scholarly journals Sequelae and Comorbidities of COVID-19 Manifestations on the Cardiac and the Vascular Systems

2022 ◽  
Vol 12 ◽  
Author(s):  
Yashvardhan Batta ◽  
Cody King ◽  
John Johnson ◽  
Natasha Haddad ◽  
Myriam Boueri ◽  
...  

COVID-19 patients with pre-existing cardiovascular conditions are at greater risk of severe illness due to the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus. This review evaluates the highest risk factors for these patients, not limited to pre-existing hypertension, cardiac arrhythmias, hypercoagulation, ischemic heart disease, and a history of underlying heart conditions. SARS-CoV-2 may also precipitate de novo cardiac complications. The interplay between existing cardiac conditions and de novo cardiac complications is the focus of this review. In particular, SARS-CoV-2 patients present with hypercoagulation conditions, cardiac arrhythmias, as significant complications. Also, cardiac arrhythmias are another well-known cardiovascular-related complication seen in COVID-19 infections and merit discussion in this review. Amid the pandemic, myocardial infarction (MI) has been reported to a high degree in SARS-CoV-2 patients. Currently, the specific causative mechanism of the increased incidence of MI is unclear. However, studies suggest several links to high angiotensin-converting enzyme 2 (ACE2) expression in myocardial and endothelial cells, systemic hyper-inflammation, an imbalance between myocardial oxygen supply and demand, and loss of ACE2-mediated cardio-protection. Furthermore, hypertension and SARS-CoV-2 infection patients’ prognosis has shown mixed results across current studies. For this reason, an in-depth analysis of the interactions between SARS-CoV2 and the ACE2 cardio-protective mechanism is warranted. Similarly, ACE2 receptors are also expressed in the cerebral cortex tissue, both in neurons and glia. Therefore, it seems very possible for both cardiovascular and cerebrovascular systems to be damaged leading to further dysregulation and increased risk of mortality risk. This review aims to discuss the current literature related to potential complications of COVID-19 infection with hypertension and the vasculature, including the cervical one. Finally, age is a significant prognostic indicator among COVID-19 patients. For a mean age group of 70 years, the main presenting symptoms include fever, shortness of breath, and a persistent cough. Elderly patients with cardiovascular comorbidities, particularly hypertension and diabetes, represent a significant group of critical cases with increased case fatality rates. With the current understanding of COVID-19, it is essential to explore the mechanisms by which SARS-CoV-2 operates to improve clinical outcomes for patients suffering from underlying cardiovascular diseases and reduce the risk of such conditions de novo.

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Max Ruge ◽  
Joanne Michelle D Gomez ◽  
Gatha G Nair ◽  
Setri Fugar ◽  
Jeanne du Fay de Lavallaz ◽  
...  

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has killed hundreds of thousands worldwide. Those with cardiovascular disease represent a vulnerable population with higher risk for contracting COVID-19 and worse prognosis with higher case fatality rates. Congestive heart failure (CHF) may lead to worsening COVID-19 symptoms. However, it is unclear if CHF is an independent risk factor for severe COVID-19 infection or if other accompanying comorbidities are responsible for the increased risk. Methods: From March to June 2020, data was obtained from adult patients diagnosed with COVID-19 infection who were admitted in the Rush University System for Health (RUSH) in Illinois. Heart failure patients, determined by ICD code assignments extracted from the electronic medical records, were identified. Multivariable logistic regression was performed between predictor variables and a composite outcome of severe infection consisting of Intensive Care Unit (ICU) admission, intubation, or in-hospital mortality. Results: In this cohort (n=1136), CHF [odds ratio (OR) 1.02] alone did not predict a more severe illness. Prior myocardial infarction [(MI), OR 3.55], history of atrial fibrillation [(AF), OR 2.14], and male sex (OR 1.55) were all significantly (p<0.001) associated with more severe COVID-19 illness course when controlling for CHF (Figure 1). In the 178 CHF patients, more advanced age (68.8 years vs. 63.8 years; p<0.05) and female sex (54.5% vs. 39.1%; p<0.05) were associated with increased severity of illness. Conclusions: Prior MI, history of AF, and male sex predicted more severe COVID-19 illness course in our cohort, but pre-existing heart failure alone did not. However, CHF patients who are females and older in age are at risk for severe infection. These findings help clinicians identify patients with comorbidities early at risk for severe COVID-19 illness.


BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e015967 ◽  
Author(s):  
Steen Møller Hansen ◽  
Sam Riahi ◽  
Søren Hjortshøj ◽  
Rikke Mortensen ◽  
Lars Køber ◽  
...  

ObjectiveExposure to electric shock has been associated with an increased risk of developing delayed cardiac arrhythmias and cardiac diseases. We examined whether electric shock patients have an increased risk of developing cardiac disease, cardiac arrhythmias or death compared with the general Danish population.DesignMatched cohort study.SettingA nationwide study in Denmark from 1994 to 2011.ParticipantsWe identified 11 462 Danish patients who visited an emergency ward or were admitted to a hospital due to electric shock from 1994 to 2011. Each patient was matched for age and sex with five random controls from the Danish population.Main outcome measuresMortality, cardiac procedures and cardiac diseases following electric shock.ResultsA total of 7390 electric shock patients were seen at an emergency ward and 4072 electric shock patients were admitted to a hospital. The median patient age was 28.6 years (Q1–Q3, 21.3–37.7) for the emergency ward patients and 26.4 years (Q1–Q3, 18.3–37.4) for admitted patients. In both groups, most patients were male (74.0% and 76.8%). Few of the electric shock patients had a record of cardiovascular disease at baseline (364/11 462, 3.2%). The 5-year cumulative incidence of death was 0.47% (95% CI 0.29% to 0.65%) for emergency ward patients and 1.04% (95% CI 0.71% to 1.37%) for admitted patients. No difference in 5-year survival was observed compared with matched controls (emergency ward, p=0.10; admitted patients, p=0.80). Fewer than four patients received a pacemaker within 30 days.ConclusionsThis nationwide study did not demonstrate an increase in mortality among patients seen at hospitals after accidental electric shock compared with a background population. Cardiac procedures and diseases following electric shock were very rare. We suggest that nearly all patients can be discharged safely from the emergency room after electric shock without further observation.


2020 ◽  
Vol 17 (2) ◽  
pp. 29-32
Author(s):  
Bishnu Mani Dhital ◽  
Sudhir Regmi ◽  
Shyam Raj Regmi ◽  
Bidhan Shrestha ◽  
Keshav Budhathoki ◽  
...  

Background: Electrical injury and its consequences after exposure to electric shock has been associated with an increased risk of developing immediate and delayed cardiac arrhythmias. The aim of this study was to evaluate the prevalence of cardiac arrhythmias and different symptoms in patient with high voltage and low voltage electrical injury. Methods: All 50 consecutive patients who were admitted in Chitwan Medical College from April 2018 to March 2020 were prospectively studied. Patients were categorized into high and low voltage injury group and their variables were compared. Results: The mean age of the patients was 32.3±10.4 years among them 41 (82%) were male. Patients who sustain high voltage electrical injury (>1000V) were 18 (36%) and low voltage injury (<1000V) were 32 (64%). Cardiac arrhythmias like sinus tachycardia (11.1% vs 6.2%, p=0.054), sinus bradycardia (11.1% vs 3.1% p=0.254), ventricular premature beats (5.6% vs3.1%, p=0.674), atrial fibrillation (11.1% vs 0%, p=0.054) were observed in high voltage and low voltage group. The commonest presenting symptoms in both groups were pain (77.8% vs 84.4% p=0.560) and fatigue (55.6% vs 40.6%, p=0.328). Conclusion: In this study few non fatal cardiac arrhythmias were observed in both high and low voltage electrical injury group. There is no significant difference in the presenting symptoms and types of arrhythmias observed between low voltage and high voltage injury group.


