Coronavirus Disease 2019 and Catheterisation Laboratory Considerations: “Looking for Essentials”

The current coronavirus disease 2019 (COVID-19) outbreak is a significant health crisis that impacts every healthcare system worldwide, and has led to a dramatic change in dealing with different diseases during the pandemic. Interventional cardiologists are frontline workers who deal with many cardiovascular emergencies, either in patients with proven COVID-19 or in suspected cases. Many heart associations worldwide are currently setting appropriate recommendations for the management of emergency cardiac interventions. In this expert opinion, the authors highlight the essential requirements in the cardiac catheterisation laboratory during the COVID-19 pandemic

Renal "hyperfiltrators" are at elevated risk of death and chronic diseases

Background: The definition of glomerular hyperfiltration has not been agreed upon and the pathophysiological mechanisms have not been well explored. Low serum creatinine concentrations may be associated with increased risk of coronary heart disease (CHD) or cardiopulmonary events the impact of which needs further study

Torsades de pointes induced by concomitant use of chlorpheniramine and propranolol: An unusual presentation with no QT prolongation

Drug-inducedtorsades de pointes (TdP) is a rare but potentially fatal adverse effect of commonly prescribed medications including cardiac and noncardiac drugs. Importantly, many drugs have been reported to cause the characteristic Brugada syndrome-linked electrocardiography (ECG) abnormalities and/or (fatal) ventricular tachyarrhythmias. Chlorpheniramine and propranolol have the arrhythmogenic effects reported previously. A review of literature revealed a large number of case reports of chlorpheniramine or propranolol use resulting in QTc prolongation, TdP, or both. However, we wish to report the case of a patient who was treated with a combination of chlorpheniramine and propranolol, whose ECG showed no QT prolongation but who suffered from cardiac arrest due to TdP

Coronary Arteriovenous Fistulas in Adult Patients: Surgical Management and Outcomes

Abstract Objective: The aim of this study was to describe the demographic, clinical and anatomic characteristics of coronary arteriovenous fistulas in adult patients who underwent open cardiac surgery and to review surgical management and outcomes. Methods: Twenty-one adult patients (12 female, 9 male; mean age: 56.1±7.9 years) who underwent surgical treatment for coronary arteriovenous fistulas were retrospectively included in this study. Coronary angiography, chest X-ray, electrocardiography and transthoracic echocardiography were preoperatively performed in all patients. Demographic and clinical data were also collected. Postoperative courses of all patients were monitored and postoperative complications were noted. Results: A total of 25 coronary arteriovenous fistulas were detected in 21 patients; the fistulas originated mainly from left anterior descending artery (n=9, 42.8%). Four (19.4%) patients had bilateral fistulas originating from both left anterior descending and right coronary artery. The main drainage site of coronary arteriovenous fistulas was the pulmonary artery (n=18, 85.7%). Twelve (57.1%) patients had isolated coronary arteriovenous fistulas and 4 (19.4%), concomitant coronary artery disease. Twenty (95.3%) of all patients were symptomatic. Seventeen patients were operated on with and 4 without cardiopulmonary bypass. There was no mortality. Three patients had postoperative atrial fibrillation. One patient had pericardial effusion causing cardiac tamponade who underwent reoperation. Conclusion: The decision of surgical management should be made on the size and the anatomical location of coronary arteriovenous fistulas and concomitant cardiac comorbidities. Surgical closure with ligation of coronary arteriovenous fistulas can be performed easily with on-pump or off-pump coronary artery bypass grafting, even in asymptomatic patients to prevent fistula related complications with very low risk of mortality and morbidity

Chlorpheniramine and phenylephrine induced coronary vasospasm manifesting as Kounis syndrome in a patient with moderate mitral stenosis

We report a case of Kounis syndrome (allergic angina) documented with normal coronary arteries on angiography and echocardiographically proved moderate mitral stenosis in a patient with severe chest pain and electrocardiographic ST-segment elevations but with normal troponin levels

Prevalence of metabolic syndrome in young patients with ST-elevation myocardial infarction

Background: Atherosclerotic cardiovascular disease influences young patients as well as the elderly. A large proportion of patients with coronary artery disease (CAD) have metabolic syndrome (MS), although the frequency and association of its different components are not clear. To the best of our knowledge, there is no any study about the prevalence of MS among young patients with ST-elevation myocardial infarction (STEMI). We sought to determine the prevalence of MS in patients below 46 years of age who presented with STEMI and underwent primary percutaneous coronary intervention. Methods: In the present prospective study, 141 consecutive patients with STEMI <46 years of age admitted to intensive coronary care unit. STEMI was defined according to the ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. All patients were grouped presence of MS. In the second step, the components of MS were analyzed, excluding patients with diabetes mellitus (DM). Results: The total prevalence of MS was 46.8% (n = 66). In MS group, the most frequent component of MS was low high-density lipoprotein (HDL) levels (84.8%), followed by elevated triglycerides (TGs) (78.1%). A total of 121 patients did not have DM and 51 (42.1%) of these patients presented with MS. Conclusions: The prevalence of MS in young patients with STEMI is high. Low HDL cholesterol (HDLc) concentrations and high TG levels are cardiovascular risk factors, regardless of low-density lipoprotein cholesterol levels and they are found too often in our study. These results highlight the need to implement preventative strategies for reducing overall cardiovascular risk in young patients as well as elderly

