Potential Cardiac Complications Research Articles

Evaluation of Cardiologic Alterations in Radiographs of Dogs with Bronchopneumonia Before and After Treatment

Pneumonia, a common respiratory disease in small animals, causes significant hypoxemia in dogs due to reduced lung capacity and cardiac output. In addition, pneumonia may lead to cardiac complications. This study aimed to evaluate the alterations in cardiac silhouette and main vessel views in dogs that underwent bronchopneumonia treatment, and the alterations were evaluated in radiographs of the dogs with bronchopneumonia before and after treatment. For this purpose, radiographic data from 26 dogs diagnosed with and treated for bronchopneumonia were analyzed. The measurements included left atrial size, long axis, short axis, the fourth thoracic vertebra length, aorta width, caudal vena cava width, and thoracic width. Radiographs obtained before and after treatment indicated no changes in the long and short axes of the vertebral hearth score, the fourth thoracic vertebrae length, aorta and caudal vena cava width, and thoracic width. However, in pre-treatment radiographs, the left atrial size was found to be larger compared to post-treatment radiographs. A strong positive correlation was observed between measurements of LAs and LAs/TV4 in both pre- and post-treatment radiographs, as well as in the measurement differences between pre- and post-treatment radiographs. As a consequence, the radiographs employed to monitor bronchopneumonia treatment may serve as an initial indicator of potential cardiac complications in affected dogs.

Effects of transcutaneous electrical nerve stimulation on pain, respiratory function, and analgesic drug usage after thoracotomy: a prospective randomized study.

Transcutaneous electrical nerve stimulation (TENS) has been applied to alleviate post-thoracotomy pain. In this study, we investigated the effects of TENS on pain scores, additional opioid doses, opioid-related side effects, and potential respiratory and cardiac complications. In this controlled, randomized study, 40 patients underwent muscle-sparing thoracotomy. The TENS group consisted of 20 patients (Group T), while the control group included 20 patients (Group C). Postoperative pain scores, supplemental analgesia doses, opioid-related side effects, and postoperative cardiac and respiratory complications were measured. There was no statistically significant difference between the two groups in terms of demographic characteristics. Pain scores in Group T were consistently lower throughout various time intervals. The additional analgesia dose in Group T was significantly lower at 24, 48, and 72h (respectively, p = 0.007, p = 0.043, p = 0.032). Opioid-related constipation, nausea, and vomiting were lower in Group T (respectively, p = 0.047, p = 0.044). Group T exhibited significantly lower postoperative complications related to secretion retention (p = 0.044). The application of TENS for post-thoracotomy pain control helps prevent secretion retention and reduces opioid usage, thus mitigating opioid-related side effects.

Abstract Mo127: Nitrate Supplementation Plus Voluntary Activity in C57Bl/6 Mice Improves Fitness and Impairs Cardiac Calcium Handling In a Sex Specific Fashion

