Takotsubo syndrome as a cardiac manifestation of multisystem inflammatory syndrome in children

Cases of severe heart damage in patients presenting with multisystem inflammatory syndrome in children are one of the most intriguing phenomena during the coronavirus disease of 2019 pandemic. The pathophysiology of myocardial changes in the course of this syndrome has not been fully understood yet. We present a case of a child with multisystem inflammatory syndrome in children and with cardiac changes corresponding to Takotsubo syndrome.

The connection between hospital mortality and inflamation markers in COVID-19 patients and ischaemic heart disease

The purpose of the work to investigate the connection between hospital mortality and markers of systemic inflammation in COVID-19 patients with ischemic heart disease (IHD).Material and methods. The data of 52 patients’cases of diseases on COVID-19 with IHD who underwent inpatient treatment were analyzed. The first group included 40 patients who were discharged with recovery, and the second group included 12 patients who died. The degree of systemic inflammation syndrome in the selected groups of patients was estimated by the number of leukocytes and cellular composition of peripheral blood upon admission to the hospital, and based on the data received, the value of hematological integral indices was calculated.Results. It has been established that group II patients who died of cardiovascular complications connected with COVID-19 had significantly higher levels of systemic inflammatory response, which exhibits a significant increase in the total blood white blood cell content and increases in the percentage of neutrophils with a decrease in the percentage of lymphocytes and is substantially higher than the integrated haematological indices: leukocyte shift index, index of the ratio of neutrophils to lymphocytes and index of the ratio of neutrophils to monocytes. During the systemic inflammatory reaction, it has been observed that the inflammatory process aggravates the coronary atherosclerotic plaque making them more susceptible to rupture. Therefore, we can assume that existing IHD combined with an enhanced inflammatory response can lead to heart damage in patients infected with SARS-CoV- 2.Conclusion. Lymphocytopenia, excessive activation of the inflammatory cascade and heart damage are important features of COVID-19 disease and have high predictive value.

Cardiac-Related Lesions in Newly Diagnosed Patients with Acute Leukemia

Background: More and more cases of leukemia with heart injury have been reported, mostly due to tumor cell infiltration, endothelial injury and high viscosity of leukemia cells in circulating blood. To evaluate whether the newly diagnosed acute leukemia patients have suffered heart-related injuries, and determine the possible related factors, we carried out this study. Methods: From January 2015 to August 2019, we retrospectively selected 408 patients from the Department of Hematology and Cardiology, Zhongnan Hospital of Wuhan University. There were 200 newly diagnosed acute leukemia patients (including 15 acute hyperleukocytic leukemia patients), 105 patients without cancer and no known heart disease, and 103 cases of confirmed coronary heart disease. We collected the basic information of patients, echocardiographic data and myocardial enzyme results. We also followed up all newly diagnosed acute leukemia patients for prognostic analysis. All data were logarithmically transformed to make the data normally distributed. Normally distributed samples were compared using independent sample t-tests, Mann-Whitney U rank sum test was used for non-normally distributed samples and qualitative data was using chi-square test. The log-rank test was used to perform univariate analysis through Kaplan-Meier curves, and meaningful values were screened for multivariate COX regression analysis. The statistical analysis was performed with the SPSS software. Results: Compared with the control group, patients with newly diagnosed acute leukemia had already experienced some heart-related injuries. The average values of myocardial enzyme indexes such as CKMB,LDH,hs-cTnI,BNP and echocardiography indexes such as LV,EDV,ESV,SV,EF were all significantly different. But the degree of heart damage was lower than that of the coronary heart disease group. Compared with hyperleukocytic leukemia, non-hyperleukocytic leukemia had suffered more serious heart damage, especially myocardial enzyme indexes such as HBDH and LDH were significantly increased. Analyze the relationship between age, gender, cardiovascular risk factors (hypertension, diabetes and smoking history), myocardial enzyme indexes, echocardiography indexes and survival, to screen for risk factors related to the prognosis of the disease. Variables with statistically significant effect measurement values include age (p<0.001), LDH (p=0.018), and EF (p=0.053). In addition, the meaningful variables in the previous single-factor analysis were subjected to multi-factor COX regression analysis, and age (HR = 1.515, 95 %CI, 0.994-2.311, P = 0.001), EF (HR = 0.526, 95% CI, 0.361-0.766, P=0.05) were independent factors related to the prognosis of patients. Classification based on the clinical diagnosis of echocardiography in newly diagnosed acute leukemia patients, significant differences in myocardial enzymes and related indicators of echocardiography were included for ROC plots. The 3 indicators with the highest results for the area under the curve (AUC) from ROC plots were LV, EDV and HBDH, AUC were 0.721,0.619 and 0.615, respectively. This result revealed that the best predictor of leukemia myocardial damage was LV. It showed the predict ability of LV (AUC = 0.721, 95%CI = 0.643-0.799, P <0.001; sensitivity = 42.4%; specificity = 91.8%). Conclusions： According to our research, we have confirmed that the cardiac function of newly diagnosed acute leukemia patients is significantly different from that of patients without leukemia, and these differences will have an impact on the prognosis of patients. Among them, the best predictor of leukemia heart damage is LV, and EF is an independent risk factor for the prognosis of leukemia patients. In addition, newly diagnosed acute leukemia patients are more likely to have an increase in left ventricular diameter and a significant decrease in ejection fraction. Further research is needed to explore the specific mechanism in the future. Disclosures No relevant conflicts of interest to declare.

