Chest Heaviness Research Articles

Utilizing Smartphone ECG for Early Detection and Management of Ischemic Heart Disease: A Case Report

Ischemic Heart Disease (IHD) remains a significant cause of morbidity and mortality worldwide. We present a case report of a 54-year-old individual presenting with symptoms suggestive of IHD, including palpitations and chest heaviness. Utilizing a Spandan device at home, the patient detected anteroseptal and lateral wall ischemia, prompting consultation with a cardiologist. Subsequent diagnostic evaluations revealed Left Ventricular Hypertrophy (LVH), concentric LVH, regional wall motion abnormality, and Grade I diastolic dysfunction. Hypertension and dyslipidemia were identified as prominent risk factors, with additional findings of carotid artery disease. Management strategies included antihypertensive medications, lipid-lowering therapy, and lifestyle modifications. This case underscores the complexity of diagnosing and managing IHD, highlighting the importance of comprehensive assessment and multidisciplinary care in optimizing patient outcomes.

Complete Heart Block Secondary to Section Concomitant Use of Metoprolol and Fluoxetine in a Case of Chronic Depression and Systemic Hypertension: A Case Report

Bradyarrhythmia can be brought on by intrinsic or extrinsic causes that disrupt the cardiac conduction system, with iatrogenic drug usage being the most common extrinsic cause. Atrioventricular (AV) block is frequently brought on by beta-blockers, calcium channel blockers, anti-arrhythmics, and digoxin. The first course of treatment for heart block involves stopping the problematic medications. Psychotropic medications have the potential to cause cardiotoxic adverse effects that affect the heart. In a patient with a pre-existing cardiac disorder, psychotropic drugs can manifest with dangerous arrhythmias. It is yet unknown what intricate processes cause these effects. A variety of arrhythmias may be brought on by or made worse by many commonly used drugs. Hereby, the authors present a case report of 56-year-old hypertensive male, a known case of chronic depression with chest heaviness. The Electrocardiogram (ECG) revealed Complete Heart Block (CHB) with Right Bundle Branch Block (RBBB). The patient was on fluoxetine and beta-blockers for his mental illness and hypertension. Three days after withholding the drugs, the CHB resolved, and his baseline ECG remained as RBBB. The present case highlights the interaction of drugs leading to CHB in present patient. Therefore, the importance of a detailed drug history in such cases becomes imperative.

The Role of Invasive Hemodynamic Monitoring in Patients with Severe Mitral Regurgitation Undergoing Herniorrhaphy Operation

Background: Mitral regurgitation (MR) indeed presents challenges during noncardiac surgeries, especially as the severity of MR tends to increase with age and poses a higher risk of perioperative complications. Accurate hemodynamic monitoring becomes crucial in these cases to manage potential complications effectively. However, the standard monitoring in MR conditions during operation, such as TEE, is not always available, but there are other options for invasive monitoring, such as arterial lines, which provide accurate hemodynamic monitoring.
 Case presentation: A 64-year-old, male, presented with Reponible Lateral Inguinal Hernia with comorbid of severe mitral and tricuspid regurgitation alongside congestive heart failure. The patient was premedicated with fentanyl 25 mcg intravenously, followed by oxygen supplementation with 3 lpm nasal cannula and insertion of the arterial line. Anaesthesia was performed using a lumbar epidural technique, with the insertion of an epidural catheter in the L1-L2 intervertebral space, Reponible Lateral Inguinal Hernia. The local anesthesia agent chosen was plain bupivacaine with a concentration of 0.5% and a volume of 8 ml. The onset of action of epidural anesthesia is achieved within 20 minutes as long as the operation reaches a total blockade as high as T8. The patient is monitored with standard monitors and an artery line during surgery. There were no complaints of shortness of breath, chest heaviness, or chest pain felt by the patient during the operation.
 Conclusion: Epidural anesthesia technique can provide stable hemodynamics in patients with severe mitral-tricuspid regurgitation and congestive heart failure and hemodynamic monitoring plays an important role postoperatively to prevent further deterioration and maintain stability.

