Pandemic of Fear or What Statistics Hide: Patients with Cardiovascular Disease are at Increased Risk During COVID-19

Insufficient statistical information on the structure of mortality in the era of the pandemic is disclosed in this article. It analyzes the statistics and the causes of death during the COVID-19 pandemic from a new coronavirus infection and cardiovascular disease. Actual international data on a decrease in the hospitalization rate of patients with acute coronary syndrome are presented. A comparative analysis of statistics from European countries and Russia shows that cardiovascular diseases are the leading cause of death in populations, and patients with cardiovascular diseases are at increased risk for morbidity and mortality during the COVID pandemic.

A Case of Heart Transplantation after Ischaemic Preconditioning

A case of successful heart transplantation from a donor that suffered an out of hospital cardiac arrest lasting approximately one hour is presented. The recipient, a 27-year-old female nurse, was diagnosed with arrhythmogenic right ventricular cardiomyopathy in 2012. The donor was a 24-year-old male who after consuming an unknown quantity of alcohol and cocaine aboard a yacht was found floating face-down in the sea. The patient to be pulseless and CPR commenced after 7 minutes. The length of time that he spent in the sea was unknown. Return of spontaneous circulation (ROSC) occurred after 20 minutes of CPR on site. However, the patient arrested again in the ambulance and CPR was performed until he arrived Hospital, still in cardiac arrest. The patient arrested three more times before achieving a stable circulation. He was transferred to the intensive care unit on high doses of Noradrenaline and Adrenaline to maintain an adequate mean arterial blood pressure. An initial echocardiogram (ECHO) revealed a hypocontractile left ventricle (LV) with an estimated ejection fraction (EF) of 30%.Over the following 3 days the patient’s cardiac function improved. He was weaned off inotropic support and a repeat ECHO showed a normal LV with an EF of 70%. A brain MRI showed diffuse swelling consistent with global hypoxic injury with wide areas of cortical and basal ganglia infarction. The patient’s parents gave their consent and he was offered for organ transplantation on day 6. The operation was successful, with the recipient making an uneventful recovery. She received immunosuppressive treatment with cyclosporine, prednisolone and azathioprine and experienced one episode of early mild rejection with full resolution. She remains well 8 months later.

Cutaneous Manifestations of Infective Endocarditis

Despite advances in diagnosis and treatment, infective endocarditis still shows considerable morbidity and mortality rates. The dermatological examination in patients with suspected infective endocarditis may prove very useful, as it might reveal suggestive abnormalities of this disease, such as Osler’s nodes and Janeway lesions. We report a case of a women with infective endocarditis and the typical cutaneous manifestations. Despite advances in diagnosis and treatment, infective endocarditis still shows considerable morbidity and mortality rates. The dermatological examination in patients with suspected infective endocarditis may prove very useful, as it might reveal suggestive abnormalities of this disease, such as Osler’s nodes and Janeway lesions. We report a case of a women with infective endocarditis and the typical cutaneous manifestations.

An Unexpected Case of Isolated Left Ventricular Apical Hypoplasia in an Asymptomatic Patient

Isolated left ventricular (LV) apical hypoplasia is a rare type of congenital heart disease. It is often asymptomatic in childhood but may lead to complications later on in life. The proposed mechanism is inadequate LV dilatation during development of the primitive ventricle, resulting in a spherical LV. To our knowledge, we describe for the first time a case of isolated LV apical hypoplasia in an asymptomatic patient, diagnosed on investigation of an abnormal 12-lead resting electrocardiogram (ECG).

An Asymptomatic Left Ventricular Pseudoaneurysm found incidentally at 12 months post Myocardial Infarction: Case Report and Review of the Literature

Highlights: Left ventricular pseudoaneurysms are a rare mechanical complication of myocardial infarction. If found acutely following infarction (within 2 weeks, with some advocating up to 3 months), surgical repair is recommended due to their high risk of rupture.Whilst associated with chest pain, dyspnoea and heart failure, some individuals are asymptomatic, with the diagnosis made incidentally on routine follow-up often months to years post infarction. Less is known about the natural history of these chronic pseudoaneurysms, with concerns around their propensity to rupture perhaps less than the mortality risk of surgical repair.We present the case of a 70 year-old asymptomatic man who was found to have a 1.6cm left ventricular pseudoaneurysm found incidentally on routine transthoracic echocardiogram. at 12-months post posterior myocardial infarctionThe consensus opinion of our institution's multi-disciplinary team regarding further management of this patient, with reference to the current limited data on chronic pseudoaneurysms, will be discussed.

