Tag Archives: COVID-19

In the midst of the first wave of the COVID-19 pandemic in the United Kingdom, we observed new-onset systolic hypertension associated with hypernatraemia and hypokalaemia with normal serum urea among hospitalised patients. We investigated two patients and found elevated urinary potassium (without causal drugs) and hyporeninaemic hypoaldosteronism (plasma renin <0.2 nmol/L/hr [reference range: 0.5–3.5 nmol/L/hr] and aldosterone <60 pmol/L [reference range: 60–250 pmol/L]) in both. Congenital and secondary endocrine causes of hypertension were excluded. We treated one of the patients with amiloride, which resulted in normalisation of

Introduction T-wave oversensing (TWOS) is a well-recognised phenomenon encountered in cardiac implantable electronic devices (CIEDs), particularly in high-energy platforms.1 TWOS occurs when the ventricular repolarisation signal, corresponding to the surface ECG T-wave, is mistakenly identified as a de novo depolarisation by the device. The principal effect of this is to ‘double count’ the heart rate. This may lead the device to mistakenly register a ventricular rate high enough to reach the threshold for detection of a tachycardic episode, which may in turn precipitate the CIED to inappropriately discharge. TWOS may be seen for a number

Introduction In late 2019, the first case of a patient with pneumonia of unknown cause was reported in Wuhan, China. The disease, called coronavirus disease 2019 (COVID-19), spread rapidly and caused a pandemic. The virus that causes this infection is called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1 Besides respiratory tract disease, which is considered the main and most common clinical manifestation of COVID-19, other systems, including the cardiovascular system, could also be affected. Factors, such as tissue hypoxia, which results as the pneumonia progresses, and inflammation of the vessel walls, have been suggested a

Introduction Cardiac rehabilitation (CR) is a multi-factorial intervention incorporating education, physical activity and psychosocial support to address the risk factors for cardiovascular disease (CVD) and improve health behaviour.1,2 A recent Cochrane review evaluating 85 randomised-controlled trials concluded that the benefits of exercise-based CR include reduced mortality, lowering hospital admissions, and may improve health-related quality of life.3 Research by Hinde et al. suggests the achievement of 85% engagement in CR could see a reduction of 49,000 hospital admissions and 19,500 fewer deaths over 10 years, saving millions in costs

Introduction Myocarditis is a known complication of COVID-19, however, recently concerns have been raised regarding myocardial injury in the presence of a substantial coronary thrombus burden, in combination with atherosclerotic plaque.1,2 Widespread community transmission of COVID-19 has led to some presentations of myocardial infarction associated with active COVID-19 infection.1 We present the angiographic findings of such a case with a heavy burden of thrombus, despite only minor obstructive coronary disease. Case presentation A 36-year-old man was admitted to a local hospital with respiratory failure secondary to COVID-19 pneumonia. Init

Introduction Retrospective studies revealed that vitamin D may protect against severe COVID-19 disease,1,2 and some pilot studies suggest that it even improves prognosis.3,4 The two most widely accepted theories are the vitamin D modulation of immunity and the renin–angiotensin system.5,6 So far, the mechanism of the benefit of vitamin D in COVID-19 remains unknown. Role of ACE2 Angiotensin-converting enzyme 2 (ACE2) converts angiotensin (Ang) II to Ang(1–7) and Ang I to Ang(1–9) (figure 1).7 Ang(1–7) has a very short half-life (<9 seconds), and the release of a soluble catalytic ectodomain of ACE2 (ceACE2) from the vascular endoth

Background The COVID-19 pandemic dramatically affected many aspects of everyday life and necessitated rapid changes to healthcare delivery. Health systems around the world started to rely more heavily upon remote consultations for safe healthcare delivery.1 Despite the clear advantage of limiting movement, and, hence, reducing the risks of either contracting or spreading COVID-19, a transition to remote consultations must be treated with caution. Research in primary care prior to the pandemic found that doctors were less likely to exclude serious illness when consultations were conducted by telephone rather than face-to-face.2 Alongside the s

Case presentation A 45-year-old man presented to the emergency department with a 10-day history of feeling unwell, non-exertional chest tightness, shortness of breath and reduced exercise tolerance. He found no relief with sublingual glyceryl trinitrate and complained of a productive, green cough. A COVID-19 nasopharyngeal assay prior to admission was negative for SARS-CoV-2. Past medical history included type 2 diabetes mellitus, hypertension and stable angina. There was no significant history of tobacco, alcohol or illicit substance use. On examination the patient was haemodynamically stable with positive findings of quiet heart sounds and

Background Heart failure is a common cause of hospital admission in the UK, and the leading cause of admission in people aged 65 years or older.1 Treatment with angiotensin-converting enzyme (ACE) inhibitors (ACEi), angiotensin-receptor blockers (ARB) and beta blockers are associated with reduced morbidity and mortality, while prompt imaging with a transthoracic echocardiogram (TTE) enables earlier diagnosis and appropriate management.2 It has been recommended that a TTE should be done within 48 hours of admission. Coronavirus disease 2019 (COVID-19) was declared as a global pandemic on 11 March 2020,3 and the UK had 491,805 cases by 30 Septe

Introduction Since its appearance in December 2019 in Wuhan (Hubei, China), more than 300 million people worldwide have been infected with the SARS-CoV-2 virus1 (which generates multi-systemic involvement and is an emerging cause of myocardial compromise). This article presents an illustrative case of dilated cardiomyopathy as a complication of viral myocarditis due to SARS-CoV-2. Case presentation Table 1. Most relevant laboratory findings Test Result Reference values Leukocytes 13,400/µL 4,200–10,400/µL Lymphocytes 1,300/µL 300–1,500/µL Haemoglobin 14 g/dL 11.7–15.5 g/dL Platelets 282,000/µL 156,000–373,000/µL