Nitrate supplements are commonly combined with aerobic exercise to potentially improve performance and cardiac function. Whether this combination benefits cardiac function at the organ and cellular levels is unclear. We will determine if nitrates affect fitness or cardiac function in both sexes. C57Bl/6 mice (9-mos) were given 1mM sodium nitrate (drinking water) and/or access to a running wheel for 3 mos. Cardiac function (echocardiography), blood pressure (tail cuff) and fitness (treadmill) were measured. Calcium transients (Fura-2) and contractions (2Hz) were measured in ventricular myocytes and calcium handling proteins were measured by qPCR. In both sexes, nitrates did not change blood pressure or voluntary wheel running although females ran more than males (3.7±0.3km vs 2.2±0.3km, p=0.002). In exercised female mice, nitrates increased fitness from baseline while control did not (top speed at exhaustion: 24.2±1.4 to 28.0±1.5 cm/s, p=0.07 vs 23.3±1.0 to 30.7±2.0 cm/s, p=0.002) but nitrate supplemented males showed no fitness benefit. However, while exercise improved cardiac function and contractility compared to sedentary mice, nitrates plus exercise impaired cardiac function in a sex-specific manner. Nitrate-treated males who exercised had lower E/A ratios (1.8±0.3 vs 1.3±0.1, p=0.01) and worse diastolic function than control exercised males. By contrast, nitrate-treated female mice who exercised had smaller global longitudinal strain (-19.5±1.5 vs -11.8±3.0%, p=0.01) than controls, indicative of worse systolic function. Corresponding changes were seen at the cellular level. Exercised males given nitrates had slower a calcium transient decay than controls (44.8±4 vs 73.8±6 ms, p=0.01), while females given nitrates had slower velocity to peak calcium (0.031±0.004 vs 0.018±0.003 µm/ms, p=0.005) and smaller cellular contractions (2.9±0.5 µm vs 1.4±0.5 µm: p=0.03). Cardiac calcium handling proteins were also modified in females. Exercise plus nitrates caused a decrease in SERCA2a and ryanodine receptor 2 expression (mRNA) compared to the control exercise group. Studies in males are ongoing. Exercise plus nitrates increased fitness levels in only females and reduced cardiac function in a sex specific way when compared to exercise alone. This suggests a potential balance between benefits to fitness and potential cardiac complications that could affect athletes taking nitrate supplementation.

Acute Cardiac Events in Hospitalized Older Adults With Respiratory Syncytial Virus Infection

Respiratory syncytial virus (RSV) infection can cause severe respiratory illness in older adults. Less is known about the cardiac complications of RSV disease compared with those of influenza and SARS-CoV-2 infection. To describe the prevalence and severity of acute cardiac events during hospitalizations among adults aged 50 years or older with RSV infection. This cross-sectional study analyzed surveillance data from the RSV Hospitalization Surveillance Network, which conducts detailed medical record abstraction among hospitalized patients with RSV infection detected through clinician-directed laboratory testing. Cases of RSV infection in adults aged 50 years or older within 12 states over 5 RSV seasons (annually from 2014-2015 through 2017-2018 and 2022-2023) were examined to estimate the weighted period prevalence and 95% CIs of acute cardiac events. Acute cardiac events, identified by International Classification of Diseases, 9th Revision, Clinical Modification or International Statistical Classification of Diseases, Tenth Revision, Clinical Modification discharge codes, and discharge summary review. Severe disease outcomes, including intensive care unit (ICU) admission, receipt of invasive mechanical ventilation, or in-hospital death. Adjusted risk ratios (ARR) were calculated to compare severe outcomes among patients with and without acute cardiac events. The study included 6248 hospitalized adults (median [IQR] age, 72.7 [63.0-82.3] years; 59.6% female; 56.4% with underlying cardiovascular disease) with laboratory-confirmed RSV infection. The weighted estimated prevalence of experiencing a cardiac event was 22.4% (95% CI, 21.0%-23.7%). The weighted estimated prevalence was 15.8% (95% CI, 14.6%-17.0%) for acute heart failure, 7.5% (95% CI, 6.8%-8.3%) for acute ischemic heart disease, 1.3% (95% CI, 1.0%-1.7%) for hypertensive crisis, 1.1% (95% CI, 0.8%-1.4%) for ventricular tachycardia, and 0.6% (95% CI, 0.4%-0.8%) for cardiogenic shock. Adults with underlying cardiovascular disease had a greater risk of experiencing an acute cardiac event relative to those who did not (33.0% vs 8.5%; ARR, 3.51; 95% CI, 2.85-4.32). Among all hospitalized adults with RSV infection, 18.6% required ICU admission and 4.9% died during hospitalization. Compared with patients without an acute cardiac event, those who experienced an acute cardiac event had a greater risk of ICU admission (25.8% vs 16.5%; ARR, 1.54; 95% CI, 1.23-1.93) and in-hospital death (8.1% vs 4.0%; ARR, 1.77; 95% CI, 1.36-2.31). In this cross-sectional study over 5 RSV seasons, nearly one-quarter of hospitalized adults aged 50 years or older with RSV infection experienced an acute cardiac event (most frequently acute heart failure), including 1 in 12 adults (8.5%) with no documented underlying cardiovascular disease. The risk of severe outcomes was nearly twice as high in patients with acute cardiac events compared with patients who did not experience an acute cardiac event. These findings clarify the baseline epidemiology of potential cardiac complications of RSV infection prior to RSV vaccine availability.

