Brainstem stroke: A fatal thromboembolic event after new onset atrial fibrillation during covid-19 infection: A case report and literature review

COVID-19 HEART unveiling as atrial fibrillation: pathophysiology, management and future directions for research

BACKGROUND

COVID-19 infections are known to cause numerous systemic complications including cardiovascular disorders. In this regard, clinicians recently noticed that patients recovering from COVID-19 infections presented with diverse set of cardiovascular disorders in addition to those admitted to ICU (intensive care unit). COVID-19 heart has multifaceted presentation ranging from dysrhythmias, myocarditis, stroke, coronary artery disease, thromboembolism to heart failure. Atrial fibrillation is the most common cardiac arrhythmia among COVID-19 patients. In the background section, we briefly discussed epidemiology and spectrum of cardiac arrhythmias in COVID-19 patients.

MAIN BODY

In this state-of-the-art review we present here, we present the information regarding COVID-19-induced A-fib in sections, namely mechanism of action, clinical presentation, diagnosis and treatment. Unfortunately, its occurrence significantly increases the mortality and morbidity with a potential risk of complications such as cardiac arrest and sudden death. We included separate sections on complications including thromboembolism and ventricular arrhythmias. Since its mechanism is currently a gray area, we included a separate section on basic science research studies that are warranted in the future to comprehend its underlying pathogenic mechanisms.

CONCLUSIONS

Taken together, this review builds upon the current literature of COVID-19-induced A-fib, including pathophysiology, clinical presentation, treatment and complications. Furthermore, it provides recommendations for future research moving forward that can open avenues for developing novel remedies that can prevent as well as hasten clinical recovery of atrial fibrillation in COVID-19 patients.

Factors influencing the length of stay in the moroccan intensive care unit in patients surviving critical COVID-19 infection

Introduction

Methods

Results

Conclusion

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Our objective is to determine the factors that influence the length of hospitalization of patients admitted to an intensive care unit.

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The average length of hospitalization for a critical infection with COVID-19 is 6 days (SD = 7Days).

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The length of time between the consultation and the onset of symptoms higher than 8 days affects the length of hospitalization.

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During hospitalization, the use of mechanical ventilation, the use of tocilizumab, having a billateral nosocomial pneumonia are all factors that impact the length of hospitalization.

New-Onset Atrial Fibrillation in COVID-19 Infection: A Case Report and Review of Literature

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, many cases of arrhythmias have been reported in patients with COVID-19 infection. We present the case of a 66-year-old female with no known cardiovascular history who presented with worsening shortness of breath and productive cough and tested positive for COVID-19 infection in the ED. The patient had a recent hospitalization for COVID-19 infection during which she was treated with dexamethasone and remdesivir therapy and her course remained uncomplicated at that time. Following this, she developed worsening shortness of breath at home for which she presented to the ED. During this hospitalization, she was treated with dexamethasone, remdesivir, and supplemental oxygen. On day six of hospitalization, the patient became tachycardic and had palpitations. Cardiac monitor and EKG showed evidence of new-onset atrial fibrillation (NOAF). Initially patient received metoprolol and diltiazem, both of which failed to achieve adequate rate control. Following this, the patient was started on carvedilol 30 mg every six hours, which attained good rate control. Her CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled), vascular disease, age 65 to 74, and sex category) score was 4 for which she was started on apixaban 5mg twice daily. The patient was discharged on the same medications. Despite increasing reported incidences of NOAF in COVID-19 infection, only little is known about the optimal management strategies and possible etiopathology. The aim of our review is to highlight the possible mechanisms triggering atrial fibrillation in COVID-19 infection and go over the management strategies while reviewing the available literature.

Purpura as a late complication of covid-19 infection that should not be ignored: Case report and brief review

Introduction and importance

The SARS COV2 infection is a challenging pandemic that has affected millions of people with a very high mortality rate. In addition to the typical respiratory symptoms, it can also cause variable skin lesions, such as vascular purpura in some exceptional cases.

Case presentation

We report the case of a 60-year-old woman who was admitted for a SARS COV2 infection, the evolution was marked by the appearance of a vascular purpura at D20 after the beginning of the symptoms.

Discussion

The cutaneous manifestations associated with the SARS COV2 infection are polymorphic. Vascular purpura is one of them. Its diagnosis is retained in the light of a combination of arguments, which makes it a real challenge for the physician to diagnose it. The management of the disease is based on a symptomatic treatment. The clinical evolution is, in general, favorable.