Abstract 14926: Case of Severe Myocarditis Associated With Nivolumab-Relatlimab

Introduction: Immune checkpoint inhibitors (ICIs) are the standard of care for cancer but can cause immune-related adverse events (irAEs). Nivolumab/Relatlimab combination was approved in March 2022 for unresectable or metastatic melanoma. Cardiac toxicity associated with ICIs is rare but can be fatal. Prompt recognition is key. Description: We present a case of an 84-year-old with no cardiac history who experienced worsening fatigue a week after Nivolumab/Relatlimab infusion. This was followed by myalgia, double vision, shortness of breath, and chest heaviness. Her symptoms worsened, and she sought medical care. Tests showed elevated high-sensitivity troponin T and total creatine kinase levels of 1100 and 6000, respectively. Her first EKG revealed first degree AV block. Within hours, she developed a complete AV block. Her initial LVEF was 75%. She was diagnosed with “triple M" syndrome (myositis, myocarditis, and myasthenia) and received pulse-dose steroids and IV immunoglobulin. She developed myasthenic crisis with respiratory failure requiring intubation. Repeat echocardiogram revealed a drop in LVEF to 43% with new regional wall motion abnormalities attributed to worsening myocarditis. Considering fast progression and poor prognosis, the patient and her family chose comfort measures over escalation of care. Discussion: Myocarditis is a known but rare irAE with reported incidence of less than 1%. It can be associated with myositis and/or myasthenia. Clinical presentation varies, but rapidly progressive conduction disease is one of the most commonly described conditions. Direct T-cell cytotoxicity is the proposed mechanism. Cardiac irAEs can fully resolve if treated early. However, mortality remains elevated. Conclusion: This is one of the few reported cases of severe myocarditis from Nivolumab/Relatlimab. As the combination is still in phase IV development, more cases may emerge in the future and early recognition is vital.

A rare case of asthmatic patient with left Chilaiditi's syndrome.

The following case report aims to highlight the rarity of the case in question, in which there is left Chilaiditi syndrome in a patient with bronchial asthma. The patient is a 79-year-old woman who arrived in January 2023 at my facility for episodes of recurrent dyspnea, chest heaviness, wheezing, eructation, dysphagia, epigastric abdominal pain associated with frequent episodes of bronchitis. He performed simple spirometry which showed mixed mild-moderate ventilatory deficit with reduction of small airway volumes, reduced peak expiratory flow and negative broncho reversibility tests for asthma. At 3 months, the patient returned to my attention with a chest radiograph showing marked elevation of the left hemidiaphragm with deviation of the cardiac shadow to the right. He repeated the spirometry which resulted in a clear improvement compared to the previous control with an important variation of the peak respiratory flow during ICS/LABA, the objective finding previously found disappeared, this indicating the presence of an underlying bronchial asthma. The radiological picture was identified by me as Left Chilaiditi Syndrome, as the patient had gastrointestinal symptoms which accompanied the procession of respiratory symptoms. The diagnostic suspicion must be early in these pathologies and the proton pump inhibitors and new generation alginates with the presence of hyaluronic acid and melatonin must also be included in the treatment of the symptoms, which have an important action on gastroesophageal reflux disease (GERD) secondary to this herniation of the viscera into the thoracic cavity. The rarity is represented by the left localization of the diaphragmatic pathology.

THU674 Papillary Thyroid Carcinoma Presenting As A Benign Ectopic Thyroid Mass In The Anterior Mediastinum. A Case Report

Abstract Disclosure: M.V. David-santos: None. C. Narvacan-montano: None. Background: Ectopic Thyroid Tissue (ETT) is a rare developmental anomaly that is due to the failure of the thyroid gland to assume its position in front of the trachea. Ectopic Thyroid tissue in the mediastinum is very rare, with only a few cases reported in the literature. An incidental Papillary Thyroid Carcinoma presenting as a mediastinal mass that turns out to be benign ectopic thyroid cells is even rarer. Case: This is the case of a 33-year-old female who presented with sudden onset difficulty of breathing and chest heaviness. On workup, she was found to have an anterior mediastinal mass, which showed ectopic thyroid cells on biopsy. Further evaluation of the neck area revealed a 1.25 cm x 1 x 1.13 cm nodule on the thyroid gland which showed suspicious for Papillary Thyroid Carcinoma on Fine needle aspiration biopsy. The patient underwent Total Thyroidectomy and Excision of the Anterior Mediastinal Mass. The histopathologic report of the thyroid mass revealed a Conventional Unifocal Papillary Thyroid Carcinoma, while the excised tissues comprising the mediastinal mass were consistent with benign ectopic thyroid tissues with colloid goiter. Conclusion: The presence of the ectopic thyroid mass in the anterior mediastinum may be a potential area for metastasis. The final pathologic report nevertheless, categorizes this Papillary thyroid carcinoma as having a low risk of metastasis as per the American Thyroid Association Classification of 2015. Hence the conservative approach of Suppression therapy and active surveillance is the choice of management for this unusual case. Presentation: Thursday, June 15, 2023

