Pneumonia – ABC CARDIOL

IJCS

Case Report

Vascular Spectrum of Imaging Findings in COVID-19: Ischemic, Hemorrhagic, and Thromboembolic Complications

Pedro Neves Paiva de Castro et al. Lucia Antunes Chagas Eduardo Wajnberg Roberto Santos … Pedro Cougo Dequitier Carvalho Machado

Abstract

Ischemic strokes secondary to occlusion of large vessels have been described in patients with COVID-19. Also, venous thrombosis and pulmonary thromboembolism have been related to the disease. Vascular occlusion may be associated with a prothrombotic state due to COVID-19-related coagulopathy and endotheliopathy. Intracranial hemorrhagic lesions can additionally be seen in these patients. The causative mechanism of hemorrhage could be associated with anticoagulant therapy or factors such as coagulopathy and endotheliopathy. We report on cases of ischemic, thrombotic, and hemorrhagic complications in six patients diagnosed with SARS-CoV-2 infection. Chest computed tomography (CT) showed typical SARS-CoV-2 pneumonia findings in all the cases, which were all confirmed by either serology or reverse transcription polymerase chain reaction (RT-PCR) tests.

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Original Article

Disease Severity Affects Ventricular Repolarization Parameters in Patients With COVID-19

Mevlut Koc et al. Hilmi Erdem Sumbul Erdinc Gulumsek Hasan Koca … Yurdaer Bulut Emre Karakoc Tuba Turunc Edip Bayrak Huseyin Ali Ozturk Muhammed Zubeyir Aslan Abdullah Orhan Demirtas Yahya Kemal Icen

Abstract

Background:

There is no study evaluating the T_peak-T_end (Tpe) interval, Tpe/QT ratio, and Tpe/QTc ratio to assess cardiac arrhythmias in patients with COVID-19.

Objective:

We aimed to examine whether there is a change in QT, QTc, Tpe interval, Tpe/QT ratio, and Tpe/QTc ratio in patients with COVID-19.

Methods:

The study included 90 patients with COVID-19 infection and 30 age-and-sex-matched healthy controls. QT, QTc, Tpe interval, Tpe/QT ratio, and Tpe/QTc ratio were measured. The participants included in the study were divided into the following 4 groups: healthy controls (group I), patients with COVID-19 without pneumonia (group II), patients with COVID-19 and mild pneumonia (group III), and patients with COVID-19 and severe pneumonia (group IV). Statistical significance was set at p < 0.05.

Results:

It was found that baseline heart rate, presence of hypertension and diabetes, white blood cell count, blood urea nitrogen, creatinine, potassium, aspartate aminotransferase, alanine aminotransferase, NT-proBNP, high sensitive C reactive protein, D-dimer, hs-cTnI, Tpe, Tpe/QT, and Tpe/QTc increased from group I to group IV, and they were significantly higher in all patients in group IV (p < 0.05). Systolic-diastolic blood pressure, hemoglobin, and calcium levels were found to be lowest in group IV and significantly lower than in other groups (< 0.05). QT and QTc intervals were similar between groups. It was determined that increased heart rate, calcium, D-dimer, NT-proBNP and hs-CRP levels were significantly related to Tpe, Tpe/QT, and Tpe/QTc.

Conclusions:

In patients with COVID-19 and severe pneumonia, Tpe, Tpe/QT ratio, and Tpe/QTc ratio, which are among ventricular repolarization parameters, were found to be increased, without prolonged QT and QTc intervals. In this study, we cannot definitively conclude that the ECG changes observed are directly related to COVID-19 infection or inflammation, but rather associated with severe COVID-19 scenarios, which might involve other causes of inflammation and comorbidities. (Arq Bras Cardiol. 2020; 115(5):907-913)

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Letter to the Editor

Cardiovascular Imaging in Patients with COVID-19

Gabriel Blacher Grossman et al. Ronaldo de Souza Leão Lima

Dear Editor,

In the latest issue of the Arquivos Brasileiros de Cardiologia, Costa et al. reviewed the role of cardiovascular imaging and interventional procedures in patients with novel coronavirus infection.

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Editorial

COVID-19: A New Challenge in Pregnancy and Heart Disease

Walkiria Samuel Avila et al. Regina Coeli de Carvalho

The outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was declared a pandemic by the World Health Organization on March 11, 2020. Although SARS-CoV-2 isolation, gene sequencing, and structural analysis have been completed,therapies for COVID-19.

The first epidemiological data have pointed to a worse outcomes and higher mortality of COVID-19 in patients with chronic diseases, such as heart disease and arterial hypertension. Subsequently, the Brazilian Health Ministry included in the high-risk group pregnant, puerperal and post-abortion women.

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IJCS

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

Novel Coronavirus Pneumonia and Cardiomyopathy: A Case Report

Mustafa Ahmet Huyut

Case report

A 59-year-old female had had fever for 4 days, after catching a cold. One day before visiting the hospital, she had fever and cough, but no chest tightness, chest pain, chills, nausea and vomiting or diarrhea. She did not feel better after receiving antifebrile agents. Then, she was admitted to our outpatient clinic in BHT Clinic Tema Hospital. Four days before, the patient had had contact with her relative who had traveled from Europe. In her previous medical history, bariatric surgery had been performed 3 years before and she had still type II diabetes mellitus, hyperlipidemia, and hypertension as pre-existing conditions. She was hospitalized in our hospital on March/20/2020, and still had fever after admission, with the highest temperature of 39.5 °C, heart rate of 119 beats per minute; the electrocardiography was consistent with sinus tachycardia and QTc was calculated at 0.398 seconds, blood pressure at 94/60 mmHg, and conspicuous tachypnea with a respiratory rate of 24/min with sufficient oxygenation (95% ambient air saturation). The identification of 2019 novel coronavirus (2019-nCoV) in RT-PCR was positive from a throat swab. The risk of simultaneous contamination with other respiratory viruses and other pathogens were negative for the throat swab. The CT characteristics of the patient were similar to the case series reported by Pan et al. (). Laboratory results showed leukopenia, with 4.1×10/L, lymphopenia with 0.8×10/L, an only slightly increased CRP level, with 18.4 mg/L and a low procalcitonin level, with 0.01 ng/mL. The patient underwent a TTE examination with a 3.5-MHz transducer (Vivid-7 GE Medical System, Horten, Norway). Examinations and measurements were performed according to the recommendations of the American Echocardiography Unit. Simpson’s method was used to calculate LVEF. At the admission, LVEF was calculated at 65%, with normal TTE findings.

