Myocardial Infarction In COVID-19 Patients Admitted to the Shahid Mostafa Khomeini Hospital of Ilam: A Case Series

Adverse Cardiovascular, Cerebrovascular, and Peripheral Vascular Effects of Marijuana Inhalation: What Cardiologists Need to Know

British Journal of Hospital MedicineVol. 81, No. 7 Case ReportMultiple spontaneous coronary thrombosis causing ST-elevation myocardial infarction in a patient with COVID-19Hibba Kurdi, Daniel R Obaid, Zia UlHaq, Adrian Ionescu, Baskar SekarHibba KurdiCorrespondence to: Hibba Kurdi; E-mail Address: [email protected]Morriston Cardiology Centre, Morriston Hospital, Swansea, UKSearch for more papers by this author, Daniel R ObaidMorriston Cardiology Centre, Morriston Hospital, Swansea, UKSearch for more papers by this author, Zia UlHaqMorriston Cardiology Centre, Morriston Hospital, Swansea, UKSearch for more papers by this author, Adrian IonescuMorriston Cardiology Centre, Morriston Hospital, Swansea, UKSearch for more papers by this author, Baskar SekarMorriston Cardiology Centre, Morriston Hospital, Swansea, UKSearch for more papers by this authorHibba Kurdi; Daniel R Obaid; Zia UlHaq; Adrian Ionescu; Baskar SekarPublished Online:13 Jul 2020https://doi.org/10.12968/hmed.2020.0337AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bangalore S, Sharma A, Slotwiner A et al.. ST-segment elevation in patients with Covid-19: a case series. N Engl J Med. 2020;382(25):2478–2480. https://doi.org/10.1056/NEJMc2009020 Crossref, Medline, Google ScholarBikdeli B, Madhavan MV, Jimenez D et al.. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up. J Am Coll Cardiol. 2020;75(23):2950–2973. https://doi.org/10.1016/j.jacc.2020.04.031 Crossref, Medline, Google ScholarBritish Society of Thoracic Imaging. Radiology decision tool for suspected COVID-19. 2020. https://www.bsti.org.uk/media/resources/files/NHSE_BSTI_APPROVED_Radiology_on_CoVid19_v6_ucQ1tNv.pdf (accessed 24 June 2020) Google ScholarChoi S, Jang WJ, Song YB et al.. D-dimer levels predict myocardial injury in ST-segment elevation myocardial infarction: a cardiac magnetic resonance imaging study. PLoS One. 2016;11(8):e0160955–e0160955. https://doi.org/10.1371/journal.pone.0160955 Crossref, Medline, Google ScholarCorrales-Medina VF, Alvarez KN, Weissfeld LA et al.. Association between hospitalization for pneumonia and subsequent risk of cardiovascular disease. JAMA. 2015;313(3):264–274. https://doi.org/10.1001/jama.2014.18229 Crossref, Medline, Google ScholarFang Y, Zhang H, Xie J et al.. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology. 2020;19:200432. https://doi.org/10.1016/j.crad.2020.03.008 Crossref, Google ScholarThachil J. The versatile heparin in COVID-19. J Thromb Haemost. 2020;18(5):1020–1847. https://doi.org/10.1111/jth.14821 Crossref, Medline, Google ScholarWatson J, Whiting PF, Brush JE. Interpreting a COVID-19 test result. BMJ. 2020;369:m1808. https://doi.org/10.1136/bmj.m1808 Medline, Google ScholarXiong TY, Redwood S, Prendergast B, Chen M. Coronaviruses and the cardiovascular system: acute and long-term implications. Eur Heart J. 2020;41(19):1798–1800. https://doi.org/10.1093/eurheartj/ Crossref, Medline, Google Scholar FiguresReferencesRelatedDetailsCited byRole of Acute Thrombosis in Coronavirus Disease 2019Critical Care Clinics, Vol. 38, No. 3The day after tomorrow: cardiac surgery and coronavirus disease-20198 December 2021 | Journal of Cardiovascular Medicine, Vol. 23, No. 2Coronary Stent Thrombosis in COVID-19 Patients: A Systematic Review of Cases Reported Worldwide27 January 2022 | Viruses, Vol. 14, No. 2Selective intracoronary administration of glycoprotein IIb/IIIa inhibitors for acute myocardial infarction in a patient with COVID-19 during percutaneous coronary interventionKardiologiya i serdechno-sosudistaya khirurgiya, Vol. 15, No. 2COVID-19 and Acute Myocardial Injury and Infarction: Related Mechanisms and Emerging Challenges5 May 2021 | Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 26, No. 5A Review of Coronary Artery Thrombosis: A New Challenging Finding in COVID-19 Patients and ST-elevation Myocardial InfarctionCurrent Problems in Cardiology, Vol. 46, No. 3COVID-19 Infection: Viral Macro- and Micro-Vascular Coagulopathy and Thromboembolism/Prophylactic and Therapeutic Management14 September 2020 | Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 26, No. 1Hematologic Emergencies in Patients with Covid-1918 November 2021Therapeutic Implications of COVID-19 for the Interventional Cardiologist17 December 2020 | Journal of Cardiovascular Pharmacology and Therapeutics, Vol. 378 2 July 2020Volume 81Issue 7ISSN (print): 1750-8460ISSN (online): 1759-7390 Metrics History Published online 13 July 2020 Published in print 2 July 2020 Information© MA Healthcare LimitedPDF download