2021 ◽  
Vol 12 (3) ◽  
pp. 1822-1832
Author(s):  
Andrew Lalchhuanawma ◽  
Divya Sanghi ◽  
Lalhlimpuii Chawngthu

The WHO declaration of the novel coronavirus (Covid-19) caused by SARS-CoV-2 as a pandemic has raised serious questions and has since been a global health concern. Data on the clinical characteristics, laboratory findings of deceased covid-19 individuals are sparse. The study analyzed the clinical and laboratory profiles of Covid-19 deceased in Zoram Medical College Mizoram, India. We gathered information from the Mizoram Government Covid-19 portal and hospital medical record section. The study examined eight confirmed Covid-19 deaths out of the total nine Covid-19 fatalities reported in Mizoram as of February 14, 2021. The decedents' mean age was 62.88 (±18.659) years; among them, 87.5% were males, and blood group B was associated with half of the deceased. In Mizoram, the case fatality rate, crude death rate, and recovery rate were 0.2%, 7.27 per million, and 99.40%, respectively, with 3547 cases per million. The median length of hospital and ICU stay (between admission and death) was 15.5 and 11 days. The common presenting symptoms were fever (75%), shortness of breath (62.5%), cough/ sore throat (50%). Hypertension (62.5%) and diabetes mellitus (62.5%) were the two most prevalent comorbidities, followed by cardiovascular diseases (25%). The concurrence of hypertension and diabetes mellitus constituted 87.5%, 75% of the decedents reported the presence of at least one of the comorbidities. The two most common complications were an acute respiratory failure (87.5%) and cardiovascular complications (87.5%). Increased risk of severe Covid-19 disease increases with advanced age (>60 years), gender (male), and underlying comorbidities.


2021 ◽  
Vol 2021 ◽  
pp. 1-33
Author(s):  
Leila Karimi ◽  
Somayeh Makvandi ◽  
Amir Vahedian-Azimi ◽  
Thozhukat Sathyapalan ◽  
Amirhossein Sahebkar

Background. Based on what is known at this time, pregnant women are at an increased risk of severe illness from COVID-19 compared to nonpregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes. To investigate the effects of coronavirus disease 2019 (COVID-19) on mortality of pregnant and postpartum women, we performed a systematic review of available published literature on pregnancies affected by COVID-19. Methods. Web of Science, SCOPUS, and MEDLINE- databases were searched for original studies concerning the effect of COVID-19 on mortality of pregnant and postpartum women published by July 10, 2020. Meta-analyses of proportions were used to combine data and report pooled proportions. Results. 117 studies with a total of 11758 pregnant women were included. The age ranged between 15 and 48 years. Most subjects were infected with SARS-CoV-2 in the third trimester. Disease severity was not reported in 1125 subjects. Maternal mortality was 1.3%. In 100% of fatal cases with adequate data, fever alone or with cough was one of the presenting symptoms. Also, dyspnea (58.3%) and myalgia (50%) were the most common symptoms. Sore throat (8.3%) and gastrointestinal symptoms (anorexia, nausea) (8.3%) were rare. The rate of comorbidities was 20% among COVID-19 deaths. The majority of COVID-19-infected women who died had cesarean section (58.3%), 25% had a vaginal delivery, and 16.7% of patients were not full term. Conclusion. COVID-19 infection in pregnant women was associated with higher rates (and pooled proportions) of cesarean section and mortality. Because new data are continuously being generated and published, the findings of this study can be complete and updated with new researches. The results of this study can guide and improve prenatal counseling of COVID-19-infected pregnant women.


2021 ◽  
Vol 2 (4) ◽  
pp. 01-08
Author(s):  
Gouri Sakre ◽  
Gulappa Devagappanavar

