
Author(s):  
Enrico Bentivegna ◽  
Michelangelo Luciani ◽  
Valerio Spuntarelli ◽  
Giorgio Sesti ◽  
Flavia Del Porto ◽  
...  
Keyword(s):  
Therapeutic Strategy ◽  
Bleeding Risk ◽  
Right Heart ◽  
Bleeding Management ◽  
Critical Situation ◽  
Haemodynamic Parameters ◽  
Complex Patients ◽  
Life Threatening ◽  
Uncommon Condition ◽  
In Transit

AbstractRight heart thrombus (RHT) in transit is an uncommon condition associated with high mortality. Increased use of echocardiography has allowed an easier detection of RHT; however, there is no consensus about the most appropriate management of this critical situation. Therapeutic strategy should be decided according to patient’s haemodynamic parameters, clinical data, and bleeding risk. This paper, referring to the most current evidences, underlines the difficulty to establish the best therapeutic strategies in RHT among complex patients as there are no relevant guidelines. In some conditions, multidisciplinary management is the best way to find the most correct therapy despite the bad prognosis.

scholarly journals Focal ST-segment elevation without coronary occlusion: myocardial infarction with no obstructive coronary atherosclerosis associated with COVID-19—a case report

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Casey Meizinger ◽  
Bruce Klugherz
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Respiratory Failure ◽  
Coronary Atherosclerosis ◽  
Myocardial Injury ◽  
Cardiovascular Complications ◽  
St Segment Elevation ◽  
St Segment ◽  
Hypoxic Respiratory Failure ◽  
Artery Disease

Abstract Background While it is understood that coronavirus disease 2019 (COVID-19) is primarily complicated by respiratory failure, more data are emerging on the cardiovascular complications of this disease. A subset of COVID-19 patients present with ST-elevations on electrocardiogram (ECG) yet normal coronary angiography, a presentation that can fit criteria for myocardial infarction with no obstructive coronary atherosclerosis (MINOCA). There is little known about non-coronary myocardial injury observed in patients with COVID-19, and we present a case that should encourage further conversation and study of this clinical challenge. Case summary An 86-year-old man presented to our institution with acute hypoxic respiratory failure and an ECG showing anteroseptal ST-segment elevation concerning for myocardial infarction. Mechanic ventilation was initiated prior to presentation, and emergent transthoracic echocardiography reported an ejection fraction of 50–55%, with no significant regional wall motion abnormalities. Next, emergent coronary angiography was performed, and no significant coronary artery disease was detected. The patient tested positive for COVID-19. Despite supportive management in the intensive care unit, the patient passed away. Discussion We present a case of COVID-19 that is likely associated with MINOCA. It is crucial to understand that in COVID-19 patients with signs of myocardial infarction, not all myocardial injury is due to obstructive coronary artery disease. In the case of COVID-19 pathophysiology, it is important to consider the cardiovascular effects of hypoxic respiratory failure, potential myocarditis, and significant systemic inflammation. Continued surveillance and research on the cardiovascular complications of COVID-19 is essential to further elucidate management and prognosis.

scholarly journals Asymptomatic mediastinal extra-adrenal paraganglioma as a cause of sudden death: a case Report

2019 ◽  
Vol 14 (1) ◽  
pp. 564-567
Author(s):  
Qiancheng Xu ◽  
Yingya Cao ◽  
Hongzhen Yin ◽  
Rongrong Wu ◽  
Tao Yu ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Case Report ◽  
Respiratory Failure ◽  
Pressure Drop ◽  
Thoracic Cavity ◽  
Severe Hypotension ◽  
Life Threatening ◽  
History Of ◽  
Posterior Mediastinal ◽  
Extra Adrenal Paraganglioma

AbstractA 23-year-old female patient was referred for treatment of a posterior mediastinal tumour. There was no history of hypertension or headache and no other complaints. The patient’s blood pressure increased to 210/125 mmHg after surgically manipulating the tumour, subsequently reversing to severe hypotension (25/15 mmHg) immediately after the tumour was removed. The life-threatening and irreversible blood pressure drop was difficult to treat with fluid and vasopressors, and the patient ultimately died of cardio-respiratory failure. Asymptomatic paraganglioma can be non-functional but can also be fatal. For any lump in the thoracic cavity, paraganglioma should be ruled out.

