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Camelo ALM, Zamora Obando HR, Rocha I, Dias AC, Mesquita ADS, Simionato AVC. COVID-19 and Comorbidities: What Has Been Unveiled by Metabolomics? Metabolites 2024; 14:195. [PMID: 38668323 PMCID: PMC11051775 DOI: 10.3390/metabo14040195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/14/2024] [Accepted: 03/26/2024] [Indexed: 04/28/2024] Open
Abstract
The COVID-19 pandemic has brought about diverse impacts on the global population. Individuals with comorbidities were more susceptible to the severe symptoms caused by the virus. Within the crisis scenario, metabolomics represents a potential area of science capable of providing relevant information for understanding the metabolic pathways associated with the intricate interaction between the viral disease and previous comorbidities. This work aims to provide a comprehensive description of the scientific production pertaining to metabolomics within the specific context of COVID-19 and comorbidities, while highlighting promising areas for exploration by those interested in the subject. In this review, we highlighted the studies of metabolomics that indicated a variety of metabolites associated with comorbidities and COVID-19. Furthermore, we observed that the understanding of the metabolic processes involved between comorbidities and COVID-19 is limited due to the urgent need to report disease outcomes in individuals with comorbidities. The overlap of two or more comorbidities associated with the severity of COVID-19 hinders the comprehension of the significance of each condition. Most identified studies are observational, with a restricted number of patients, due to challenges in sample collection amidst the emergent situation.
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Affiliation(s)
- André Luiz Melo Camelo
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Hans Rolando Zamora Obando
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Isabela Rocha
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Aline Cristina Dias
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Alessandra de Sousa Mesquita
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
| | - Ana Valéria Colnaghi Simionato
- Laboratory of Analysis of Biomolecules Tiselius, Department of Analytical Chemistry, Institute of Chemistry, Universidade Estadual de Campinas (UNICAMP), Campinas 13083-970, São Paulo, Brazil; (A.L.M.C.); (H.R.Z.O.); (I.R.); (A.C.D.); (A.d.S.M.)
- National Institute of Science and Technology for Bioanalytics—INCTBio, Institute of Chemistry, Universidade Estadual de (UNICAMP), Campinas 13083-970, São Paulo, Brazil
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Yamoldinov NR, Dudarev MV, Sarksyan DS, Maleev VV. [Сardiac arrhythmias in people who have had a coronavirus infection COVID-19: A review]. TERAPEVT ARKH 2023; 95:991-995. [PMID: 38158958 DOI: 10.26442/00403660.2023.11.202480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 11/17/2023] [Indexed: 01/03/2024]
Abstract
Heart rhythm disorders are one of the most common complications of coronavirus infection. Heart rhythm disorders can develop in 6-17% of hospitalized patients, and in convalescents, COVID-19 can manifest itself up to 12 months after the completion of the acute phase of the disease. Among the mechanisms for the development of cardiac arrhythmias, there are a direct cytopathic effect of SARS-CoV-2 on the myocardium, systemic inflammatory response syndrome, electrolyte imbalance, hypoxia, the use of antibacterial, antimalarial and antiviral drugs, exudative pericarditis, autonomic dysfunction. The main COVID-19-mediated heart rhythm disorders are sinus tachycardia and bradycardia, atrial fibrillation, ventricular tachycardia, long QT syndrome. Despite a significant amount of research, the literature data on the prevalence of certain types of cardiac arrhythmias (especially in COVID-19 convalescents), as well as methods for their correction, are somewhat contradictory and need to be clarified. Taking into account the impact of arrhythmia on the quality of life and mortality, active monitoring of convalescents of coronavirus infection, identification and development of approaches to the treatment of heart rhythm disorders in patients who have had COVID-19, seem to be relevant and promising areas in modern cardiology.
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Affiliation(s)
| | | | | | - V V Maleev
- Central Research Institute of Epidemiology
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3
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Zaballos M, Fernández I, Rodríguez L, Álvarez-Zaballos S, Duque P, Terradillos E, Piñeiro P, Garutti I, Guerrero JE, Hortal J. Cohort study to assess the prevalence of prolonged QT and arrhythmias in critically ill patients during the early phase of the COVID-19 pandemic. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2023; 70:561-568. [PMID: 37717632 DOI: 10.1016/j.redare.2023.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/10/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Patients with SARS-CoV-2 infection may present cardiovascular involvement including myocarditis, arrhythmias and QT interval prolongation. Our objective was to evaluate the impact of COVID-19 and its treatment on ventricular repolarization and development of arrhythmias in critically ill patients. METHODS Retrospective cohort study of critically ill COVID-19 patients during a 3-month period in whom at least one ECG was available. Relevant clinical data and specific treatment administered for COVID-19 were recorded. Prolonged QTc was considered prolonged when it measured ≥ 460 ms in women and ≥450 ms in men. The incidence and type of arrhythmias during the same period were recorded. RESULTS A total of 77 patients with a mean age of 62 ± 13 years, 20 women and 57 men, were evaluated. Sixty percent of the patients were hypertensive, 52% had a BMI > 30, and 70% developed acute renal failure during admission. Some 56% of the patients presented QTc prolongation. Forty-four percent presented some type of arrhythmia during their stay in the ICU, 21% of which were atrial arrhythmias. Overall mortality was 53%, with no differences between patients with or without prolonged QTc. CONCLUSIONS In our series, a high proportion of critical patients with COVID-19 presented prolonged QTc and arrhythmias. The factors involved have been related to the elevation of cardiac biomarkers, the myocardial involvement of the virus and concomitant medication received in the ICU.
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Affiliation(s)
- M Zaballos
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Medicina Legal, Psiquiatría y Patología, Universidad Complutense, Madrid, Spain.
| | - I Fernández
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - L Rodríguez
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - S Álvarez-Zaballos
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - P Duque
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - E Terradillos
- Oberärztin, Institut für Anästhesiologie und Intensivmedizin, San Galo, Sankt Gallen, Switzerland
| | - P Piñeiro
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - I Garutti
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Farmacología, Universidad Complutense, Madrid, Spain
| | - J E Guerrero
- Servicio de Medicina Intensiva, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Hortal
- Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Departamento de Farmacología, Universidad Complutense, Madrid, Spain
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DeMarco E, Turnipseed M, Clarke B, Qadeer F. Possible nirmatrelvir/ritonavir-induced bradycardia in a patient with asymptomatic COVID-19. SAGE Open Med Case Rep 2023; 11:2050313X231168304. [PMID: 37113391 PMCID: PMC10119650 DOI: 10.1177/2050313x231168304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/17/2023] [Indexed: 04/29/2023] Open
Abstract
COVID-19 emerged in 2019 and was declared a pandemic by the World Health Organization in March 2020. COVID-19 is highly transmissible and can lead to bilateral pneumonia with severe respiratory failure. COVID-19 has led to more than 6.5 million deaths worldwide. The significant morbidity and mortality due to COVID-19 have resulted in the development of treatment modalities, such as novel antivirals, to reduce hospitalizations and progression of disease. In 2021, the US Food and Drug Administration authorized nirmatrelvir/ritonavir for emergency use in nonhospitalized patients with COVID-19. Nirmatrelvir is a newly developed protease inhibitor and is combined with a commonly used pharmacokinetic boosting agent, ritonavir. Given the novelty of nirmatrelvir/ritonavir, potential adverse effects remain uncertain. In this case, we describe a patient who was initiated on a course of nirmatrelvir/ritonavir and developed symptomatic bradycardia.
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Affiliation(s)
- Elizabeth DeMarco
- Elizabeth DeMarco, Shore Medical Center, 100 Medical Center Way, Somers Point, NJ 08244, USA.
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Priya SP, Sunil PM, Varma S, Brigi C, Isnadi MFAR, Jayalal JA, Shadamarshan RA, Kumar SS, Kumari NV, Kumar RPR. Direct, indirect, post-infection damages induced by coronavirus in the human body: an overview. Virusdisease 2022; 33:429-444. [PMID: 36311173 PMCID: PMC9593972 DOI: 10.1007/s13337-022-00793-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/19/2022] [Indexed: 11/29/2022] Open
Abstract
Background Severe acute respiratory syndrome Coronavirus-2 invades the cells via ACE2 receptor and damages multiple organs of the human body. Understanding the pathological manifestation is mandatory to endure the rising post-infection sequel reported in patients with or without comorbidities. Materials and methods Our descriptive review emphasises the direct, indirect and post-infection damages due to COVID-19. We have performed an electronic database search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines with selective inclusion and exclusion criteria. Results The included studies substantiated the extensive damages in the multiple organs due to direct and indirect consequences of COVID-19. After an apparent recovery, the prolonged presentation of the symptoms manifests as post-COVID that can be related with persisting viral antigens and dysregulated immune response. Conclusion A few of the symptoms of respiratory, cardiovascular, and neuropsychiatric systems that persist or reappear as post-COVID manifestations. Vaccination and preventive programs will effectively reduce the prevalence but, the post-COVID, a multisystem manifestation, will be a significant tribulation to the medical profession. However, the issue can be managed by implementing public health programs, rehabilitation services, and telemedicine virtual supports to raise awareness and reduce panic.
