P405 ALDOSTERONE AND INTERLEUKIN–6: IS IT A NEW ASSOCIATION IN COVID–19?

Introduction

Several pieces of evidence have confirmed the interleukin–6 (IL–6) activity in the cytokine storm induced by COVID–19 pneumonia. Furthermore, the correlation between serum IL–6 levels and plasma aldosterone has been widely ascertained in patients with primary aldosteronism (PA). Hence, the highest levels of aldosterone may increase IL–6 in COVID–19 patients with PA.

Case Presentation

We reported the clinical case of a 47–year–old woman with severe COVID–19 pneumonia complicated by Guillain–Barré Syndrome (GBS). At admission, the patient presented severe interstitial pneumonia complicated by hypoxemia and respiratory failure, which required mechanical ventilation. Blood tests revealed very high levels of IL–6 (serum IL–6: 402 pg / mL) and its soluble receptor (soluble IL–6 receptor> 1900 pg / mL). In addition, the patient was diagnosed with PA after accidental evidence of right adrenal adenoma, resistant arterial hypertension, severe hypokalemia, and elevated serum levels of aldosterone with a high aldosterone/renin ratio. Therefore, infusion therapy with spironolactone was administered with a rapid improvement of the clinical condition. Later she was diagnosed with acute motor and sensory axonal neuropathy and with the indication of motor rehabilitation.

Conclusions

The higher aldosterone levels in PA could be associated with more severe forms of COVID–19, stimulating the production of IL–6 and its pro–inflammatory effects. Hence, the association between IL–6 and aldosterone may have a synergistic effect in the development of more severe complications such as GBS. The highest aldosterone levels and activity could be also identified in patients with COVID–19 pneumonia and secondary aldosteronism. More studies are needed to evaluate spironolactone therapy in COVID–19.

P337 SPORTS CARDIOLOGY NURSE IMPORTANCE IN YOUNG SPORTSMEN SUFFERING FROM ACUTE HEART DISEASE PREVENTION AND REHABILITATION. PILOT EXPERIENCE: REMOTE MONITORING DURING THE SARSCOV–2 PANDEMIC

This is because it is difficult to understand that a “well trained” heart is not necessarily a “healthy” heart, and many malignant arrhythmias are triggered by physical activity. A project on diagnosis and prevention aimed at recognizing acute cardiac pathologies in young sportsmen has been launched using professional nursing figures, who in addition to having acquired relevant skills in the critical, interventional and clinical cardiology area, have also acquired additional skills in the field of the Biomedical and Neuromotor Sciences. The “sport cardiology nurse” can represent a relevant support for athletes’ acute cardiac pathologies prevention and rehabilitation. It takes the young patient throughout the process together with the Doctor: – Outpatient activity (recognition of ECG alterations, preparation of the patient for drug tests, Tilt test, management of complications) – Interventional cardiology activities: implantation of loop recorders and implantable defibrillators. – Rehabilitation and physical, nutritional and psychological education. With the SARS–CoV–2 pandemic, our work has undergone a drastic change. We have worked with telemedicine and activated remote monitoring for implanted cardiac devices. Our experience from January 2020 to today counts the enrolment of 80 patients undergoing ICD implantation, of which 8 subcutaneous, in young athletes. With the video visiting service it was possible to follow young patients who had been diagnosed with acute heart disease, to monitor and identify the onset of symptoms and / or arrhythmias. Remote monitoring is managed by the Sports Cardiology Nurse and the Doctor in charge. Given the results obtained, the project also aims to expand its skills in the environments most attended by young people, such as schools and sports centres in association with local companies in a not too far future. This “Sport Cardiology” aims to train more nursing professionals, to plan interventions aimed at reducing mortality and to spread the basic concepts of health education in the field of prevention.

C70 HIGH–SENSITIVE CARDIAC TROPONINS ELEVATION: NOT ONLY A CARDIAC DISEASE. ROLE OF HETEROPHILE ANTIBODIES

Introduction

High–sensitive troponins I and T (hs–TnI and hs–TnT) represents the main biomarkers of Acute Coronary Syndrome diagnosis when combined with ST–T segment changes at ECG and typical clinical presentation. Elevated serum values of cardiac troponins can also be found in several cardiac diseases such as myopericarditis, pulmonary embolism and heart failure, conversely also in non–cardiac diseases. Among them, the analytical interference due to heterophile antibodies (HA) represent a rare non–cardiac cause of troponins elevation.

Case Presentation

We report a case of a 20–year–old man admitted to our Cardiology department for palpitations and dyspnea, associated with persistently high levels of TnI–HS. He presented no cardiovascular risk factors. During hospitalization the patient was asymptomatic with persistent TnI–HS elevation (1051.4 pg/mL; r.n. 0–34 pg/mL) associated with no CK–MB values changes or typical rise and fall of myocardial damage biomarkers at lab test. Cardiac magnetic resonance excluded myopericarditis or cardiomyopathies in this patient, therefore HA capture test was performed using HA blocking tube reagents. The analytical interference due to HA has been identified with a post–test hs–TnI value of 16.9 pg/mL.

Conclusions

The analytical interference due to HA is a rare and underestimated cause of false–positive results in cardiac troponin essay, however it should be excluded mostly in young patients without cardiovascular risk factors. Persistent hs–TnI and hs–TnT elevation combined with the absence of typical rise and fall of cardiac troponins and with no CK–MB alterations should help the clinician to recognize this analytical phenomenon at the emergency department.