Fragmentacja zespołu QRS w 12-odprowadzeniowym EKG u chorych ze zwolnionym przepływem wieńcowym

Background: Coronary slow flow (CSF) is characterised by delayed opacification of coronary arteries in the absence of epicardial occlusive disease. It has been reported that CSF may cause angina, myocardial ischaemia, and infarction. Fragmentation of QRS complex (fQRS) is an easily evaluated non-invasive electrocardiographic parameter. It has been associated with alternation of myocardial activation due to myocardial scar and/or ischaemia. Whether CSF is associated with fQRS is unknown. The presence of fQRS on ECG may be an indicator of myocardial damage in patients with CSF.Aim: To investigate the presence of fQRS in patients with CSF.Methods: Sixty patients (mean age 55.5 ± 10.5 years) with CSF and 44 patients with normal coronary arteries without associated CSF (mean age 53 ± 8.4 years) were included in this study. The fQRS was defined as the presence of an additional R wave or notching of R or S wave or the presence of fragmentation in two contiguous leads corresponding to a major coronary artery territory.Results: The presence of fQRS was higher in the CSF group than in the controls (p = 0.005). Hypertension was significantly more common in the CSF group (p &lt; 0.001). There was no significant association between the presence of fQRS and an increasing number of vessel involvements. Logistic regression analysis demonstrated that the presence of CSF was the independent determinant of fQRS (OR = 10.848; 95% CI 2.385–49.347; p = 0.002).Conclusions: Fragmented QRS, indicating increased risk for arrhythmias and cardiovascular mortality, was found to be significantly higher in patients with CSF. We have not found an association between the presence of fragmented QRS and the degreeof CSF. Further prospective studies are needed to establish the significance as a possible new risk factor in patients with CSF.Wstęp: Zwolniony przepływ wieńcowy (CSF) cechuje się opóźnieniem opacyfikacji tętnic wieńcowych przy braku zwężeń w tętnicach nasierdziowych. Istnieją doniesienia, że CSF może powodować dławicę, niedokrwienie mięśnia sercowego i zawał serca. Fragmentacja zespołu QRS (fQRS) jest nieinwazyjnym, łatwym do oceny parametrem elektrokardiograficznym. Uważa się, że fQRS stanowi następstwo zmian aktywności mięśnia sercowego spowodowanych przez blizny i/lub niedokrwienie. Nie wiadomo, czy CSF wiąże się z obecnością fQRS. Stwierdzenie fQRS w badaniu EKG może być wskaźnikiem uszkodzenia miokardium u chorych z CSF.Cel: Celem niniejszego badania była ocena występowania fQRS u chorych z CSF.Metody: Do badania włączono 66 pacjentów (średnia wieku 55,5 ± 10,5 roku) z CSF i 44 osób z prawidłowymi tętnicami wieńcowymi, u których nie występowało zwolnienie przepływu wieńcowego (średnia wieku 53 ± 8,4 roku). Defragmentację zespołu QRS definiowano jako obecność dodatkowego załamka R, zawęźlenie załamka R lub S bądź obecność fragmentacji w dwóch sąsiadujących odprowadzeniach odpowiadających obszarowi unaczynienia tętnicy wieńcowej.Wyniki: Obecność fQRS stwierdzano częściej w grupie chorych z CSF niż w grupie kontrolnej (p = 0,005). Nadciśnienie tętnicze występowało istotnie częściej u osób z CSF (p &lt; 0,001). Nie wykazano istotnych zależności między obecnością fQRS a zwiększoną liczbą zajętych naczyń. Na podstawie analizy regresji logistycznej stwierdzono, że CSF była niezależnym czynnikiem determinującym występowanie fQRS (OR = 10,848; 95% CI 2,385–49,347; p = 0,002).Wnioski: Wykazano, ze fQRS, świadcząca o zwiększonym ryzyku zaburzeń rytmu i zgonu z przyczyn sercowo-naczyniowych, występowała istotnie częściej u chorych z CSF. Autorzy nie stwierdzili zależności między występowaniem fQRS a zaawansowaniem CSF. Należy przeprowadzić dalsze prospektywne badania w celu określenia znaczenia fQRS jako potencjalnego nowego czynnika ryzyka u chorych z CSF