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Affiliation(s)
- Sivan Padma Priya
- Department of Basic Medical Sciences, RAK College of Dental Sciences, RAK Medical and Health Sciences, Ras Al Khaimah, UAE
| | - P. M. Sunil
- Department of Oral Pathology and Microbiology, Sree Anjaneya Institute of Dental Sciences, Calicut, Kerala India ,Centre for Stem Cells and Regenerate Medicine, Malabar Medical College, Calicut, Kerala India
| | - Sudhir Varma
- Department of Clinical Sciences, College of Dentistry, Center for Medical and Bio-Allied Health Science Research, Ajman University, Ajman, UAE ,Saveetha Dental College and Hospitals, Chennai, India
| | - Carel Brigi
- Molecular Medicine and Translational Research, University of Sharjah, Sharjah, UAE
| | - Mohammad Faruq Abd Rachman Isnadi
- Department of Pathobiology and Medical Diagnostics, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Malaysia
| | - J. A. Jayalal
- Department of Surgery, Kanyakumari Medical College and Hospital, Asaripallam, India
| | - R. Arunkumar Shadamarshan
- Dental Officer and Graded Specialist (Oral and Maxillofacial Surgery), Indo Bhutan Friendship Hospital, IMTRAT, Thimpu Bhutan, 11001 Bhutan
| | - S. Suresh Kumar
- Centre for Materials Engineering and Regenerative Medicine,, Bharath Institute of Higher Eduction and Research, Chennai, 600073 Tamil Nadu India
| | - Neela Vasantha Kumari
- Department of Medical Microbiology and Parasitology, Universiti Putra Malaysia (UPM), Serdang, Selangor 43400 Malaysia
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Jusic A, Stellos K, Ferreira L, Baker AH, Devaux Y. (Epi)transcriptomics in cardiovascular and neurological complications of COVID-19. JOURNAL OF MOLECULAR AND CELLULAR CARDIOLOGY PLUS 2022; 1:100013. [PMID: 36164464 PMCID: PMC9330360 DOI: 10.1016/j.jmccpl.2022.100013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 06/16/2023]
Abstract
Although systemic inflammation and pulmonary complications increase the mortality rate in COVID-19, a broad spectrum of cardiovascular and neurological complications can also contribute to significant morbidity and mortality. The molecular mechanisms underlying cardiovascular and neurological complications during and after SARS-CoV-2 infection are incompletely understood. Recently reported perturbations of the epitranscriptome of COVID-19 patients indicate that mechanisms including those derived from RNA modifications and non-coding RNAs may play a contributing role in the pathogenesis of COVID-19. In this review paper, we gathered recently published studies investigating (epi)transcriptomic fluctuations upon SARS-CoV-2 infection, focusing on the brain-heart axis since neurological and cardiovascular events and their sequelae are of utmost prevalence and importance in this disease.
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Affiliation(s)
- Amela Jusic
- Cardiovascular Research Unit, Department of Precision Health, Luxembourg Institute of Health, L-1445 Strassen, Luxembourg
- Department of Biology, Faculty of Natural Sciences and Mathematics, University of Tuzla, 75000 Tuzla, Bosnia and Herzegovina
| | - Konstantinos Stellos
- Department of Cardiovascular Research, European Centre for Angioscience (ECAS), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (Deutsches Zentrum für Herz-Kreislauf-Forschung, DZHK), Heidelberg/Mannheim Partner Site, Mannheim, Germany
- Department of Cardiology, University Hospital Mannheim, Mannheim, Germany
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Lino Ferreira
- CNC-Center for Neurosciences and Cell Biology, CIBB-Centre for Innovative Biomedicine and Biotechnology, University of Coimbra, Portugal
- Faculty of Medicine, University Coimbra, 3000-548 Coimbra, Portugal
| | - Andrew H. Baker
- Centre for Cardiovascular Science, University of Edinburgh, Queen's Medical Research Institute, 47 Little France Crescent, Edinburgh EH16 4TJ, UK
- CARIM Institute, University of Maastricht, Universiteitssingel 50, 6200 MD Maastricht, the Netherlands
| | - Yvan Devaux
- Cardiovascular Research Unit, Department of Precision Health, Luxembourg Institute of Health, L-1445 Strassen, Luxembourg
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Vlachogiannis NI, Baker KF, Georgiopoulos G, Lazaridis C, van der Loeff IS, Hanrath AT, Sopova K, Tual‐Chalot S, Gatsiou A, Spyridopoulos I, Stamatelopoulos K, Duncan CJ, Stellos K. Clinical frailty, and not features of acute infection, is associated with late mortality in COVID-19: a retrospective cohort study. J Cachexia Sarcopenia Muscle 2022; 13:1502-1513. [PMID: 35257497 PMCID: PMC9088314 DOI: 10.1002/jcsm.12966] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 01/12/2022] [Accepted: 02/03/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is associated with excess mortality after hospital discharge. Identification of patients at increased risk of death following hospital discharge is needed to guide clinical monitoring and early intervention. Herein, we aimed to identify predictors of early vs. late mortality in COVID-19 patients. METHODS A total of 471 patients with polymerase chain reaction-confirmed COVID-19 were followed up for 9 months [median (inter-quartile range) of follow-up time: 271 (14) days] after hospital admission. COVID-19-related signs and symptoms, laboratory features, co-morbidities, Coronavirus Clinical Characterisation Consortium (4C) mortality and Clinical Frailty Scale (CFS) scores were analysed by logistic regression for association with early (28 day) vs. late mortality. Receiver operating characteristic (ROC) analysis was used to determine the discriminative value of 4C and CFS scores for early vs. late mortality. RESULTS A total of 120 patients died within 28 days from hospital admission. Of the remaining 351 patients, 41 died within the next 8 months. Respiratory failure, systemic inflammation, and renal impairment were associated with early mortality, while active cancer and dementia were associated with late mortality, after adjustment for age and sex. 4C mortality score and CFS were associated with both early [odds ratio (OR) (95% confidence interval-CI): 4C: 1.34 (1.25-1.45); CFS: 1.49 (1.33-1.66)] and late [OR (95% CI): 4C: 1.23 (1.12-1.36); CFS: 2.04 (1.62-2.56)] mortality. After adjustment for CFS, the association between 4C and late mortality was lost. By ROC analysis, 4C mortality score was superior to CFS for 28 day mortality [area under the curve (AUC) (95% CI): 0.779 (0.732-0.825) vs. 0.723 (0.673-0.773), respectively; P = 0.039]. In contrast, CFS had higher predictive value for late mortality compared with 4C mortality score [AUC (95% CI): 0.830 (0.776-0.883) vs. 0.724 (0.650-0.798), respectively; P = 0.007]. CONCLUSIONS In our cohort, late mortality in COVID-19 patients is more strongly associated with premorbid clinical frailty than with severity of the acute infection phase.