Stroke and Myocardial Infarction (MI) in Hereditary Thrombotic Thrombocytopenic Purpura (HTTP): Similarities to Sickle Cell Anemia (SSA)

Plugging the Hole: Diagnosis and Management of Post–Myocardial Infarction Ventricular Septal Defect

HEART HALF FULL

There have been several local and systemic adverse events associated with mRNA COVID-19 vaccines. Pericarditis, myocarditis and myocardial infarction are examples of cardiac complications related to these vaccines. In this article, we conducted a systematic review of case reports and case series to identify the clinical profile, investigations, and management of reported cardiac complications post-mRNA COVID-19 vaccines. We systematically searched PubMed, Scopus, Web of Science, and Google Scholar, as well as the medRxiv preprint server, with terms including: 'SARS-CoV-2', 'COVID-19', 'messenger RNA vaccine*', 'mRNA-1273 vaccine', 'BNT162 vaccine', 'myocarditis', 'pericarditis', 'stroke' and 'Myocardial Ischemia' up to 25 September 2021. Studies were excluded if they were not case reports or case series, or reported cases from non-mRNA vaccines. Case reports and case series were included that investigated the potential cardiac complications associated with mRNA COVID-19 vaccines. The JBI checklist was used to assess quality and data synthesis was conducted using a qualitative methodology called narrative synthesis. Sixty-nine studies, including 43 case reports and 26 case series, were included. Myocarditis/myopericarditis and pericarditis were the most common adverse events among the 243 reported cardiac complications, post mRNA COVID-19 vaccination. Males with a median age of 21years had the highest frequency of myocarditis. Almost three quarters (74.4%) of cases with myocarditis had received the BNT162b2 vaccine and 87.7% had received the second dose of the vaccine. Chest pain (96.1%) and fever (38.2%) were the most common presentations. CK-MB, troponin, and NT-proBNP were elevated in 100%, 99.5% and 78.3% of subjects, respectively. ST-segment abnormality was the most common electrocardiogram feature. Cardiac magnetic resonance imaging, which is the gold-standard approach for diagnosing myocarditis, was abnormal in all patients diagnosed with myocarditis. Non-steroidal anti-inflammatory drugs were the most prescribed medication for the management of myocarditis. Apart from inflammatory conditions, some rare cases of Takotsubo cardiomyopathy, myocardial infarction, myocardial infarction with non-obstructive coronary arteries, and isolated tachycardia were also reported following immunisation with mRNA COVID-19 vaccines. We acknowledge that only reviewing case reports and case series studies is one potential limitation of our study. We found that myocarditis was the most commonly reported adverse cardiac event associated with mRNA COVID-19 vaccines, which presented as chest pain with a rise in cardiac biomarkers. Further large-scale observational studies are recommended.