953 Role of Routine Preoperative Echocardiograms in Adolescent Idiopathic Scoliosis Patients undergoing Deformity Correction Surgery

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Hassan ◽  
S Shah ◽  
M Patel
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Clinical Assessment ◽  
Clinical Symptoms ◽  
Deformity Correction ◽  
Cost Effective ◽  
Cardiovascular Complications ◽  
Anterior Correction ◽  
Perioperative Complication ◽  
Clinical Records

Abstract Introduction Patients with Adolescent Idiopathic Scoliosis (AIS) are often noted to have routine preoperative Echocardiograms (ECHO). The prevalence of ECHO abnormalities and their impact on perioperative outcome is not clear, especially balancing against its costs. The study aims at identifying the significance of routine preoperative ECHO for AIS patients. Methodology Clinical records of 295 adolescent AIS patients, &gt;10years age (mean 15.64years), who underwent primary posterior corrective surgery in a tertiary spinal centre, between 2015-2020, were reviewed. Patients with revision surgery, anterior correction, syndromic/neuromuscular scoliosis and/or pre-existent known cardiac comorbidities were excluded. Results 139(47%) patients had preoperative ECHO. 21(15%) patients showed echocardiographic abnormalities (11 trivial valvular abnormalities, 5 mild root dilatation, 3 mild pericardial effusion and 2 septal defects). None of these patients showed any clinical symptoms/signs or required Cardiology assessment; and none had perioperative cardiovascular complications. Conversely, four(1.36%) patients demonstrated auscultatory murmurs on preoperative clinical assessment. None reported any perioperative complication. The average known cost of an echocardiogram was noted to be £363. Conclusions Routine preoperative Echocardiogram for all AIS patients is not recommended or deemed cost-effective. Positive clinical assessment finding could be used as a screening tool for performing ECHO in AIS patients.

scholarly journals Acute pulmonary embolism in COVID-19 patient: a case report of free-floating right heart thrombus successfully treated with fibrinolysis

2020 ◽  
Author(s):  
Fernando Scudiero ◽  
Antonino Pitì ◽  
Roberto Keim ◽  
Guido Parodi
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Retrospective Studies ◽  
Right Heart ◽  
Clinical Issue ◽  
Systemic Thrombolysis ◽  
Case Summary ◽  
High Prevalence ◽  
Life Threatening ◽  
Complex Scenario

Abstract Background Despite the fast-growing understanding of the coronavirus disease 2019 (COVID-19), patient management remains largely empirical or based on retrospective studies. In this complex scenario, an important clinical issue appears to be represented by the high prevalence of thromboembolic events, but the data regarding high-risk pulmonary embolism (PE) is still not available. Case summary A patient with COVID-19 developed sudden shortness of breath and hypoxia. Early echocardiographic diagnosis of high-risk PE related to right heart thrombus was performed. Systemic thrombolysis was administered with excellent clinical and haemodynamic response. Discussion Pulmonary thromboembolism is a common occurrence in severe COVID-19 infection. In our experience, systemic thrombolysis proved to be effective and for this reason may be considered for life-threatening PE in COVID-19 patients.

scholarly journals The Diverse Calpain Family in Trypanosomatidae: Functional Proteins Devoid of Proteolytic Activity?

Cells ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 299
Author(s):  
Vítor Ennes-Vidal ◽  
Marta Helena Branquinha ◽  
André Luis Souza dos Santos ◽  
Claudia Masini d’Avila-Levy
Keyword(s):  
Proteolytic Activity ◽  
Current Knowledge ◽  
Current Therapy ◽  
Calcium Dependent ◽  
Administration Routes ◽  
Life Threatening ◽  
Living Organisms ◽  
Almost All ◽  
Open Question ◽  
Calpain Inhibitors

Calpains are calcium-dependent cysteine peptidases that were originally described in mammals and, thereafter, their homologues were identified in almost all known living organisms. The deregulated activity of these peptidases is associated with several pathologies and, consequently, huge efforts have been made to identify selective inhibitors. Trypanosomatids, responsible for life-threatening human diseases, possess a large and diverse family of calpain sequences in their genomes. Considering that the current therapy to treat trypanosomatid diseases is limited to a handful of drugs that suffer from unacceptable toxicity, tough administration routes, like parenteral, and increasing treatment failures, a repurposed approach with calpain inhibitors could be a shortcut to successful chemotherapy. However, there is a general lack of knowledge about calpain functions in these parasites and, currently, the proteolytic activity of these proteins is still an open question. Here, we highlight the current research and perspectives on trypanosomatid calpains, overview calpain description in these organisms, and explore the potential of targeting the calpain system as a therapeutic strategy. This review gathers the current knowledge about this fascinating family of peptidases as well as insights into the puzzle: are we unable to measure calpain activity in trypanosomatids, or are the functions of these proteins devoid of proteolytic activity in these parasites?