Predictors of Mortality and Associated Lactate Trends in Cardiogenic Shock Patients Treated with Impella® Placement - A Single Center Experience

Background: The Impella® devices have increasingly become a desired treatment option for cardiogenic shock (CS) as demonstrated by studies analyzing real-world use of hemodynamic support devices. However, data regarding outcomes after Impella® device implant and optimal timing of device placement remains scarce. This study investigates prognostic factors including serial lactate levels in CS patients treated with Impella®.Methods: This retrospective study reviewed 76 consecutive patients diagnosed with CS supported with Impella® at a large, tertiary-care university medical center. Clinical variables and outcomes examined include co-morbidities, pre- and post-procedural lactate levels, and mortality.Results: Of the 76 patients requiring an Impella®, 70% of patients survived to hospital discharge. Those who died post-device implant had a higher prevalence of hyperlipidemia (HLD), chronic kidney disease (CKD), and more likely to require multiple (>1) vasopressors. The mean pre-procedural lactate levels were significantly higher (5.86 +/- 5.11 vs 2.16 +/- 1.50, p = 0.01) in the population who died, along with the change in lactate levels (1.90 +/- 2.56 vs -0.40 +/- 1.73, p=0.04). Those who died within 24 hours of implant showed a trend toward higher mean pre-procedural lactate levels (8.46 +/- 6.00 vs 3.86 +/- 3.31, p = 0.12).Conclusions : Higher pre-procedural lactate levels, HLD, CKD, and increased vasopressor requirement were predictive of increased mortality in CS patients post-Impella® placement, especially within 24 hours of implant. Through serial lactate measurements, we demonstrated favorable outcomes in patients with early stabilization or greater lowering of post-procedural lactate levels suggestive of improved end organ perfusion.

Covid-19 And Co-Infections: An Overview Of Ace2 Mediated Viral Entry Of Sars-Cov-2 And Multiorgan Failure In Covid-19

COVID-19 is highly fatal disease having high mortality rate and is declared as pandemic situation by world health organization. It shows a clear indication that every individual is at risk of this pandemic especially older individual and immunocompromised persons. As its casual agent is SARS-Cov-2 and the main target site of this virus is the ACE2 receptor of lungs. But as compared to lungs ACE2 receptor is highly expressed in other organs i.e. kidney, liver, brain, GI tract, cutaneous, adipose tissues and cardiovascular system these organs are susceptible to COVID-19 infections because of having ACE2 receptor. Many co-infections associated with COVID-19 are reported i.e. neurological manifestation of COVID-19, cutaneous manifestations of COVID-19, endothelial cell infection and endotheliitis, adipose tissues infections, cerebral hemorrhage, liver injury, cardiovascular complications, kidney infection, trigger immune system response and subsequent organ failure. In this review we highlight ACE2 mediated viral entry of the SARS-Cov-2 and subsequent multi organ failure in COVID-19.

Association of COVID-19 and Cancer: Risk Statistics and Management of COVID-19 in Cancer Patients

COVID-19 is extremely lethal disease and almost 190 countries is suffering from the latest pandemic. The literature indicates that COVID-19 is more prevalent in patients with compromised immune systems. Patients with cancer are particularly vulnerable to COVID-19 because of immune compromised condition due to immunosuppressive therapy. Immunotherapy results in mixing or overlap of COVID-19 associated pneumonia and immune-related pneumonitis and thus makes the diagnosis process very confusing. On the other side in this pandemic, treating cancer patients in hospital will bring a lot of risk. There is still no strong evidence on the cancer-COVID-19 connection. Yet, in this pandemic, patients with cancer should be treated as special cases. Risk management is highly needed in the critical time of this pandemic. This review highlights the association between COVID-19 and cancer, also the strategy to minimize the risk of COVID-19 in cancer patients.

Heart Rate Variability in a Patient with Coronavirus Disease 2019

This case study investigates the heart rate (HR) and heart rate variability (HRV) in a patient with coronavirus disease 2019 (COVID-19). We report the case of a 58-year old male who contracted COVID-19. During his disease, 24-hour Holter electrocardiography (ECG) was performed continuously. For comparison, his 24-hour Holter ECGs from the previous 10 years were available. In this patient, COVID-19 was associated with a decrease in HR and a paradoxical decline in HRV. An abrupt decline in HRV and a decrease in HR may signal the onset of COVID-19 before common symptoms such as dry cough or fever appear. In addition, HRV and HR measurements may help to evaluate the course of the disease.

A Perspective Study on Oral-fecal Transmission of COVID-19, its Prevention and Management

The novel coronavirus outbreak arose in Wuhan, China in Dec, 2019. It is declared the 6th public health emergency by the WHO and named as COVID-19. SARS-CoV-2 is non-segmented positive sense ssRNA virus, belongs to the Coronaviridae under the Nidovirales and spread largely in human being and other mammals. Person to person, airborne and surface transmission is common, the virus gets entered to host through nose, mouth, eyes, food, water and feces. An infected patient can transmit the virus to 2.2 healthy individuals. A patient in the US showed gastrointestinal symptoms vomiting, nausea and pass loose stools. Later the patient declared positive for SARS-CoV-2 based on viral detection in stools and respiratory samples. The gastrointestinal symptoms like diarrhea, nausea, vomiting, abdominal discomfort and detection of SARS-CoV-2 in stools of infected and recovered patients indicates potential oral-fecal transmission route, it could be potential risk for the spread of COVID-19. The flatus is gas produced by aerophagia or bacterial fermentation in intestine and expelled out through esophagus or anus. It consists of Hydrogen, Oxygen, Nitrogen, Carbon dioxide and Methane, their percentage composition is 99%. Previous study showed that bacteria can transmit through bare-bottom farting. The gastrointestinal manifestation and possible oral-fecal transmission, the flatulence could be the risk of transmission for COVID-19. Personal hygiene must be adapted to prevent the spread of disease.