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Affiliation(s)
- Nikolaos I. Vlachogiannis
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Kenneth F. Baker
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
- NIHR Newcastle Biomedical Research CentreNewcastle University and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Georgios Georgiopoulos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens Medical SchoolAthensGreece
| | - Charalampos Lazaridis
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | | | - Aidan T. Hanrath
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
| | - Kateryna Sopova
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Simon Tual‐Chalot
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
| | - Aikaterini Gatsiou
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
| | - Ioakim Spyridopoulos
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
- NIHR Newcastle Biomedical Research CentreNewcastle University and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Kimon Stamatelopoulos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
- Department of Clinical TherapeuticsNational and Kapodistrian University of Athens Medical SchoolAthensGreece
| | - Christopher J.A. Duncan
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle Upon TyneUK
- NIHR Newcastle Biomedical Research CentreNewcastle University and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
| | - Konstantinos Stellos
- Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical SciencesNewcastle UniversityNewcastle Upon TyneUK
- RVI and Freeman HospitalsNewcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- NIHR Newcastle Biomedical Research CentreNewcastle University and Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle Upon TyneUK
- Department of Cardiovascular Research, European Center for Angioscience (ECAS)Heidelberg UniversityMannheimGermany
- German Centre for Cardiovascular Research (DZHK), partner site Heidelberg/MannheimMannheimGermany
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Gupta A, Marzook H, Ahmad F. Comorbidities and clinical complications associated with SARS-CoV-2 infection: an overview. Clin Exp Med 2022; 23:313-331. [PMID: 35362771 PMCID: PMC8972750 DOI: 10.1007/s10238-022-00821-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/12/2022] [Indexed: 01/08/2023]
Abstract
The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes major challenges to the healthcare system. SARS-CoV-2 infection leads to millions of deaths worldwide and the mortality rate is found to be greatly associated with pre-existing clinical conditions. The existing dataset strongly suggests that cardiometabolic diseases including hypertension, coronary artery disease, diabetes and obesity serve as strong comorbidities in coronavirus disease (COVID-19). Studies have also shown the poor outcome of COVID-19 in patients associated with angiotensin-converting enzyme-2 polymorphism, cancer chemotherapy, chronic kidney disease, thyroid disorder, or coagulation dysfunction. A severe complication of COVID-19 is mostly seen in people with compromised medical history. SARS-CoV-2 appears to attack the respiratory system causing pneumonia, acute respiratory distress syndrome, which lead to induction of severe systemic inflammation, multi-organ dysfunction, and death mostly in the patients who are associated with pre-existing comorbidity factors. In this article, we highlighted the key comorbidities and a variety of clinical complications associated with COVID-19 for a better understanding of the etiopathogenesis of COVID-19.
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Affiliation(s)
- Anamika Gupta
- Cardiovascular Research Group, Sharjah Institute for Medical Research, University of Sharjah, Sharjah, 27272, UAE
| | - Hezlin Marzook
- Cardiovascular Research Group, Sharjah Institute for Medical Research, University of Sharjah, Sharjah, 27272, UAE
| | - Firdos Ahmad
- Cardiovascular Research Group, Sharjah Institute for Medical Research, University of Sharjah, Sharjah, 27272, UAE. .,Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, 27272, UAE.
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9
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Alqahtani MS, Abbas M, Alsabaani A, Alqarni A, Almohiy HM, Alsawqaee E, Alshahrani R, Alshahrani S. The Potential Impact of COVID-19 Virus on the Heart and the Circulatory System. Infect Drug Resist 2022; 15:1175-1189. [PMID: 35345472 PMCID: PMC8957310 DOI: 10.2147/idr.s351318] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/08/2022] [Indexed: 12/13/2022] Open
Abstract
Heart attacks, arrhythmias, and cardiomyopathy are all linked to the 2019 coronavirus disease (COVID-19), which has been identified as a risk factor for cardiovascular disease. Nothing can be held accountable in the current state of affairs. Undiagnosed chronic systolic heart failure (CSHF) develops when the heart’s second half of the cardiac cycle does not function properly. As a result, the heart’s blood pumping function is interrupted. Stress-induced cardiomyopathy may be caused by a variety of factors inside the body (SICM). Cytokine storm and microvascular dysfunction are among the issues. There is inflammation in the heart muscle, which may lead to stress-induced cardiomyopathy. A major part of our study is going to be devoted to understanding the effects of coronavirus on the cardiovascular system and blood vessels. A lot of time and effort has been put into figuring out the health effects of radiation exposure. The heart and circulatory system are shown to be affected by the coronavirus in this research. COVID-19 is shown to influence persons with heart disease, heart failure, arrhythmias, microvascular angiopathy, and cardiac damage in this study.
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Affiliation(s)
- Mohammed S Alqahtani
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia.,BioImaging Unit, Space Research Centre, Michael Atiyah Building, University of Leicester, Leicester, LE1 7RH, U.K
| | - Mohamed Abbas
- Electrical Engineering Department, College of Engineering, King Khalid University, Abha, 61421, Saudi Arabia.,Computers and Communications Department, College of Engineering, Delta University for Science and Technology, Gamasa, 35712, Egypt
| | - Abdullah Alsabaani
- Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, 61421, Saudi Arabia
| | - Amjad Alqarni
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia
| | - Hussain M Almohiy
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia
| | - Entisar Alsawqaee
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia
| | - Raghad Alshahrani
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia
| | - Shahd Alshahrani
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha, 61421, Saudi Arabia
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10
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From Biomedical Applications of Alginate towards CVD Implications Linked to COVID-19. Pharmaceuticals (Basel) 2022; 15:ph15030318. [PMID: 35337116 PMCID: PMC8955152 DOI: 10.3390/ph15030318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/28/2022] [Accepted: 03/04/2022] [Indexed: 12/12/2022] Open
Abstract
In the past year, researchers have focused their attention on developing new strategies for understanding how the coronavirus affects human health and developing novel biomaterials to help patients with cardiovascular disease, which greatly increases the risk of complications from the virus. Natural biopolymers have been investigated, and it has been proven that alginate-based materials have important features. This review presents an overview of alginate-based materials used for developing innovative biomaterial platforms for biomedical applications to mitigate the effects of the coronavirus. As presented in this review, COVID-19 affects the cardiovascular system, not only the lungs. The first part of the review presents an introduction to cardiovascular diseases and describes how they have become an important problem worldwide. In the second part of the review, the origin and unique properties of the alginate biopolymer are presented. Among the properties of alginate, the most important are its biocompatibility, biodegradability, low cost, nontoxicity, unique structure, and interesting features after chemical modification. The third section of the review illustrates some of the functions of alginate in biomedical, pharmaceutical, and drug delivery applications. Researchers are using alginate to develop new devices and materials for repairing heart tissues that have been damaged by the coronavirus. Further, insights regarding how cardiovascular disease affects COVID-19 patients are also discussed. Finally, we conclude the review by presenting a summary of the impacts of COVID-19 on cardiovascular patients, their implications, and several hypothetical alginate-based treatments for infected patients.
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Darmadi D, Pakpahan C, Ruslie RH. Gastrointestinal Endoscopy and Coronavirus Disease-2019 Pandemic. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2). It has become a pandemic since March 11, 2020. It carries a significant burden and hampers gastrointestinal endoscopy practice. Since SARS-CoV-2 receptors are found in the gastrointestinal tract, COVID-19 also manifests as gastrointestinal symptoms. The viable virus is also detected in stool, carrying a high risk of transmission. Therefore, gastrointestinal endoscopy practice needs to be changed to prevent spreading from patients and medical personnel. All patients should be screened for the possibility of infection. Triage is done to determine the urgency of cases. Elective cases are postponed while semi-urgent and urgent cases are treated accordingly. A level 2 personal protective equipment (PPE) should be used for negative/suspected COVID-19 and a level 3 PPE is used for the confirmed case. Endoscopy unit should have negative-pressure room or proper ventilation, separated unit between negative/suspected and confirmed cases, exclusive equipment for COVID-19 case, and proper disinfection of equipment and room. Medical personnel must be screened regularly and positive information regarding gastrointestinal endoscopy practice should be spread to patients.
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12
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Niazi S, Niazi F, Doroodgar F, Safi M. The Cardiac Effects of COVID-19: Review of articles. Curr Probl Cardiol 2022; 47:100981. [PMID: 34534589 PMCID: PMC8438797 DOI: 10.1016/j.cpcardiol.2021.100981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 08/13/2021] [Accepted: 09/03/2021] [Indexed: 01/08/2023]
Abstract
Cardiovascular wellbeing has been dramatically affected by severe acute respiratory syndrome coronavirus (SARS-CoV-2), the reason for the coronavirus disease pandemic 2019 (COVID-19) pandemic. There is a greater risk of morbidity and death in individuals with preexisting heart diseases. Clinical syndromes of the acute coronary syndrome, acute myocardial injury, myocarditis, arrhythmias, heart failure, and venous thromboembolism can, directly and indirectly, affect the heart. There may also be adverse heart effects of specific therapeutics under review for COVID-19. The renin-angiotensin-aldosterone system (RAAS) mechanism in virus replication makes it essential to understand the consequences of the system-modulating medications. For optimum patient care, detailed knowledge of specific cardiovascular symptoms of COVID-19 and the role of RAAS in the prognosis of COVID-19 disease is necessary.
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Affiliation(s)
- Sana Niazi
- Medical Students Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Feizollah Niazi
- Research Center of Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farideh Doroodgar
- Negah Specialty Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Morteza Safi
- Cardiovascular Research Center of Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Batta Y, King C, Johnson J, Haddad N, Boueri M, Haddad G. Sequelae and Comorbidities of COVID-19 Manifestations on the Cardiac and the Vascular Systems. Front Physiol 2022; 12:748972. [PMID: 35095546 PMCID: PMC8795698 DOI: 10.3389/fphys.2021.748972] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/28/2021] [Indexed: 01/08/2023] Open
Abstract
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.