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Anatomopathological Correlation

Case 3/2019 – Young Male with Intense Dyspnea, Pulmonary Infiltrate, Normal Cardiac Area and Obliteration of the Apical Portion of the Left Ventricle

Victor Sarli Issa et al. Luiz Alberto Benvenuti

Clinical aspects

This is the case of a young, male patient, smoker, who had hypothyroidism post-treatment with radioactive iodine, who sought medical care due to symptoms of dyspnea and cough for a week; these complaints had been preceded by chest pain at exertion two weeks before. The medical evaluation at the first consultation was notable for the presence of tachycardia and mild leukocytosis in the whole blood count.

The chest X-ray was normal despite the presence of dyspnea at rest. Interestingly, the ECG performed during a routine medical evaluation 11 months before symptom onset showed signs suggestive of heart disease, with left chamber overload.

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Anatomopathological Correlation

Case 3/2018 – A 60-year-old Female with Chagasic Heart Disease, Admitted Due to Heart Failure Decompensation, Cachexia and Pulmonary Infection

Gustavo Alonso Arduine et al. Vera Demarchi Aiello

Clinical aspects

This 60-year-old patient had the following problems: dyspnea, dry cough, weight loss, slightly elevated body temperature, anemia, enlarged pulmonary hila, hilar calcifications (lymph nodes) and pulmonary nodule (granuloma with necrosis). In addition, she had the following antecedents: Chagas disease (not confirmed, because no serology for Chagas disease was performed), systemic arterial hypertension, heart failure with reduced ejection fraction, and previous akinetic areas, apical aneurysm and sustained ventricular tachycardia.

Of the granulomatous diseases, sarcoidosis has unspecific symptoms, such as fever, weight loss, nocturnal sweating and fatigue. Other symptoms depend on the organs or parts of the body affected, such as the lungs (dry cough, dyspnea, chest pain), eyes (eye pain, blurred vision), skin, musculoskeletal system (joint pain, myalgias) and lymph nodes (swelling). Although heart involvement is diagnosed in 5% to 10% of the cases, on postmortem examination, it can range from 10% to 76%, causing bundle-branch block, repolarization disorders, arrhythmias and cardiomyopathy.^, Isolated cardiac sarcoidosis can occur in up to 25% of the cases; thus, absence of extracardiac sarcoidosis does not exclude heart involvement.^,

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Artigo Original

Influenza and pneumococcal vaccination in heart failure: a little applied recommendation

Wolney de Andrade Martins et al. Margarete Domingues Ribeiro Lucia Brandão de Oliveira Luciana da Silva Nogueira de Barros … Ana Cristina da Silva Moreira Jorge Camila Mirante dos Santos Daniella de Paiva Almeida Isaías Fiuza Cabral Renata Tavares de Souza Thyago Antônio Biagioni Furquim

BACKGROUND: Heart failure (HF) is associated with frequent decompensation and admissions to the emergency service. Influenza (INF) and Pneumococcal (pneumonia) vaccinations are recommended in the guidelines, however, respiratory infections are the third leading cause of hospitalization in heart failure. OBJECTIVE: To assess the frequency of vaccination against INF and PNM in patients with HF in government healthcare units. METHODS: An observational study carried out in Teresópolis, a mountain region in Rio de Janeiro, employed three strategies: (I) study of requests for vaccine against INF and/or PNM in the Health Department of Teresópolis between 2004 and 2006; (II) direct inquiry to 61 patients with heart failure treated in primary care about their vaccination status against INF and PNM; (III) direct inquiry about their vaccination status against INF and PNM to 81 patients with decompensated chronic heart failure treated in the only emergency service open to the public. RESULTS: In strategy I, INF and/or PNM vaccination was 15.3% of those with indications for cardiovascular and respiratory diseases. The median time between indication and vaccination was 32 days. In strategy II, the percentage of patients vaccinated against INF, aged > 60, was 23.1% and 24.6% against PMN at all ages. In strategy III, the percentage of patients vaccinated against INF was 35.8% and against PNM was 2.5%. CONCLUSION: The rate of vaccination against INF and PNM in patients with HF is very low and even lower in those with decompensated HF treated in emergency services.

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Case Report

Influenza A (H1N1) pneumonia in an immunossupressed patient after heart transplantation

Fernando Bacal et al. Luis Fernando Seguro Tania Ogawa Sandrigo Mangini … Alfredo Fiorelli Edimar Bocchi

The role of the immune response during Influenza H1N1 virus infection is not yet fully established, but it is believed that it decisively participates in the severity of the disease as well as in the development of acute respiratory distress syndrome. The role of immunomodulating therapies in the control of viral infections is not a consensus either, and data from the literature defining the indications for their use are lacking. The present report is, to our knowledge, the first on a heart transplant patient who developed H1N1 virus infection and had a favorable outcome, thus generating discussion on the real role of immunosuppressive therapy as a risk factor for the severe form of the disease.

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