scholarly journals Food Allergen Detection Methods: A Coordinated Approach

2004 ◽  
Vol 87 (6) ◽  
pp. 1383-1390 ◽  
Author(s):  
Philip R Goodwin
Keyword(s):  
Hazard Analysis ◽  
Adult Population ◽  
Control Point ◽  
Cost Effective ◽  
Test Methods ◽  
Detection Methods ◽  
Critical Control Point ◽  
Life Threatening ◽  
Monitoring And Surveillance ◽  
Analytical Approaches

Abstract The levels (1–2%) and increasing severity of allergic responses to food in the adult population are well documented, as is the phenomenon of even higher (3–8%) and apparently increasing incidence in children, albeit that susceptibility decreases with age. Problematic foods include peanut, milk, eggs, tree nuts, and sesame, but the list is growing as awareness continues to rise. The amounts of such foods that can cause allergic reactions is difficult to gauge; however, the general consensus is that ingestion of low parts per million is sufficient to cause severe reactions in badly affected individuals. Symptoms can rapidly—within minutes—progress from minor discomfort to severe, even life-threatening anaphylactic shock in those worst affected. Given the combination of high incidence of atopy, potential severity of response, and apparently widespread instances of “hidden” allergens in the food supply, it is not surprising that this issue is increasingly subject to legislative and regulatory scrutiny. In order to assist in the control of allergen levels in foods to acceptable levels, analysts require a combination of test methods, each designed to produce accurate, timely, and cost-effective analytical information. Such information contributes significantly to Hazard Analysis Critical Control Point programs to determine food manufacturers’ risk and improves the accuracy of monitoring and surveillance by food industry, commercial, and enforcement laboratories. Analysis thereby facilitates improvements in compliance with labeling laws with concomitant reductions in risks to atopic consumers. This article describes a combination of analytical approaches to fulfill the various needs of these 3 analytical communities.

scholarly journals AdipoRon, the first orally active adiponectin receptor activator, attenuates postischemic myocardial apoptosis through both AMPK-mediated and AMPK-independent signalings

2015 ◽  
Vol 309 (3) ◽  
pp. E275-E282 ◽  
Author(s):  
Yanqing Zhang ◽  
Jianli Zhao ◽  
Rui Li ◽  
Wayne Bond Lau ◽  
Yue-Xing Yuan ◽  
...  
Keyword(s):  
Apoptotic Cell ◽  
Ischemia Reperfusion ◽  
Cardiac Injury ◽  
Cardiovascular Complications ◽  
Dominant Negative ◽  
Tunel Staining ◽  
Dna Ladder ◽  
Receptor Activator ◽  
Myocardial Ischemia Reperfusion ◽  
Orally Active

Adiponectin (APN) is a cardioprotective molecule. Its reduction in diabetes exacerbates myocardial ischemia/reperfusion (MI/R) injury. Although APN administration in animals attenuates MI/R injury, multiple factors limit its clinical application. The current study investigated whether AdipoRon, the first orally active molecule that binds APN receptors, may protect the heart against MI/R injury, and if so, to delineate the involved mechanisms. Wild-type (WT), APN knockout (APN-KO), and cardiomyocyte specific-AMPK dominant negative (AMPK-DN) mice were treated with vehicle or AdipoRon (50 mg/kg, 10 min prior to MI) and subjected to MI/R (30 min/3–24 h). Compared with vehicle, oral administration of AdipoRon to WT mice significantly improved cardiac function and attenuated postischemic cardiomyocyte apoptosis, determined by DNA ladder formation, TUNEL staining, and caspase-3 activation (all P < 0.01). MI/R-induced apoptotic cell death was significantly enhanced in mice deficient in either APN (APN-KO) or AMPK (AMPK-DN). In APN-KO mice, AdipoRon attenuated MI/R injury to the same degree as observed in WT mice. In AMPK-DN mice, AdipoRon's antiapoptotic action was partially inhibited but not lost. Finally, AdipoRon significantly attenuated postischemic oxidative stress, as evidenced by reduced NADPH oxidase expression and superoxide production. Collectively, these results demonstrate for the first time that AdipoRon, an orally active APN receptor activator, effectively attenuated postischemic cardiac injury, supporting APN receptor agonists as a promising novel therapeutic approach treating cardiovascular complications caused by obesity-related disorders such as type 2 diabetes.

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