Role of Ayurveda, Lifestyle Modification, and Panchakarma Therapy on Stabilization of Atherosclerotic Plaque in Known Coronary Artery Disease Patient

Atherosclerois is a major health concern in India and imposes a significant burden on the population. The prevalence of risk factors such as hypertension, obesity, smoking and high cholesterol levels contribute to the rising incidence of atherosclerosis in the country. A 57-year-old male presented with primary complaints of chest pain and heaviness, left arm pain, upper back pain, jaw pain, dyspnea on exertion grade I, flatulence, gaseous distension, cervical pain, scapular region pain, shoulder pain, constipation, and insomnia. He also complained of postprandial angina New York Heart Association (NYHA) Class III. The patient was a photographer by profession and had a history of hypertension, diabetes mellitus, and coronary artery disease. On 29th February 2020, he underwent computed tomography (CT) coronary angiography at another clinic which revealed stenosis of the 3 main coronary arteries – more than 90% stenosis in mid left anterior descending artery (LAD), 80–90% stenosis in proximal left circumflex artery (LCx), and 80–90% stenosis in proximal right coronary artery (RCA). The patient was advised an Ayurveda-based low-carbohydrate high antioxidant diet of 1,000 calories daily for the first 12 weeks. This case report supports the relationship between an Ayurveda-based low-carbohydrate high antioxidant diet and atheroma regression in a high-risk coronary artery disease patient.

Prodromal Symptoms in Patients Presenting With Myocardial Infarction.

Background Prodromal symptoms are warning signs of an impending acute myocardial infarction (AMI). However, they are often overlooked by both patients and primary clinicians, and little is known about them. Therefore, this study aims to assess the frequency and types of prodromal symptoms in patients with AMI. Methodology This descriptive cross-sectional study was conducted at a tertiary care cardiac center. Consecutive patients diagnosed with AMI within the last week were evaluated for prodromal symptoms. The prodromal symptoms included chest pain, chest heaviness, chest burning, palpitations, fatigue, sleep disturbance, shortness of breath (SOB), dizziness, anxiety, sudden heat or cold, back pain, and vomiting. Results In a sample of 242 patients, 79.6% were males, with a mean age of 54.7 ± 12.2 years, and 179 (74%) were diagnosed with ST-segment elevation myocardial infarction (STEMI). Among the participants, 142 (58.7%) showed no prodromal symptoms. Among those with prodromal symptoms, chest pain was the predominantly reported prodromal symptom with a frequency of 68%, followed by chest heaviness at 44%, palpitations at 42%, shortness of breath at 34%, and chest burning at 27%. Unusual fatigue in 23% and sleep disturbance in 22% of the patients were also reported. Conclusion The findings from this study revealed that prodromal symptoms were present in a significant proportion of acute myocardial infarction (MI) cases, with more than four in 10 patients reporting these early warning signs. The most commonly observed prodromal symptoms were chest pain, chest heaviness, palpitations, shortness of breath, and chest burning. The timely identification of these symptoms can help prevent infarction, thereby reducing the burden of heart failure and other related mortalities.

