Abstract 16925: Covid-19 Vaccine Associated Acute Myocarditis

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Mishita Goel ◽  
Aldin Jerome ◽  
Verisha Khanam ◽  
Raashi Chawla ◽  
Nishit Choksi
Keyword(s):  
Chest Pain ◽  
Adverse Effects ◽  
Rna Virus ◽  
Normal Sinus Rhythm ◽  
Acute Myocarditis ◽  
Sudden Onset ◽  
Normal Sinus ◽  
Hyperintense Signal ◽  
Normal Chest ◽  
Wall Motion Abnormalities

Case Presentation: A 19 year old male presented with sudden onset chest pain radiating to back. He was a smoker and denied using cocaine since his last hospitalization for cocaine-induced myocardial infarction 2 years ago. UDS was negative. EKG showed normal sinus rhythm with no ST-T wave changes. Initial troponin was 0.850. Potassium levels were low at 2.9 mmol/L but other labs were normal. Chest CT angiography ruled out aortic dissection. He was started on heparin drip. Stat Echocardiogram showed LVEF of 55-60% with no wall motion abnormalities. Repeat potassium levels normalized after replacement, however, his troponins were trending up from 3.9 and 11.5. He continued to complain of severe chest pain, so underwent cardiac catheterization which showed normal coronary arteries and LVEF 55-60%. Heparin drip was discontinued and NSAIDs and colchicine were started. Cardiac MRI (see Figure) was done that showed patchy mid-wall and epicardial delayed gadolinium enhancement involving the basal inferolateral wall, with mild hyperintense signal on the triple IR sequence, suggestive of myocarditis. On further probing, he reported receiving a second dose of Moderna COVID vaccine 3 days prior to presentation. Discussion: In December 2019, a novel RNA virus causing COVID-19 infection was reported, which quickly reached a pandemic level. COVID-19 vaccines were granted emergency use authorization by FDA. With millions of people receiving COVID-19 vaccinations worldwide, rare adverse effects are now being reported. The benefits of vaccination undoubtedly outweigh any minor side effects. However major adverse effects like this are potentially fatal. This case report warrants further investigation into the association of myocarditis with COVID-19 vaccinations and further recommendations regarding vaccination in younger adults.

Myocarditis case associated with Campylobacter jejuni

2018 ◽  
Vol 43 (5) ◽  
pp. 568-570
Author(s):  
Hakan Ayyildiz ◽  
Mehmet Kalayci ◽  
Nadire Cinkilinc ◽  
Mahmut Bozkurt ◽  
Makbule Kutlu Karadag
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Campylobacter Jejuni ◽  
Bacterial Infections ◽  
Troponin I ◽  
Normal Sinus Rhythm ◽  
Cardiac Enzymes ◽  
Normal Sinus ◽  
Anterior Hemiblock ◽  
High Sensitive Troponin

Abstract Objective Myocarditis is an inflammatory disease of the heart caused by various agents and especially enteroviruses, and it is difficult to diagnose and treat. Myocarditis is rarely associated with bacterial infections. Although the most common bacterial infections are Salmonella spp. and Shigella spp., extremely rare cases of Myocarditis due to Campylobacter jejuni are also reported. Patient and methods A 17-year-old male patient with no previous chronic illness was admitted to our emergency department with complaints of abdominal pain, diarrhea, vomiting, and chest pain. He stated that symptoms began after eating a chicken burger a few days ago. Results In the laboratory tests performed, CK-MB and high sensitive Troponin I values were determined as 33.8 IU/L and 1816 ng/L, respectively. Electrocardiogram results revealed left axis left anterior hemiblock in the normal sinus rhythm as well as a ST-T change in the inferior and lateral derivations. Campylobacter jejuni was detected in the stool sample of the patient. Conclusion Myocarditis is one of the rare complications of C. jejuni infection. Bacterial myocarditis should be considered when troponin and cardiac enzymes are elevated in patients admitted to the emergency department with diarrhea and chest pain.

scholarly journals TREMORS MIMICKING ATRIAL FLUTTER IN AN ELDERLY LADY

2022 ◽  
Vol 54 (4) ◽  
pp. 370-372
Author(s):  
Intisar Ahmed ◽  
Hunaina Shahab ◽  
Aamir Hameed Khan
Keyword(s):  
Chest Pain ◽  
Sinus Rhythm ◽  
Hospital Stay ◽  
Atrial Flutter ◽  
Normal Sinus Rhythm ◽  
Correct Diagnosis ◽  
Normal Sinus ◽  
Inappropriate Treatment ◽  
History Of

A 77 -year-old lady with history of hypertension and Parkinson`s disease was admitted with cough and fever and diagnosed as pneumonia. On second day of admission, she started having chest pain, initial ECG was interpreted as atrial flutter. When her ECG was reviewed by a cardiologist, ECG features were found to be consistent with artifacts due to tremors. A repeat 12 leads ECG clearly demonstrated normal sinus rhythm and the patient remained completely asymptomatic throughout the hospital stay. Tremor induced artifacts can be mistaken for arrhythmias. Correct diagnosis is important, in order to avoid inappropriate treatment and unnecessary interventions.

