No abstract

Cardiovascular complications in coronavirus disease 2019 (COVID-19) patients have been associated with poor prognosis. Myocarditis, acute coronary syndrome, heart failure, and arrhythmia have been reported. We present a case of a 55-year-old female patient with no significant past medical history who was admitted due to COVID-19 induced acute hypoxemic respiratory failure. She developed multiple asymptomatic episodes of long sinus pauses as her oxygen requirements increased. These resolved without atropine and pacing as her respiratory status improved. Hypoxemia, cytokine storm, dysautonomia, direct viral infiltration, and surrounding myocardial inflammation are thought to be responsible for bradyarrhythmias associated with COVID-19. Both symptomatic and asymptomatic cases have been reported. Hospitalized COVID-19 patients should be monitored closely on telemetry in order to promptly recognize any arrhythmia; hence preventing an unexplained rapid decline in cardiopulmonary status by intensifying care and managing the arrhythmia in a timely manner. Follow-up studies would be needed to determine the long-term outcomes of COVID-19 patients who developed bradyarrhythmias.

von Willebrand factor (vWF) aids coagulation at sites of vessel injury. Elevated vWF levels have been associated with an increased risk of ischemic heart disease (IHD); however, it is unclear whether vWF deficiency, seen in patients with von Willebrand disease (vWD), protects people against IHD. We determined and compared the prevalence and risk of IHD in patients with versus without vWD by using data from the National Inpatient Sample (2009–2014), excluding patients younger than 18 and older than 75 years. The primary outcome was the odds ratio (OR) of IHD in patients with versus without vWD. Secondary outcomes were major medical comorbidities and demographic characteristics in patients with vWD. Of 224,475,443 weighted hospital-discharge samples, we identified 82,809 patients with a vWD diagnosis. The odds of IHD were lower in patients with vWD than in those without (OR=0.54; 95% CI, 0.52–0.56). After multivariable logistic regression analysis and adjustment for age, sex, and typical IHD risk factors (hypertension, smoking, diabetes, hyperlipidemia, chronic kidney disease, obesity, and family history of IHD), the likelihood of IHD remained lower in patients with vWD than in patients without (OR=0.65; 95% CI, 0.63–0.67). Our study shows that vWF deficiency, as seen in patients with vWD, is associated with a decreased prevalence of IHD. Further investigation may confirm these findings.

No abstract

A positive Murphy’s sign in a patient with right upper quadrant abdominal pain is the arrest of inspiration during deep palpation of the quadrant. It is usually suggestive of acute cholecystitis. We report an unusual case of a positive Murphy’s sign not due to acute cholecystitis, but rather from a pericardial hematoma from a right atrial tear causing right heart failure. The patient required an atrial tear repair to prevent a cardiac tamponade.