EFFECTS OF BIO-MEDICAL WASTE ON VARIOUS ILL HEALTH SYMPTOMS IN MYSURU CITY: AN ANALYTICAL STUDY

Sharps, infectious, medicinal, and radioactive waste, as well as other hazardous and poisonous components of waste from healthcare facilities, pose serious risks to both human health and the environment if they are not properly handled, disposed of, or prohibited from being mixed with other municipal waste. The present study deals with analysis of health issues reported by the individuals dwelling in nearby areas. A total of 120 respondents were selected for the study and they were administered a structured checklist to assess the presence/absence of various health issues – a. aches and pains, b. cardiac related issues, c. psychological symptoms and d. other symptoms affecting effective management of BMW. Chi-square tests were employed to analyse the results and results revealed on the whole, 19.0% of the respondent’s reported headaches. 29.7% of them indicated general fatigue, 34.5% of them reported eye irritation, 20.3% of them reported throat irritation and 19.3% of them reported joint pain. In the case of cardiac related ailments, 21.7% of the selected sample experienced shortness of breath, 25.2% of them reported cough, 17.9% of them indicated chest pain, 11.7% of them reported chest heaviness and 16.9% of them experienced chest tightness. In psychological issues, 20.3% of the selected sample experienced difficulty in concentrating, 24.8% of them reported irritability, and 11.0% of them indicated depression. In other symptoms, 22.1% of the respondents reported Diarrhea, 19.7% of the indicated Constipation, 18.6% of them reported rashes, 31.0% of them indicated nasal stiffness, 11.7% of them indicated nose bleeding, 37.6% of them reported nausea, and 27.2% of them reported vomiting. Age related increase in the specific health were found in the cases of headache, general fatigue, eye irritation, throat irritation, cough, chest heaviness, irritability and depression, nasal stiffness, nasal bleeding, nausea and vomiting.

Oto-neurological manifestation in post COVID-19 patients: a randomized prospective observational study

<p><strong>Background</strong>: The corona virus disease (COVID-19) is caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) and is characterized by symptoms of the lower respiratory tract involvement, such as fever, cough, dyspnea, and chest heaviness.<strong> </strong>Sensorineural hearing loss (SNHL) is most frequent audio-vestibular symptom described, occurring alone or in association with tinnitus and vertigo.</p><p><strong>Methods: </strong>This study was conducted in COVID-19 tertiary care center Prayagraj. COVID-19 positive patients who were included in moderate to severe category were taken up for the study and data was collected from 1<sup>st</sup> June 2021 to 1<sup>st</sup> July 2022 for audiological assessment and presence of equilibrium disorder. All patients were investigated on basis of closed ended questionnaire.<strong> </strong></p><p><strong>Results:</strong> Out of 1000 patients incidence of ear heaviness was found in 3.3%., decreased hearing in 0.9%., tinnitus in 1.9%., equilibrium in 0.4% and migraine in 0.4%, which was higher as compared to the normal population but not significant.<strong></strong></p><p><strong>Conclusions: </strong>SARS-CoV-2 infection<strong> </strong>may cause<strong> </strong>thrombosis in audiovestibular artery and may alter the blood flow in cochlea and vestibule and cause otoneurological manifestation.</p><p><strong> </strong></p>

PSUN15 Recurrence of Benign Pheochromocytoma

Abstract INTRODUCTION: Pheochromocytoma is a rare, usually benign, tumor of adrenal medulla. The prevalence is about 4.5-6.5%. The common presenting symptoms are headache, palpitations, diaphoresis, flushing, hypertension, and tachycardia. The high catecholamine levels can also result in arrhythmias, cardiomyopathy, stroke, and even death. It can also be asymptomatic and diagnosed as an adrenal incidentaloma on routine imaging. Due to its diverse and non-specific presentation, it is often called a great mimic in medicine. It is diagnosed both biochemically with plasma or urine metanephrines and by imaging (CT or MRI). The first line treatment is surgical resection of adrenal gland, adrenalectomy. Resected tumors should be pathologically confirmed for absence of malignancy. The recurrence of benign pheochromocytoma after adrenalectomy is rare. Recurrence rate following adrenalectomy is 6.5-16.5%. There are no identified predictors of recurrence but usually it occurs after 2-3 years. Annual imaging and biochemical testing for plasma and urinary metanephrines is recommended for early diagnosis of recurrence. CASE PRESENTATION: A middle aged female with past medical history of uncontrolled hypertension and uncontrolled diabetes mellitus underwent CT scan for abdominal pain, fatigue, and unintentional weight loss. She also complained of intermittent palpitations, chest heaviness, sweating, facial flushing, and headaches. Family history was negative for endocrinopathies or endocrine malignancies. CT showed 12 cm right adrenal mass. Plasma metanephrines were ordered given the imaging findings and they were elevated at more than 13000 pg/nl (normal < 60 pg/ml). All other adrenal hormones were within normal range. She was diagnosed with pheochromocytoma and underwent right adrenalectomy. The tumor was confirmed to be benign by histopathology. Post-surgery her symptoms resolved, and biochemical tests normalized with plasma metanephrine at 35 pg/ml. She presented again 4 years later with similar symptoms. Patient experienced palpitation and noted to have high blood pressure at home. She had also been experiencing flushing and having a sense of impending doom. On examination the patient was diaphoretic and review of systems was positive for heat intolerance, polydipsia and polyuria. EKG revealed sinus tachycardia and blood glucose was elevated. Labs revealed elevated plasma metanephrine and normetanephrine levels. Renin activity and plasma aldosterone levels were normal. CT scan confirmed soft tissue masses, 2. 0 x4. 0 cm posteriorly and 2. 0 x3.2cm laterally, in the pararenal space surrounding the right kidney, suggestive of local recurrence of pheochromocytoma. CONCLUSION: Even though rare, the recurrence of pheochromocytoma can occur, usually after 2-3 years. Annual imaging and biochemical testing is recommended to diagnose recurrent pheochromocytoma, especially in patients with large tumors (>5cm). Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m., Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

