SARS-CoV-2, the cause of the COVID-19 pandemic has significantly impacted cardiovascular healthcare. Patients with pre-existing cardiovascular disease are at higher risk of morbidity and mortality. The virus may affect the heart directly and indirectly with clinical syndromes of acute myocardial injury, myocarditis, acute coronary syndromes, heart failure, arrhythmias, and venous thromboembolism. Some therapeutics under investigation for COVID-19 may also have adverse cardiac effects. The involvement of the RAAS system in viral entry makes it pertinent to consider the effects of medications that modulate the system. Comprehensive knowledge of peculiar cardiovascular manifestations of COVID-19 and the role of RAAS in the prognosis of COVID-19 disease is needed for optimal patient management.

SummaryBackground: Atrial fibrillation is often first recognized after a complication such as embolic stroke has occurred. Limited data are available for the prospective identification of patients at risk for developing atrial fibrillation.Hypothesis: Demonstration of areas of slow conduction in the atrium by means of P-wave signal averaging may identify individuals at risk for atrial fibrillation.Methods: P-wave signal averaging from the surface electrocardiogram was performed in 199 normal controls and 81 patients with paroxysmal atrial fibrillation using an automated, P-triggered, high-resolution signal for analysis.Results: Of the variables measured, the filtered P-wave duration and P-wave integral were significantly different between controls and patients (filtered P-wave duration 120 ± 9 vs. 145 ± 21 and P-wave integral 666 ± 208 vs. 868 ± 352), whereas the terminal root-mean-square (RMS) voltages (RMS 20, RMS 30, RMS 40) showed no significant differences between the two groups. Regression analysis of the first and second measurement of the filtered P-wave duration obtained during consecutive tests showed excellent reproducibility (r and r 2 of 0.96 and 0.92). The duration of the filtered P wave showed no age dependence but was shorter in women.

Even though uncommon in pregnancy, aortic dissection is a potentially catastrophic vascular complication, occurring mainly in the late stages of pregnancy. Vascular events, including aortic dissection are recognized complications of crack-cocaine use. The authors report a case of aortic dissection in early pregnancy related to crack-cocaine use. They believe that the combined effects of pregnancy and crack cocaine on the vasculature create the requisite milieu potentiating such catastrophic events as aortic dissection. This paper reviews the possible underlying pathophysiologic mechanisms and the available diagnostic, therapeutic, and management options.

No abstract

SummaryBuckground: Measurements by P-wave signal-averaged electrocardiogram (P-SAECG) of P-wave duration and Pwave voltage integral are higher in patients with atrial fibrillation (AF) than in those with sinus rhythm. Hypertension is perhaps the most common cardiovascular antecedent cause of AF, and particularly a disproportionate cause of morbidity and mortality among blacks. The purpose of this study waq to examine the effect of hypertension and ethnicity on P-SAECG parameters in patients without AF.evpothesis: It was hypothesized that P-SAECG parameters can identify hypertensives, and are disproportionately higher in hypertensive blacks.Merhods: In all, 234 normotensives and 84 hypertensives underwent P-SAECG analysis. In an ancillary study group of 34 hypertensive black men, the relationship between seventy of hypertension and measured parameters of P-SAECG was evaluated.Results: Mean filtered P-wave duration and total P-wave voltage integral for normotensives of both ethnic groups were similar. Hypertensive blacks had greater increase in Pwave duration ( I38 ? I6 vs. 132 ? I2 ms; p < 0.01, N 42:42) and total P-wave voltage integral (922 k 285 vs. 764 k 198 pV-ms; p < 0.00 1) than white hypertensives. Conclusions: Patients at very early stages of hypertension have demonstrable evidence of prolonged atrial conduction by P-SAECG and, thus, cardiac electrical remodeling. Pwave duration and total P-wave voltage integral increase with seventy of hypertension. Hypertensive blacks manifest a greater increase in P-SAECG parameters than whites. This may portend an increased cardiovascular risk for black patients with hypertension.