Pandemics – ABC CARDIOL

IJCS

Original Article

Characteristics of ST-Elevation Myocardial Infarction during the SARS-CoV-2 Outbreak

Guilherme Pinheiro Machado et al. Gustavo Neves de Araujo Rafael Beltrame André Luiz Theobald … Matheus de Souza Niches Julia Fagundes Fracasso Victoria Milan Julia Luchese Custodio Camila Porto Cardoso Pedro Henrique Torres Tietz Giulia Bonatto Reichert Marcia Moura Schmidt Alexandre Schaan de Quadros Marco Vugman Wainstein

Abstract

Background

The SARS-CoV-2 outbreak has led to radical transformation in social, economic, and healthcare systems. This may lead to profound indirect consequences on clinical presentation and management of patients with ST-segment–elevation myocardial infarction.

Objectives

The objective of this study was to describe the characteristics, management, and outcomes of patients admitted with acute myocardial infarction with ST-segment elevation (STEMI), in two tertiary reference hospitals during the SARS-CoV-2 outbreak and compare them with patients admitted in the previous year.

Methods

We analyzed data from a multicenter STEMI registry from reference centers in the South Region of Brazil from March 2019 to May 2021. The beginning of the COVID-19 outbreak was considered to be March 2020 and compared to the same period in 2019. Only patients with STEMI submitted to primary percutaneous coronary intervention (PCI) were included in the analysis. Mortality rates were compared with chi-square test. All hypothesis tests had a two-sided significance level of 5%.

Results

A total of 1169 patients admitted with STEMI were enrolled in our registry, 635 of whom were admitted during the pandemic period. The mean age of our sample was 61.6 (± 12.4) years, and 66.7% of patients were male. Pain-to-door time and door-to-balloon time were longer during the pandemic period. However, there was no difference in mortality rates or major adverse cardiovascular outcomes (MACE).

Conclusions

We observed a stable incidence of STEMI cases in our registry during the SARS-CoV-2 outbreak with higher pain-to-door time and door-to-balloon time, without any influence on mortality rates however.

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Original Article

Clinical Aspects Of Hypertensive Patients With COVID-19 Hospitalized In A Campaign Hospital In Northeast Brazil

Luan George Xavier et al. Renato Sampaio Mello Neto Marcos Henrique de Oliveira Morais Pedro Jorge Cronemberger … Maria do Carmo Carvalho Martins Marta Rosal

Abstract

Background

In view of the absence of effective therapy for COVID-19, many studies have been conducted seeking to identify determining factors for the development of severe forms, aiming to direct efforts to avoid the worst outcomes in patients susceptible to severe conditions. One of the main comorbidities associated with complicated forms of the disease is systemic arterial hypertension (SAH).

Objective

To assess aspects of the clinical, demographic, laboratory, and radiological characteristics of hypertensive patients with COVID-19 to contribute to the knowledge of the relationship between the presence of this comorbidity and the severity of the disease.

Methods

A total of 380 patients with a diagnosis of acute SARS-CoV-2 infection hospitalized between June and August 2020 were included. Patients were divided into two groups according to the presence or absence of a previous diagnosis of hypertension. For comparison between groups, a significant difference was established if p < 0.05.

Results

Of the total of 380 patients, 202 (53.16%) had a clinical diagnosis of SAH. Hypertensive patients were significantly older (p < 0.01) and had more comorbidities (p < 0.01) than the non-hypertensive group. In laboratory tests, hypertensive patients had higher levels of blood glucose (p = 0.014), creatinine (p = 0.002), and urea (p = 0.003), while values for alanine aminotransferase (ALT) (p < 0.01), aspartate aminotransferase (AST) (p = 0.006), and sodium (p = 0.024) were lower. There was no difference between groups in radiographic parameters.

Conclusions

This study showed that, although the hypertensive group had some laboratory alterations that elicited severe disease, these patients did not have worse outcomes.

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IJCS

Editorial

Small Exercise Breaks can Save your Brain from Prolonged Sitting

A sedentary lifestyle is one of the major risk factors for the development of cardiovascular diseases. For instance, in 2019, stroke was the second-leading cause of death, as well as the primary cause of death and disability combined in the world. Active commuting to work is one strategy to decrease sedentary time and its impact, and the COVID-19 pandemic has changed work and daily routines worldwide. Moreover, the necessary social distancing has led to increased sedentary time, especially for those who are engaged in office desk work .

