Introduction:The ongoing global pandemic, coronavirus disease 2019 (COVID-19), an illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has ranged from an asymptomatic state to unprecedented number of deaths worldwide. In symptomatic patients, a viral pneumonia can unrelentingly progress to multi-system failure with preferential cardiac tropism. Although the full spectrum of COVID-19 cardiac manifestations is still not clear; acute cardiac injury (ACI) remains a common finding. The goal of our study, not only is to examine the current prevalence of ACI among COVID-19 infected patients but also, the reported mortality.Method:After thoroughly searching the literature for appropriate studies, a systematic review and meta-analysis were performed. Inclusion criteria were 1) Cohort study, case-control study, or case series study. 2) The study population included individuals with COVID-19 3) The presence or absence of cardiac injury was reported in the study 4) Mortality among patients with cardiac injury is reported or can be calculated.Results:Ten studies were included with a total of 1664 patients. The prevalence of ACI was 30.8%. The mortality rate among patients with concurrent COVID-19 and ACI was 53%.Conclusion:ACI can occur in one third of patients with COVID-19. Concurrent COVID-19 and ACI entails a high mortality rate. Serum troponin level can be a good prognostic tool in COVID-19.
Ebstein’s anomaly is a congenital defect, which is rarely present in adults with arrhythmias and right heart failure with tricuspid regurgitation. The diagnosis is made by non-invasive cardiac imaging with transthoracic echocardiography or cardiac magnetic resonance imaging. However, mild and atypical anatomical variants require a more specific investigation to make the diagnosis and differentiate it from other pathologies which have a similar presentation, including Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC). We present the case of a 66-year-old gentleman with a history of recurrent admissions due to decompensated heart failure exacerbations, now presenting with gradually worsening dyspnea. An echocardiogram was obtained, showing a thin-walled, dilated, and dysfunctional right ventricle (RV) with severe tricuspid regurgitation due to poor coaptation of the tricuspid leaflets. Although a very distinctive epsilon wave was seen on his electrocardiogram, highly suggestive of arrhythmogenic RV cardiomyopathy (ARVC), which would be enough to explain his presentation and initial echocardiogram; an off-axis plane of the tricuspid valve without any RV aneurysm or dilation of the RV outflow tract was incongruent with this diagnosis. Additional echocardiographic images were determinant to demonstrate both apical displacement and tethering of the septal tricuspid leaflet with an abnormally long anterior tricuspid leaflet, suggestive of Ebstein’s anomaly. This diagnosis was confirmed with cardiac magnetic resonance imaging. Mild variants of Ebstein’s anomaly, especially in the presence of confounding findings require focused imaging to ascertain the diagnosis. We review these non-traditional findings in trying to differentiate Ebstein’s from ARVC.
We report a case of ST-elevation myocardial infarction (STEMI) due to septic emboli secondary to Staphylococcus capitis endocarditis in a 32-year-old male patient with a past medical history of infectious endocarditis requiring mechanical aortic, mitral and tricuspid valve replacement presented with sharp chest pain and shortness of breath. Electrocardiogram demonstrated an acute inferior STEMI.Coronary angiography revealed occlusion of the terminal left anterior descending (LAD) artery associated with a large apical wrap-around segment exhibiting TIMI 0 flow. Primary angioplasty was not performed given the distal location of the embolus. Clinical suspicion for septic or thrombotic coronary artery embolism was high given the patient's history of mechanical valve prosthesis and in the setting of sub-therapeutic INR. Transesophageal echocardiography revealed a new mobile echodensity on the mitral prosthesis consistent with vegetation. S. capitis was isolated from blood cultures, confirming the diagnosis of endocarditis.S. capitis is a rare cause of prosthetic valve endocarditis and should remain in the differential of septic coronary artery embolism among patients with features of infectious endocarditis.
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