Coronary Artery Ectasia in Patients with and Without Diabetes: A Study from Northern Pakistan

Objectives: To determine the association of coronary artery ectasia in terms of its severity and vessels involved in diabetes patients and non-diabetes patients.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Cardiology, PAEC General Hospital, Islamabad Pakistan from Jun 2018 to Jun 2020.
 Methodology: All patients who underwent coronary angiography were included in this study. Two hundred patients (100 patients having diabetes and 100 patients not having diabetes) who presented with chest pain and chest heaviness were diagnosed with coronary artery ectasia on coronary angiography included in this study.
 Results: Two hundred patients, 100 patients had diabetes, and 100 patients had no diabetes. 71 (35.5%) of the patients were males, and 29 (14.5%) were females. The left anterior descending artery alone was responsible for 23% of Coronary Artery Ectasia, followed by the right coronary artery (16%) in diabetic patients. In patients with diabetes with multiple vessels, the left anterior descending artery and left circumflex artery were most frequently (21%) involved vessels, while left anterior descending and right coronary artery were observed to have Coronary artery ectasia in 16% of diabetes patients.
 Conclusion: No significant difference in the severity of coronary artery ectasia was noted among diabetes and non-diabetes patients. Left anterior descending was most frequently involved vessels in diabetes patients and right coronary artery in nondiabetes patients. Left anterior descending and left circumflex artery both had coronary artery ectasia in most of the diabetes patients and non-diabetes patients.

Tolerance of the mRNA COVID-19 vaccines in patients with reported taxane reactions

Tolerance of the mRNA COVID-19 vaccines in patients with reported taxane reactions

Hydatid Cyst Pleural and Pericardial Effusions as a Complication of Postoperative Hydatid Cyst Resection from the Liver: A Case Report

Hydatid cyst is a zoonotic endemic disease in Iraq. It carries considerable complications eitherrelated to the disease itself or following its surgical removal. Pleural and pericardial effusion isa rare postoperative complication of hydatid cyst removal. A 65year-old Iraqi female patientcomplained of right-sided chest heaviness and palpitation one month following surgical removal of2 large hydatid cysts. There were no other associated symptoms. Physical examination revealedthe possibility of pleural and pericardial effusions (poor air entry and stony dullness of the rightposterior part of lower zone, difficulty to palpate the apex beat, increase heart dullness, and nopericardial rub). The diagnosis was confirmed by chest X-ray and echocardiogram. She receivedAlbendazole tablet 400 mg twice daily for 6 weeks with a good response. The Early presumptionof the disease in an endemic area with a good dose and appropriate course of Albendazole tabletstreatment can give very good results. To our best knowledge, this is the first case in the worldwho presented with hydatid cyst pleural and pericardial effusions and responded completely to theAlbendazole tablets.