Acute prolonged sitting seems to lead to transient impairment of the endothelial function in the healthy population, whether this phenomenon is related to cardiovascular or cerebrovascular events is unknown. Nonetheless, prolonged sitting impairs the cerebrovascular function.^, Conversely, exercise breaks from prolonged sitting seem to restore the endothelial and cerebrovascular function. Therefore, active breaks from prolonged sitting could be a good strategy to mitigate the effects of sedentary time. However, the ideal duration and intensity need further investigation. Additionally, the difficulty to implement exercise breaks as a daily routine for office workers must be considered.

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IJCS

Case Report

Cardiac Manifestations Associated With Coronavirus Disease: A Case Report

Gabriela Ribeiro Prata Leite Barros et al. Raphaela Tereza Brigolin Garofo Bernardo Noya Alves de Abreu Adriano Camargo de Castro Carneiro André Luiz Esteves Mendonça

Abstract

This study presents a 47-year-old female patient, with a history of diabetes, who contracted SARS-CoV-2 and exhibited cardiovascular complications.

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IJCS

Review Article

Kawasaki-Like Disease, a New Phenotype in Sars-CoV-2?

Beatriz Sordi Chara et al. Júlia Machado Rickli Caroline Figueiredo da Silva Gabriela Pomaleski … Rafael de March Ronsoni Marcus Vinícius Magno Gonçalves

Abstract

The coronavirus disease (COVID-19), that assumed pandemic proportions in March 2020, mainly affects the respiratory tract, causing severe interstitial pneumonia in adults. Worldwide data indicate that COVID-19 tends to be more benign in children, which is evidenced by a high incidence of asymptomatic or mild upper airways’ infection cases in this population. However, recent studies have been associating Kawasaki-like symptoms as a nonclassical presentation of coronavirus disease in pediatrics. It is suggested that the intense cytokine cascade, promoted by the SARS-CoV-2 infection, can trigger a multisystem inflammatory response as an atypical Kawasaki form in genetically predisposed individuals. In this context, patients may develop more severe clinical features with a greater predisposition to myocardial involvement, Macrophage Activation Syndrome, and Kawasaki Disease Shock Syndrome. Despite critical conditions, patients usually respond to conventional treatment of Kawasaki Disease with intravenous immunoglobulin. This article intends to provide an approach to the association between Kawasaki-Like Syndrome and COVID-19.

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Original Article

Emergency Department Visits and Deaths from Cardiovascular Diseases at a Referral Center for Cardiology During the COVID-19 Pandemic

Luis Sérgio Carvalho Luciano et al. Luiz Eduardo Koenig São Thiago Isabela de Carlos Back Leandro Waldrich … Luiza Di Bernardi de São Thiago Amabile Rodrigues Alves Beatriz Campos Comelli Mariane Janning Santos Luiz Carlos Giuliano

Abstract

Background

The COVID-19 pandemic has imposed measures of social distancing and, during this time, there has been an elevation in cardiovascular mortality rates and a decrease in the number of emergency visits.

Objectives

To assess and compare in-hospital mortality for cardiovascular diseases and emergency department visits during the COVID-19 pandemic and the same period in 2019.

Methods

Retrospective, single-center study that evaluated emergency visits and in-hospital deaths between March 16, 2020 and June 16, 2020, when the steepest fall in the number of emergency admissions for COVID-19 was registered. These data were compared with the emergency visits and in-hospital deaths between March 16 and June 16, 2019. We analyzed the total number of deaths, and cardiovascular deaths. The level of significance was set at p < 0.05.

Results

There was a 35% decrease in the number of emergency visits and an increase in the ratio of the number of deaths to the number of emergency visits in 2020. The increase in the ratio of the number of all-cause deaths to the number of emergency visits was 45.6% and the increase in the ratio of the number of cardiovascular deaths to the number of emergency visits was 62.1%. None of the patients who died in the study period in 2020 tested positive for COVID-19.