scholarly journals Flecainide is well-tolerated and effective in patient with atrial fibrillation at 12 months: a retrospective study

2020 ◽  
Vol 14 ◽  
pp. 175394472092682
Author(s):  
Mikayla Muzzey ◽  
Katie B. Tellor ◽  
Karthik Ramaswamy ◽  
Martin Schwarze ◽  
Anastasia L. Armbruster
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Effects ◽  
Control Strategies ◽  
Normal Sinus Rhythm ◽  
Hot Flashes ◽  
Retrospective Chart Review ◽  
Structural Heart Disease ◽  
Rhythm Control ◽  
Normal Sinus ◽  
Proven Efficacy

Introduction: Current atrial fibrillation (AF) guidelines recommend flecainide as a first-line rhythm control option in patients without structural heart disease. While there is proven efficacy in clinical trials and guideline support, it is hypothesized that flecainide may be underutilized due to negative outcomes in the CAST trial and that adverse effects are less common than previously perceived. Methods: This retrospective chart review evaluated patients ⩾18 years initiated on flecainide for AF from August 2011 to October 2016 by a cardiology provider at the study site. Exclusion criteria included: <5 days of flecainide therapy, AF due to a reversible cause, and inadequate documentation. The primary outcome was efficacy of flecainide at maintaining symptomatic control at 6 and 12 months. Secondary outcomes included characterization of alterations in rhythm control strategies and documented normal sinus rhythm per electrocardiogram at 6 and 12 months. Results: Of the 326 patients identified, 144 patients were included. After 6 and 12 months, 102 patients (70.8%) and 89 patients (61.8%) of the 144 were symptomatically controlled. Atenolol use ( p = 0.024), female sex ( p = 0.006), hypertension ( p = 0.040), and dronedarone failure ( p = 0.012) were associated with flecainide discontinuation at 6 months. At 12 months, only previous propafenone failure ( p = 0.032) was significant. Of the 144 patients, 16 (11.1%) reported adverse effects with dizziness, hot flashes, bradycardia, and headache (1.4% each) being the most common. Conclusion: Flecainide is a well-tolerated medication, even at 12 months, with very minor adverse effects. These results support the utility of flecainide in guideline recommended patient populations.

Spontaneous Coronary Artery Dissection in Multiple Gestation Peripartum Period

2021 ◽  
Vol 17 (2) ◽  
pp. 124-125
Author(s):  
Kootaybah Alsheikhly ◽  
Hiba Obeid ◽  
Jason Donaghue
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
African American Woman ◽  
Normal Sinus Rhythm ◽  
American Woman ◽  
Sudden Onset ◽  
Artery Dissection ◽  
Multiple Gestation ◽  
Spontaneous Coronary Artery Dissection ◽  
Coronary Artery Dissection

Background: Non-atherosclerotic spontaneous coronary artery dissection (SCAD) is defined as a non-traumatic and non-iatrogenic separation of the coronary arterial wall. SCAD is a highly uncommon cause of myocardial infarction (0.1 to 0.4 %). Case presentation: 40-year-old African American woman, G1T1P0A0L2, with a past medical history of tobacco abuse and obesity who had uncomplicated cesarean section delivery for healthy twins two weeks prior presented with substernal, sudden onset chest pain. The pain radiated to left arm and back, pressure-like, and is associated with nausea, vomiting, and dyspnea. On examination she was within normal limits except for a well-healed C-section wound. An electrocardiogram showed normal sinus rhythm with Nonspecific ST Abnormality. The first set of troponins less than 0.03, the second set shows troponins 0.18 and D-dimer 2340. The chest x-ray was unremarkable. An echocardiogram showed only mild to moderate mitral valve regurgitation. CT angiography of the chest showed no evidence of pulmonary embolism. She was started on a heparin drip and catheterization the next day showed no atherosclerotic coronary artery disease, but SCAD of inferior diagonal first branch noted. No intervention was done, heparin was stopped. The patient was started on aspirin, statin, Clopidogrel, Metoprolol, and Lisinopril per cardiology recommendation. Conclusions: As an internist and primary care provider, we should keep Non-atherosclerotic SCAD in mind when a young female patient presents with acute chest pain. More studies are needed to find out the optimal management. Current recommended conservative medical management includes long-term aspirin, beta blocker, and one year of clopidogrel, with the addition of a statin in patients with dyslipidemia.

scholarly journals Atypical chest pain in a young woman with an interatrial bronchogenic cyst

2021 ◽  
Vol 14 (4) ◽  
pp. e241736
Author(s):  
Essam Saad ◽  
Pooja Singh ◽  
Marc Iskandar
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Sinus Rhythm ◽  
Cardiac Mri ◽  
Bronchogenic Cyst ◽  
Normal Sinus Rhythm ◽  
Pathology Report ◽  
Atypical Chest Pain ◽  
Normal Sinus