Current Management and Future Directions for Pulmonary Arterial Hypertension Associated with Congenital Heart Disease.

Current management of patients with congenital heart disease has increased their survival into adulthood. This is accompanied by potential cardiac complications, including pulmonary hypertension associated with congenital heart disease (PAH-CHD). PAH-CHD constitutes a challenging subgroup of pulmonary hypertension and requires expert management to improve quality of life and prognosis. Novel agents have shown a significant improvement in morbidity and mortality in patients with pulmonary arterial hypertension. However, the long-term effects of these medications on PAH-CHD patients remain somewhat uncertain, necessitating treatment plans largely founded on the clinical experience of the healthcare providers. The aim of this review is to summarize the current evidence and future perspectives regarding treatment strategies for PAH-CHD to help better guide management of this complex disease.

Management of Two Cases of Expanded Dengue Syndrome with Myocarditis, Arrhythmia and Heart Failure

Dengue infection may present as asymptomatic, dengue fever, dengue hemorrhagic fever and dengue shock syndrome. However, atypical manifestations in other organs called expanded dengue syndrome. One of the cardiac complications in dengue is myocarditis. Our two patients resented here with fever followed by chest pain, sweating and collapse of Blood pressure and their lab reports were quite similar such as low platelet, ECG change, raised Troponin I, low ejection fraction on echocardiography. They were rescued by injection intravenous Methylprednisolone therapy. Here we present this case series to improve recognition and prevent progression to fatal outcome. In this regards healthcare providers should maintain a high degree of suspicion regarding potential cardiac complications in patients with dengue fever J Bangladesh Coll Phys Surg 2023; 41: 109-113

Abstract 11882: Acute Cardiac Events Among Older Adults Hospitalized With Laboratory-Confirmed Respiratory Syncytial Virus

Introduction: Respiratory syncytial virus (RSV) can cause severe illness among older adults, but potential cardiac complications have not been comprehensively described. We evaluated the frequency and severity of acute cardiac events among older adults hospitalized with laboratory-confirmed RSV to inform recommendations for RSV vaccine candidates in development. Methods: The RSV-Associated Hospitalization Surveillance Network (RSV-NET) abstracted medical record data among all hospitalized patients identified with laboratory-confirmed RSV infection (clinician-ordered testing) in a population-based catchment area of 38 counties in 9 states. Among adults aged ≥50 years hospitalized with RSV during the 2015-16 to 2017-18 RSV seasons, we estimated the period prevalence and 95% confidence interval (CI) of acute cardiac events, identified from the patient’s discharge diagnoses and ICD-10 codes. Multivariable generalized estimating equation models estimated the adjusted risk ratio (aRR) of intensive care unit (ICU) admission and in-hospital death by acute cardiac event status. Results: Among 3959 adults aged ≥50 years hospitalized with RSV (mean age 73 years), 20.8% (CI, 19.5-22.1) experienced an acute cardiac event during hospitalization, most frequently acute heart failure (14.3%; CI, 13.2-15.4; Table). Acute cardiac events were common among adults aged ≥75 years (25.0%; CI, 23.1-27.0) and among those with underlying cardiac disease (30.4%; CI: 28.5-32.3). Compared to patients without an acute cardiac event, those with an acute cardiac event were more likely to experience ICU admission (16.8% vs 27.0%; aRR: 1.7, CI: 1.5-1.9) and in-hospital death (4.1% vs 8.8%; aRR: 2.0, CI: 1.6-2.5). Conclusions: One in 5 older adults hospitalized with RSV experienced an acute cardiac event, which was associated with approximately double the risk of severe outcomes. Adults at greater risk of cardiac complications from RSV may benefit from vaccines when available.