Acute Myocardial Infarction after Intravenous Thrombolysis for Acute Ischemic Stroke: Case Series and Systematic Review

Introduction: Left ventricular (LV) thrombus is a known complication of myocardial infarction (MI) and it usually occurs in areas of poorly contracting LV muscle as a result of endocardial injury with associated inflammation. There is a high risk of embolization within 3 months among patients with MI complicated by mural thrombus and this risk is maximum during the first 1–2 weeks. We report a case series of five patients who presented with acute coronary syndrome with LV apical thrombus and treated with triple anti-thrombotic therapy of rivaroxaban, aspirin, and clopidogrel. Case Series: Our series involves 5 cases who developed LV apical thrombus after acute coronary syndrome. Four patients had anterior wall ST-elevation MI (STEMI) whereas 1 patient had inferior wall STEMI. One of the patients with anterior STEMI also had COVID pneumonitis. All of these patients received triple anti-thrombotic therapy consisting of tab Aspirin 75 mg OD, tab clopidogrel 75 mg OD, and tab rivaroxaban 20 mg OD for 3 months duration. Repeat ECHO after 3 months showed complete resolution of LV thrombus in all of our cases. Discussion: LV thrombus reported in STEMI patients is from 1.6% up to 39% in various studies. The incidence of LV thrombus is on decreasing trend as a result of modern revascularization strategies. The role of novel oral anticoagulants (NOACs) in treating LV thrombus is scant as compared to oral Vitamin K antagonists (VKAs) like warfarin. The current recommendation for anticoagulation in the presence of a LV thrombus after acute coronary syndrome is with VKAs for up to 6 months. Conclusion: Although there is uncertainty in decision-making regarding antithrombotic therapy, our case series demonstrate that triple antithrombotic therapy with NOACs results in resolution of LV thrombus without any additional bleeding events in patients presenting with acute coronary syndrome. NOACs have an advantage of not requiring PT/INR monitoring and have less bleeding complications. Further large-scale research or randomized controlled trials are needed to find the optimal therapies in such cases.

Apical Ballooning Syndrome or Takotsubo Syndrome: A Novel Cardiac Syndrome

The cardiotoxic effects of synthetic cathinones remain largely unknown. In this study, we present two cases, a case series and a scoping review, to explore synthetic cathinone associated cardiotoxicity. Case 1 involved a 28-year-old male with non-ST-elevation myocardial infarction after ingesting a substance containing 4-methylmethcathinone (4-MMC), 3-methylmethcathinon (3-MMC), and methcathinone. Case 2 involved a 49-year-old male with ventricular fibrillation after 4-methylmethcathinone ingestion, who was diagnosed with severe three-vessel disease. A retrospective analysis was performed on self-reported synthetic cathinone poisonings reported to the Dutch Poisons Information Centre from 2012 to 2022. A total of 222 mono-intoxications with cardiotoxicity were included, mostly involving 3-methylmethcathinon (63%). Often tachycardia, hypertension, palpitations, and chest pain were reported. A comprehensive literature search was performed on PubMed to identify the studies reporting cardiac arrest, myocardial infarction, cardiac inflammation, cardiomyopathy, and life-threatening arrhythmias following synthetic cathinone use. A total of 30 articles reporting 40 cases were included. The reported complications included cardiac arrest (n = 28), ventricular tachycardia (n = 4), supraventricular tachycardia (n = 1), ST-elevation myocardial infarction (n = 2), non-ST-elevation myocardial infarction (n = 2), cardiomyopathy (n = 1), and myocarditis (n = 2). A total of ten different associated synthetic cathinones were identified. Cardiac arrest, myocardial infarction, and ventricular arrhythmias have been reported following the use of synthetic cathinones, underscoring the importance of obtaining a detailed recreational drug use history from patients presenting with syncope, chest pain, or palpitations.