Cardiotoxic effects induced by the use of antimetabolites in the chemotherapy of oncological diseases

In modern medical practice, the treatment of cancer is one of the most pressing issues. Many of the drugs used in the treatment of cancer have a toxic effect on the cardiovascular system of patients. The main clinical manifestations of cardiotoxicity are ischemic heart damage, rhythm disturbances, thrombosis, angina, asymptomatic changes in the electrocardiogram, and others. Side effects can develop both during the treatment period and months after the end of the course of chemotherapy. This is especially important for patients with concomitant cardiac or vascular pathology, since the severity of developing side effects can lead to disability or death of cancer survivors. The article discusses the data on the frequency of detection of the negative effect of pyrimidine, purine and folic acid antagonists on the cardiovascular system of cancer patients, the mechanisms of cardiotoxic effects of drugs in such patients, the possibilities of preventing heart damage and correcting for already developed lesions. The aim of this work is to collect, compare and systematize the available disparate data on the cardiotoxic effects of antitumor drugs of the antimetabolite group. An important condition for saving and preserving the quality of life of cancer patients is the identification of cardiovascular pathologies at the stage of preparation for chemotherapy, which can be facilitated by the active cooperation of oncologists and cardiologists. The search for information was carried out on the bases of scientific medical publications (eLibrary.ru, PubMed) taking into account the clinical recommendations for the treatment of malignant neoplasms.

Heart Disease in Women

All women face the threat of heart disease. Knowing the symptoms and risks unique to women, as well as eating a hearthealthy diet and exercising, can help protect you. Heart disease is often thought to be more of a problem for men. However, it’s the most common cause of death for both women and men in the United States. Because some heart disease symptoms in women can differ f Heart attack symptoms for women. The most common heart attack symptom in women is the same as in men some type of chest pain, pressure or discomfort that lasts more than a few minutes or comes and goes. But chest pain is not always severe or even the most noticeable symptom, particularly in women. Women often describe it as pressure or tightness. And, it’s possible to have a heart attack without chest pain. Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as: Neck, jaw, shoulder, upper back or abdominal discomfort, Shortness of breath, Pain in one or both arms, Nausea or vomiting, Sweating, Lightheadedness or dizziness, unusual fatigue, Indigestion. These symptoms may be vague and not as noticeable as the crushing chest pain often associated with heart attacks. This might be because women tend to have blockages not only in their main arteries but also in the smaller ones that supply blood to the heart-a condition called small vessel heart disease or coronary microvascular disease. Women tend to have symptoms more often when resting, or even when asleep, than they do in men. Emotional stress can play a role in triggering heart attack symptoms in women. Because women don’t always recognize their symptoms as those of a heart attack, they tend to show up in emergency rooms after heart damage has occurred. Also, because their symptoms often differ from men’s, women might be diagnosed less often with heart disease than men are. If you have symptoms of a heart attack or think you’re having one, call for emergency medical help immediately. Don’t drive yourself to the emergency room unless you have no other options. Rom those in men, women often don’t know what to look for