Effect of renin-angiotensin system blocker on COVID-19 in young patients with hypertension

Hypertension is found frequently in patients with COVID-19 and is often treated with ACE inhibitors (ACEIs) and angiotensin receptor blockers (ARBs). SARS-CoV-2, the pathogen of COVID-19, binds to the receptors of ACE2 to enter the alveolar cells, raising questions on whether these drugs are salutary or harmful with respect to any propensity for COVID-19 or to disease prognosis. We investigated the impact of ACEI/ARB and the clinical prognosis of patients with hypertension with COVID-19. In this study, 250 patients with hypertension (<45 years old) with COVID-19 were recruited. None of these patients had any chronic disease except for hypertension. The study population was grouped according to antihypertensive medication: ACEI/ARB user and non-ACEI/ARB user. Patients were followed for clinical prognosis and biochemical and radiological findings during their hospital stay. Adverse cardiovascular event (myocardial infarction, all-cause death, stroke), transfer to the intensive care unit, severity of symptoms during the treatment course, length of hospital stay and effort capacity in the treadmill stress test were recorded. During hospital stay, there was no significant difference in terms of length of hospital stay, medication for COVID-19, left ventricular ejection fraction on echocardiography and metabolic equivalents in the treadmill stress test between patients treated with and without ACEI/ARB. During treatment of COVID-19, there was no significant difference in clinical adverse event, effort capacity and clinical course between patients with and without ACEI/ARB. It appears that patients with COVID-19 may continue to use ACEI/ARB or that ACEI/ARB may be added safely to their antihypertensive treatment.

Initial Experience with Fractionation Mapping in the Identification of Vagal Ganglionated Plexus During Cardioneuroablation

This is a series case report of five symptomatic patients presented with diagnosis of sinus bradycardia, first and second degrees atrioventricular (AV) blocks, that were referred to pacemaker implantation. During the screening, a functional cause for the bradycardia and AV blocks were documented by treadmill stress test, 24-hour Holter monitoring and atropine test. After the confirmation of the diagnosis, patients were submitted to cardioneuroablation on an anatomical basis supported by a tridimensional electroanatomical fractionation mapping software. The technique and the acute and short-term results of the cardioneuroablation are described.

The Ordering of Medical Things: Medical Practices and Complexity

<p>This project is an investigation into medicine in action. The aim is to understand how medical interactions generate order via the diagnosis of disease; how the patient, the body, and illness are made intelligible, and how particular courses of action are decided upon as a result. Using video and audio data supplied by the Applied Research on Communication in Health (ARCH) research team, this project follows Simon, a middle aged, Caucasian male with chest pain, as he participates in consultations with his GP and cardiologist, and as he undergoes a cardio treadmill-stress test. This project argues for adopting an Actor-Network theory (ANT) based approach to studying interactions. Unlike more traditional sociology approaches, this project considers the role of non-human objects in interaction. Non-human objects are often key actors in the interactions that provide the world with a sense of order. I will provide an epistemological justification for ANT's key premises and outline the method that these premises entail. Following three interactions, this project illustrates that the principal actors involved in producing intelligibility varies. In the GP consultation, the GP and Simon were principal actors in rendering chest pain intelligible. In the treadmill stress test, the material instrumentation, carefully aligned with the Simon's body by the cardiologist, was vital to ensuring a particular account of the heart was produced. Simon was little more than a compliant body in this interaction. In the final interaction, the cardiologist was the principal actor in making sense of these accounts of chest pain and the potentially conflicting picture of the "healthy" heart. The cardiologist suggests that the account of the heart produced by the treadmill-stress test may be flawed, and encourages Simon to self-monitor and self-regulate. I will argue that the uncertainty generated by conflicting accounts is common to medical practices. Medical professionals respond to this by encouraging individuals to monitor and reduce risk. By adopting the ANT approach, I found that the patient and his body are sometimes intelligible as somatic entities, sometimes as an expressive, accounting agent, and sometimes as a self-responsible individual. These various renditions hold together as a being a single individual "Simon".</p>

The Ordering of Medical Things: Medical Practices and Complexity

<p>This project is an investigation into medicine in action. The aim is to understand how medical interactions generate order via the diagnosis of disease; how the patient, the body, and illness are made intelligible, and how particular courses of action are decided upon as a result. Using video and audio data supplied by the Applied Research on Communication in Health (ARCH) research team, this project follows Simon, a middle aged, Caucasian male with chest pain, as he participates in consultations with his GP and cardiologist, and as he undergoes a cardio treadmill-stress test. This project argues for adopting an Actor-Network theory (ANT) based approach to studying interactions. Unlike more traditional sociology approaches, this project considers the role of non-human objects in interaction. Non-human objects are often key actors in the interactions that provide the world with a sense of order. I will provide an epistemological justification for ANT's key premises and outline the method that these premises entail. Following three interactions, this project illustrates that the principal actors involved in producing intelligibility varies. In the GP consultation, the GP and Simon were principal actors in rendering chest pain intelligible. In the treadmill stress test, the material instrumentation, carefully aligned with the Simon's body by the cardiologist, was vital to ensuring a particular account of the heart was produced. Simon was little more than a compliant body in this interaction. In the final interaction, the cardiologist was the principal actor in making sense of these accounts of chest pain and the potentially conflicting picture of the "healthy" heart. The cardiologist suggests that the account of the heart produced by the treadmill-stress test may be flawed, and encourages Simon to self-monitor and self-regulate. I will argue that the uncertainty generated by conflicting accounts is common to medical practices. Medical professionals respond to this by encouraging individuals to monitor and reduce risk. By adopting the ANT approach, I found that the patient and his body are sometimes intelligible as somatic entities, sometimes as an expressive, accounting agent, and sometimes as a self-responsible individual. These various renditions hold together as a being a single individual "Simon".</p>

Left anterior descending artery myocardial bridge manifesting as episodic, symptomatic exertional non-sustained ventricular tachycardia

A 48-year-old man presented to the emergency department (ED) with exertional chest pressure associated with palpitations and lightheadedness. He was found to have non-sustained ventricular tachycardia (NSVT) in the ED, which resolved spontaneously. Given his history of hyperlipidaemia, unknown family history due to being adopted and episode of NSVT in the ED, he underwent cardiac catheterisation, which showed non-obstructive coronary artery disease and distal left anterior descending artery myocardial bridge (MB). The patient subsequently underwent ECG treadmill stress test with reproduction of chest pressure and NSVT. The patient was referred to cardiac surgery for definitive management of symptomatic MB and underwent resection of MB.