ETIOLOGY AND CLINICAL PROFILE OF PERICARDIAL EFFUSION PATIENTS

Background Pericardial effusion is one of the most prevalent disorders . Pericardial effusion can create substantial symptoms and a lower quality of life, but its also linked to a higher risk of cardiopulmonary failure, mortality, and death. Pericardial effusion has a variety of causes that are related to the relative occurrence of certain diseases in different parts of the world. Methods:it was a retrospective study that includes data from all pericardial effusion cases diagnosed . Echocardiography was used to diagnose a total of 50 cases with pericardial effusion. Complete blood count with ESR, blood urea, serum creatinine, tuberculin skin test, chest X-ray, ECG, Thyroid profile, ANA, Rheumatoid factor, CT chest / MRI, and pericardiocentesis were all used to determine the source of the pericardial effusion. Cells, proteins, LDH, malignant cells, ADA, PCR (for Mycobacterium tuberculosis), gram staining, AFB staining, and cultures were all examined in the pericardial fluid. Iatrogenic (cardiac surgery, catheterization) and post-traumatic cases were excluded . Results: The majority of the patients were between the ages of 50 and 70. Thirty patients (60%) were men and 20 patients (40%) were women. Tuberculosis was the most prevalent cause of pericardial effusion, accounting for 28 % of cases, followed by Idiopathic 18%, Uremia 12 %, and Malignant 14 %. HIV infection was the least common cause of pericardial effusion, accounting for 2% of cases. Tachycardia was the most common clinical symptom, in 70% of patients, followed by Breathlessness (60%), and fever (56 %). Conclusions:Tachycardia, shortness of breath, fever, heaviness of chest, cough, chest pain, and other symptoms of pericardial effusion have been noted in this study. Tuberculosis, idiopathic/viral, uremic, neoplastic, CCF, hypothyroidism, post-MI, etc. are all major factors for the development of pericardial effusion.

Management of Psychiatric Disorders in Patients with Cardiovascular Diseases.

Management of Psychiatric Disorders in Patients with Cardiovascular Diseases.

EFFECT OF SATVAVAJAYCHIKITSA (COUNSELLING AND ASSURANCE) AND SHIRODHARA IN THE MANAGEMENT OF PSYCHOGENIC ERECTILE DYSFUNCTION: A CASE STUDY

Any stimulus (intrinsic or extrinsic) that triggers a biological response is known as stress. Stress can exert various negative effects on the body ranging from alterations in homeostasis to life-threatening effects and death. Erectile dysfunction can be a manifestation of chronic stress. ED is the most common male sexual dysfunction that affects 10-25% of middle-aged and elderly men. ED may result from many etiologic factors like psychogenic, endocrino- logic, neurogenic, arteriogenic or venoocclusive dysfunction. These factors are not mutually exclusive and multi- ple factors contribute to ED in many patients. According to modern science Psychogenic factors frequently coex- ist with other etiologic factors and should be considered in all cases. A patient aged 35 years came to the OPD of A&U Tibbia college with complaints of inability to initiate and maintain erection along with abnormal vision, dizziness, retrosternal burning, indigestion, heaviness in chest and disinterest. He was advised for Shirodhara along with counselling (Satvvajaychikitsa) and after a couple of days, there was a significant improvement in pa- tient. In this case study, we are trying to highlight the contribution of stress & psyche on male sexual dysfunction and its management through Satvavajaychikitsa (counselling) and Shirodhara. Keywords: Erectile dysfunction, Satvavajaychikitsa, Shirodhara.

Long COVID and mental health.

Long COVID and mental health.

Persistent Symptoms in Post-COVID-19 Patients Attending Follow-Up OPD at Sukraraj Tropical and Infectious Disease Hospital (STIDH), Kathmandu, Nepal.

The long-term effects of COVID-19 among survivors is a matter of concern. This research aimed to study persistent symptoms in post-COVID-19 patients attending a follow-up clinic at a tertiary care hospital in Nepal. All patients, presenting to the outpatient clinic during the study duration of six weeks, with history of positive reverse transcriptase- polymerase chain reaction for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) at least two weeks prior to presentation, were included. The duration of follow-up ranged from 15 till 150 days with the mean duration of 28 days after diagnosis of COVID-19. Of 118 patients, 43 (36.4%) had a history of mild COVID-19, 15 (12.8%) had moderate, and 60 (50.8%) had severe. At the time of presentation, 97 (82.2%) patients reported that they had at least one persistent/new symptom beyond two weeks from the diagnosis of COVID-19. Dyspnea, fatigue, chest heaviness, and cough were the commonest persistent complaints in 48 (40.7%), 39 (33.1%), 33 (28%), and 32 (27.1%) patients, respectively. The findings in our study highlight the need for extended monitoring of post-COVID-19 patients following discharge, in order to understand and mitigate long-term implications of the disease.