Background: According to CDC, Coronavirus disease 2019 (COVID-19) is caused by a new coronavirus which was first identified in Wuhan, China, in December 2019. Although most people who have COVID-19 have mild symptoms, it can also cause severe illness and even death. Some groups, including older adults and people who have certain underlying medical conditions, are at increased risk of severe illness. On February 11, 2020, the World Health Organization announced an official name for the disease that is causing the 2019 novel coronavirus outbreak. The new name of this disease is coronavirus disease 2019, abbreviated as COVID-19. Objectives: Analysis of COVID 19 data in the Davanagere district from April 2020 to August 2020. Methods: In this current study the secondary data is obtained from the Official Website of Government of Karnataka, Covid-19 Informational Portal – Media Bulletin. By using different indicators Davanagere district covid data is further used to calculate Attack rate, Case fatality rate and complete case fatality rate. Results: In this study it is found that, in the month of April there were no covid positive cases reported till fourth week of month, by fourth week, total two positive cases were reported the first case being encountered on 28th April 2020, with discharge of those patient in the end of the month. The attack rate has steeped up from 8.018 to 355.74 per one lakh population i.e. about 44 times more than initial months of pandemic. The strict preventive measures were followed by public and government too. So the prevalence rate is less in May, June and went on increasing once the unlocking is done. In summer the total positive cases steeping up from 2 cases to 154 total positive cases for the month April to May, and there is steady in rise of total positive cases for the month June with total positive cases of 153. In the beginning of summer there were fewer cases as pandemic was just begun and chances of transmission were very less. As monsoon appeared in June last week there is surge in total positive cases. With added burden of Unlock 1.0 phase, as public started moving out from home without any freak of infection. Conclusion: In this study it is found that due to strict nationwide lockdown and social distancing, hygiene practices among the Davanagere people has made it possible to restrict the spread of covid among the people, although the international immigration of Davanagere residents lead to transmission of infection. Further removal of lockdown after three months has lead to three fold spread of disease. Also there is rise in death rate, attack rate and case fatality in Davanagere district.


Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4278-4278
Author(s):  
Marko Kavcic ◽  
Brian T. Fisher ◽  
Jeffrey S. Gerber ◽  
Kateri H. Leckerman ◽  
Yimei Li ◽  
...  

Abstract Abstract 4278 Background Pediatric acute myeloid leukemia (AML) survival rates have improved primarily because of treatment protocol advancement via cooperative-group clinical trials. Contrary to the consistency in chemotherapy protocols, there is often a lack of consensus for supportive care therapies leading to significant variation in practice. Invasive fungal infections are a major cause of treatment-related morbidity and mortality in pediatric AML. However, the lack of pediatric-specific guidelines for antifungal therapy has the potential to result in either under- or over-utilization of antifungal agents across institutions. We aimed to explore the variability in antifungal use across hospitals caring for children that were treated for de novo AML with a homogeneous induction regimen. Methods The Pediatric Health Information System (PHIS) administrative database was used to establish a cohort of children treated for de novo AML between 1999 and 2010 at one of 43 freestanding children's hospitals across the United States. Only institutions with 15 or more AML patients during the study period were considered in the final analysis. Patients were included if they were assigned an ICD-9 discharge diagnosis code for myeloid or unspecified leukemia and if their daily pharmaceutical billing data supported the receipt of an ADE induction regimen (cytarabine, daunorubicin, and etoposide with or without gemtuzumab ozogamicin). The induction period was defined as the start of the first to the initiation of the third course of chemotherapy. Each institution's inpatient induction period antifungal use, including azoles, echinocandins and amphotericin products, was reported as days of antifungal use per 1000 induction hospital days. A negative binomial regression analysis was performed to adjust rates of antifungal use by demographic variables (age, gender and race) and frequency of severe illness days. Severe illness days were defined by the need for intensive care resources such as intubation, mechanical ventilation or vasopressors. The all-cause induction case fatality rate for each institution was also determined. Results We identified 931 ADE-treated AML patients from 38 children's hospitals with an overall induction case fatality rate of 3.8%. Variation in antifungal use was defined for 28 institutions caring for 815 patients. (Figure 1) Antifungal use exposure days varied widely across institutions ranging from 384 per 1000 hospital days to 958 per 1000 hospital days (median: 836 per 1000 hospital days). Azoles were most commonly used (591 per 1000 hospital days) followed by amphotericin products (120 per 1000 hospital days) and echinocandins (60 per 1000 hospital days). After adjusting for demographic characteristics and the frequency of severe hospital days, variation in antifungal use persisted across institutions, ranging from 393 per 1000 hospital days to 946 per 1000 hospital days. (Figure 2) Induction case fatality rates also varied by institution but did not correlate with antifungal use (Spearman's rho=0.28, p=0.15) (Figure 2). Conclusions Wide variability in inpatient antifungal use for children with AML exists across pediatric institutions in the United States, but this variability does not appear to correlate with induction case fatality rates. Additional studies are necessary to define the ideal approach to optimizing antifungal therapy for children with AML. Disclosures: No relevant conflicts of interest to declare.


Author(s):  
Senthil Raj K. ◽  
Adithyan Geetha Suresh ◽  
Selvavinayagam T. S. ◽  
Shruthee Suresh Geetha ◽  
Vinay Kumar K. ◽  
...  