Conclusion

In-hospital mortality for cardiovascular diseases increased proportionally to the number of emergency visits during the COVID-19-imposed social distancing compared with the same period in 2019. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

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IJCS

Letter to the Editor

The Big Mistake of not Considering Physical Activity an Essential Element of Care During the Covid-19 Pandemic

Francisco José Gondim Pitanga et al. Carmem Cristina Beck Cristiano Penas Seara Pitanga

Dear Editor,

In response to the letter to the editor entitled “Declaring physical activity as ‘essential’ during the Covid-19 pandemic may not be a good measure” that presented contributions to our point of view entitled “Should physical activity be considered essential activity during the Covid-19 pandemic?” we thank you for the suggestions and we present a reply letter with our arguments:

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Viewpoint

A Probable Relationship between Physical Exercise and COVID-19 Mediated by the Renin-Angiotensin-Aldosterone System

Renato Aparecido de Souza et al. Priscila Missaki Nakamura Inaian Pignatti Teixeira Marco Tulio de Souza Wonder Passoni Higino

The Pathways of the RAAS

The classical pathway of the RAAS is initiated by the release of angiotensinogen by the liver, which, combined with renin secreted by the kidneys, produces angiotensin I (Angio I). Angio I is converted to angiotensin II (Angio II) by the action of the angiotensin-converting enzyme (ACE) in the lungs. The physiological effects of Angio II are mediated primarily through membrane receptors, especially of the Angio II type 1 (AT1) receptor. These receptors, when stimulated, promote vasoconstriction, hypertrophy and hyperplasia of vascular cells, sodium retention, generation of reactive oxygen species (ROS), and inflammatory, thrombotic and fibrotic processes, which can cause tissue damage.

A counter-regulatory pathway of the RAAS involves the conversion of Angio II to angiotensin 1–7 (Angio-1–7) and membrane receptors (MAS) through the enzymatic activity of angiotensin-converting enzyme 2 (ACE2), which promotes a vasodilatory, anti-inflammatory, anti-fibrotic, and anti-proliferative effect on the tissues. Under appropriate physiological conditions, there is a balance between these two RAAS pathways ().

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IJCS

Editorial

Physical Activity, Exercise and Sports and Covid-19: What Really Matters

Claudio Gil Soares de Araújo

The ability to move is essential for an independent life. It is widely recognized that those who spend the most time either lying down or sitting and are physically inactive tend to have limited autonomy, poor health-related quality of life, and adverse prognosis of outcomes.

This editorial will briefly discuss the relationship between COVID-19 and physical movement. To better address this important relationship and for sake of clarity, some concepts should be defined first. In sport and exercise sciences, “physical activity” is defined as any bodily movement produced by skeletal muscles that results in energy expenditure, “exercise” is a subset of physical activity that is planned, structured, and repetitive and “sport” is an activity that most often, but not always, involves exercise and predetermined rules and participation in games or races or competitions.

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IJCS

Case Report

Pulmonary Embolism in Patients with Covid-19 in Direct Oral Anticoagulant

Fabio Augusto De Luca et al. Guilherme Arruda Vinicius Esteves André Feldman … Ítalo Bruno dos Santos Sousa José Célio Vieira Brandão Raquel Muarrek Garcia Olga Ferreira de Souza

Introduction

The global pandemic caused by the new coronavirus (COVID-19) has been promoting major challenges and unprecedented clinical decisions in the medical scenario. Currently, according to the World Health Organization, the disease affects over 185 countries, with over 12 million people infected and nearly 500 thousand deaths.

Among the most serious manifestations of the syndrome, the high prevalence of thromboembolic events, up to 31% of the patients hospitalized in intensive care units, according to an international series, calls attention.^– Different mechanisms of action related to the infection by SARS-CoV-2 may be related to thrombosis: excessive inflammation, tissue hypoxia, immobilization, and disseminated intravascular coagulation (DIC); however, one question remains: Is the etiology linked to some specific effect of the virus or a reflex of the severity of the case? Despite the anticoagulant therapy emerging as a major weapon in the therapeutic arsenal, data is still scarce in the literature regarding the efficacy and safety of warfarin or direct oral anticoagulants (DOAC) in this specific setting. It should be highlighted that, of the 1.5 million people currently infected in Brazil, a significant number present a history of cardiovascular disease and are presently taking anticoagulants. This class of drugs may show serious interactions with investigational therapies currently employed for COVID-19, which could increase the risk of thrombotic or hemorrhagic events. In this context, it becomes imperative to highlight that the thrombosis associated with COVID-19 and anticoagulant therapy is a unique scenario and must be investigated.