Evaluation of Pre and Post-operative Pulmonary Artery Pressures in Children with Adenotonsillar Hypertrophy and Correlation with Chronicity: A Prospective Study on 50 Children.

Children with grade III or IV of adenotonsillar hypertrophy especially of a longer duration, may show cardiovascular changes due to mouth breathing. These changes can be detected on doppler echocardiocardiography which can be used as a screening tool. Fifty paediatric patients of grade 3 and 4 adenotonsillar hypertrophy underwent adenotonsillar resection after a pre-operative work up which included doppler echocardiography to measure pulmonary artery pressures. A post-operative doppler echocardiography was done after three months. 11 children (22%) showed deranged pulmonary artery pressure values with increased mean pulmonary artery pressure (MPAP) and pulmonary artery systolic pressure (PSAP) on preoperative doppler echocardiography, and 2 out of these 11 children had Pulmonary Artery Hypertension. A significant (p < 0.001) improvement was noted in pulmonary artery pressure values (MPAP and PSAP returned to normal) after adenotonsillectomy in 3-month postoperative echocardiography. Also, a statistically significant correlation was obtained between chronicity of symptoms and raised pulmonary artery pressures. Our study concluded that these children with chronic untreated upper airway obstructive symptoms get predisposed to potential cardiac complications. And these grave consequences can be easily prevented by a timely intervention.

Unveiling the Uncommon: A Paediatric Case of Influenza-Related Atrioventricular Block

This case report highlights a 5-year-old child who developed a first-degree atrioventricular (AV) block during an influenza B infection. Influenza is a common viral illness that can cause severe morbidity and mortality, especially in children with underlying medical conditions. The case emphasizes the potential cardiac complications of influenza and the need for prompt recognition in paediatric patients. The child presented with bradycardia and a prolonged PR interval on the electrocardiogram, indicating AV block. The child had no other symptoms and was discharged in stable condition after two days of observation. Prompt recognition and evaluation of cardiac manifestations in influenza-infected patients, including thorough medical history and diagnostic workup, are crucial for the timely management and prevention of long-term sequelae. This case underscores the importance of considering cardiac complications in severe cases of influenza, especially in the paediatric population, and emphasizes the need for healthcare providers to be vigilant in identifying potential cardiac manifestations during influenza outbreaks.

Association of Non-Alcoholic Fatty Liver Disease with Cardiac Arrhythmias and Cardiac Conduction Defects: A Review of the Literature

Non-alcoholic fatty liver disease (NAFLD) is a prevalent condition that affects a significant portion of the global population and imposes a heavy clinical and economic burden. Recent studies have provided substantial evidence linking NAFLD to cardiac electrical abnormalities, including atrial and ventricular arrhythmias, heart blocks, conduction delays, and ECG changes. These cardiac electrical disturbances play a significant role in cardiac diseases that are the leading cause of death in NAFLD patients. This paper aims to provide an update on the proposed mechanisms underlying arrhythmogenesis in NAFLD and summarize the latest research findings in this field. Managing NAFLD requires a comprehensive approach that includes treating the underlying liver condition and regular ECG monitoring to detect and address any potential cardiac complications. Meta-analyses are recommended for future research further to elucidate the association between NAFLD and cardiac arrhythmias. Understanding and effectively managing the cardiac implications of NAFLD will contribute to improved patient care and outcomes.

Progression of coronary artery calcification after radiation therapy for esophageal cancer.