Conclusion

Although rare and still not fully explained, skin involvement during SARS COV2 infection has been described. It should not be neglected and it should be diagnosed early and treated appropriately, especially in asymptomatic patients.

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Infection with the COVID-19 virus can be manifested by clinical signs of varying severity, sometimes fatal.

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Being a systemic disease, SARS COV2 infection may be revealed, in addition to respiratory symptoms, by skin lesions including vascular purpura

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We report a case of vascular purpura occurring post-infection

Cardiogenic shock revealing myocarditis after mRNA vaccination against covid-19: Case report and brief review for the first case in Morocco

Introduction

and importance: After its unexpected effectiveness in the clinical trials, the anti-COVID-19 vaccine type mRNA was launched on December 11, 2020, but a few months later, several reports of post-mRNA vaccination myocarditis were published, but without any proven causal link.

Case presentation

We report the case of a 14-year-old teenager admitted to the emergency department for a cardiogenic shock, the patient mentioned that he had an anti-COVID 19 vaccination 10 days before his admission. First, the vasoactive drugs had stabilized the patient; the troponins came back highly favorable but later confirmed myocarditis by magnetic resonance imaging. In this sense an etiological analysis was made and it came back without any particularities, leaving us relating the myocarditis to the vaccination.

Clinical discussion

Post-vaccination myocarditis is a rare event, with very few reports in the literature. After the introduction of COVID vaccination, several reports were published, mostly after the mRNA vaccine. Until now, no causal link has been proven, so we need to have more reports in this sense to have a better knowledge of this phenomenon.

Conclusion

Until we obtain a more precise explanation of the mechanism of myocarditis after vaccination with the anti-COVID-19 vaccine, all symptoms suggesting myocarditis should be systematically monitored during the first 7 days after vaccination.

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Myocarditis after COVID 19 vaccination is currently a controversial issue.

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Cardiac MRI is the gold standard for diagnosis.

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Cardiogenic shock is a serious complication of acute myocarditis.

Association of pulmonary embolism and acute coronary syndrome during COVID-19 infection: Case report and a brief review

INTRODUCTION AND IMPORTANCE

COVID 19 infection is considered a potentially serious disease since it is responsible for important respiratory and cardiovascular complications with a high morbid-mortality.

CASE PRESENTATION

We report the case of a 54-year-old diabetic patient with hypertension who was admitted for heart failure with a reduced LVEF of 23% triggered by a pulmonary embolism and an acute coronary syndrome in the context of COVID-19 infection.

CLINICAL DISCUSSION

Indeed, these complications may be secondary to a prothrombotic and hypercoagulable state as well as endothelial dysfunction caused by the vascular and systemic inflammation and cytokine storm induced by SARS-CoV-2. Although the clinical polymorphism of COVID 19 infection is recognized, the association of myocardial ischemia with pulmonary embolism is uncommon and of adverse prognosis. This justifies a rapid and adapted multidisciplinary management.

CONCLUSION

In the absence of contraindication, thromboprohylaxis should be initiated for all hospitalized patients with COVID-19 to minimize the risk of thromboembolic complications.

SARS-CoV-2 infection presenting as rhabdomyolysis: case report and review

Coronavirus disease 2019 (COVID-19) is the health crisis of our time and a great challenge we face, requiring the implementation of worldwide general containment. The symptoms and complications of COVID-19 are diverse, and rhabdomyolysis is an atypical manifestation. We report a case of a 63-year-old patient, admitted to the emergency room for myalgia and fever evolving over 5 days, in whom laboratory and other examinations indicated rhabdomyolysis complicated by renal insufficiency. During the diagnostic workup, the real-time polymerase chain reaction (RT-PCR) test result for COVID-19 was positive, revealing infection with sudden acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although the severity of COVID-19 infection relates mainly to acute respiratory syndrome, other complications can be prognostic, and these complications make the management of this disease difficult. Rhabdomyolysis is one of the fatal complications; first, because the pathophysiological mechanism is not yet understood, and second, because rhabdomyolysis, itself, is usually complicated by acute renal failure. This complication makes the disease management difficult, especially in patients with SARS. Rhabdomyolysis during COVID-19 infection represents a significant challenge, given the few reported cases, and further research is required to develop a therapeutic consensus.