scholarly journals Hydroxychloroquine- and Azithromycin-Induced Transient Left-Bundle Branch Block in a Patient with COVID-19

2021 ◽  
pp. 92-97
Keyword(s):  
Side Effects ◽  
Left Bundle Branch Block ◽  
Sinus Tachycardia ◽  
Systemic Diseases ◽  
The Novel ◽  
Bundle Branch Block ◽  
Cardiac Symptoms ◽  
Case Summary ◽  
Novel Coronavirus ◽  
High Infectivity

Background: COVID-19 has emerged and rapidly spread worldwide due to the high infectivity of the novel coronavirus. A new regimen consisting of a combination of hydroxychloroquine and azithromycin has been under evaluation for efficacy and side effects, especially cardiotoxicity. Case summary: A 58-year-old man was admitted to the hospital for COVID-19 pneumonia. His initial ECG showed sinus tachycardia. He was started on combination therapy of azithromycin and hydroxychloroquine. After the second dose of hydroxychloroquine and initial dose of azithromycin, his ECG showed complete left-bundle branch block (LBBB). The treatment was stopped, and the patient had no cardiac symptoms. On Day 8 of admission, his repeat ECG showed an absence of LBBB. Discussion: The cumulative dose of hydroxychloroquine observed in patients treated for malaria or systemic diseases is cardiotoxic, and few cases of LBBB, have been reported. It is, however, not known whether the use of azithromycin in association with a small dose of hydroxychloroquine induces transient LBBB.

Prognosis of incidental left bundle branch block

EP Europace ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. 956-963
Author(s):  
Abbasin Zegard ◽  
Osita Okafor ◽  
Joseph de Bono ◽  
Richard Steeds ◽  
Lucy Hudsmith ◽  
...  
Keyword(s):  
Myocardial Fibrosis ◽  
Left Bundle Branch Block ◽  
Total Mortality ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Cardiac Events ◽  
Bundle Branch Block ◽  
Ventricular Ejection Fraction ◽  
Clinical Events ◽  
Cardiac Symptoms

Abstract Aims Incidental left bundle branch block (iLBBB) is a frequent cause for cardiology referrals. In such instances, there is uncertainty as to its prognosis. We sought to determine the utility of cardiovascular magnetic resonance (CMR) in the risk stratification of patients with iLBBB. Methods and results Clinical events were collected in patients with iLBBB who had CMR. Controls had no cardiac symptoms or cardiac disease, a normal CMR scan and electrocardiogram. Amongst patients with iLBBB [n = 193, aged 62.7 ± 12.6 years (mean ± SD)], 110/193 (56.9%) had an abnormal phenotype (iLBBBCMR+) and 83/110 (43.0%) had a normal phenotype (iLBBBCMR−). Over 3.75 years (median; inter-quartile range: 2.7–5.5), iLBBBCMR+ had a higher total mortality [adjusted hazard ratio (aHR) 6.49, 95% confidence interval (CI) 1.91–22.0] and total mortality or major adverse cardiac events (MACEs; aHR 9.15, 95% CI 2.56–32.6) than controls (n = 107). In contrast, iLBBBCMR− had a similar risk of total mortality compared with controls, but total mortality or MACEs was higher (aHR 4.24, 95% CI 1.17–15.4; P = 0.028). Amongst iLBBB patients, both myocardial fibrosis (aHR 5.15, 95% CI 1.53–17.4) and left ventricular ejection fraction (LVEF)  ≤ 50% (aHR 3.88, 95% CI 1.67–9.06) predicted total mortality. Myocardial fibrosis plus LVEF ≤50% was associated with the highest risk of total mortality (aHR: 9.87, 95% CI 2.99–32.6) and total mortality or MACEs (aHR 3.98, 95% CI 1.73–9.11). Conclusions Outcomes in iLBBBCMR+ were poor whereas survival in iLBBBCMR− was comparable with controls. Myocardial fibrosis and LVEF <50% had an additive effect on the risk of clinical outcomes. A CMR scan is pivotal in risk-stratifying patients with iLBBB.

