A Rare Case Report of Saddle Embolism in the Abdominal Aorta Following Acute Myocardial Infarction

Background and Objective: Systemic embolism can be one of the unfortunate side effects of left ventricular thrombus following acute heart infarction, and its timely diagnosis and treatment is very important. In this report, a patient with saddle embolism in the abdominal aorta due to the complete separation of the left ventricular thrombus following acute anterior infarction is presented. Case Report: The patient is a 60-year-old man who referred to the emergency room complaining of severe retrosternal chest pain, nausea and cold sweats. In the ECG, he had ST segment elevation in leads V1-V5, and with the diagnosis of acute anterior infarction with ST segment elevation (acute anterior STEMI), he underwent primary angioplasty with stent placement (Primary PCI) on the left anterior descending artery. In transthoracic echocardiography three days later, a large thrombus was seen in the apex of the left ventricle. Seven days after stent implantation, the patient experienced severe pain and paraplegia of the lower limbs. In Doppler ultrasound, bilateral iliac artery occlusion was seen. Despite treatment with aspirin, clopidogrel, and anticoagulants, the left ventricular thrombus was embolized to the bifurcation of the abdominal aorta and caused bilateral acute ischemia of the lower limbs. The patient underwent emergency embolectomy and was discharged one week later with a stable condition and two antiplatelets and warfarin. Three months later, warfarin was discontinued. Conclusion: According to this case report, abdominal aortic saddle embolism following acute myocardial infarction may rarely be seen. Paying attention to clinical symptoms, careful examination and quick diagnosis and treatment can improve the prognosis. In any patient with a left ventricular thrombus following an acute myocardial infarction, the possibility of systemic embolism should be considered

Imaging data in COVID-19 patients: focused on echocardiographic findings

To assess imaging data in COVID-19 patients and its association with clinical course and survival and 86 consecutive patients (52 males, 34 females, mean age = 58.8 year) with documented COVID-19 infection were included. Seventy-eight patients (91) were in severe stage of the disease. All patients underwent transthoracic echocardiography. Mean LVEF was 48.1 and mean estimated systolic pulmonary artery pressure (sPAP) was 27.9 mmHg. LV diastolic dysfunction was mildly abnormal in 49 patients (57.6) and moderately abnormal in 7 cases (8.2). Pericardial effusion was present in 5/86 (minimal in size in 3 cases and mild- moderate in 2). In 32/86 cases (37.2), the severity of infection progressed from �severe� to �critical�. Eleven patients (12.8) died. sPAP and computed tomography score were associated with disease progression (P value = 0.002, 0.002 respectively). Tricuspid annular plane systolic excursion (TAPSE) was significantly higher in patients with no disease progression compared with those who deteriorated (P value = 0.005). Pericardial effusion (minimal, mild or moderate) was detected more often in progressive disease (P = 0.03). sPAP was significantly lower among survivors (P value = 0.007). Echocardiographic findings (including systolic PAP, TAPSE and pericardial effusion), total CT score may have prognostic and therapeutic implication in COVID-19 patients. © 2021, The Author(s), under exclusive licence to Springer Nature B.V. part of Springer Nature

A Rare Case Report of Saddle Embolism in the Abdominal Aorta Following Acute Myocardial Infarction

Background and Objective: Systemic embolism can be one of the unfortunate side effects of left ventricular thrombus following acute heart infarction, and its timely diagnosis and treatment is very important. In this report, a patient with saddle embolism in the abdominal aorta due to the complete separation of the left ventricular thrombus following acute anterior infarction is presented. Case Report: The patient is a 60-year-old man who referred to the emergency room complaining of severe retrosternal chest pain, nausea and cold sweats. In the ECG, he had ST segment elevation in leads V1-V5, and with the diagnosis of acute anterior infarction with ST segment elevation (acute anterior STEMI), he underwent primary angioplasty with stent placement (Primary PCI) on the left anterior descending artery. In transthoracic echocardiography three days later, a large thrombus was seen in the apex of the left ventricle. Seven days after stent implantation, the patient experienced severe pain and paraplegia of the lower limbs. In Doppler ultrasound, bilateral iliac artery occlusion was seen. Despite treatment with aspirin, clopidogrel, and anticoagulants, the left ventricular thrombus was embolized to the bifurcation of the abdominal aorta and caused bilateral acute ischemia of the lower limbs. The patient underwent emergency embolectomy and was discharged one week later with a stable condition and two antiplatelets and warfarin. Three months later, warfarin was discontinued. Conclusion: According to this case report, abdominal aortic saddle embolism following acute myocardial infarction may rarely be seen. Paying attention to clinical symptoms, careful examination and quick diagnosis and treatment can improve the prognosis. In any patient with a left ventricular thrombus following an acute myocardial infarction, the possibility of systemic embolism should be considered

Worldwide Survey of COVID-19-Associated Arrhythmias

Background: Coronavirus disease 2019 (COVID-19) has led to over 1 million deaths worldwide and has been associated with cardiac complications including cardiac arrhythmias. The incidence and pathophysiology of these manifestations remain elusive. In this worldwide survey of patients hospitalized with COVID-19 who developed cardiac arrhythmias, we describe clinical characteristics associated with various arrhythmias, as well as global differences in modulations of routine electrophysiology practice during the pandemic. Methods: We conducted a retrospective analysis of patients hospitalized with COVID-19 infection worldwide with and without incident cardiac arrhythmias. Patients with documented atrial fibrillation, atrial flutter, supraventricular tachycardia, nonsustained or sustained ventricular tachycardia, ventricular fibrillation, atrioventricular block, or marked sinus bradycardia (heart rate<40 bpm) were classified as having arrhythmia. Deidentified data was provided by each institution and analyzed. Results: Data were collected for 4526 patients across 4 continents and 12 countries, 827 of whom had an arrhythmia. Cardiac comorbidities were common in patients with arrhythmia: 69% had hypertension, 42% diabetes, 30% had heart failure, and 24% had coronary artery disease. Most had no prior history of arrhythmia. Of those who did develop an arrhythmia, the majority (81.8%) developed atrial arrhythmias, 20.7% developed ventricular arrhythmias, and 22.6% had bradyarrhythmia. Regional differences suggested a lower incidence of atrial fibrillation in Asia compared with other continents (34% versus 63%). Most patients in North America and Europe received hydroxychloroquine, although the frequency of hydroxychloroquine therapy was constant across arrhythmia types. Forty-three percent of patients who developed arrhythmia were mechanically ventilated and 51% survived to hospital discharge. Many institutions reported drastic decreases in electrophysiology procedures performed. Conclusions: Cardiac arrhythmias are common and associated with high morbidity and mortality among patients hospitalized with COVID-19 infection. There were significant regional variations in the types of arrhythmias and treatment approaches