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International Cardiovascular Forum Journal
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This is an Open Access Journal

Open Access journal
ISSN (Print) 2409-3424 - ISSN (Online) 2410-2636
Published by Barcaray Publishing

[2 journals]

COVID - 19 - a New Challenging Disease for Intensivists and Cardiologists.
From Basic Science to the Clinical Setting
- Authors: Robert Skalik
  Abstract: A novel coronavirus causing Acute Respiratory Distress Syndrome (SARS-CoV-2) has been considered the cause of a large number of lower respiratory tract infections leading to severe respiratory failure in many cases. However, the evidence-based hospital reports show that the COVID -19 infestation may range from an asymptomatic or minimally symptomatic course with an almost bizarre deterioration of life parameters (“silent hypoxia”) through to critically ill patients with multiple organ failure including that of the lungs, kidneys, nervous system and other organs. Moreover, this coronavirus disease may cause significant lung damage in asymptomatic COVID-19 positive patients who recover at home.The virus enters through the angiotensin-converting enzyme 2 receptor (ACE2) widely expressed in the cardiovascular system and other organs and tissues, which can result in myocardial injury, myocarditis, acute myocardial infarction, heart failure, arrhythmias, brain stroke, acute pleuritis, pneumonia and venous thromboembolic events. COVID -19 - induced failure of some central mechanisms controlling breathing and the circulation may explain the mismatch between the clinical symptoms and the objective physiologic life parameters in many patients treated by intensivists or cardiologists. The severity of coronavirus disease is dependent on numerous factors including the magnitude of the host immune response, the impairment of central and peripheral nervous system, age, co-morbidities (e.g. diabetes, arterial hypertension, obesity, chronic heart failure) and presumably genetic proclivity. A brand-new treatment approach with use of alternative or experimental therapies such us Extracorporeal Membrane Oxygenation (ECMO), plasmapheresis, proinflammatory interleukins - targeted drugs, covalescent plasma transfusion, virus replication inhibitors is obviously needed in some COVID-19 patients.
  PubDate: 2020-08-07
  DOI: 10.17987/icfj.v20i0.683
  Issue No: Vol. 20 (2020)
Association of COVID-19 and Cancer: Risk Statistics and Management of
COVID-19 in Cancer Patients
- Authors: Shahzar Khan, Hasnain Jan, Shah Faisal, Ayyaz Khan, Rashida Ilyas, Khadija Bibi, Sadeeq ur Rehman
  Abstract: COVID-19 is extremely lethal disease and almost 190 countries is suffering from the latest pandemic. The literature indicates that COVID-19 is more prevalent in patients with compromised immune systems. Patients with cancer are particularly vulnerable to COVID-19 because of immune compromised condition due to immunosuppressive therapy. Immunotherapy results in mixing or overlap of COVID-19 associated pneumonia and immune-related pneumonitis and thus makes the diagnosis process very confusing. On the other side in this pandemic, treating cancer patients in hospital will bring a lot of risk. There is still no strong evidence on the cancer-COVID-19 connection. Yet, in this pandemic, patients with cancer should be treated as special cases. Risk management is highly needed in the critical time of this pandemic. This review highlights the association between COVID-19 and cancer, also the strategy to minimize the risk of COVID-19 in cancer patients.
  PubDate: 2020-08-07
  DOI: 10.17987/icfj.v20i0.691
  Issue No: Vol. 20 (2020)
A Perspective Study on Oral-fecal Transmission of COVID-19, its Prevention
and Management
- Authors: Abdullah Abdullah, Shah Faisal, Hasnain Jan, Rimsha Zainab, Ayyaz Khan, Anees ur Rahman, Baseerat Bibi, Hania Ishaq
  Abstract: The novel coronavirus outbreak arose in Wuhan, China in Dec, 2019. It is declared the 6th public health emergency by the WHO and named as COVID-19. SARS-CoV-2 is non-segmented positive sense ssRNA virus, belongs to the Coronaviridae under the Nidovirales and spread largely in human being and other mammals. Person to person, airborne and surface transmission is common, the virus gets entered to host through nose, mouth, eyes, food, water and feces. An infected patient can transmit the virus to 2.2 healthy individuals. A patient in the US showed gastrointestinal symptoms vomiting, nausea and pass loose stools. Later the patient declared positive for SARS-CoV-2 based on viral detection in stools and respiratory samples. The gastrointestinal symptoms like diarrhea, nausea, vomiting, abdominal discomfort and detection of SARS-CoV-2 in stools of infected and recovered patients indicates potential oral-fecal transmission route, it could be potential risk for the spread of COVID-19. The flatus is gas produced by aerophagia or bacterial fermentation in intestine and expelled out through esophagus or anus. It consists of Hydrogen, Oxygen, Nitrogen, Carbon dioxide and Methane, their percentage composition is 99%. Previous study showed that bacteria can transmit through bare-bottom farting. The gastrointestinal manifestation and possible oral-fecal transmission, the flatulence could be the risk of transmission for COVID-19. Personal hygiene must be adapted to prevent the spread of disease.