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Viewpoint

Severe Cardiovascular Complications of COVID-19: a Challenge for the Physician

Nathalie Cristina Crivelari et al. Gisele Queiroz de Oliveira Clarice Hyesuk Lee Park Gregorio da Cruz Riemma … Isabela Bispo Santos da Silva Costa Marcus Vinícius Guimarães de Lacerda Glaucia Maria Moraes de Oliveira Francisco Carlos da Costa Darrieux Luciana Sacilotto Ludhmila Abrahão Hajjar

Introduction

Since December 31, 2019, when China reported the appearance of cases of acute respiratory failure caused by a new species of coronavirus, SARS-CoV-2, which causes the disease called COVID-19, almost 20 million cases were confirmed, causing 726 thousand deaths worldwide. In Brazil, on August 8^th, 2020, there was approximately 3 million cases and 100 thousand death by the disease.

Its rapid spread, its high potential for hospitalization, and its high lethality, especially in the most fragile groups such as geriatric patients and those with comorbidities, particularly cardiovascular ones, make this pandemic a challenge never faced by modern medicine. To date, we have no specific medication that has effective and safe results for the treatment of COVID-19. The scientific community has sought to research drugs with therapeutic plausibility, and controlled and randomized studies are underway. Many therapeutic proposals are based on in vitro experiments. The medications used are described in case records, with no solid scientific evidence for their use, and with a high probability of causing damage due to their adverse effects alone or in combination.

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Viewpoint

Difficult Times: The Coronavirus Pandemic and Cardiology Residency – The Experience of the Rio Grande do Sul Cardiology Institute

Raphael Boesche Guimarães et al. Simone Louise Savaris Henrique Basso Gomes Marcelo Haertel Miglioranza

Medical residency programs were first established in 1889 in Baltimore, Maryland, at John Hopkins University. At the time, Dr. William Healstead realized that seriously ill patients treated by recently certified clinicians had higher mortality rates. In response to this, and in the hopes of increasing the quality and success rates of patient care, Healstead created a new type of training program, in which emerging clinicians would receive their final training in the hospital environment itself. This model, replicated globally, is currently known as medical residency.

In Brazil, the Orthopedic Department at Hospital of Clínicas, associated with the University of São Paulo (USP), pioneered the first Brazilian medical residency program in 1945. However, this training model was not officially adopted in the country until September 5, 1977, through decree No. 80281, which instituted residency training as a formal component of medical graduate training. ^– Since then, physicians worldwide have been able to train in specialized medical residency programs that not only deepen their theoretical understanding, but also provide a supervised environment for development of the practical skills required by their desired area of expertise.

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IJCS

Letter to the Editor

Declaring Physical Activity as ‘Essential’ During the COVID-19 Pandemic May not be a Good Measure

Rogério Tosta Almeida et al. Ciro Oliveira Queiroz Estela M. L. Aquino

Dear Editor,

We congratulate the authors on the viewpoint entitled “Should Physical Activity Be Considered Essential During the COVID-19 Pandemic?”, and we are thankful for the opportunity to provide some contributions on this current and relevant topic.

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IJCS

Original Article

Lung Ultrasound as a Triage Tool in an Emergency Setting during the Covid-19 Outbreak: comparison with CT Findings

Monica Luiza de Alcantara et al. Marcos Paulo Lacerda Bernardo Tatiana Bagrichevsky Autran Rodolfo de Paula Lustosa … Marcelo Tayah Lucia Antunes Chagas Dequitier Carvalho Machado

Abstract

Background

Lung ultrasound (LUS) can detect interstitial alveolar changes confined to the subpleural region, like those described in Covid-19.

Objetive

To evaluate how LUS findings correlate with chest computed tomography (CT) in patients admitted to the emergency department (ED) with suspicion of Covid-19.

