Clozapine-Induced Pericardial Effusion Presenting with Persistent Tachycardia

Clozapine is an atypical antipsychotic used in refractory schizophrenia and depression. Its use is often complicated by its vast side-effect profile including cardiovascular reactions, agranulocytosis, and seizures. Specifically, the cardiac complications of clozapine have been shown to predominantly cause myocarditis and pericarditis. In this case report, the case of a 58-year-old male being treated for treatment-resistant depression and schizophrenia who suffers from tachycardia is presented. He is treated empirically for orthostatic hypotension with IV fluids without much success. Further imaging and echocardiography demonstrated a pericardial effusion, a rare reaction (≤1 : 10000) that has only been documented in a handful of case reports. This anecdotal evidence highlights the significance of polyserositis/pericardial effusion in the context of clozapine-induced orthostatic hypotension resistant to rehydration. When starting a patient on clozapine, it is important to consider further workup and monitoring with laboratory baseline biomarkers and cardiac evaluation with symptomatic individuals. Upon immediate cessation of clozapine, the pericardial effusion should spontaneously resolve without complication and should not be rechallenged.

Suspected Cardiovascular Side Effects of two Covid-19 Vaccines

Fatalities or cardiovascular side effects of vaccines were rather uncommon in the past. So far, numerous reports of side effects and deaths associated with Covid-19 vaccination have been accepted behind the background of the pandemic situation. Cardiac and heart circulatory disturbances resp. cardiovascular side effects associated with the application of Covid-19 vaccines have not been recognized up to now with the exception of thrombotic/embolic side effects and cases of myocarditis. But the mechanism of action suggests that downregulation of ACE2 by non-neutralised spike proteins may have cardiovascular effects.The objective of this analysis was to determine the total number of reported adverse events and fatalities and to record suspected cardiovascular adverse events up to the cut-off date in European countries. Therefore, a current review/analysis of spontaneously reported fatalities as well as of adverse events after application of Covid-19 vaccines has been performed. Data were retrieved from the EudraVigilance web reports of the European Medicines Agency (EMA), partly also from the safety reports of the German PEI. Covid-19 vaccine-associated suspected side effects and related deaths are alarming. Surprisingly, numerous cardiovascular reactions were reported, many of which were life-threatening. Cardiac and heart circulatory caused fatalities alone accounted for about 33% of all ComirnatyR vaccine-related deaths. The second most important side effects were vascular thrombotic/embolic side effects, often also associated with serious consequences. Based on their quality and quantity, these side effects seem to be characteristic for spike-producing vaccines and do not appear to be substance-specific. Further investigations are needed to clarify the approximately 3.5 times more frequent cases of sinus vein thrombosis and the some different frequent cases of thrombotic/embolic events after VaxzevriaR. The hypothesis could be confirmed. Because of their importance and their sometimes life-threatening consequences, cardiovascular side effects need to be better communicated.Limitations of the investigation result from the individual reporting and recording procedure, the lack of detailed individual information and the lack of an appropriate comparison population.

Features of hemodynamics of pulmonary circulation during the diving reflex

The adaptive cardiovascular reactions of the human diving reflex were studied. The diving reflex was activated by submerging a face in cold water under laboratory conditions. Forty volunteers (aged 18–24) were examined. ECG, arterial blood pressure (ABP) and central blood flow were recorded by the impedance rheography method in resting state, during diving simulation (DS) and after apnea. During DS there is a statistically significant decrease in the dicrotic index (DCI), which reflects a decrease in the resistive vessel tone and as well as diastolic index (DSI), characterizing lung perfusion. A comparison of the latent periods (LP) of an increase in ABP and a drop in DCI showed that a decrease in pulmonary vascular tone develops faster than ABP begins to increase. The LP for lowering DCI is from 0.6 to 10 s; for an increase in ABP — from 6 to 30 s. A short LP for DCI and the absence of a correlation between a decrease in ABP and DCI suggests that a decrease in pulmonary vascular tone during DS occurs reflexively and independently of a change in ABP.

Correction to: Effectiveness of lidocaine/prilocaine cream on cardiovascular reactions from endotracheal intubation and cough events during recovery period of older patients under general anesthesia: prospective, randomized placebo-controlled study

An amendment to this paper has been published and can be accessed via the original article.

Bioinformation Algorithm for Selecting a Method for Premedication of Patients with Arterial Hypertension with Amiodarone-Associated Thyrotoxicosis Type I during Neurosurgical Operations

Signs associated with adverse cardiovascular reactions after surgery were established in 46 patients with arterial hypertension, cardiac arrhythmias and type I amiodarone-associated thyrotoxicosis. These signs included an increase in the circadian index above 1.52, the presence of pauses in the heart rate for more than 3 seconds, the number of group ventricular extrasystoles per day exceeding 30, an increase in LF/HF with RR-intervalometry more than 1.3. In order to reduce the risk of cardiac arrhythmias in the postoperative period, a premedication with long-acting benzodiazepines in combination with magnesium preparations over a prolonged course is recommended.

Effectiveness of lidocaine/prilocaine cream on cardiovascular reactions from endotracheal intubation and cough events during recovery period of older patients under general anesthesia: prospective, randomized placebo-controlled study

Background Endotracheal intubation is known to pose significant physiological, pharmacokinetic, and dynamic changes and postoperative respiratory complications in patients under general anesthesia. Method An RCT trial was organized by the Third Affiliated Hospital at Sun Yat-sen University, China. Patients were eligible for inclusion in the trial if they were over 60 years old and had upper-abdominal surgery during the induction of anesthesia and had enrolled in endotracheal intubations. The primary end point included cardiovascular reactions during the induction of anesthesia and endotracheal intubations and cough events during the recovery period. In the test group, 2 g of lidocaine/prilocaine cream (and in the control group, 2 g of Vaseline) were laid over the surface of the tracheal tube cuff. Results The systolic blood pressure (F value = 62.271, p < 0.001), diastolic blood pressure (F value = 150.875, p < 0.001), and heart rate (F value = 75.627, p < 0.001) of the test group were significantly lower than the control group. Cough events during the recovery period in the test group were better (spontaneous cough, χ2 value = 10.591, p < 0.001; induced cough, χ2 value =10.806, p < 0.001). Conclusion In older patients, coughing and cardiovascular reactions under anesthesia and endotracheal intubations were reduced, as a result of using lidocaine/prilocaine cream on the surface of the tracheal tube cuff. Trial registration International Clinical Trials Network NCT02017392, 2013-12-16.