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Affiliation(s)
- Yashvardhan Batta
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - Cody King
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - John Johnson
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | - Natasha Haddad
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
| | | | - Georges Haddad
- Department Physiology and Biophysics, College of Medicine, Howard University, Washington, DC, United States
- *Correspondence: Georges Haddad,
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14
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Majidpoor J, Mortezaee K. Interleukin-6 in SARS-CoV-2 induced disease: Interactions and therapeutic applications. Biomed Pharmacother 2022; 145:112419. [PMID: 34781146 PMCID: PMC8585600 DOI: 10.1016/j.biopha.2021.112419] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023] Open
Abstract
Interleukin-6 (IL-6) is a multi-tasking cytokine that represents high activity in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and cancer. High concentration of this pleiotropic cytokine accounts for hyperinflammation and cytokine storm, and is related to multi-organ failure in patients with SARS-CoV-2 induced disease. IL-6 promotes lymphopenia and increases C-reactive protein (CRP) in such cases. However, blockade of IL-6 is not a full-proof of complete response. Hypoxia, hypoxemia, aberrant angiogenesis and chronic inflammation are inter-related events occurring as a response to the SARS-CoV-2 stimulatory effect on high IL-6 activity. Taking both pro- and anti-inflammatory activities will make complex targeting IL-6 in patient with SARS-CoV-2 induced disease. The aim of this review was to discuss about interactions occurring within the body of patients with SARS-CoV-2 induced disease who are representing high IL-6 levels, and to determine whether IL-6 inhibition therapy is effective for such patients or not. We also address the interactions and targeted therapies in cancer patients who also have SARS-CoV-2 induced disease.
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Affiliation(s)
- Jamal Majidpoor
- Department of Anatomy, School of Medicine, Infectious Disease Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Keywan Mortezaee
- Department of Anatomy, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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15
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Akter F, Araf Y, Naser IB, Promon SK. Prospect of 3D bioprinting over cardiac cell therapy and conventional tissue engineering in the treatment of COVID-19 patients with myocardial injury. Regen Ther 2021; 18:447-456. [PMID: 34608441 PMCID: PMC8481096 DOI: 10.1016/j.reth.2021.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/01/2021] [Accepted: 09/23/2021] [Indexed: 01/08/2023] Open
Abstract
Due to multiple mutations of SARS-CoV-2, the mystery of defeating the virus is still unknown. Cardiovascular complications are one of the most concerning effects of COVID-19 recently, originating from direct and indirect mechanisms. These complications are associated with long-term Cardio-vascular diseases and can induce sudden cardiac death in both infected and recovered COVID-19 patients. The purpose of this research is to do a competitive analysis between conventional techniques with the upgraded alternative 3D bioprinting to replace the damaged portion of the myocardium. Additionally, this study focuses on the potential of 3D bioprinting to be a novel alternative. Finally, current challenges and future perspective of 3D bioprinting technique is briefly discussed.
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Affiliation(s)
- Fariya Akter
- Biotechnology Program, Department of Mathematics and Natural Sciences, Brac University, Dhaka, Bangladesh
| | - Yusha Araf
- Department of Genetic Engineering and Biotechnology, School of Life Sciences, Shahjalal University of Science and Technology, Sylhet, Bangladesh
| | - Iftekhar Bin Naser
- Biotechnology Program, Department of Mathematics and Natural Sciences, Brac University, Dhaka, Bangladesh
| | - Salman Khan Promon
- Department of Life Sciences, School of Environment and Life Sciences, Independent University, Bangladesh (IUB), Bashundhara, Dhaka, Bangladesh
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16
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Vitiello A, Ferrara F. Risk of drug-induced cardiac arrhythmia during COVID-19 therapeutic treatment. Egypt Heart J 2021; 73:103. [PMID: 34792677 PMCID: PMC8600338 DOI: 10.1186/s43044-021-00228-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 11/05/2021] [Indexed: 12/15/2022] Open
Abstract
Therapeutic treatment of severe COVID-19 infection involves the administration of multiple pharmacologic agents to reduce the risk of serious complications; this may result in drug interactions and possible adverse reactions and induced cardiotoxicity. The risk-benefit ratio associated with the use of medications to treat COVID-19 should be carefully monitored. In addition, the severe COVID-19 patient may experience cardiac damage, and alteration of normal cardiac electrophysiology function. Severe COVID-19 with cardiac involvement and the risk of drug-induced adverse reactions may cause cardiac arrhythmias, including long qt syndrome, which in some cases may lead to sudden death. In this short review we briefly review the pharmacological agents used to treat severe COVID-19 with increased risk of causing long qt forms.
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Affiliation(s)
- Antonio Vitiello
- Pharmaceutical Department, Usl Umbria 1, Via XIV Settembre 06132, Perugia, Italy
| | - Francesco Ferrara
- Pharmaceutical Department, Asl Napoli 3 Sud, Dell’amicizia street 22, 80035 Nola, Naples, Italy
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17
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Ko SY, Nguyen NK, Lee CL, Lee LA, Nguyen KUT, Lee EC. Aeromedical Implications of Long-Term COVID-19 Sequelae. Aerosp Med Hum Perform 2021; 92:898-907. [PMID: 34819216 DOI: 10.3357/amhp.5928.2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND: While many COVID-19 studies focus on acute effects of the infection, few examine the intermediate and long-term sequelae of the illness. Studies have shown that a good portion of patients have chronic effects in several body systems for several months or longer. Such effects can potentially adversely impact pilot performance in flight. We sought to determine the long-term effects of COVID-19 infection, how such effects can affect pilot performance, and how to best evaluate pilots for aeromedical flight clearance.METHODS: We used the PubMed literature search engine to review peer-reviewed articles that focused on the intermediate and long-term effects of COVID-19 infection. Chronic signs and symptoms were subdivided based on the particular body organ system affected. Merging information obtained from case reviews, article reviews, and aeromedical standards, we created a risk stratification guide to assist with the aeromedical disposition of affected pilots.RESULTS: Long-term effects of COVID-19 infection can last for several months or longer. The most common effects are fatigue, weakness, pulmonary diffusion defects, depression, and anxiety.DISCUSSION: This review article focuses on the most common intermediate- and long-term COVID-19 conditions of aeromedical significance and the corresponding course of actions recommended for the aeromedical examiner. Aeromedical evaluation should take into consideration factors related to the pilot, aircraft type, and specific aviation environment. Such evaluation may include diagnostic testing, medical specialist consultation, preflight simulation in an altitude chamber, human centrifuge testing, and/or a flight simulator checkride.Ko SY, Nguyen NK, Lee CL, Lee LA, Nguyen KUT, Lee EC. Aeromedical implications of long-term COVID-19 sequelae. Aerosp Med Hum Perform. 2021; 92(11):898-907.
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18
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Pandit RA, Gagana BN, Vaity C, Mulakavalupil B, Choudhary JS, Jain V, Chandan PM, Joshi H. Clinical Characteristics and Outcomes of COVID-19 Patients Hospitalized in Intensive Care Unit. Indian J Crit Care Med 2021; 25:992-1000. [PMID: 34963716 PMCID: PMC8664017 DOI: 10.5005/jp-journals-10071-23945] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Meta-analysis and clinical studies suggest coronavirus disease-2019 (COVID-19) patients in ICU have a high mortality rate of 30-45%, which has evolved as a function of criteria of admission and the management modalities. MATERIALS AND METHODS We conducted a retrospective evaluation for characteristics and outcomes in critical care set up across six months. RESULTS 514 patients (74.3% males and 25.6% females) were evaluated. 9.72% (n = 50) patients expired, 78% (n = 39) were males. Mean age (years) was 57 (±14, range 64, 95% CI 55-58). 65.7% (n = 338) were of age more than 50 years, of which 71.5% (n = 242) were males. Males at 20% higher risk for death than women. (RR = 1.2, 95% CI 0.66-2.31, p = 0.61 NS). There was 18% less risk of mortality in female vs male with comorbidities (RR 0.82, 95% CI 0.67-1.12, p = 0.32 NS). Risk for mortality in diabetics was significantly increased by 116% vs nondiabetics. (RR 2.16, p = 0.0055, 95% CI 1.28-3.67). Highly significant risk of mortality in age group >50 years (3.13 times higher) vs age ≤50 years. (RR 3.18, 95% CI 1.71-8.64, p = 0.0003). 50.2% had moderate ARDS at admission. High flow nasal cannula was used in 47.2%. There is 5.79 times more likelihood to be on the ventilator with moderate to severe ARDS vs mild ARDS (RR = 5.79, 95% CI 3.10-11.05, p <0.0001). Risk for death was six times higher for patients on ventilator vs not on ventilator (RR = 6.08, 95% CI 3.49-10.59, p <0.0001). The mean number of days on ventilator for patients who underwent tracheostomy (n = 49) was 14 days as compared to 6.6 days in patients who were extubated (n = 57) (p <0.0001). P/F ratio had negative correlation with number of days of hospitalisation (Pearson r -0.391, 95% CI -0.46- -0.31, p <0.0001). 67% less chances of mortality in patients on steroids (RR = 0.33, 95% CI 0.19-60, p = 0.0012). Mean duration of ICU stay (days) was 8 (± 5, range 29, 95% CI 7.5-8.4). CONCLUSIONS We observed that a strict adherence to the basic principles of ARDS management resulted in a lower mortality in ICU setting. HOW TO CITE THIS ARTICLE Pandit RA, Gagana BN, Vaity C, Mulakavalupil B, Choudhary JS, Jain V, et al. Clinical Characteristics and Outcomes of COVID-19 Patients Hospitalized in Intensive Care Unit. Indian J Crit Care Med 2021;25(9):992-1000.