Methods

Cross-sectional study of 20 patients (median age 43 years; interquartile range, 37–63 years; 50% male). All patients underwent LUS and chest CT on the day of ED admission. Each hemithorax was divided into 6 segments with similar landmarks, and equivalent scores (sc) of lesion severity were defined for both methods. The number of affected segments on LUS (LUSseg) was divided into tertiles (0-1, 2-5, and ≥6), and compared with number of affected segments on CT (CTseg), LUSsc, CTsc, and percentage of affected lung parenchyma through visual analysis (CTvis). ANOVA or Kruskal–Wallis test for continuous variables, chi-square test for categorical variables, and receiver operating characteristic (ROC) curve analysis to define optimal cutoff points were performed. P<0.05 was considered statistically significant.

Results

Median LUSsc, CTsc, CTseg, and CTvis were significantly different between groups. A clear separation between groups was demonstrated; patients with 7 LUSsc and >3 LUSseg, respectively.

Conclusion

LUS findings correlate with chest CT, and can help identify patients with normal lung or minor pulmonary involvement secondary to Covid-19. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

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Viewpoint

Heart Failure with Preserved Ejection Fraction and COVID-19: a Pernicious Relationship

Evandro Tinoco Mesquita et al. Antonio Jose Lagoeiro Jorge Humberto Villacorta Luiz Claudio Danzmann Wolney de Andrade Martins

Introduction

The ongoing pandemic of Severe Acute Respiratory Virus-2 (SARS-CoV2) infection was first recognized in China in 2019 and brought significant health and economic threats around the world. On January 31, 2020, the World Health Organization (WHO) declared the disease caused by SARS-CoV2 an international public health emergency and on March 11, 2020, the WHO declared it a pandemic.^, Three months after the initial WHO declaration, there are more than 5 million confirmed cases worldwide and 300,000 deaths. In Brazil, in the same time interval, there were more than 850,000 cases and 43,000 deaths, with an upward trend.

The epidemiological and clinical severity of the pandemic by COVID-19 was initially supported by 4 alarming elements: (a) respiratory transmission with a high infectivity rate; (b) high lethality in specific subgroups; (c) high demand for intensive care and mechanical ventilation; and (d) no effective vaccine or specific treatment. Given the magnitude of the problem and the scarcity of resources, there was a recommendation for hospitalizing critically ill patients and providing them with supportive treatment and, above all, mitigation via social isolation aimed at flattening out the epidemic curve.^–

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Case Report

The Association between Covid-19 and ST Elevation Myocardial Infarction: Variable Clinical Presentations on a Case Report Series

Vinicius Esteves et al. Cleverson Neves Zukowski Fabio Augusto de Luca Italo Bruno dos Santos Sousa … Bruno Santana Bandeira Angelina Camiletti Guilherme Arruda André Feldman Olga Ferreira de Souza

Introduction

The current global pandemic caused by the new coronavirus (COVID-19) already reaches 185 countries with approximately 3 million infected people and more than 200 thousand deaths.^, With continental dimensions and an elevated socioeconomic disparity, Brazil, by the beginning of May, presents with increasing infection rates and mortality close to 8%. The numbers may be higher considering the lack of adequate testing of the population and healthcare professionals.

According to the World Health Organization (WHO), cardiovascular diseases represent the leading cause of deaths around the world. . Recent reports confirmed that patients with cardiovascular comorbidities are at a higher risk to develop the most severe form of the COVID-19.^– The association between these two pathologies can lead to high morbidity and mortality rates and has been the object of continuous efforts by the medical community. In this sense the management of Acute Coronary Syndrome (ACS) has undergone changes in both diagnosis and treatment since the beginning of the pandemic.^– Another aggravating factor regarding the approach of ACS during this period is the multiple clinical presentations and differential diagnosis associated with COVID-19, such as myopericarditis, pulmonary embolism and arrhythmia.^–

