scholarly journals Myocarditis and pericarditis in association with COVID-19 mRNA-vaccination: cases from a regional pharmacovigilance centre

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Ioanna Istampoulouoglou ◽  
Georgios Dimitriou ◽  
Selina Späni ◽  
Andreas Christ ◽  
Barbara Zimmermanns ◽  
...  
Keyword(s):  
Chest Pain ◽  
Length Of Stay ◽  
Adverse Events ◽  
European Society ◽  
Vaccine Dose ◽  
Acute Chest Pain ◽  
Pharmacovigilance Centre ◽  
Median Length ◽  
Median Latency ◽  
European Society Of Cardiology

In this article we summarize suspected adverse events following immunization (AEFI) of pericarditis, myocarditis and perimyocarditis that were reported by our regional pharmacovigilance centre after COVID-19 mRNA-vaccination and discuss their association with these vaccines. Seventeen cases were reported between March and July 2021. Of these, nine had perimyocarditis, five myocarditis and three pericarditis. Twelve patients were male (71 %). The median age was 38 years (range 17 - 88). The most commonly observed presenting symptom was acute chest pain (65%). While 47% of the patients were previously healthy, 53% had at least one pre-existing comorbidity, with hypertension being the most prevalent (24%). The European Society of Cardiology diagnostic criteria for the reported AEFIs were fulfilled in twelve cases (71%). The AEFIs occurred after the first vaccine dose in six cases (35%), after the second vaccine dose in ten cases (59%) and after both doses in one case (6%). The median latency of all AEFIs taken together was 14 days (range 1 - 28) after the first vaccination and 3 days (range 1 - 17) after the second one. All patients except one were hospitalized (94%) with a median length of stay of 7.5 days (range 3 - 13). The majority of patients (n = 11, 65%) did not experience any complications, and 13 (77%) of the patients were recovered or recovering at the time of discharge. In 16 of the 17 cases (94%), the association between the AEFI and mRNA-vaccination was considered possible by the pharmacovigilance centre.

scholarly journals Impact of more conservative European Society of Cardiology guidelines on the management of patients with acute chest pain

2021 ◽  
Author(s):  
Calvin L. Kienbacher ◽  
Verena Fuhrmann ◽  
Raphael Tulder ◽  
Christof Havel ◽  
Wolfgang Schreiber ◽  
...  
Keyword(s):  
Chest Pain ◽  
European Society ◽  
Acute Chest Pain ◽  
European Society Of Cardiology

scholarly journals Effectiveness and Safety of the European Society of Cardiology 0-/1-h Troponin Rule-Out Protocol: The Design of the ESC-TROP Multicenter Implementation Study

Cardiology ◽  
2020 ◽  
Vol 145 (11) ◽  
pp. 685-692
Author(s):  
Arash Mokhtari ◽  
Ardavan Khoshnood ◽  
Jakob Lundager Forberg ◽  
Caroline Hård af Segerstad ◽  
Ulf Ekström ◽  
...  
Keyword(s):  
Chest Pain ◽  
Clinical Assessment ◽  
European Society ◽  
Troponin T ◽  
High Sensitivity ◽  
Routine Care ◽  
Coronary Syndrome ◽  
European Society Of Cardiology ◽  
Pain Patients ◽  
Rule Out

Chest pain is one of the most common complaints at the emergency department (ED), and it is commonly the perceived likelihood of acute coronary syndrome (ACS) that drives management. Guidelines from the European Society of Cardiology (ESC) recommend the use of a 0-/1-h high-sensitivity cardiac troponin T (hs-cTnT) protocol to rule out or in ACS, but this is mostly based on observational studies. The aim of the ESC-TROP trial is to determine the safety and effectiveness of the ESC 0-/1-h hs-cTnT protocol when implemented in routine care. Adult chest pain patients at 5 EDs in the Skåne Region, Sweden, are included in the trial. The 0-/1-h hs-cTnT ESC protocol supplemented with clinical assessment and electrocardiography (ECG) is implemented at 3 EDs, and the other 2 EDs act as concurrent controls. Outcomes will be evaluated during the 10 months after the implementation and the corresponding 10 months of the previous year. The 2 co-primary outcomes are (a) acute myocardial infarction (AMI) and all-cause death within 30 days in patients discharged from the ED, and (b) ED length of stay of the same patients. Secondary outcomes include the proportion of chest pain patients discharged from the ED and the number of ruled-out patients undergoing objective testing within 30 days. The ESC-TROP trial will determine the performance and applicability of the 0-/1-h hs-cTnT ESC protocol supplemented with clinical assessment and ECG when implemented in routine ED care. It will provide evidence whether 0-/1-h hs-cTnT testing is safe, effective, and feasible, and whether widespread implementation as recommended by ESC guidelines should be supported.

Cardiovascular symptoms

ESC CardioMed ◽  
2018 ◽  
pp. 8-17
Author(s):  
Alan G. Japp ◽  
Iain Simpson ◽  
Stephen Pettit ◽  
Arthur Yue ◽  
Junaid Zaman
Keyword(s):  
Heart Failure ◽  
New York ◽  
Chest Pain ◽  
Chronic Heart Failure ◽  
Objective Assessment ◽  
Acute Chest Pain ◽  
Heart Association ◽  
Diagnostic Value ◽  
Optimal Approach ◽  
European Society Of Cardiology

The symptomatic repertoire of cardiac disease is relatively narrow and most conditions will present with one or more of chest pain, dyspnoea, palpitation, syncope, or presyncope. On the other hand, the differential diagnosis of each of these symptoms is broad and includes both cardiac and non-cardiac disorders. Certain features of acute chest pain alter the likelihood of acute coronary syndrome but, in isolation, the history is usually insufficient to rule in or rule out the diagnosis. Intermittent chest pain can be categorized as typical angina, atypical angina, or non-anginal based on three symptom characteristics; this classification has substantial diagnostic value and helps to determine the need for and the most appropriate mode of further investigation. Orthopnoea and paroxysmal nocturnal dyspnoea are more specific for heart failure than other forms of dyspnoea. However, it is not possible to diagnose either acute or chronic heart failure by the history alone. For both angina and chronic heart failure, the European Society of Cardiology recommends objective assessment of symptom severity using the Canadian Cardiovascular Society and New York Heart Association classifications respectively. Definitive diagnosis of palpitation usually requires documentation of the cardiac rhythm during symptoms but a clear description of the symptom may suggest the likely diagnosis and guide the optimal approach to rhythm monitoring. The history is invaluable in differentiating syncope and presyncope from other causes of transient loss of consciousness and dizziness. Beyond this, clinical features such as prodromal symptoms or precipitation of episodes by exposure to pain can help to distinguish cardiac from reflex syncope.

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