- Original Article
Cardiovascular Outcomes in Nova Scotia During the Early Phase of the COVID-19 Pandemic
This study sought to determine the impact of the COVID-19 pandemic response to healthcare delivery on outcomes in patients with cardiovascular disease. - Case Reports
Recurrence of Myopericarditis Following mRNA COVID-19 Vaccination in a Male Adolescent
COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease has spread worldwide, resulting in health and economic crises. Vaccination against SARS-CoV-2 infection is considered a valid prevention measure to control this pandemic. There have been reports of cases of myopericarditis following mRNA COVID-19 vaccination. We present a case of a 20-year-old man with recurrent myopericarditis following an initial episode of influenza virus–induced myopericarditis and after a second dose of the mRNA-1273 Moderna COVID-19 vaccine. - Case Reports
Utility of Oral Quinine Sulfate for the Treatment of Brugada Syndrome Presenting as Electrical Storm in Remote Areas: Resilience in the COVID-19 Era
Electrical storm is a malignant presentation of Brugada syndrome (BrS). Pharmacologic antiarrhythmic therapy is mandatory for this condition, followed by implantation of an implantable cardioverter–defibrillator to prevent sudden cardiac death. We report a case of a BrS patient presenting with electrical storm in a remote area. A referral to tertiary healthcare services was turned down due to the capacity demands of COVID-19 cases. Oral quinine was used as a bailout therapy and successfully maintained the arrhythmia suppression. - Case Reports
Recurrent Chest Pain After COVID-19: Diagnostic Utility of Cardiac Magnetic Resonance Imaging
We report a case of myocarditis in an adult patient with recent coronavirus disease 2019 (COVID-19) infection presenting as recurrent ST-segment elevation, mimicking coronary vasospasm. This case highlights the wide range of presentations of COVID-19–related myocarditis. The novel teaching point is that COVID-19 myocarditis can present with acute manifestations such as chest pain and transient ST-segment elevation even several weeks after complete recovery from the initial infection. Cardiac magnetic resonance imaging should be considered in patients with chest pain syndromes and angiographically normal coronary arteries, as the presence of late gadolinium enhancement and a high T2 signal can be diagnostic. Acute Myocarditis Following mRNA-1273 SARS-CoV-2 Vaccination
Myocarditis has been described previously as a rare side effect of both influenza and smallpox vaccines. In this report, we present a case of acute perimyocarditis in a young, healthy man after vaccination with the mRNA-1273 severe acute respiratory syndrome coronavirus -2 (SARS-CoV-2; Moderna) vaccine. He presented with chest pain and decompensated heart failure 3 days after administration of his second dose, and his symptoms resolved by 9 days post-inoculation. This case highlights a rare but potentially serious side effect of this mRNA vaccine that primary care physicians and cardiologists should be aware of in order to identify and appropriately manage these patients.- Review
Cardiovascular and Renal Risk Factors and Complications Associated With COVID-19
The current COVID-19 pandemic, caused by the severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus, represents the largest medical challenge in decades. It has exposed unexpected cardiovascular vulnerabilities at all stages of the disease (pre-infection, acute phase, and subsequent chronic phase). The major cardiometabolic drivers identified as having epidemiologic and mechanistic associations with COVID-19 are abnormal adiposity, dysglycemia, dyslipidemia, and hypertension. Hypertension is of particular interest, because components of the renin–angiotensin system (RAS), which are critically involved in the pathophysiology of hypertension, are also implicated in COVID-19. - Original Article
Emergency Department Visits, Care, and Outcome After Stroke and Myocardial Infarction During the COVID-19 Pandemic Phases
It is not known if initial reductions in hospitalization for stroke and myocardial infarction early during the coronavirus disease–2019 pandemic were followed by subsequent increases. We describe the rates of emergency department visits for stroke and myocardial infarction through the pandemic phases. - Original Article
Postoperative Nosocomial COVID-19 Infection in Cardiac Surgery: An Uncommon Event With High Mortality Rate
The COVID-19 pandemic has had a major impact on cardiac surgery patients. Significant reductions in access to surgical treatment have forced surgeons to prioritise patients and follow strict COVID-19 protocols to protect surgeons, staff, and patients. Adult cardiac surgery and the COVID-19 pandemic: aggressive infection mitigation strategies are necessary in the operating room and surgical recovery. Nosocomial infections among cardiac surgery patients have been reported and are associated with a high mortality rate. - Emerging Evidence
An Evaluation of Cardiology Virtual Care During the COVID-19 Pandemic