Electrical-mechanical relationships in experimentally produced bundle-branch block and complete heart block

1959 ◽  
Vol 14 (6) ◽  
pp. 956-960 ◽  
Author(s):  
Philip Samet ◽  
Robert S. Litwak ◽  
William H. Bernstein ◽  
Norman Kenyon
Keyword(s):  
Right Ventricular ◽  
Left Bundle Branch Block ◽  
Heart Block ◽  
Sinus Tachycardia ◽  
Complete Heart Block ◽  
Left Ventricular ◽  
Ventricular Contraction ◽  
Bundle Branch Block ◽  
Idioventricular Rhythm ◽  
The Right

Right and left ventricular pressure curves were recorded simultaneously with the electrocardiogram in the dog. Control observations were made during sinus tachycardia with normal intraventricular conduction, and repeated after production of right and left bundle-branch block and after production of complete heart block with idioventricular rhythm. The mode relationship between onset of isometric contraction in the two ventricles was 0.00 seconds during sinus tachycardia. During right bundle-branch block, left ventricular contraction started 0.01 second prior to the right; during left bundle-branch block, right ventricular contraction started 0.02 second prior to the left. During left ventricular idioventricular rhythm, left ventricular isometric contraction started 0.01 second prior to the right; during right ventricular idioventricular rhythm, right ventricular contraction started 0.01 second prior to the left. These changes in relative onset of ventricular contraction are far less than those expected on theoretical grounds. Submitted on March 26, 1959

scholarly journals Heart Failure with Transient Left Bundle Branch Block in the Setting of Left Coronary Fistula

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Stephen P. Juraschek ◽  
Lara C. Kovell ◽  
Ryan E. Childers ◽  
Grant V. Chow ◽  
Glenn A. Hirsch
Keyword(s):  
Heart Failure ◽  
Left Bundle Branch Block ◽  
New Left ◽  
Left Shoulder ◽  
Ecg Changes ◽  
Coronary Fistula ◽  
Transient Ischemia ◽  
Bundle Branch Block ◽  
Cardiac Symptoms ◽  
Coronary Steal

Coronary arterial fistulas are rare communications between vessels or chambers of the heart. Although cardiac symptoms associated with fistulas are well described, fistulas are seldom considered in the differential diagnosis of acute myocardial ischemia. We describe the case of a 64-year-old man who presented with left shoulder pain, signs of heart failure, and a new left bundle branch block (LBBB). Cardiac catheterization revealed a small left anterior descending (LAD)-to-pulmonary artery (PA) fistula. Diuresis led to subjective improvement of the patient's symptoms and within several days the LBBB resolved. We hypothesize that the coronary fistula in this patient contributed to transient ischemia of the LAD territory through a coronary steal mechanism. We elected to observe rather than repair the fistula, as his symptoms and ECG changes resolved with treatment of his heart failure.

scholarly journals Stability of SARS-CoV-2 in Different Environments and the Effect of Disinfectants on its Survival

2020 ◽  
Vol 24 (2) ◽  
pp. 178-189
Author(s):  
Parisa Abedi Elkhichi ◽  
◽  
Masoumeh Aslanimehr ◽  
Mojtaba Niazadeh ◽  
◽  
...  
Keyword(s):  
Effective Treatment ◽  
Low Temperatures ◽  
Environmental Stability ◽  
The Novel ◽  
Exclusion Criteria ◽  
Protective Measures ◽  
Review Study ◽  
The Stability ◽  
Novel Coronavirus ◽  
High Infectivity

In December 2019, the prevalence of a pneumonia with unknown cause was reported in China which was later named Coronavirus Disease 2019 (COVID-19) caused by a virus called SARS-CoV-2. One of the most important ways of COVID-19 transmission is contaminated surfaces. In this review study, we investigated the stability of SARS-CoV-2 in air and on surfaces and the methods of preventing its spread Reported in studies conducted from 2003 to April 2020 which were searched in PubMed, Scopus, Embace, and Google Scholar databases using keywords including Coronavirus, COVID-19, SARS-CoV-2, disinfection, transmission and surfaces. Out of 118 articles identified in the initial search, 73 were remained after screening their titles and abstracts. By applying inclusion and exclusion criteria, 51 articles were finally selected for review. The novel coronavirus epidemic in humans is more widespread than previous coronaviruses, indicating the high infectivity and environmental stability of the virus. The SARS-CoV-2 can stay active for up to 28 days at low temperatures (4°C). Currently, due to the lack of effective treatment and vaccines, the best ways to deal with this disease is to avoid contamination, use disinfectants, and prevent its spread by protective measures.

scholarly journals A case report of a rare cardiac complication in novel coronavirus disease