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Affiliation(s)
- Rahul A Pandit
- Department of Critical Care Medicine, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - BN Gagana
- Department of Critical Care Medicine, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - Charudatt Vaity
- Department of Critical Care Medicine, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - Bindu Mulakavalupil
- Department of Critical Care Medicine, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - Jitendra S Choudhary
- Department of Critical Care Medicine, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - Vivek Jain
- Department of Critical Care Medicine, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - Pramila M Chandan
- Department of Critical Care Medicine, Fortis Hospital Mulund, Mumbai, Maharashtra, India
| | - Harsh Joshi
- Department of Critical Care Medicine, Fortis Hospital Mulund, Mumbai, Maharashtra, India
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19
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Tokarek T, Dziewierz A, Malinowski KP, Rakowski T, Bartuś S, Dudek D, Siudak Z. Treatment Delay and Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction during the COVID-19 Pandemic. J Clin Med 2021; 10:jcm10173920. [PMID: 34501369 PMCID: PMC8432080 DOI: 10.3390/jcm10173920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/18/2021] [Accepted: 08/27/2021] [Indexed: 02/02/2023] Open
Abstract
Pandemic-specific protocols require additional time to prepare medical staff and catheterization laboratories. Thus, we sought to investigate treatment delay and clinical outcomes in COVID-19 positive and negative patients with ST-segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention (PCI) during on- and off-hours. All consecutive patients with STEMI treated with PCI between 1 March and 31 December 2020 were enrolled in the analysis. A propensity score match was used to compare COVID-19 positive and negative patients for on- and off-hours. The study group was comprised of 877 paired patients treated during regular hours (every day 7:00 a.m. to 16:59 p.m.) and 418 matched pairs with PCI performed during off-hours (every day 17:00 p.m. to 06:59 a.m.) (ORPKI Polish National Registry). No difference in periprocedural mortality was observed between the two groups (on-hours: COVID-19 negative vs. COVID-19 positive: 17 (1.9%) vs. 11 (1.3%); p = 0.3; off-hours: COVID-19 negative vs. COVID-19 positive: 4 (1.0%) vs. 7 (1.7%); p = 0.5). Additionally, a similar rate of periprocedural complications was reported. Patients diagnosed with COVID-19 were exposed to longer time from first medical contact to angiography (on-hours: 133.8 (±137.1) vs. 117.1 (±135.8) (min); p = 0.001) (off-hours: 148.1 (±201.6) vs. 112.2 (±138.7) (min); p = 0.003). However, there was no influence of COVID-19 diagnosis on mortality and the prevalence of other periprocedural complications irrespective of time of intervention.
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Affiliation(s)
- Tomasz Tokarek
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; (A.D.); (T.R.); (S.B.)
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland
- Correspondence: ; Tel.: +48-12-400-22-62
| | - Artur Dziewierz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; (A.D.); (T.R.); (S.B.)
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Krzysztof Piotr Malinowski
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Tomasz Rakowski
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; (A.D.); (T.R.); (S.B.)
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Stanisław Bartuś
- Department of Cardiology and Cardiovascular Interventions, University Hospital, 2 Jakubowskiego St., 30-688 Krakow, Poland; (A.D.); (T.R.); (S.B.)
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Dariusz Dudek
- 2nd Department of Cardiology, Jagiellonian University Medical College, 31-008 Krakow, Poland; (K.P.M.); (D.D.)
| | - Zbigniew Siudak
- Faculty of Medicine and Health Science, Jan Kochanowski University, 25-369 Kielce, Poland;
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20
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Lubis M. Management of Inflammatory Bowel Disease during Coronavirus Disease 2019 Pandemic. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Inflammatory bowel disease (IBD) is a chronic inflammation consisted of ulcerative colitis and Crohn’s disease. IBD is a global disease with heavy economic burden. Coronavirus disease-2019 (COVID-19) is a novel disease which spread rapidly and becomes a pandemic. This pandemic situation affects the management of IBD. Severe acute respiratory syndrome coronavirus-2 as the etiology of COVID-19 requires angiotensin-converting enzyme (ACE2) as its receptor. ACE2 is found to be abundant in the gastrointestinal tract, particularly the small intestine and colon. This causes the presence of gastrointestinal symptoms in COVID-19 and interacts with gastrointestinal diseases including IBD. The diagnosis of IBD in patients with COVID-19 is similar with general population with precautions regarding endoscopic procedure. IBD does not increase the risk for contracting COVID-19 nor worsen the outcome of COVID-19. The first step in managing patients with IBD during pandemic is by implicating strict health protocol. There is still a controversy regarding surgery for IBD during pandemic. Medications for IBD are safe during pandemic except systemic corticosteroids. IBD patients without COVID-19 should continue their medications until the goal of disease remission is achieved. If asymptomatic COVID-19 is present, corticosteroid dose should be lowered, tapered, and stopped if available. Anti-tumor necrosis factor (TNF) administration should be postponed for 2 weeks. If COVID-19 manifestations exist, systemic corticosteroid, thiopurine, methotrexate, and anti-TNF should be discontinued. Supporting treatment for COVID-19 can be administered safely. In case of relapsing, the treatment of IBD must be started with the limitation of systemic corticosteroid.
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21
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Hasan R. Heart Failure and Coronavirus Disease-19. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Globally, 4.2% population suffer from heart failure. The condition has a mortality rate between 56% and 78%. Coronavirus disease-2019 (COVID-19) was first reported in December 2019 and became a pandemic since March 11, 2020. As COVID-19 emerges, cardiovascular disorders including, heart failure, become one of the most common comorbidity that increase the risk for contracting the disease. Heart failure and COVID-19 have reciprocal relationship. Patients with heart failure are at higher risk for COVID-19 with more unfavorable outcome. COVID-19 itself may deteriorate pre-existing heart failure in the subject. This situation is mediated by the presence of angiotensin converting enzyme-2 (ACE-2) in cardiac myocytes and pericytes, direct effect of viral invasion to myocytes and pericytes, downregulation of ACE-2 which hampers cardiovascular function, and uncontrolled inflammation known as cytokine storm. Prudent management, including implementation of telemedicine, continuation of ACE inhibitor and angiotensin receptor blocker, and medications’ side effects monitoring, is important in managing patients with coexisting heart failure and COVID-19.
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22
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Raghavan S, Gayathri R, Kancharla S, Kolli P, Ranjitha J, Shankar V. Cardiovascular Impacts on COVID-19 Infected Patients. Front Cardiovasc Med 2021; 8:670659. [PMID: 34055939 PMCID: PMC8155350 DOI: 10.3389/fcvm.2021.670659] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/14/2021] [Indexed: 01/08/2023] Open
Abstract
The SARS-CoV-2 virus has taken more than 2 million lives on a global scale. Over 10 million people were confirmed with COVID-19 infection. The well-known spot of primary infection includes the lungs and the respiratory system. Recently it has been reported that the cardiovascular system and coagulation mechanisms were the second major targets of biological system affected due to the viral replication. The replication mechanism of SARS-CoV-2 involves the angiotensin-converting enzyme 2- (ACE2) surface receptors of endothelial cells belonging to various organs which act as the binding site for the viral spike (S) protein of SARS-CoV-2. The COVID-19 virus has been recently listed as a primary risk factor for the following cardiovascular conditions such as pericarditis, myocarditis, arrhythmias, myocardial injury, cardiac arrest, heart failure and coagulation abnormalities in the patients confirmed with COVID-19 viral infection. Direct and indirect type of tissue damage were the two major categories detected with cardiovascular abnormalities. Direct myocardial cell injury and indirect damage to the myocardial cell due to inflammation were clinically reported. Few drugs were clinically administered to regulate the vital biological mechanism along with symptomatic treatment and supportive therapy.