Advances in cancer treatment have resulted in increased attention toward potential cardiac complications, especially following treatment for esophageal cancer, which is associated with a risk of coronary artery disease. As the heart is directly irradiated during radiotherapy, coronary artery calcification (CAC) may progress in the short term. Therefore, we aimed to investigate the characteristics of patients with esophageal cancer that predispose them to coronary artery disease, CAC progression on PET-computed tomography and the associated factors, and the impact of CAC progression on clinical outcomes. We retrospectively screened 517 consecutive patients who received radiation therapy for esophageal cancer from our institutional cancer treatment database between May 2007 and August 2019. CAC scores were analyzed clinically for 187 patients who remained by exclusion criteria. A significant increase in the Agatston score was observed in all patients (1 year: P = 0.001*, 2 years: P < 0.001*). Specifically for patients receiving middle-lower chest irradiation (1 year: P = 0.001*, 2 years: P < 0.001*) and those with CAC at baseline (1 year: P = 0.001*, 2 years: P < 0.001*), a significant increase in the Agatston score was observed. There was a trend for a difference in all-cause mortality between patients who had irradiation of the middle-lower chest ( P = 0.053) and those who did not. CAC can progress within 2 years after the initiation of radiotherapy to the middle or lower chest for esophageal cancer, particularly in patients with detectable CAC before radiotherapy initiation.

Incidence of myocarditis among patients recovered from COVID-19 infection identified using cardiac magnetic resonance imaging

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Coronavirus disease 2019 (COVID-19) has caused significant morbidity and mortality worldwide and has been associated with several cardiac complications including myocarditis. COVID-19 patients with myocardial injury have worse clinical outcomes than those without cardiac involvement. Hence, early detection of myocardial involvement in those who have recovered would be helpful in risk stratification of these patients. Locally, there has been no literature regarding cardiac involvement detected by cardiac magnetic resonance (CMR) imaging among COVID-19 patients. This study aims to report the incidence of patients who developed myocarditis among those who recovered from COVID-19 infection and who underwent CMR imaging in our institution. Methodology A single-center retrospective cohort study was performed in our institution. Consecutive patients from January 1, 2020, to December 31, 2021, who were initially referred for cardiac CMR examination due to cardiac symptoms and who met the following inclusion criteria 1) 19 years old and above; 2) with a history of a previously confirmed diagnosis of COVID-19 using reverse transcription-polymerase chain reaction (RT-PCR) swab test; 3) patients were considered recovered by the discharging criteria and 4) underwent CMR imaging for evaluation to rule out myocarditis in our institution. The primary outcome was determining the number of patients with positive and negative conventional MRI findings based on late gadolinium enhancement and edema. Results Fifty-four percent (54%) of patients had positive conventional MRI findings indicative of myocarditis (myocardial edema or late gadolinium presence). The most common co-morbid condition remains to be Hypertension (55%), followed by Diabetes Mellitus (17%). Dyspnea, palpitations and chest discomfort were the most commonly reported symptoms in 29 (54%), 24 (44%) and 21 (39%) patients, respectively. Twenty-nine patients (54%) were observed with increased T2 signal or positive LGE. Myocardial edema was found in 9 (31%) patients. Among them, 8 (57%) patients were observed with positive LGE. There was no significant difference of LV and RV systolic function among patients with positive and negative conventional CMR findings. Conclusion Myocarditis is one of the cardiovascular complications among patients who recovered from COVID-19, as demonstrated by our cardiac MRI study. Evaluation of the cardiac status of recovered COVID-19 patients needs to be closely monitored, and cardiac MRI may be a sensitive imaging tool to investigate any cardiac involvement further. This study provided local data on those with potential structural changes and cardiac complications aligned with the clinical history, which may be unique in our population after recovering from the disease. Further research with a larger sample size, risk factors, and the intervention to prevent disease progression may need more attention.

Abstract 14248: The Impact of Trastuzumab on the Pulmonary Artery Systolic Pressure in Patients With HER-2 Positive Breast Cancer