2020 ◽  
Author(s):  
Alireza Malekrah ◽  
Alireza Fatahian
Keyword(s):  
Atrioventricular Block ◽  
Cardiac Involvement ◽  
Pacemaker Implantation ◽  
Cardiac Conduction ◽  
Bundle Branch Block ◽  
Electrolyte Disturbances ◽  
Case Summary ◽  
Novel Coronavirus ◽  
Echocardiographic Findings

Abstract Background Since late 2019, the outbreak of COVID-19 has rapidly spread worldwide. As it is a newly emerged disease, many of its manifestations and complications are unknown to us. Cardiac involvement and arrhythmias are another aspect of the disease about which very little is known. Case summary A 71-year-old male patient presented at the Emergency Department complaining of fever, a dry cough, and dyspneoa. He was admitted due to these symptoms suggestive of COVID-19, and a chest CT and PCR test confirmed the diagnosis. During admission, cardiac involvement was detected, i.e. second-degree atrioventricular block with intermittent left bundle branch block (LBBB) which progressed to fixed LBBB and eventually developed into atrial fibrillation/flutter with bradycardia. Both cardiac troponin and echocardiographic findings for detecting myocarditis were negative. We waited 14 days for resolution of atrioventricular block before permanent pacemaker implantation, but the condition still did not improve after the waiting period. Discussion COVID-19 is mainly a respiratory infection but cardiac involvement is not uncommon in the course of the disease. Arrhythmia, during this infection, seems to be caused by an inflammatory response in the myocardium, electrolyte disturbances, and hypoxia; the course of the disease in our case study shows that the virus can preferentially and irreversibly involve the cardiac conduction system.

scholarly journals The high infectivity of SARS-CoV-2 B.1.1.7 is associated with increased interaction force between Spike-ACE2 caused by the viral N501Y mutation

2021 ◽  
Author(s):  
Jadson C. Santos ◽  
Geraldo A. Passos
Keyword(s):  
Interaction Force ◽  
Phylogenetic Group ◽  
Viral Infectivity ◽  
The Novel ◽  
Receptor Binding Domain ◽  
Angiotensin Converting Enzyme 2 ◽  
The United Kingdom ◽  
Novel Coronavirus ◽  
Determining Factor ◽  
High Infectivity

AbstractThe Spike glycoprotein receptor-binding domain (RBD) of SARS-CoV-2 mediates the viral particle’s binding to the angiotensin-converting enzyme 2 (ACE2) receptor on the surface of human cells. Therefore, Spike-ACE2 interaction is a crucial determining factor for viral infectivity. A new phylogenetic group of SARS-CoV-2 (lineage B.1.1.7) has been recently identified in the COVID-19 Genomics UK Consortium dataset, which features an amino acid substitution in the Spike RBD (N501Y mutation). Infections with the SARS-CoV-2 lineage B.1.1.7 have been overgrowing in recent weeks in the United Kingdom, indicating an even greater spread capacity than that seen with previous strains of the novel coronavirus. We hypothesized that this rapid spreading/infectivity of the B.1.1.7 lineage might be due to changes in the interaction force between the mutant Spike RBD and ACE2. This study employed in silico methods involving mutagenesis (N501Y mutation) and interface analysis focusing on the Spike RDB-ACE2 interaction. The results showed that the SARS-CoV-2 N501Y mutant (lineage B.1.1.7) establishes a more significant number of interactions relating to the mutant residue Y501 (Spike RDB) with residues Y41 and K353 (ACE2). This finding shows that the increased infectivity of SARS-CoV-2 lineage B.1.1.7 is associated with the interaction force between the Spike RBD Y501 mutant residue with the ACE2 receptor, which in this strain is increased.

scholarly journals Effectiveness of Amiodarone in Resistant Arrhythmias1

1980 ◽  
Vol 73 (12) ◽  
pp. 842-844
Author(s):  
Arthur Hollman ◽  
Phyllis M Holt
Keyword(s):  
Atrial Fibrillation ◽  
Ventricular Tachycardia ◽  
Side Effects ◽  
Left Bundle Branch Block ◽  
Ventricular Arrhythmias ◽  
Considerable Improvement ◽  
Amiodarone Therapy ◽  
Drug Resistant ◽  
Bundle Branch Block ◽  
Development Of Tolerance