A survey evaluation was conducted in the division of cardiology at a tertiary care academic centre to assess barriers, facilitators, acceptability, and feasibility of virtual care during the COVID-19 pandemic. Survey responses from 26 health care providers, 45 patients, and 2 caregivers showed that virtual visits (primarily by telephone) were feasible and generally acceptable to most respondents. Key opportunities for improvement included availability of easy-to-use video platforms, space and equipment in clinics, provision of information to patients before visits, and appropriate selection of patients for virtual visits. - Review
Takotsubo Syndrome During the COVID-19 Pandemic: State-of-the-Art Review
The current coronavirus disease 2019 (COVID-19) presents an ongoing medical challenge, as it involves multiple organs, including the cardiovascular system. Takotsubo syndrome (TTS) has been described in the context of COVID-19 in 2 different scenarios: as a direct complication of the infection, and as an indirect outcome secondary to the psychological burden of quarantine and social isolation (ie, stress-induced cardiomyopathy). Confirming the diagnosis of TTS in COVID-19 may be challenging due to the limited use of coronary angiography consistent with the recommended guidelines aimed at minimizing contact with infected individuals. - Original Article
Rate of COVID-19 Infection in Patients With ST-Segment Elevation Myocardial Infarction
The incidence of coronavirus disease 2019 (COVID-19) in patients with ST-segment elevation myocardial infarction (STEMI) has not been fully described. - Original Article
The COVID-19 Pandemic and Coronary Angiography for ST-Elevation Myocardial Infarction, Use of Mechanical Support, and Mechanical Complications in Canada: A Canadian Association of Interventional Cardiology National Survey
As a result of the COVID-19 pandemic first wave, reductions in ST-elevation myocardial infarction (STEMI) invasive care, ranging from 23% to 76%, have been reported from various countries. Whether this change had any impact on coronary angiography (CA) volume or on mechanical support device use for STEMI and post-STEMI mechanical complications in Canada is unknown. - Review
Classical and Counter-Regulatory Renin–Angiotensin System: Potential Key Roles in COVID-19 Pathophysiology
In the current COVID-19 pandemic, severe acute respiratory syndrome coronavirus 2 uses angiotensin-converting enzyme-2 (ACE-2) receptors for cell entry, leading to ACE-2 dysfunction and downregulation, which disturb the balance between the classical and counter-regulatory renin–angiotensin system (RAS) in favor of the classical RAS. RAS dysregulation is one of the major characteristics of several cardiovascular diseases; thus, adjustment of this system is the main therapeutic target. RAS inhibitors—particularly angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II type 1 receptor blockers (ARBs)—are commonly used for treatment of hypertension and cardiovascular disease. - Systematic Review/Meta-Analysis
Angiotensin Receptor Blockers and Angiotensin-Converting Enzyme Inhibitors in COVID-19: Meta-analysis/Meta-regression Adjusted for Confounding Factors
Angiotensin receptor blockers (ARBs) and/or angiotensin-converting enzyme (ACE) inhibitors could alter mortality from coronavirus disease 2019 (COVID-19), but existing meta-analyses that combined crude and adjusted results may be confounded by the fact that comorbidities are more common in ARB/ACE inhibitor users. - Original Article
Cardiovascular Physicians, Scientists, and Trainees Balancing Work and Caregiving Responsibilities in the COVID-19 Era: Sex and Race-Based Inequities
The ongoing COVID-19 pandemic has exposed a work-life (im)balance that has been present but not openly discussed in medicine, surgery, and science for decades. The pandemic has exposed inequities in existing institutional structure and policies concerning clinical workload, research productivity, and/or teaching excellence inadvertently privileging those who do not have significant caregiving responsibilities or those who have the resources to pay for their management. - Original Article
Delays in ST-Elevation Myocardial Infarction Care During the COVID-19 Lockdown: An Observational Study
Management of ST-elevated myocardial infarction (STEMI) necessitates rapid reperfusion. Delays prolong myocardial ischemia and increase the risk of complications, including death. The COVID-19 pandemic may have affected management of STEMI. We evaluated the relative volume of hospitalizations and clinical time intervals within a regional STEMI system. - Original Article
Acute Coronary Syndrome in the Era of SARS-CoV-2 Infection: A Registry of the French Group of Acute Cardiac Care
In this study, we aimed to report clinical characteristics and outcomes of patients with and without SARS-CoV-2 infection who were referred for acute coronary syndrome (ACS) during the peak of the pandemic in France. - Case Reports
Paraneoplastic Syndrome and SARS-CoV-2—Incremental Effect of 2 Thrombogenic Conditions?