Introduction: Despite that trastuzumab (TZB) improves life expectancy and prognosis in patients with HER-2 positive breast cancer (BC), cardiotoxicity is a well-established complication. However, other potential cardiac complications of TZB such as pulmonary hypertension (PHTN) are poorly investigated. Aim: Evaluate the effect of TZB on pulmonary artery systolic pressure (PASP) and measure the predictors of developing elevated PASP. Methods: The medical records for all females who received TZB treatment for confirmed HER-2 positive BC at King Hussein Cancer Centre in Jordan between 2014 - 2019 who had a documented normal PASP of ≤35 mmHg before treatment were evaluated. Results: A total of 436 patients with a mean age of 53±11 years were included. The leading comorbidities were hypertension and diabetes mellitus affecting 26.2% and 15.4% of the patients, respectively. 15.6% of the study’s population were active smokers. Prior to initiating TZB, 22.3% had left ventricular hypertrophy (LVH), 14.3% had mild tricuspid valve regurgitation (TR), 11.5% had pericardial effusion, and 4.8% had mild aortic valve regurgitation (AR).Of alarming significance, 24.8% of the patients had their PASP increased after one year. Patients who developed elevated PASP tend to be older (56.9 vs 51.3, P&lt;0.001), had baseline mild TR (26.3% vs 10.3%, P&lt;0.001), LVH (39.4% vs 17.6%, P&lt;0.001), and mild AR (9.1% vs 3.7%, P=0.031).Multivariate analysis showed that the only predictors of elevated PASP are TR at baseline (OR 3.9; 95% CI 1.58-6.17, P=0.001), and age (OR 1.04; 95% CI 1.01-1.06, P=0.005). However, baseline LVH (OR 1.79; 95% CI 0.98-3.26, P=0.057), number of the TZB cycles (OR 0.93; 95% 0.85-1.02, P=0.152), and the total dose of TZB (OR 1; 95% CI 1-1, P=0.284) were non-significant predictors. At 1 year follow up, the mean total cumulative dose of TZB was 6.8±1.8 grams that were given at a mean of 15±3 cycles. Moreover, major events (heart failure exacerbation, pulmonary embolism, and acute coronary syndrome) were recorded in 3.9% of the patients and death occurred in 4.1%. Conclusions: Trastuzumab demonstrated an increase in the PASP in a considerable portion of the patients at 1-year interval with this elevation being substantially concerning due to being highly indicative of PHTN.

Evaluation of neurological and cardiac development of newborn infants born to mothers infected with COVID-19

Background/Aim: In the coronavirus disease 2019 (COVID-19) pandemic, which has been affecting the world for the last 2 years, pulmonary, cardiovascular, and neurological adverse effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported. These negative influences entail a risk for fetal progress. In this study, by performing a detailed clinical evaluation, postnatal ultrasonography, and echocardiography, we aimed to investigate potential neurological and cardiac complications of newborns born to pregnant women infected with COVID-19. Methods: This prospective and cross-sectional study was conducted between January and July 2021. Newborn infants (0–28 days postpartum) born to mothers with proven COVID-19 infection by positive RT-PCR test during pregnancy were enrolled. Fetal cardiac development was evaluated by a pediatric cardiologist with an echocardiographic examination. Fetal neurologic evaluation was performed by a pediatric neurologist using both neurologic examination and transfontanelle ultrasonography (TFUS). Infants were reevaluated every 2 months until 6 months of age. Results: Thirty-three female and 32 male infants born to 64 pregnant women, one being a twin birth, were included in the study. Seven women developed COVID-19 infection in the first trimester, 11 in the second trimester, and 46 in the third trimester. Neurological examination and TFUS were normal in all newborns except one with microcephaly. The etiologic cause could not be detected in this infant, and his neurodevelopment was normal in the follow-up. The cardiac examination did not reveal any significant disorders. Eleven infants failed the standard “Auditory Brainstem Response” (ABR) hearing screening test, so a second test was performed. Only two infants required further investigation after the second test. Conclusion: We did not observe any neurologic and cardiologic teratogenic effects associated with COVID-19 infection during pregnancy.

Infecciones por Listeria, Corynebacterium y Bacillus

Listeria, Corynebacterium, and Bacillus are ubiquitous gram-positive bacilli. L. monocytogenes is a zoonotic pathogen that is transmitted by food. Listeriosis is a disease with a wide spectrum of severity that ranges from self-limiting febrile gastroenteritis to severe invasive disease with frequent involvement of the central nervous system. It predominantly affects people with some degree of cellular immunosuppression. It has a predilection for pregnant women, in whom it does not tend to produce severe disease, but is associated with severe obstetric complications and high rates of neonatal morbidity and mortality. C. diphtheriae is the causal agent of cutaneous or respiratory tract diphtheria, with potential cardiac or neurological complications mediated by the diphtheria toxin. The rest of the Corynebacterium species have traditionally been considered saprobionts, although various species have been described as the causal agents of opportunistic infections in recent decades. B. anthracis produces cutaneous, respiratory, or gastrointestinal anthrax, according to the spores’ route of entry. The spores are capable of germinating and multiplying, generating the toxin that is responsible for the disease. It is considered a potential bioterrorism agent for its high degree of lethality.