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Affiliation(s)
- Somasundaram Raghavan
- Department of Pharmaceutical Sciences, University of Tennessee Health Science Center, Memphis, TN, United States
| | - R. Gayathri
- CO2 Research and Green Technologies Centre, VIT University, Vellore, India
| | | | | | - J. Ranjitha
- CO2 Research and Green Technologies Centre, VIT University, Vellore, India
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23
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Beckerman JK, Alarfaj M, Tracy CM, Faiwiszewski AD, Choi AD. Coronavirus disease 2019 (COVID-19)-associated constrictive pericarditis. BMJ Case Rep 2021; 14:14/5/e242018. [PMID: 33975843 PMCID: PMC8117986 DOI: 10.1136/bcr-2021-242018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This report documents a rare case of COVID-19-associated constrictive pericarditis (CP) in the setting of a recent COVID-19 infection. A 55-year-old man with a history of hypertension and gout presented with acute hypoxic respiratory failure and was diagnosed with COVID-19 pneumonia with progression to acute respiratory distress syndrome. His hospital course was complicated by a large pericardial effusion; an emergent bedside transthoracic echocardiography was concerning for cardiac tamponade, so pericardiocentesis was performed. A workup with cardiac magnetic resonance imaging showed changes consistent with a diagnosis of CP. Viral and idiopathic aetiologies are the most common cause of CP in the developed world, with COVID-19 now a proposed predisposing viral illness. The virus induces systemic inflammation and pericardial changes that can lead to CP physiology. Imaging modalities including echocardiogram and cardiac magnetic resonance play an integral role in confirming the diagnosis.
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Affiliation(s)
- Jennifer Kate Beckerman
- Department of Internal Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Mohammad Alarfaj
- Department of Internal Medicine, George Washington University School of Medicine, Washington, DC, USA
| | - Cynthia M Tracy
- Division of Cardiology, George Washington University School of Medicine, Washington, DC, USA
| | - Ariel D Faiwiszewski
- Division of Cardiology, George Washington University School of Medicine, Washington, DC, USA
| | - Andrew D Choi
- Division of Cardiology and Department of Radiology, George Washington University School of Medicine, Washington, DC, USA
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24
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COVID-19 and Cardiovascular Disease: Issues of Diagnosis and Treatment. Fam Med 2021. [DOI: 10.30841/2307-5112.1.2021.231873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
COVID-19 affects not only the respiratory system, but also the cardiovascular system. The damage to the cardiovascular system in COVID-19 is multifactorial and several mechanisms are involved, including direct invasion, inflammation, thrombosis, autoantibody synthesis, and oxygen imbalance. The inflammation causes the release of cytokines, especially interleukin-6, and damage to cardiomyocytes. The overproduction of cytokines leads to an abnormal inflammatory response called a cytokine storm, which is believed to be the culprit in cardiovascular events in COVID-19 patients.
Cardiovascular disease is common in patients with COVID-19, and these patients are at increased risk of morbidity and mortality. There is still no data on cardiac dysfunction due to myocardial damage in patients recovering from COVID-19. Most often, this is normal heart function after complete recovery. But often there are myocardial damage and an increased level of troponin as a marker of the severity of the disease associated with a cytokine storm, hypoxia, vasopressors and blood clotting disorders. It is important for every physician to make a differential diagnosis between decompensated heart failure complicated by pulmonary infection and COVID-19 infection. Monitoring and influencing myocardial injury is extremely important in critically ill patients.
Treatment of COVID-19 patients with cardiovascular complications is mostly supportive. The role of pharmacological blocking of the reninangiotensin-aldosterone system in patients with cardiovascular disease and COVID-19 infection requires further research as the relationship appears to be very complex. To date, professional cardiological societies do not recommend canceling ACE inhibitors or agiotensin II receptor antagonists for patients taking these drugs for other indications. Special care should be taken about the potential cardiovascular side effects of the various therapies used to treat viral infections. When using them, daily monitoring of the QT interval on the ECG is proposed.
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Xu Q, Samanapally H, Nathala P, Salunkhe V, Furmanek S, Cahill MN, McGuffin T, Mohammad T, Marsili B, Petrey J, Carrico R, Ramirez J, Akca O, Clifford SP, Pahwa S, Roser L, Kong M, Huang J. Outcomes and Risk Factors for Cardiovascular Events in Hospitalized COVID-19 Patients. J Cardiothorac Vasc Anesth 2021; 35:3581-3593. [PMID: 33867235 PMCID: PMC7997853 DOI: 10.1053/j.jvca.2021.03.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/18/2021] [Accepted: 03/21/2021] [Indexed: 12/25/2022]
Abstract
Objective To analyze outcomes and risk factors of cardiovascular events in a metropolitan coronavirus disease 2019 (COVID-19) database, and to perform a subgroup analysis in African American populations to determine whether outcomes and risk factors are influenced by race. Design Retrospective cohort analysis from March 9, 2020 to June 20, 2020. Setting Population-based study in Louisville, KY, USA. Participants Seven hundred adult inpatients hospitalized with COVID-19. Interventions N/A. Measurements and Main Results This cohort consisted of 126 patients (18%) with cardiovascular events and 574 patients without cardiovascular events. Patients with cardiovascular events had a much higher mortality rate than those without cardiovascular events (45.2% v 8.7%, p < 0.001). There was no difference between African American and white patients regarding mortality (43.9% v 46.3%, p = 1) and length of stay for survivors (11 days v 9.5 days, p = 0.301). Multiple logistics regression analysis suggested that male, race, lower SaO2/FIO2, higher serum potassium, lower serum albumin, and number of cardiovascular comorbidities were highly associated with the occurrence of cardiovascular events in COVID-19 patients. Lower serum albumin and neoplastic and/or immune-compromised diseases were highly associated with cardiovascular events for African American COVID-19 patients. SaO2/FIO2 ratio and cardiovascular comorbidity count were significantly associated with cardiovascular events in white patients. Conclusions Cardiovascular events were prevalent and associated with worse outcomes in hospitalized patients with COVID-19. Outcomes of cardiovascular events in African American and white COVID-19 patients were similar after propensity score matching analysis. There were common and unique risk factors for cardiovascular events in African American COVID-19 patients when compared with white patients.
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Affiliation(s)
- Qian Xu
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY
| | - Harideep Samanapally
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Pavani Nathala
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Vidyulata Salunkhe
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Stephen Furmanek
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Meredith N Cahill
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY; School of Medicine, University of Louisville, Louisville, KY
| | | | - Tahboub Mohammad
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Bradford Marsili
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY
| | - Jessica Petrey
- Kornhauser Health Sciences Library, University of Louisville, Louisville, KY
| | - Ruth Carrico
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Julio Ramirez
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY
| | - Ozan Akca
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY
| | - Sean P Clifford
- Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY
| | - Siddharth Pahwa
- Department of Cardiovascular & Thoracic Surgery, University of Louisville, Louisville, KY
| | - Lynn Roser
- School of Nursing, University of Louisville, Louisville, KY
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, Louisville, KY
| | - Jiapeng Huang
- Division of Infectious Diseases, Center of Excellence for Research in Infectious Diseases (CERID), University of Louisville, Louisville, KY; Department of Anesthesiology & Perioperative Medicine, University of Louisville, Louisville, KY; Department of Cardiovascular & Thoracic Surgery, University of Louisville, Louisville, KY; Center for Integrative Environmental Health Sciences, University of Louisville, Louisville, KY.
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Tousoulis D. Heart failure: From novel pharmaceutical therapies to circulation support systems. Hellenic J Cardiol 2021; 61:359-361. [PMID: 33617963 DOI: 10.1016/j.hjc.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Dimitris Tousoulis
- 1st Cardiology Department, National and Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece.