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Editorial

Open Science and the Role of Cardiology Journals in the COVID-19 Pandemic

Claudio Tinoco Mesquita

In July 2020, Brazil has the world’s second highest Covid-19 death toll. The COVID-19 pandemic is spreading fast in America. Since the first case of COVID-19 was confirmed, it took 114 days in Brazil (February 26-June 19) and 98 days in the USA (January 21-April 29) for the number of cases to reach more than 1,000,000. Parallel to the rapid growth of COVID-19 cases, there has been a progression in the number of scientific publications. Until June 2020, more than 25,800 papers about COVID-19 were published in PubMed (17,800 open access – 69%). This volume of scientific publications is unprecedent. The Journal of the American Medical Association (JAMA), for example, received more than 11,000 submissions from January 1 to June 1, 2020, compared with approximately 4,000 submissions during the same period in 2019. The International Journal of Cardiovascular Sciences is facing a similar situation with more than doubled manuscripts submitted. Our aim is to discuss the importance of Open Science during the COVID-19 pandemic and the role of cardiology journals in this special moment.

COVID-19 is a new disease and many of its aspects are still obscure. What is known about SARS-CoV-2 transmission, incubation, and environmental stability? What are the risk factors for the disease? What is the best evidence-based therapy? What is the real importance of asymptomatic and presymptomatic virus shedding in SARS- CoV-2 transmission? How long neutralizing antibodies persist following infection, and do they confer immunity to reinfection? These and many other key questions are still unanswered. There is a great need for fast and efficient publication of information, but at the same time all efforts must be made to assure quality, and avoid biases and limitations.

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Viewpoint

Challenges in Pharmacological Management of Cardiovascular Diseases in Covid-19: do Benefits Outweigh Risks?

Samuel de Sousa Pedro et al. Fernanda Carla Ferreira de Brito Christianne Bretas Vieira Scaramello

Introduction

Cardiovascular diseases (CVD) are the main cause not only of global mortality but also of reduced quality of life. They cover ischemic heart disease, stroke, heart failure, peripheral artery disease, and various other heart and vascular conditions. In 2017, CVDs caused about 17.8 million deaths worldwide, corresponding to 330 million years of life lost and another 35.6 million years of life with disabilities. Almost 80% of deaths occur in low- and middle-income countries, such as Brazil, where the occurrence of CVDs and their risk factors are on the rise as a result of an ongoing epidemiological transition. In low-income countries CVDs greatly affect working-age populations, and the total economic loss resulting from this group of diseases is high, representing 2% of Gross Domestic Product. In addition, the disability caused by CVDs has economic consequences at multiple levels: individual, family, economic agents, public institutions, government, and society as a whole.

Recent studies also show that chronic conditions, such as CVD, increase the risk of aggravation and death associated with the new coronavirus 2019 disease (COVID-19), whose outbreak was characterized as a pandemic by the World Health Organization (WHO) in March 2020. The new coronavirus is a betacoronavirus called SARS-CoV-2 (Severe Acute Respiratory Syndrome coronavirus 2), phylogenetically identical to other coronaviruses capable of determining acute respiratory distress syndrome (ARDS), which is responsible for numerous deaths. The most common symptoms of COVID-19 include fever, cough, dyspnea, myalgia, fatigue, diarrhea, sore throat, chest pain, confusion, and lethargy. Acute and chronic cardiovascular complications have also been observed in the course of COVID-19, being attributed to several mechanisms, such as relative ischemia, systemic inflammation mediated by pathogens, with increased levels of several biomarkers. In this context, studies point to the relevance not only of chronic conditions, such as hypertension, but also of the age and immunological status of the host, characterizing a complex, multifactorial, and bidirectional model that can comprehend the drugs used to treat these pathologies.

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Viewpoint

Should Physical Activity Be Considered Essential During the COVID-19 Pandemic?

Francisco José Gondim Pitanga et al. Carmem Cristina Beck Cristiano Penas Seara Pitanga

Introduction

The novel coronavirus (COVID-19) disease, considered a pandemic by the World Health Organization (WHO), which until April 13, 2020, had 1,776,867 confirmed cases with 111,828 deaths worldwide, led the Ministry of Health of Brazil to prepare a manual with several actions to prevent the spread of the disease. Among these actions, social distancing is recommended, instructing people to remain at home. In addition, many heads of state and municipal executive power across Brazil have issued decrees proposing the closure of several spaces, including gyms, clinics, clubs, and other public and private spaces for physical activity. These actions caused the Brazilian population to have difficulties to continue the practice of physical activity.