Background:  This study aims to assess the socio-demographic and clinical profile of the patients infected with SARS-CoV-2 in Tamil Nadu, India and to identify the associated prognostic determinants.Methods: Facility-level observational data pertaining to the case investigation of 15045 lab confirmed cases of COVID-19 reported in Tamil Nadu from March to June 2020 was used for the purpose of the study. The demographic and clinical profile of the COVID-19 confirmed cases and age-sex specific estimates of severity of illness were analysed. Determinants of prognosis were tested for statistical significance using Chi square and Student t test as appropriate.Results: The mean age was 40±7 years with a male predilection. Thirty six percent of the cases were symptomatic, with fever being the predominant symptom, followed by cough and breathlessness. The Case ICU rate and Case Fatality rate were found to be 6.2% and 2.9% respectively. Increasing age, male sex and underlying comorbid illness were found to significantly affect prognosis in these patients. However, it was observed that females experienced higher risk of severe illness and fatality in the younger age groups.Conclusions: While the observed findings reiterate the prognostic significance of age, gender and comorbidity as evidenced by other studies, the increased risk of severe illness and fatality among younger females provides a new direction for further research from a socio-epidemiological perspective.


2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S271-S272
Author(s):  
Christina Gagliardo ◽  
Eberechi I Nwaobasi-Iwuh ◽  
Niva Shah ◽  
Aparna Prasad ◽  
Neeraja Kairam ◽  
...  

Abstract Background Nearly 4 million children have tested positive for coronavirus disease 2019 (COVID-19) in the United States. Some studies suggest infants might be at increased risk for severe illness and hospitalization from COVID-19. Our objective was to describe the clinical and laboratory features of young infants admitted to a hospital system with COVID-19. Methods An observational retrospective study was performed in infants ≤1 year of age admitted with COVID-19 from March 1, 2020 to May 30, 2021. Data was extracted into a REDCap database and analyzed using descriptive statistics. Results Sixteen infants &lt; 1 year were hospitalized with COVID-19. Fever, poor feeding, and respiratory symptoms were the most common presenting symptoms (Table 1). Two required pediatric intensive care unit (ICU) care, three required oxygen support, and one was intubated. There were no deaths. Five infants with echocardiograms performed showed normal findings. Four infants received Remdesivir without side effects. Conclusion Infants with COVID-19 can present with severe disease requiring ICU care and oxygen support. In our experience, a large proportion of infants developed hematologic abnormalities, but none had cardiac involvement. Preventive measures including vaccination will become critical to decrease transmission and severe disease in this young patient population. Disclosures All Authors: No reported disclosures


2019 ◽  
Vol 4 (2) ◽  
pp. 79 ◽  
Author(s):  
Soawapak Hinjoy ◽  
Somkid Kongyu ◽  
Pawinee Doung-Ngern ◽  
Galayanee Doungchawee ◽  
Soledad D. Colombe ◽  
...  

A nationwide prevention and control campaign for leptospirosis in Thailand has led to a decreased incidence rate, but the mortality and case fatality rates have remained stable. Regarding the limited knowledge of risk factors, a case-control study of the association between environmental and behavioral exposure with severe leptospirosis was implemented to identify the risk factors among adults in Thailand. The study was conducted in 12 hospital-based sites. Hospitalized patients with suspected clinical symptoms of leptospirosis were tested for leptospirosis by culture, loop mediated isothermal amplification (LAMP), real-time PCR, and the microscopic agglutination test (MAT). All participants answered a standardized questionnaire about potential risk factors. Risk factors were identified by univariable and multivariable logistic regression. Of the 44 confirmed cases, 33 (75.0%) presented with severe illness, as determined by clinical criteria, and were categorized as severe cases. Non-severe cases were defined as patients with non-severe symptoms of leptospirosis. Living nearby a rubber tree plantation (adjusted OR 11.65, 95% CI 1.08–125.53) and bathing in natural bodies of water (adjusted OR 10.45, 95% CI 1.17–93.35) were both significantly associated with an increased risk of severe leptospirosis. We recommend designating rubber plantations in Thailand as high-risk zones and closely monitoring hospitalized patients in those areas.


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