Coronary artery disease is a global problem with high mortality rates and significant residual sequelae that affect long-term quality of life. Myocardial infarction (MI) in neonates is a recognized, uncommon entity, but the incidence and broad spectrum of the disease is unknown and likely underestimated due to limited reporting which in the majority is confined to acute ischemic events. The challenges involve clinical diagnosis which masquerades in the early phase as non-specific symptoms and signs that are commonly found in a host of neonatal disorders. Precise diagnostic criteria for neonatal MI are lacking, and management is driven by clinical presentation and hemodynamic stabilization rather than an attempt to rapidly establish the root cause of the condition. We conducted a review of the published reports of neonatal MI from 2000 to 2014, to establish an approach to the diagnosis and management based on the existing evidence. The overall evidence from 32 scientific articles stemmed from case reports and case series which were graded as low-to-very low quality. Neonatal MI resembles childhood and adult MI with features that involve characteristic ECG changes, raised biomarkers, and diagnostic imaging, but with lack of robust, standardized criteria to facilitate prompt diagnosis and timely intervention. The mortality rate of neonatal MI ranges from 40 to 50% based on inclusion criteria, but the short-term data reflect normal quality of life in survivors. An algorithm for the diagnosis and management of neonatal MI may optimize outcomes, but at the present time is based on limited evidence. Well-designed clinical studies focusing on the definition, diagnosis, and management of neonatal MI, backed by international consensus guidelines, are needed to alter the prognosis of this serious condition.

Pharmacoepidemiology has been defined as the study of the uses and the effects of drugs in large numbers of people and is important for the surveillance of drugs after marketing. With the recent movement from a reactive to a rather proactive pharmacovigilance, (pharmaco)epidemiological research plays an increasing role in basically all stages of the drug development process. Data on the disease planned to be treated with a new drug have to be gained which can be useful e.g. for the riskbenefit analysis of that compound (e.g. for the comparison of rates of adverse events in the treated population with the disease with rates of such events in the untreated population with the disease). Additionally, good knowledge of diseases is valuable for daily clinical practice. Hence, apart from the classical drug safety studies, pharmacoepidemiology groups conduct more and more disease epidemiology or drug utilisation studies in order to learn more about the natural history of diseases. The aim of this thesis was to increase the knowledge of psoriasis by providing new information and complementing existing data. Psoriasis is a chronic inflammatory skin disease which is common in certain parts of the world. The gain of new insights into the pathogenesis of this disease has prompted the recent development of new therapeutic drugs, primarily biologicals, and vice versa. The studies of this thesis were conducted with data from the General Practice Research Database, which contains longitudinal primary care clinical records from several million patients representative of the United Kingdom population. The general practitioners have been trained to record information on patient demographics and characteristics, lifestyle factors, symptoms, medical diagnoses, referrals to hospitals or specialists, and therapies in a standard and anonymous way. Several hundred studies have been conducted using this extensively validated database. In the first three case-control studies, the influence of beta-blockers and other antihypertensives (Study 3.1), of lithium and antipsychotics (Study 3.2), and of thiazolidinediones and other antidiabetics (Study 3.3) on the risk of developing psoriasis were investigated. The study population consisted of 36,702 patients with a first-time psoriasis diagnosis between 1994 and 2005 and the same number of patients without psoriasis, matched on age, sex, index date, general practitioner, and history in the database. Exposure to the drug classes was evaluated taking duration and timing of use and potential confounding into account. In contrast to the notion in the literature (including standard dermatology textbooks), which was mainly based on data from case reports and case series, use of beta-blockers and other antihypertensives did not materially alter the risk of incident psoriasis. On the contrary, the second study confirmed the suggestion that long-term exposure to lithium can induce psoriasis. Furthermore, for atypical antipsychotics, primarily olanzapine, a statistically significantly decreased psoriasis risk was found for current exposure of longer duration. This observation needs further confirmation. Small clinical trials had shown potential clinical benefits of thiazolidinediones on psoriasis symptoms. Study 3.3 additionally suggested that longer-term exposure to thiazolidinediones reduces the risk of developing psoriasis. The risk also tended to be decreased after use of metformin, however, this needs further investigation. Studies 3.4 to 3.6 were cohort studies with a nested case-control analysis in which the study population defined for Studies 3.1 to 3.3 (= cohort population) was followed for identification of incident diabetes mellitus (Study 3.4), myocardial infarction (MI) or stroke / transient ischaemic attack (TIA) (Study 3.5), and cancer (Study 3.6) in patients with or without psoriasis. Incidence rates (IRs) and unadjusted incidence rate ratios (IRRs) were calculated. In the nested case-control analysis, patients with the outcome of interest were matched on age, sex, and index date to four control patients from the cohort population, and the psoriasis history stratified by duration and severity (using treatment as proxy) was compared by calculating adjusted odds ratios (ORs). The overall diabetes IR in psoriatic patients was about 35% higher than in psoriasis-free patients. Psoriasis patients with intensive systemic treatment for their skin disease and a disease history of longer duration showed an about 2.5 times increased risk of diabetes compared to psoriasis-free patients. For MI and stroke / TIA the overall risk was not increased, but further analyses showed increased risks in subpopulations (e.g. severe psoriasis patients or patients <60 years of age [for MI]). The risk of lymphohaematopoietic or certain types of solid cancers was statistically significantly increased in patients with psoriasis, for solid cancers primarily in patients with a longer-term disease history. These large population-based studies further analysed existing hypotheses and raised new ones. The results may be valuable for healthcare professionals in their daily clinical practice and for pharmaceutical companies in the risk-benefit analysis of their drugs. Additionally, the example of the association between use of betablockers and psoriasis showed that there should be no place for dogmas in medicine and that conclusions can be challenged.