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Burkert FR, Niederreiter L, Dichtl W, Mayr A, Virgolini I, Klauser A, Weiss G, Bellmann-Weiler R. Case report of a COVID-19-associated myocardial infarction with no obstructive coronary arteries: the mystery of the phantom embolus or local endothelitis. Eur Heart J Case Rep 2021; 5:ytaa521. [PMID: 33598613 PMCID: PMC7873789 DOI: 10.1093/ehjcr/ytaa521] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 08/24/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
Background Since the first documented outbreak of a novel severe acute respiratory syndrome inducing Coronavirus in China at the end of 2019 the virus has spread to all continents, leading the WHO to declare a pandemic in March 2020. While this virus primarily targets the alveoli in the lungs, multiple authors have described an increased rate of thrombo-embolic events in affected patients. We present this case of a myocardial infarction with no obstructive coronary atherosclerosis in an otherwise healthy 48-year-old patient. Case summary A 48-year-old female, presenting with chest pain radiating to her left shoulder with no cardiovascular risk factors other than genetic predisposition, was screened for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and tested positive. Although computed tomography angiography excluded obstructive coronary heart disease, cardiac magnetic resonance imaging showed an acute myocardial infarction with no obstructive coronary arteries of the inferior wall. The patient was treated with dual anti-platelet therapy, an angiotensin-converting-enzyme inhibitor and a statin, and assigned to a cardiac rehabilitation program. Conclusion We report a serious thrombo-embolic event during an oligosymptomatic SARS-CoV-2 infection in a healthy, young patient. While these two diseases may have occurred simultaneously, by chance, it is possible that the pro-thrombotic effects of the SARS-CoV-2 infection facilitated the infarction. This case further demonstrates the significant cardiovascular morbidity potentially caused by SARS-CoV-2.
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Affiliation(s)
- Francesco Robert Burkert
- Internal Medicine Department II, Medical University Innsbruck, Landeskrankenhaus Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Lukas Niederreiter
- Internal Medicine Department II, Medical University Innsbruck, Landeskrankenhaus Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Wolfgang Dichtl
- Internal Medicine Department II, Medical University Innsbruck, Landeskrankenhaus Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Agnes Mayr
- Radiology Department, Medical University Innsbruck, Innsbruck, Austria
| | - Irene Virgolini
- Nuclear Medicine Department, Medical University Innsbruck, Innsbruck, Austria
| | - Andrea Klauser
- Radiology Department, Medical University Innsbruck, Innsbruck, Austria
| | - Günter Weiss
- Internal Medicine Department II, Medical University Innsbruck, Landeskrankenhaus Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Internal Medicine Department II, Medical University Innsbruck, Landeskrankenhaus Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
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Myocardial fibrosis after COVID-19 infection and severe sinus arrest episodes in an asymptomatic patient with mild sleep apnea syndrome: A case report and review of the literature. Respir Med Case Rep 2021; 32:101366. [PMID: 33619450 PMCID: PMC7889031 DOI: 10.1016/j.rmcr.2021.101366] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/13/2021] [Indexed: 11/29/2022] Open
Abstract
COVID-19 infection is a new disease mainly affecting the respiratory system but is also accompanied by many extra-pulmonary manifestations. A case of a 47-year old male with unique myocardial fibrosis after COVID-19 infection involving the left ventricular wall, intraventricular septum and almost complete damage of interatrial septum, in combination with asymptomatic severe sinus arrest episodes related to mild obstructive sleep apnea syndrome is described here. Myocardial fibrosis may be a consequence of COVID-19 infection. Almost complete fibrosis of interatrial septum is a unique complication of COVID-19. Cardiac MRI is very useful in detecting myocardial complications. Severe sinus arrest episodes are very unusual in patients with mild OSA syndrome.
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Tousoulis D. Heart failure: From novel pharmaceutical therapies to circulation support systems. Hellenic J Cardiol 2021; 62:452-454. [PMID: 33577984 DOI: 10.1016/j.hjc.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dimitris Tousoulis
- 1st Cardiology Department, National and Kapodistrian University of Athens University Medical School, Hippokration Hospital, Athens, Greece.
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Charman SJ, Velicki L, Okwose NC, Harwood A, McGregor G, Ristic A, Banerjee P, Seferovic PM, MacGowan GA, Jakovljevic DG. Insights into heart failure hospitalizations, management, and services during and beyond COVID-19. ESC Heart Fail 2021; 8:175-182. [PMID: 33232587 PMCID: PMC7753441 DOI: 10.1002/ehf2.13061] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/26/2020] [Accepted: 09/25/2020] [Indexed: 12/22/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus-2. The clinical presentation of this virus mainly manifests in the respiratory system but may also lead to severe complications in the cardiovascular system. The global burden of COVID-19 has led to an unprecedented need to gain further insight into patient outcomes, management, and clinical practice. This review aims to provide an overview of the current literature on heart failure (HF) hospitalizations, management, and care pathways for supporting patients during and beyond this pandemic. A literature review of five areas of interest was conducted and included: (i) HF hospitalization; (ii) recognizing the needs and supporting HF patients during COVID-19; (iii) supporting rehabilitation services; (iv) transitioning to a telehealth framework; and (v) the need for evidence. Patients with new-onset or existing HF are particularly vulnerable, but a significant reduction in HF hospital admissions has been reported. During these periods of uncertainty, the current care pathways for acute and elective cardiac patients have had to change with the relocation of HF services to protect the vulnerable and reduce transmission of COVID-19. Optimizing community HF services has the potential to reduce the pressures on secondary care during the recovery from this pandemic. Telemedicine and virtual health care are emerging technologies and overcome the risk of in-person exposure. Successful remote delivery of cardiac rehabilitation services has been reported during the pandemic. Delivery of a robust telehealth framework for HF patients will improve communication between clinician and patient. The reduction in HF admissions is a concern for the future and may result in unintended mortality. New-onset and current HF patients must understand their diagnosis and future prognosis and seek help and support using the appropriate platform when needed. Realigning HF services and the use of telemedicine and virtual health care has great potential but needs to be carefully understood to ensure engagement and approval in this population to overcome barriers and challenges.
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Affiliation(s)
- Sarah J. Charman
- Cardiovascular Research Division, Translational and Biosciences Research InstitutesNewcastle UniversityNewcastle upon TyneUK
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Lazar Velicki
- Faculty of MedicineUniversity of Novi SadNovi SadSerbia
- Clinic for Cardiovascular SurgeryInstitute of Cardiovascular Diseases VojvodinaSremska KamenicaSerbia
| | - Nduka C. Okwose
- Cardiovascular Research Division, Translational and Biosciences Research InstitutesNewcastle UniversityNewcastle upon TyneUK
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Amy Harwood
- Faculty of Health and Life SciencesCoventry UniversityCoventryUK
- University Hospitals Coventry and Warwickshire NHS TrustCoventryUK
| | - Gordon McGregor
- Faculty of Health and Life SciencesCoventry UniversityCoventryUK
- University Hospitals Coventry and Warwickshire NHS TrustCoventryUK
| | - Arsen Ristic
- Faculty of MedicineUniversity of Belgrade, Clinical Centre SerbiaBelgradeSerbia
| | - Prithwish Banerjee
- Faculty of Health and Life SciencesCoventry UniversityCoventryUK
- University Hospitals Coventry and Warwickshire NHS TrustCoventryUK
| | - Petar M. Seferovic
- Faculty of MedicineUniversity of Belgrade, Clinical Centre SerbiaBelgradeSerbia
| | - Guy A. MacGowan
- Cardiovascular Research Division, Translational and Biosciences Research InstitutesNewcastle UniversityNewcastle upon TyneUK
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
| | - Djordje G. Jakovljevic
- Cardiovascular Research Division, Translational and Biosciences Research InstitutesNewcastle UniversityNewcastle upon TyneUK
- Newcastle upon Tyne Hospitals NHS Foundation TrustNewcastle upon TyneUK
- Faculty of Health and Life SciencesCoventry UniversityCoventryUK
- University Hospitals Coventry and Warwickshire NHS TrustCoventryUK
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Ehrlich H, Elkbuli A. Cardiac arrhythmias in COVID-19 patients: A combination of viral comorbidities and pro-arrhythmic drug interactions. Am J Emerg Med 2021; 48:363-364. [PMID: 33551245 PMCID: PMC7847181 DOI: 10.1016/j.ajem.2021.01.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 01/26/2021] [Indexed: 11/01/2022] Open
Affiliation(s)
- Haley Ehrlich
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.
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Bulfamante GP, Perrucci GL, Falleni M, Sommariva E, Tosi D, Martinelli C, Songia P, Poggio P, Carugo S, Pompilio G. Evidence of SARS-CoV-2 Transcriptional Activity in Cardiomyocytes of COVID-19 Patients without Clinical Signs of Cardiac Involvement. Biomedicines 2020; 8:biomedicines8120626. [PMID: 33352880 PMCID: PMC7767122 DOI: 10.3390/biomedicines8120626] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/09/2020] [Accepted: 12/16/2020] [Indexed: 02/07/2023] Open
Abstract
Aims: A considerable proportion of patients affected by coronavirus respiratory disease (COVID-19) develop cardiac injury. The viral impact in cardiomyocytes deserves, however, further investigations, especially in asymptomatic patients. Methods: We investigated for SARS-CoV-2 presence and activity in heart tissues of six consecutive COVID-19 patients deceased from respiratory failure showing no signs of cardiac involvement and with no history of heart disease. Cardiac autopsy samples were collected within 2 h after death, and then analysed by digital PCR, Western blot, immunohistochemistry, immunofluorescence, RNAScope, and transmission electron microscopy assays. Results: The presence of SARS-CoV-2 into cardiomyocytes was invariably detected in all assays. A variable pattern of cardiomyocyte injury was observed, spanning from absence of cell death and subcellular alterations hallmarks, to intracellular oedema and sarcomere ruptures. In addition, we found active viral transcription in cardiomyocytes, by detecting both sense and antisense SARS-CoV-2 spike RNA. Conclusions: In this autopsy analysis of patients with no clinical signs of cardiac involvement, the presence of SARS-CoV-2 in cardiomyocytes has been detected, determining variable patterns of intracellular damage. These findings suggest the need for cardiologic surveillance in surviving COVID-19 patients not displaying a cardiac phenotype.