Nourin-Dependent miR-137 and miR-106b: Novel Biomarkers for Early Diagnosis of Myocardial Ischemia in Coronary Artery Disease Patients

Background: Although cardiovascular imaging techniques are widely used to diagnose myocardial ischemia in patients with suspected stable coronary artery disease (CAD), they have limitations related to lack of specificity, sensitivity and “late” diagnosis. Additionally, the absence of a simple laboratory test that can detect myocardial ischemia in CAD patients, has led to many patients being first diagnosed at the time of the development of myocardial infarction. Nourin is an early blood-based biomarker rapidly released within five minutes by “reversible” ischemic myocardium before progressing to necrosis. Recently, we demonstrated that the Nourin-dependent miR-137 (marker of cell damage) and miR-106b-5p (marker of inflammation) can diagnose myocardial ischemia in patients with unstable angina (UA) and also stratify severity of ischemia, with higher expression in acute ST-segment elevation myocardial infarction (STEMI) patients compared to UA patients. Minimal baseline-gene expression levels of Nourin miRNAs were detected in healthy subjects. Objectives: To determine: (1) whether Nourin miRNAs are elevated in chest pain patients with myocardial ischemia suspected of CAD, who also underwent dobutamine stress echocardiography (DSE) or ECG/Treadmill stress test, and (2) whether the elevated levels of serum Nourin miRNAs correlate with results of ECHO/ECG stress test in diagnosing CAD patients. Methods: Serum gene expression levels of miR-137, miR-106b-5p and their corresponding molecular pathway network were measured blindly in 70 enrolled subjects using quantitative real time PCR (qPCR). Blood samples were collected from: (1) patients with chest pain suspected of myocardial ischemia (n = 38) both immediately “pre-stress test” and “post-stress test” 30 min. after test termination; (2) patients with acute STEMI (n = 16) functioned as our positive control; and (3) healthy volunteers (n = 16) who, also, exercised on ECG/Treadmill stress test for Nourin baseline-gene expression levels. Results: (1) strong correlation was observed between Nourin miRNAs serum expression levels and results obtained from ECHO/ECG stress test in diagnosing myocardial ischemia in CAD patients; (2) positive “post-stress test” patients with CAD diagnosis showed upregulation of miR-137 by 572-fold and miR-106b-5p by 122-fold, when compared to negative “post-stress test” patients (p < 0.001); (3) similarly, positive “pre-stress test” CAD patients showed upregulation of miR-137 by 1198-fold and miR-106b-5p by 114-fold, when compared to negative “pre-stress test” patients (p < 0.001); and (4) healthy subjects had minimal baseline-gene expressions of Nourin miRNAs. Conclusions: Nourin-dependent miR-137 and miR-106b-5p are promising novel blood-based biomarkers for early diagnosis of myocardial ischemia in chest pain patients suspected of CAD in outpatient clinics. Early identification of CAD patients, while patients are in the stable state before progressing to infarction, is key to providing crucial diagnostic steps and therapy to limit adverse cardiac events, improve patients’ health outcome and save lives.

COMPARATIVE STUDY OF TREADMILL STRESS TEST(TMT) WITH INVASIVE CORONARY ANGIOGRAPHY (CAG) IN PATIENTS WITH SUSPECTED CORONARY ARTERY DISEASE

Background- There are few studies which compared invasive coronary angiography (CAG) in patients presenting with chest pain (atypical, probably ischemic) in outpatient department with negative or inconclusive treadmill stress test (TMT). Objective- To assess CAG findings in patient with suspected iscemic chest pain, with negative or inconclusive TMT. Methods- Patients with chest pain (atypical, probably ischemic) underwent TMT and classified as TMT negative or inconclusive. These patients underwent CAG and findings were analysed. Results - 50 patients completed the study protocol. Of these 50 patients who underwent TMT, 31 (62%) were TMT negative and 19 (38%) were TMT inconclusive. In TMT negative group CAG showed obstructive lesion in 6(19.4%), and non obstructive lesion in 25(80.6%). In TMT inconclusive group CAG showed obstructive lesion in 11(57.8%), while non obstructive lesion in 8(42.2%). Conclusion-In patients with atypical chest pain with negative or inconclusive TMT with suspicion of coronary ischemia CAG provides an important diagnostic tool for assessing, especially with TMT inconclusive group.

U-Wave Amplitude Increases During Exercise in Persons without Cardiovascular Disease

U wave is the wave between T wave and P wave of electrocardiogram. Inverted U waves during stress testare considered to correlate with critical disease of left anterior descending coronary artery. There is no literature regarding effect of exercise on U wave in normal persons. We retrospectively evaluated U wave changes during treadmill stress test in 25 normal persons without cardiovascular risk factors and with negative treadmill stress test. U wave amplitude increased with increasing heart rate during exercise and decreased with decrease in heart rate during recovery. Clinical significance of this observation needs further evaluation