Amiodarone is used in the treatment of previously drug-resistant supraventricular and ventricular arrhythmias. We report our experience with amiodarone in 8 patients. Five patients had paroxysmal atrial flutter, one had paroxysmal atrial fibrillation, one had supraventricular tachycardia, and one ventricular tachycardia. Considerable improvement, both objectively and subjectively, was observed in all patients. Side effects were as follows: all patients had corneal microdeposits, one developed left bundle branch block which resolved on stopping amiodarone, and one reported constipation and abdominal pains. Six patients have been treated for 10–28 months; 3 developed tolerance at 4–14 months after the introduction of amiodarone therapy, but symptoms improved with increased dosage. It is important to watch for the development of tolerance to this drug.

scholarly journals Can a COVID-19 Vaccine Live up to Americans’ Expectations? A Conjoint Analysis of how Vaccine Characteristics Influence Vaccination Intentions

2020 ◽  
Author(s):  
Matthew Motta
Keyword(s):  
Side Effects ◽  
Health Communication ◽  
Herd Immunity ◽  
Vaccine Uptake ◽  
The Novel ◽  
Vaccine Refusal ◽  
The Us ◽  
Public Health Officials ◽  
Communication Challenges ◽  
Novel Coronavirus

Objective: A vaccine for the novel coronavirus (COVID-19) could prove critical in establishing herd immunity. While past work has documented the prevalence and correlates of vaccine refusal, I assess how a less explored topic -- properties of vaccines themselves (e.g., national origin, efficacy, risk of side effects) -- might influence vaccination intentions. This information can help public health officials preempt differential vaccine demand, and inform health communication campaigns that encourage vaccine uptake. Rationale: Previous research suggests that Americans should be more likely to intend to vaccinate if presented with a US-made vaccine that carries a low risk of minor side effects, is highly effective, is administered in just one dose, and has spent significant time in development.Methods: I administered a conjoint experiment (N = 5,940 trials) in a demographically representative survey (N = 990) of US adults to assess how variation in vaccine properties influence self-reported public vaccination intentions.Results: I find that respondents prefer vaccines that are US-made, over 90% effective, and carry a less than 1% risk of minor side effects. This is potentially problematic, as some leading vaccine candidates are produced outside the US, and may be less effective and more likely to produce minor side effects than respondents would otherwise prefer. Worryingly, intended vaccine refusal rates exceed 30% for a vaccine meeting these optimal characteristics. Encouragingly, though, Americans show no clear preference for vaccines administered in one dose, or developed in under a year, and do not appear to draw a distinction between weakened viral vs. mRNA-based vaccines.Conclusion: Americans’ preferences for a novel coronavirus vaccine may be at odds with the vaccine that ultimately hits the market, posing both policy and health communication challenges for vaccination uptake.

scholarly journals Identification of susceptibility loci for adverse events following COVID-19 vaccination in the Japanese population: A web-based genome-wide association study.

2021 ◽  
Author(s):  
Shun Nogawa ◽  
Hajime Kanamori ◽  
Koichi Tokuda ◽  
Kaoru Kawafune ◽  
Miyuki Chijiiwa ◽  
...  
Keyword(s):  
Side Effects ◽  
Adverse Events ◽  
Genome Wide Association Study ◽  
Association Studies ◽  
Genome Wide Association ◽  
Genome Wide Association Studies ◽  
The Novel ◽  
Web Based ◽  
Genome Wide ◽  
Novel Coronavirus

The novel coronavirus disease 2019 (COVID-19) pandemic has spread rapidly worldwide. To prevent the spread of COVID-19, mRNA-based vaccines made by Pfizer/BioNTech (BNT162b1) and Moderna (mRNA-1273) have been widely used worldwide, including in Japan. Various adverse events after COVID-19 mRNA vaccinations have been reported, with differences observed among individuals. However, the analysis on the genetic background for susceptibility to side effects has been limited. In the present work, we performed genome-wide association studies (GWAS) for self-reported adverse events of COVID-19 mRNA vaccination in 4,545 Japanese individuals and identified 14 associated loci. Among these, 6p21 was associated with 37.5°C or higher fever, 38 °C or higher fever, and muscle pain. Our results may enable one to prepare for and manage side effects by knowing their susceptibility to the occurrence of adverse events. Furthermore, we obtained valuable data that can lead to the understanding of the mechanism of action of COVID-19 mRNA vaccines.

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