Advanced heart block as a complication of acute myocardial infarction. Role of pacemaker therapy

We undertook the present study to test the hypothesis that in a contemporary setting of high rates of use of effective medical therapy and coronary revascularization, vascular surgery soon after myocardial infarction (MI) may not be prohibitively risky within 1 year. Elective vascular surgery is generally contraindicated within the first six months of MI. However, this principle is based on high complication rates from old case series. Forty six consecutive patients underwent 63 vascular procedures after MI. Thirty major arterial reconstructions, 9 thromboembolectomies, and 22 amputations or revisions were performed. We compared patients who had vascular surgery within six months after MI (Group I, n = 30) to patients who had surgery six to 12 months after MI, Group II (n = 16). Both groups had similar demographic characteristics, coronary risk factors and Goodman and Cooperman scores of operative risk. The high overall prevalence of coronary revascularizations (37%) and treatment with aspirin (87%), beta-blockers (65%) and ACE-inhibitors (76%), did not differ significantly between both groups. There was no significant difference in the incidence of reinfarction, cardiac mortality, or total mortality in the two groups. Patients undergoing vascular surgical procedures soon after acute MI may not have prohibitively high rates of death and cardiovascular complications. These favorable outcomes may be associated with the use of effective medical therapy and coronary revascularization. Vascular surgery should not be postponed in patients with recent MI.

We undertook the present study to test the hypothesis that in a contemporary setting of high rates of use of effective medical therapy and coronary revascularization, vascular surgery soon after myocardial infarction (MI) may not be prohibitively risky within 1 year. Elective vascular surgery is generally contraindicated within the first six months of MI. However, this principle is based on high complication rates from old case series. Forty six consecutive patients underwent 63 vascular procedures after MI. Thirty major arterial reconstructions, 9 thromboembolectomies, and 22 amputations or revisions were performed. We compared patients who had vascular surgery within six months after MI (Group I, n=30) to patients who had surgery six to 12 months after MI, Group II (n=16). Both groups had similar demographic characteristics, coronary risk factors and Goodman and Cooperman scores of operative risk. The high overall prevalence of coronary revascularizations (37%) and treatment with aspirin (87%), beta-blockers (65%) and ACE-inhibitors (76%), did not differ significantly between both groups. There was no significant difference in the incidence of reinfarction, cardiac mortality, or total mortality in the two groups. Patients undergoing vascular surgical procedures soon after acute MI may not have prohibitively high rates of death and cardiovascular complications. These favorable outcomes may be associated with the use of effective medical therapy and coronary revascularization. Vascular surgery should not be postponed in patients with recent MI.