  PubDate: 2020-08-07
  DOI: 10.17987/icfj.v20i0.695
  Issue No: Vol. 20 (2020)
Covid-19 And Co-Infections: An Overview Of Ace2 Mediated Viral Entry Of
Sars-Cov-2 And Multiorgan Failure In Covid-19
- Authors: Shah Faisal, Shahzar Khan, Muhammad Ajmal, Hasnain Jan, Muhammad Taj Akbar, Rashida Ilyas, Khadija Bibi, Sadeeq ur Rehman
  Abstract: COVID-19 is highly fatal disease having high mortality rate and is declared as pandemic situation by world health organization. It shows a clear indication that every individual is at risk of this pandemic especially older individual and immunocompromised persons. As its casual agent is SARS-Cov-2 and the main target site of this virus is the ACE2 receptor of lungs. But as compared to lungs ACE2 receptor is highly expressed in other organs i.e. kidney, liver, brain, GI tract, cutaneous, adipose tissues and cardiovascular system these organs are susceptible to COVID-19 infections because of having ACE2 receptor. Many co-infections associated with COVID-19 are reported i.e. neurological manifestation of COVID-19, cutaneous manifestations of COVID-19, endothelial cell infection and endotheliitis, adipose tissues infections, cerebral hemorrhage, liver injury, cardiovascular complications, kidney infection, trigger immune system response and subsequent organ failure. In this review we highlight ACE2 mediated viral entry of the SARS-Cov-2 and subsequent multi organ failure in COVID-19.
  PubDate: 2020-08-07
  DOI: 10.17987/icfj.v20i0.693
  Issue No: Vol. 20 (2020)
Predictors of Mortality and Associated Lactate Trends in Cardiogenic Shock
Patients Treated with Impella® Placement - A Single Center Experience
- Authors: Yong Ji, Amar Desai, Gary E. Fraser, Deepika Narasimha, Islam Abudayyeh, Kenneth R. Jutzy, Anthony A. Hilliard
  Abstract: Background: The Impella® devices have increasingly become a desired treatment option for cardiogenic shock (CS) as demonstrated by studies analyzing real-world use of hemodynamic support devices. However, data regarding outcomes after Impella® device implant and optimal timing of device placement remains scarce. This study investigates prognostic factors including serial lactate levels in CS patients treated with Impella®.Methods: This retrospective study reviewed 76 consecutive patients diagnosed with CS supported with Impella® at a large, tertiary-care university medical center. Clinical variables and outcomes examined include co-morbidities, pre- and post-procedural lactate levels, and mortality.Results: Of the 76 patients requiring an Impella®, 70% of patients survived to hospital discharge. Those who died post-device implant had a higher prevalence of hyperlipidemia (HLD), chronic kidney disease (CKD), and more likely to require multiple (>1) vasopressors. The mean pre-procedural lactate levels were significantly higher (5.86 +/- 5.11 vs 2.16 +/- 1.50, p = 0.01) in the population who died, along with the change in lactate levels (1.90 +/- 2.56 vs -0.40 +/- 1.73, p=0.04). Those who died within 24 hours of implant showed a trend toward higher mean pre-procedural lactate levels (8.46 +/- 6.00 vs 3.86 +/- 3.31, p = 0.12).Conclusions : Higher pre-procedural lactate levels, HLD, CKD, and increased vasopressor requirement were predictive of increased mortality in CS patients post-Impella® placement, especially within 24 hours of implant. Through serial lactate measurements, we demonstrated favorable outcomes in patients with early stabilization or greater lowering of post-procedural lactate levels suggestive of improved end organ perfusion.