A 31-year-old woman presented to the emergency department with atypical retrosternal chest pain and dyspnoea. Investigations initially revealed atrial flutter on her electrocardiogram and an interatrial septal mass on CT angiography of the chest. Additional workup with cardiac MRI and transoesophageal echocardiogram were able to delineate the cardiac mass. Electrophysiology and cardiothoracic surgery were consulted. The mass was excised in the same hospitalisation and the pathology report demonstrated a bronchogenic cyst. After mass excision, the patient chest pain has decreased, and she reverted back to normal sinus rhythm. On further follow-up, her flecainide and metoprolol were stopped.

scholarly journals Paroxysmal Atrial Fibrillation Induced by Ciprofloxacin: A Rare Adverse Effect

2020 ◽  
Author(s):  
Fatma Hammami ◽  
Makram Koubaa ◽  
Sahar Ben Kahla ◽  
Amal Chakroun ◽  
Khaoula Rekik ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Adverse Effects ◽  
Liver Abscess ◽  
Paroxysmal Atrial Fibrillation ◽  
Epigastric Pain ◽  
Normal Sinus Rhythm ◽  
Klebsiella Pneumonia ◽  
Interval Prolongation ◽  
Normal Sinus ◽  
Qt Interval Prolongation

Despite their adverse effects, fluoroquinolones continue to be commonly prescribed antibiotics. Ciprofloxacin remains the safest with remarkably few adverse effects of all fluoroquinolones. Here, we present a rare case of paroxysmal atrial fibrillation induced by ciprofloxacin intake in a 72-year-old woman. She was treated with ciprofloxacin and ceftriaxone for urinary tract infection caused by Klebsiella pneumonia and complicated with liver abscess. On the fifth day of ciprofloxacin intake, she suddenly complained of heart palpitations and epigastric pain. An electrocardiogram revealed supraventricular tachycardia type atrial fibrillation at 130 beats per minute. No QT interval prolongation was noted. Ciprofloxacin was stopped as it was the most incriminated to induce arrhythmia. A control electrocardiogram showed normal sinus rhythm. We continued ceftriaxone use solely for 3 weeks until the resolution of the liver abscess. Although rare, early detection of atrial fibrillation induced by ciprofloxacin may decrease the severity of complications and prevent death.

scholarly journals Electrical injury - induced atrial fibrillation: A case report

2021 ◽  
pp. 85-85
Author(s):  
Milovan Stojanovic ◽  
Bojan Ilic ◽  
Marina Deljanin-Ilic ◽  
Stevan Ilic
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Head Injuries ◽  
Cardiac Monitoring ◽  
Electrical Injury ◽  
Normal Sinus ◽  
Entry Wound ◽  
Wall Motion Abnormalities

Introduction: Electrical injury can cause various cardiac dysrhythmias such as asystole, ventricular fibrillation, sinus tachycardia, and heart blocks. However, it rarely causes atrial fibrillation. Case report: Patient S.M, born in Nis in 1973, was admitted to the emergency department after receiving an electric shock (<600 V). He subsequently lost consciousness, fell down, and sustained back and head injuries. During the examination heart rate was irregular but with no heart murmurs. There was an entry wound on the front of the left thigh and an exit wound on the front of the neck. An electrocardiogram showed newly appearing atrial fibrillation. The laboratory tests showed no pathological deviation and focus cardiac ultrasound showed that contractile force was preserved with no wall-motion abnormalities and normal left atrium dimensions. The patient was administered low-molecular-weight heparin subcutaneously and propafenone (600 mg) orally. At follow up after 24 hours, an electrocardiogram showed normal sinus rhythm. Conclusion: We report a rare case of an electrical injury-induced atrial fibrillation, which was converted to sinus rhythm by pocket therapy. Although most cases of an electrical injury-induced AF represent benign conditions which are self-limited, cardiac monitoring as a routine measure should be considered.

Theophylline and Verapamil: Clinically Significant Drug Interaction

1997 ◽  
Vol 13 (6) ◽  
pp. 241-243
Author(s):  
Luella Bangura ◽  
Mark A Malesker ◽  
Naresh A Dewan
Keyword(s):  
Drug Interaction ◽  
Chest Pain ◽  
Adverse Effects ◽  
Clinical Significance ◽  
Sudden Onset ◽  
Review Of The Literature ◽  
Theophylline Clearance ◽  
Significant Drug Interaction ◽  
Case Summary ◽  
Clinically Significant

Objective: To report and describe a case of verapamil interacting with theophylline. Case Summary: A 33-year-old white man with bronchial asthma was admitted for evaluation of sudden onset of chest pain. During hospitalization, verapamil 120 mg/d was added to the theophylline regimen (600 mg bid). The patient's requirement for theophylline decreased by 50% after the initiation of verapamil. Discussion: A review of the literature indicated that concomitant verapamil may reduce theophylline clearance by 12–23%. Other reports suggest that the degree of this interaction is of much smaller magnitude and clinically insignificant. Conclusions: Although the most recent FDA labeling guidelines for theophylline mention verapamil as a documented source of drug interaction with theophylline, many clinicians may not realize the potential clinical significance. Therefore, theophylline concentrations should be monitored in patients receiving both theophylline and verapamil, even in the absence of adverse effects.

Sign in / Sign up

Export Citation Format

Share Document