Electrocardiographic Features Associated With Obstructive Sleep Apnea.

Scenario: This electrocardiogram (ECG) was obtained by paramedics from a 52-year-old man with chest heaviness, chest “fluttering,” and shortness of breath (SOB) for several hours after moving heavy items into his car. The patient stated that for the past week, he has been using pillows at night to sleep because of SOB when he lays flat. His medical history includes hypertension, type 1 diabetes, hyperlipidemia, and obstructive sleep apnea (OSA). He was obese, with a body mass index (weight in kilograms divided by height in meters squared) of 38. Current medications included amlodipine, long-acting insulin, and simvastatin. To treat his sleep apnea, he was prescribed continuous positive airway pressure for night use, but he said that he does not use it consistently and recalls not using it for several weeks. Pertinent vital signs and assessment included blood pressure, 158/94 mm Hg; heart rate, 103/min; temperature, 97.8 °F (36.6 °C); respiratory rate, 22/min; oxygen saturation by pulse oximetry, 94%; slight edema in the lower limbs, which he has had for the past few weeks; and decreased breath sounds in the lung bases on auscultation.Sinus tachycardia with trigeminal premature atrial contractions (PACs) and a nonspecific ventricular conduction delay.Such contractions (PACs) are triggered by atrial ectopic myocardial cells originating outside the sinoatrial node. They are characterized by early depolarization, a taller T wave before the early beat followed by what appears to be a pause. Importantly, the latter feature is not a pause of conduction but rather a compensatory pause as the sinus node resets. In general, PACs are benign, do not require treatment, and are most often triggered by stress, caffeine, fatigue, alcohol, and/or tobacco. However, increased frequency can be associated with structural heart changes including coronary artery disease, left ventricular hypertrophy (LVH), hypertension, heart failure, and valvular heart disease. Some patients may complain of symptoms such as a feeling of fluttering in their chest, their heart skipping a beat, or palpitations. More pronounced symptoms with an increase in the number of PACs can include fatigue, chest pain, SOB, and dizziness. In this patient, the observed conduction disturbance (slight widening of the QRS complex and deep terminal S pattern) is due to abnormal late depolarization. Of note, the terminal S pattern should not be confused with ST depression due to myocardial ischemia. In this example, the J point (end of the S wave and start of the T wave) is isoelectric; hence, ischemia is not present. In the context of OSA, this ECG pattern suggests a hypertrophied right outflow tract of crista supraventricularis, an important sign of worsening OSA. The presence of this ECG feature correlates with the incidence of pulmonary hypertension, which would explain the patient’s gradual development of SOB.Treatment of PACs depends largely on the symptoms and can include a reduction of known triggers and/or treatment of other conditions that may be causing the PACs. In this patient, the workup in the emergency department (physical examination, chest radiography, etc) revealed an enlarged heart and fluid in the lungs. Additionally, his blood natriuretic protein (BNP) level was high at 988 pg/mL (normal, <100 pg/mL) and his troponin I level was normal, 0.024 ng/mL (normal <0.033 ng/mL). He was subsequently diagnosed with new-onset heart failure and admitted. An echocardiogram revealed LVH with an ejection fraction of 33%, and a 12-lead ECG showed sinus rhythm at 98/min with a right bundle branch block with no ischemia present. This patient had known OSA with inconsistent treatment adherence as well as hypertension, both risk factors for the development of LVH and heart failure. On day 2, the patient was in a normal sinus rhythm with occasional PACs and his SOB had improved. Cardiac treadmill stress testing to rule out coronary artery disease was negative for ischemia and for arrhythmias. The patient was discharged with education in the following: worsening signs and symptoms of heart failure, low-sodium/low-fat diet, weight loss management, daily weight monitoring for early indication of potential fluid overload, and the importance of both medication and OSA treatment adherence.