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Affiliation(s)
- Gaetano Pietro Bulfamante
- Unità di Anatomia Patologica, Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy; (G.P.B.); (M.F.); (D.T.); (C.M.)
- Struttura Complessa di Anatomia Patologica e Genetica Medica, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Gianluca Lorenzo Perrucci
- Unità di Biologia Vascolare e Medicina Rigenerativa, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.S.); (G.P.)
- Correspondence: ; Tel.: +39-0258002754; Fax: +39-0258002342
| | - Monica Falleni
- Unità di Anatomia Patologica, Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy; (G.P.B.); (M.F.); (D.T.); (C.M.)
- Struttura Complessa di Anatomia Patologica e Genetica Medica, ASST Santi Paolo e Carlo, 20142 Milan, Italy
| | - Elena Sommariva
- Unità di Biologia Vascolare e Medicina Rigenerativa, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.S.); (G.P.)
| | - Delfina Tosi
- Unità di Anatomia Patologica, Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy; (G.P.B.); (M.F.); (D.T.); (C.M.)
| | - Carla Martinelli
- Unità di Anatomia Patologica, Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy; (G.P.B.); (M.F.); (D.T.); (C.M.)
| | - Paola Songia
- Unità per lo Studio delle Patologie Aortiche, Valvolari e Coronariche, Centro Cardiologico Monzino IRCCS, 20138 Milano, Italy; (P.S.); (P.P.)
| | - Paolo Poggio
- Unità per lo Studio delle Patologie Aortiche, Valvolari e Coronariche, Centro Cardiologico Monzino IRCCS, 20138 Milano, Italy; (P.S.); (P.P.)
| | - Stefano Carugo
- Unità di Cardiologia, Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20142 Milan, Italy;
| | - Giulio Pompilio
- Unità di Biologia Vascolare e Medicina Rigenerativa, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (E.S.); (G.P.)
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122 Milan, Italy
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Attoh S, Segborwotso RP, Akoriyea SK, Teddy G, Edusei L, Hobenu F, Agyemang-Bediako K, Toppar A, Fatchu RD, Akakpo PK. COVID-19 autopsy reports from the Ga-East Municipal and the 37 Military Hospitals in Accra, Ghana. Ghana Med J 2020; 54:52-61. [PMID: 33976442 PMCID: PMC8087362 DOI: 10.4314/gmj.v54i4s.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Since the declaration of COVID-19 by the World Health Organisation (WHO) as a global pandemic on 11th March 2020, the number of deaths continue to increase worldwide. Reports on its pathologic manifestations have been published with very few from the Sub-Saharan African region. This article reports autopsies on COVID-19 patients from the Ga-East and the 37 Military Hospitals to provide pathological evidence for better understanding of COVID-19 in Ghana. METHODS Under conditions required for carrying out autopsies on bodies infected with category three infectious agents, with few modifications, complete autopsies were performed on twenty patients with ante-mortem and/or postmortem RT -PCR confirmed positive COVID-19 results, between April and June, 2020. RESULTS There were equal proportion of males and females. Thirteen (65%) of the patients were 55years or older with the same percentage (65%) having Type II diabetes and/or hypertension. The most significant pathological feature found at autopsy was diffuse alveolar damage. Seventy per cent (14/20) had associated thromboemboli in the lungs, kidneys and the heart. Forty per cent (6/15) of the patients that had negative results for COVID-19 by the nasopharyngeal swab test before death had positive results during postmortem using bronchopulmonary specimen. At autopsy all patients were identified to have pre-existing medical conditions. CONCLUSION Diffuse alveolar damage was a key pathological feature of deaths caused by COVID-19 in all cases studied with hypertension and diabetes mellitus being major risk factors. Individuals without co-morbidities were less likely to die or suffer severe disease from SARS-CoV-2. FUNDING None declared.
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Affiliation(s)
- Seth Attoh
- Pathology Division, 37 Military Hospital, Accra, Ghana
| | | | | | - Gina Teddy
- Ghana Centre for Health Systems and Policy Research, Ghana Institute of Management and Public Administration, Accra, Ghana
| | - Lawrence Edusei
- Department of Pathology, Korle-Bu Teaching Hospital, Accra, Ghana
| | | | | | - Alfred Toppar
- Medical Division, 37 Military Hospital, Accra, Ghana
| | | | - Patrick K Akakpo
- Department of Pathology, School of Medical Sciences, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast, Ghana
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Manolis AS, Manolis AA, Manolis TA, Apostolopoulos EJ, Papatheou D, Melita H. COVID-19 infection and cardiac arrhythmias. Trends Cardiovasc Med 2020; 30:451-460. [PMID: 32814095 PMCID: PMC7429078 DOI: 10.1016/j.tcm.2020.08.002] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/04/2020] [Accepted: 08/14/2020] [Indexed: 02/07/2023]
Abstract
As the coronavirus 2019 (COVID-19) pandemic marches unrelentingly, more patients with cardiac arrhythmias are emerging due to the effects of the virus on the respiratory and cardiovascular (CV) systems and the systemic inflammation that it incurs, and also as a result of the proarrhythmic effects of COVID-19 pharmacotherapies and other drug interactions and the associated autonomic imbalance that enhance arrhythmogenicity. The most worrisome of all arrhythmogenic mechanisms is the QT prolonging effect of various anti-COVID pharmacotherapies that can lead to polymorphic ventricular tachycardia in the form of torsade des pointes and sudden cardiac death. It is therefore imperative to monitor the QT interval during treatment; however, conventional approaches to such monitoring increase the transmission risk for the staff and strain the health system. Hence, there is dire need for contactless monitoring and telemetry for inpatients, especially those admitted to the intensive care unit, as well as for outpatients needing continued management. In this context, recent technological advances have ushered in a new era in implementing digital health monitoring tools that circumvent these obstacles. All these issues are herein discussed and a large body of recent relevant data are reviewed.
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Affiliation(s)
- Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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Babapoor-Farrokhran S, Alzubi J, Khraisha O, Mainigi SK. Editorial commentary: Cardiac arrhythmias in the era of COVID-19 pandemic. Trends Cardiovasc Med 2020; 30:461-462. [PMID: 32927023 PMCID: PMC7484727 DOI: 10.1016/j.tcm.2020.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 11/16/2022]
Affiliation(s)
| | - Jafar Alzubi
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia 19141, PA, USA
| | - Ola Khraisha
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia 19141, PA, USA
| | - Sumeet K Mainigi
- Department of Medicine, Division of Cardiology, Einstein Medical Center, Philadelphia 19141, PA, USA; Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia 19107, PA, USA
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Fong B, London K. Prolonged Duration of Viral Shedding of SARS-CoV-2: A Case Report. Clin Pract Cases Emerg Med 2020; 4:509-512. [PMID: 33217258 PMCID: PMC7676783 DOI: 10.5811/cpcem.2020.7.49005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/24/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction The literature on the clinical course of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) suggests patients continue shedding viral particles typically for an average of 20 days until the body builds immunity against the infection. However, a few cases have shown prolonged duration in viral shedding and highlight the significant increased mortality in these patients. It has also been suggested that multiple strains of SARS-COV-2 exist, keying the possibility to reinfection. Case Report We present a case of a 57-year-old male who presented twice over 37 days with symptoms related to SARS-COV-2, and only on his second visit was found to be in hypoxemic respiratory failure and cardiogenic shock. He also reportedly had a period of convalescence in between presentations. Discussion This case highlights the still unclear disease course of SARS-COV-2 and the need for diligence in providing strong follow-up instructions and evaluation for sequelae of the infection.
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Affiliation(s)
- Brandon Fong
- Thomas Jefferson University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania
| | - Kory London
- Thomas Jefferson University Hospital, Department of Emergency Medicine, Philadelphia, Pennsylvania
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