  PubDate: 2020-08-07
  DOI: 10.17987/icfj.v20i0.673
  Issue No: Vol. 20 (2020)
Prevalence of Left Ventricular Dysfunction and Relationship with Serum
Selenium in Apparently Healthy Pregnant Women: Results from the PEACE
Registry
- Authors: Kamilu Musa Karaye, Idris Y Mohammed, Hadiza Sa'idu, Naser A Ishaq, Suleiman A Balarabe, Jamilu Tukur, Tewogbade Adedeji, Olufemiwa N Makinde, Rasaaq A Adebayo
  Abstract: Background: The study aimed to determine the prevalence of left ventricular (LV) systolic and diastolic dysfunction in apparently healthy pregnant women and if there is relationship with serum selenium, in a society with high prevalence of peripartum cardiomyopathy (PPCM).Methods: This was a prospective longitudinal study carried out in 3 centres in Kano, Nigeria. 108 apparently healthy pregnant women were consecutively recruited between the 28th and 38th weeks of gestation and re-evaluated at the 6th to 8th weeks postpartum. Serum selenium was measured at enrolment during pregnancy. LV systolic dysfunction was defined as LV ejection fraction (LVEF) below 50%. Results: LV systolic dysfunction and diastolic dysfunction were found in 6 subjects (5.6%) and 20 subjects (18.5%) during pregnancy, and in 9 subjects (10.2%) (p=0.340) and 14 (15.9%) (p=0.631) after delivery, respectively. Mean LVEF was 62.2±6.9% and 60.6±8.2% (p=0.108) during pregnancy and after delivery respectively. Selenium deficiency (<70μg/L) was found in only 2.8% of subjects, and serum selenium did not significantly correlate with indices for LV systolic (LVEF) or diastolic (mitral E/e’ ratio) functions both during pregnancy and after delivery. Conclusion: LV systolic and diastolic dysfunction and selenium deficiency were uncommon during apparently healthy pregnancy and early puerperium, and serum selenium did not correlate with indices for LV function, in a population with high prevalence of PPCM.
  PubDate: 2020-08-07
  DOI: 10.17987/icfj.v20i0.687
  Issue No: Vol. 20 (2020)
An Unexpected Case of Isolated Left Ventricular Apical Hypoplasia in an
Asymptomatic Patient
- Authors: Rachel Anne Xuereb, Sara Xuereb, Tiziana Felice, Mariosa Xuereb, Alex Borg
  Abstract: Isolated left ventricular (LV) apical hypoplasia is a rare type of congenital heart disease. It is often asymptomatic in childhood but may lead to complications later on in life. The proposed mechanism is inadequate LV dilatation during development of the primitive ventricle, resulting in a spherical LV. To our knowledge, we describe for the first time a case of isolated LV apical hypoplasia in an asymptomatic patient, diagnosed on investigation of an abnormal 12-lead resting electrocardiogram (ECG).
  PubDate: 2020-08-07
  DOI: 10.17987/icfj.v20i0.675
  Issue No: Vol. 20 (2020)
Heart Rate Variability in a Patient with Coronavirus Disease 2019
- Authors: Reiner Buchhorn, Christoph Baumann, Christian Willaschek
  Abstract: This case study investigates the heart rate (HR) and heart rate variability (HRV) in a patient with coronavirus disease 2019 (COVID-19). We report the case of a 58-year old male who contracted COVID-19. During his disease, 24-hour Holter electrocardiography (ECG) was performed continuously. For comparison, his 24-hour Holter ECGs from the previous 10 years were available. In this patient, COVID-19 was associated with a decrease in HR and a paradoxical decline in HRV. An abrupt decline in HRV and a decrease in HR may signal the onset of COVID-19 before common symptoms such as dry cough or fever appear. In addition, HRV and HR measurements may help to evaluate the course of the disease.
  PubDate: 2020-08-07
  DOI: 10.17987/icfj.v20i0.685
  Issue No: Vol. 20 (2020)
An Asymptomatic Left Ventricular Pseudoaneurysm found incidentally at 12
months post Myocardial Infarction: Case Report and Review of the
Literature
- Authors: Christian Brooks, Heather Cooke
  Abstract: Highlights: Left ventricular pseudoaneurysms are a rare mechanical complication of myocardial infarction. If found acutely following infarction (within 2 weeks, with some advocating up to 3 months), surgical repair is recommended due to their high risk of rupture.Whilst associated with chest pain, dyspnoea and heart failure, some individuals are asymptomatic, with the diagnosis made incidentally on routine follow-up often months to years post infarction. Less is known about the natural history of these chronic pseudoaneurysms, with concerns around their propensity to rupture perhaps less than the mortality risk of surgical repair.We present the case of a 70 year-old asymptomatic man who was found to have a 1.6cm left ventricular pseudoaneurysm found incidentally on routine transthoracic echocardiogram at 12-months post posterior myocardial infarction.The consensus opinion of our institution's multi-disciplinary team regarding further management of this patient, with reference to the current limited data on chronic pseudoaneurysms, will be discussed.
  PubDate: 2020-08-07
  DOI: 10.17987/icfj.v20i0.697
  Issue No: Vol. 20 (2020)