Cardiac complications following mRNA COVID-19 vaccines: A systematic review of case reports and case series.

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.

Cardiotoxic Effects of Yew Tree and Pink Periwinkle Alkaloids

Antitumour herbal medicines based on pink periwinkle and yew tree alkaloids are included in combination therapies for many types of cancer. The use of these classes of products may entail cardiotoxic effects leading to life-threatening conditions. The aim of the study was to analyse scientific literature on cardiotoxic effects of anticancer drugs based on yew tree alkaloids (taxanes) and pink periwinkle alkaloids (vinca alkaloids). The results of the analysis demonstrated that the main manifestations of taxane-induced cardiotoxicity were bradycardia, atrioventricular block, atrial and ventricular arrhythmias. Concomitant use of taxanes and anthracycline antibiotics exacerbated cardiotoxic effects of both drug classes. The use of vinca alkaloids was associated with haematological toxicity in the form of neutropenia, while cardiotoxic effect was rarely observed during monotherapy. Raising awareness among oncologists, cardiologists, and other specialists involved in the management of cancer patients about potential cardiac complications of antitumour therapy contributes to early detection of adverse reactions and allows for individual correction of treatment regimens, especially in patients with predisposition to cardiovascular disease.

Frequent constriction-like echocardiographic findings in elite athletes following mild COVID-19: in the grasp of SARS-CoV-2?

The COVID-19 pandemic had a major impact on the sports community as well. Despite the vast majority of athletes experiencing mild symptoms, potential cardiac involvement and complications have to be explored to support a safe return to play. Accordingly, we were aimed at a comprehensive echocardiographic characterization of post-COVID athletes (P-CA) by comparing them to a propensity-matched healthy, non-COVID athlete (N-CA) cohort.One hundred and seven elite athletes with COVID-19 were prospectively enrolled after an appropriate quarantine period and formed the P-CA group (23±6 years, 23% female). From our retrospective database comprising 425 elite athletes, 107 age-, gender-, body surface area-, and weekly training hours-matched subjects were selected as a reference group using propensity score matching (N-CA group). All athletes underwent a comprehensive clinical investigation protocol comprising 2D and 3D echocardiography. Left (LV) and right ventricular (RV) end-diastolic volumes (EDVi) and ejection fractions (EF) were quantified using dedicated softwares. To characterize LV longitudinal deformation, 2D global longitudinal strain (GLS) and the ratio of free wall versus septal longitudinal strain (FWLS/SLS) were also calculated. In order to describe septal flattening (SF – frequently seen in P-CA), LV eccentricity index (EI) was measured.P-CA and N-CA athletes had comparable LV and RV EDVi (P-CA vs N-CA; 77±12 vs 78±13mL/m2; 79±16 vs 80±14mL/m2, respectively). P-CA group had significantly higher LV EF (58±4 vs 56±4%, p<0.001) and GLS (−18.2±1.8 vs −17.6±2.2%, p<0.05). Eccentricity index was significantly lower in P-CA (0.89±0.10 vs 0.99±0.04, p<0.001), which was attributable to a distinct subgroup of P-CA athletes with a prominent SF (n=34, 32%), further provoked by inspiration. In this subgroup, the eccentricity index was markedly lower compared to the rest of the P-CA group (0.79±0.07 vs 0.95±0.07, p<0.001).In the SF subgroup, LV EDVi was significantly higher (80±14 vs 75±11 mL/m2, p<0.001), while RV EDVi did not differ (82±16 vs 78±15mL/m2). Moreover, the FWLS/SLS ratio was significantly lower in the SF subgroup (0.92±0.09 vs 0.97±0.08, p<0.01). Interestingly, P-CA athletes with SF experienced fatigue (17 vs 34%, p<0.05) or chest pain (0 vs 15%, p=N/A) less frequently during the course of the infection; however, the presence of a mild pericardial effusion was more common (41 vs 12%, p<0.01).Elite athletes following COVID-19 showed distinct morphological and functional cardiac changes compared to a propensity score-matched control athlete group. These results are mainly driven by a subgroup, which presented with some echocardiographic features characteristic of constrictive pericarditis (septal flattening, lower FWLS/SLS ratio, pericardial effusion). Follow-up of athletes and further, higher case number studies are warranted to determine the clinical significance and potential effects on exercise capacity of these findings.Funding AcknowledgementType of funding sources: None. Post-Covid athlete with SF