On the other hand, since the beginning of the pandemic, some studies have been published in different parts of the world, calling attention to the importance of continuing to practice physical activity. For example, in the city of Wuhan in China, the initial epicenter of the disease, people were recommended to practice physical activity even at home. In a recent study focused on elderly people, outdoor physical activity and also exercising at home were suggested as therapy to combat the physical and mental consequences of quarantine due to the Covid-19 pandemic. In addition, according to a recent position of the American College of Sports Medicine, people should continue to stay physically active while at home during the pandemic.

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Viewpoint

Covid-19 and Safety in the Cath Lab: Where We Are and Where We Are Headed

Giordana Zeferino Mariano et al. Viviana Guzzo Lemke Maria Sanali Moura Paiva Gláucia Maria Moraes de Oliveira

Safety measures in the procedure preparation stage

A study conducted in China with 72,314 patients with COVID-19 (44,672 laboratory-confirmed cases, 16,186 suspected cases, and 10,567 clinically diagnosed cases) has reported fever, cough, dyspnea, myalgia, fatigue and diarrhea as the most common symptoms. Other signs and symptoms have been reported, such as sore throat, chest pain, mental confusion, and lethargy. The authors have highlighted that COVID-19 had a benign course in 80% of the cases, and that many patients, although asymptomatic, could carry the virus. It is worth noting the importance of the differential diagnosis of dyspnea and fatigue, especially when associated with the other symptoms.

During a respiratory pandemic, patients and their families should be informed about the risks of contamination, despite all additional measures taken to minimize them. Because the number of elective procedures will be drastically reduced during that period, the length of hospital stay is predicted to be the minimum necessary for each protocol consensually elaborated. Moreover, defining a procedure as elective requires clinical judgement, because postponing it might have effects that will increase the likelihood of decompensation and adverse events during the pandemic, such as in high-risk patients with unstable angina. Therefore, the decision about performing a procedure should be individualized and based on the patient’s risk and benefit analysis.

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Viewpoint

Exercise Training: A Hero that Can Fight two Pandemics at Once

Renata Rodrigues Teixeira de Castro et al. João Giffoni da Silveira Neto Roberta Rodrigues Teixeira de Castro

The sedentarism pandemic

The WHO recommends that adults aged 18 years and older should accumulate at least 150 minutes of moderate-intensity aerobic activity, 75 minutes of vigorous-intensity aerobic activity, or a combination of both per week. People who do not meet these requirements are considered sedentary. The health benefits of physical exercise include lower risks of cardiovascular disease, hypertension, diabetes, obesity, dementia and breast and colon cancer.^– Despite all these benefits, sedentarism is a pandemic, affecting 27.5% of people globally.

Sedentarism increases the risk of the world´s major non-communicable diseases. I-Min Lee et al., estimated that physical inactivity is responsible for 6% of the burden of coronary artery disease, 7% of type 2 diabetes, 10% of breast cancer and colon cancers. Thus, inactivity is considered responsible for 9% of premature mortality, globally. Actually, sedentarism kills more people annually than the COVID-19 infection.

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Editorial

COVID-19: A Matter Close to the Heart

Gláucia Maria Moraes de Oliveira et al. Fausto J. Pinto

The world is facing a new challenge, the novel coronavirus disease 2019 (COVID-19), caused by a betacoronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), phylogenetically identical to the SARS-CoV (severe acute respiratory syndrome coronavirus) and the MERS-CoV (Middle East respiratory syndrome coronavirus) responsible for innumerable deaths in China in 2003 and in the Middle East in 2012, respectively.

On March 11, 2020, the COVID-19 outbreak was characterized as a pandemic by the World Health Organization (WHO). Twenty-three days after that announcement, the cases reported reached 1,056,777 in 182 countries, with 55,781 deaths, most of which occurring in Italy, Spain, France, China and Iran. So far, Brazil has registered 8,195 cases and 335 deaths, while Portugal, 9,886 cases and 246 deaths, figures that have increased steeply since the beginning of the pandemic.

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