We present the case of a patient with a nonbacterial thrombotic aortic valve endocarditis experiencing severe thromboembolic complications and an acute right internal carotid artery occlusion in the context of a paraneoplastic syndrome and an asymptomatic severe acute respiratory syndrome coronavirus-2 infection, despite treatment with different and overlapping anticoagulant medications. Patients with increased thrombogenicity due to an underlying disease might be at increased risk for thrombotic events during a severe acute respiratory syndrome coronavirus-2 infection. - Letters to the Editor
Admission High-Sensitivity Cardiac Troponin vs a Biochemical Score for Predicting Mortality in Patients With COVID-19
Emerging evidence indicates a role for cardiac troponin testing, specifically high-sensitivity cardiac troponin (hs-cTn) in hospitalized patients with coronavirus disease 2019 (COVID-19).1 Undetectable levels of hs-cTn in patients with (and without) COVID-19 may be helpful in identifying a low-risk subgroup, with higher levels useful in identifying patients at high-risk for hospital death.1,2 Further improvements in risk-stratification for emergency department or hospitalized patients may be achieved by adding clinical chemistry tests, such as glucose and creatinine (ie, estimated glomerular filtration rate), to generate a clinical chemistry score (CCS). - Case Reports
Rapid Response to Cytokine Storm Inhibition Using Anakinra in a Patient With COVID-19 Myocarditis
A 62-year-old woman with coronavirus disease 2019 developed acute respiratory failure and cardiogenic shock in the setting of a systemic hyperinflammatory state and apparent ST-elevation myocardial infarction. Cardiac magnetic resonance imaging showed fulminant acute myocarditis with severe left ventricular dysfunction. Treatment with the recombinant interleukin-1 receptor antagonist anakinra and dexamethasone resulted in rapid clinical improvement, reduction in serum inflammatory markers, and a marked recovery in cardiac magnetic resonance–-based markers of inflammation and contractile dysfunction. - Original Article
Cardiac Rehabilitation in Canada During COVID-19
Cardiac rehabilitation programs (CRPs) had to change quickly in response to a shift in clinical priorities related to to the coronavirus disease 2019 (COVID-19). Yet, no study has examined the effect of COVID-19 on CRPs and if there has been an adequate transition to alternative programming. - Case Reports
Multiple Arterial Thrombosis in a 78-Year-Old Patient: Catastrophic Thrombotic Syndrome in COVID-19
We describe a patient with coronavirus disease 2019 (COVID-19) and multiple concomitant thromboses occurring on the 9th day of hospital stay. Thromboses were found in distinct zones of the aorta, as well as in the renal, humeral, and pulmonary arteries. The extensive biological workup performed following this catastrophic thrombotic syndrome found no evidence for underlying prothrombotic disease. In light of current evidence regarding endothelium abnormalities related to COVID-19, this extreme case of catastrophic thrombotic syndrome suggests that COVID-19 can induce severe arterial thrombosis following intense endothelial activation. - Case Report
Left Ventricular Thrombus With COVID-19 Complication in a Patient With Dilated Cardiomyopathy
Thrombosis, especially venous thromboembolism, is a complication often associated with coronavirus disease 2019 (COVID-19). However, there have been relatively few reports of arterial thrombosis. Here, we describe a case of non-severe COVID-19 in a patient with dilated cardiomyopathy. After admission, symptoms, laboratory data, and imaging findings improved, but D-dimer levels gradually increased. Contrast computed tomography and echocardiography revealed a left ventricular thrombus. Anticoagulant treatment diminished the thrombus, and the patient recovered and was discharged. - Original Article
Impact of Right Ventricular Dysfunction on Mortality in Patients Hospitalized With COVID-19, According to Race
Epidemiologic studies suggest that Black, Asian, and minority ethnic (BAME) patients may be at risk of worse outcomes from coronavirus disease-2019 (COVID-19), but the pathophysiological drivers for this association are unknown. This study sought to investigate the relationship between findings on echocardiography, mortality, and race in COVID-19 pneumonia. - Original Article
Management of Multisystem Inflammatory Syndrome in Children Associated With COVID-19: A Survey From the International Kawasaki Disease Registry
Since April 2020, there have been numerous reports of children presenting with systemic inflammation, often in critical condition, and with evidence of recent infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This condition, since defined as the multisystem inflammatory syndrome in children (MIS-C), is assumed to be a delayed immune response to coronavirus disease 2019 (COVID-19), and there are frequently cardiac manifestations of ventricular dysfunction and/or coronary artery dilation.
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