Surgery of chronic subdural hematoma under local anesthesia and its association with recurrence: A single tertiary care center experience

ObjectiveChronic subdural hematoma (CSDH) surgery is like other neurosurgical procedures in terms of its potential for major morbidities, especially recurrence, which may mandate further surgeries. An extremely limited number of studies have looked at the type of anesthesia and its association with recurrence. In fact, most of the studies that exist are focused on the safety of local anesthesia in minimizing potential cardiac and respiratory complications, rather than looking at recurrence as an outcome. This study aimed to evaluate the association between the type of anesthesia and the recurrence of CSDH. MethodsA hospital-based case series study of combined prospective and retrospective nature was conducted on 88 patients who had undergone surgical care for CSDH during the period from January 2016 through December 2018 in the neurosurgery department of Aseer Central Hospital, Abha, Saudi Arabia. ResultsA total of 88 patients were included in the study. The median age was 70 years, and most patients (62%) had one or more comorbid disease(s), 47 (53.4%) underwent general anesthesia for CSDH surgery, whereas 41 (46.6%) underwent local anesthesia (LA). Recurrence within 3 months was seen in 12 patients (13.6%). Univariable regression analysis revealed that the risk of recurrence was four times more when surgery was performed under LA. ConclusionsThe study is the first in the English literature to conclude that drainage of CSDH under LA is associated with a higher recurrence rate; however, the authors remain neutral and recommend individualization of treatment options based on the patient’s status. Local anesthesia may be safer in terms of postoperative anesthetic complications, but it carries a higher rate of recurrence. Further well-designed randomized studies are required.

Clinical, Cardiological and Serologic Follow-Up of Chagas Disease in Children and Adolescents from the Amazon Region, Brazil: Longitudinal Study.

Background: Outbreaks of Chagas disease (CD) by foodborne transmission is a problem related to deforestation, exposing people to triatomines infected by T. cruzi, in the Amazon region. Once involving long-time follow-up, the treatment efficacy of the CD during its acute phase is still unknown. The authors aim to describe the clinical and epidemiologic profile of children and adolescents with CD, as well as treatment and cardiac involvement during the follow-up. Methods: A descriptive cohort study was conducted from 1998 to 2013 among children and adolescents up to 18 years-old with confirmed diagnosis of CD. All participants met the criteria of CD in the acute phase. Results: A total of 126 outpatients were included and received treatment and follow-up examinations during a medium period of 10.9 years/person. Most of them (68.3%) had their diagnosis established during oral transmission outbreaks. The diagnostic method with the most positive results rate (80.9%) was the IgM class anti-T. cruzi antibody test as an acute phase marker, followed by the thick blood smears (60.8%). Acute myopericarditis was demonstrated in 18.2% of the patients, most of them with favorable evolution, though 2.4% (3/126) persisted with cardiac injury observed at the end point of the follow-up. Conclusions: Antibodies against T. cruzi persisted in 54.8% of sera from the patients without prognostic correlation with cardiac involvement. Precocious treatment can decrease potential cardiac complications and assure good treatment response, especially for inhabitants living in areas with difficult accessibility.