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Cardiology in Review 2021The novel coronavirus (severe acute respiratory syndrome CoV-2 [SARS-CoV-2]), also known as COVID-19, is a single-stranded enveloped RNA virus that created a Public... (Review)
Review
The novel coronavirus (severe acute respiratory syndrome CoV-2 [SARS-CoV-2]), also known as COVID-19, is a single-stranded enveloped RNA virus that created a Public Health Emergency of International Concern in January 2020, with a global case burden of over 15 million in just 7 months. Infected patients develop a wide range of clinical manifestations-typically presenting with fever, cough, myalgia, and fatigue. Severely ill patients may fall victim to acute respiratory distress syndrome, acute heart injuries, neurological manifestations, or complications due to secondary infections. These critically ill patients are also found to have disrupted coagulation function, predisposing them to consumptive coagulopathies, and both venous and thromboembolic complications. Common laboratory findings include thrombocytopenia, elevated D-dimer, fibrin degradation products, and fibrinogen, all of which have been associated with greater disease severity. Many cases of pulmonary embolism have been noted, along with deep vein thrombosis, ischemic stroke, myocardial infarction, and systemic arterial embolism. The pathogenesis of coronavirus has not been completely elucidated, but the virus is known to cause excessive inflammation, endothelial injury, hypoxia, and disseminated intravascular coagulation, all of which contribute to thrombosis formation. These patients are also faced with prolonged immobilization while staying in the hospital or intensive care unit. It is important to have a high degree of suspicion for thrombotic complications as patients may rapidly deteriorate in severe cases. Evidence suggests that prophylaxis with anticoagulation may lead to a lower risk of mortality, although it does not eliminate the possibility. The risks and benefits of anticoagulation treatment should be considered in each case. Patients should be regularly evaluated for bleeding risks and thrombotic complications.
Topics: Anticoagulants; Blood Coagulation Disorders; COVID-19; Cytokine Release Syndrome; Disseminated Intravascular Coagulation; Embolism; Endothelium, Vascular; Fibrin Fibrinogen Degradation Products; Fibrinogen; Humans; Hypoxia; Immobilization; Inflammation; Ischemic Stroke; Myocardial Infarction; Practice Guidelines as Topic; Pulmonary Embolism; Severity of Illness Index; Thrombocytopenia; Thrombosis; Venous Thrombosis; COVID-19 Drug Treatment
PubMed: 32947478
DOI: 10.1097/CRD.0000000000000347 -
Interventional Cardiology Clinics Jul 2023Venous thromboembolism (VTE) usually develops in the deep veins of the extremities. Pulmonary embolism (PE) is a type of VTE that is most commonly (∼90%) caused by a... (Review)
Review
Venous thromboembolism (VTE) usually develops in the deep veins of the extremities. Pulmonary embolism (PE) is a type of VTE that is most commonly (∼90%) caused by a thrombus that originates from the deep veins of the lower extremities. PE is the third most common cause of death after myocardial infarction and stroke. In this review, the authors investigate and discuss the risk stratification and definitions of the aforementioned categories of PE and further explore the management of acute PE along with the types of catheter-based treatment options and their efficacy.
Topics: Humans; Venous Thromboembolism; Pulmonary Embolism; Acute Disease; Myocardial Infarction; Stroke
PubMed: 37290843
DOI: 10.1016/j.iccl.2023.03.007 -
JAMA Network Open Apr 2022During the past decades, improvements in the prevention and management of myocardial infarction, stroke, and pulmonary embolism have led to a decline in cardiovascular...
IMPORTANCE
During the past decades, improvements in the prevention and management of myocardial infarction, stroke, and pulmonary embolism have led to a decline in cardiovascular mortality in the general population. However, it is unknown whether patients receiving dialysis have also benefited from these improvements.
OBJECTIVE
To assess the mortality rates for myocardial infarction, stroke, and pulmonary embolism in a large cohort of European patients receiving dialysis compared with the general population.
DESIGN, SETTING, AND PARTICIPANTS
In this cohort study, adult patients who started dialysis between 1998 and 2015 from 11 European countries providing data to the European Renal Association Registry were and followed up for 3 years. Data were analyzed from September 2020 to February 2022.
EXPOSURES
Start of dialysis.
MAIN OUTCOMES AND MEASURES
The age- and sex-standardized mortality rate ratios (SMRs) with 95% CIs were calculated by dividing the mortality rates in patients receiving dialysis by the mortality rates in the general population for 3 equal periods (1998-2003, 2004-2009, and 2010-2015).
RESULTS
In total, 220 467 patients receiving dialysis were included in the study. Their median (IQR) age was 68.2 (56.5-76.4) years, and 82 068 patients (37.2%) were female. During follow-up, 83 912 patients died, of whom 7662 (9.1%) died because of myocardial infarction, 5030 (6.0%) died because of stroke, and 435 (0.5%) died because of pulmonary embolism. Between the periods 1998 to 2003 and 2010 to 2015, the SMR of myocardial infarction decreased from 8.1 (95% CI, 7.8-8.3) to 6.8 (95% CI, 6.5-7.1), the SMR of stroke decreased from 7.3 (95% CI, 7.0-7.6) to 5.8 (95% CI, 5.5-6.2), and the SMR of pulmonary embolism decreased from 8.7 (95% CI, 7.6-10.1) to 5.5 (95% CI, 4.5-6.6).
CONCLUSIONS AND RELEVANCE
In this cohort study of patients receiving dialysis, mortality rates for myocardial infarction, stroke, and pulmonary embolism decreased more over time than in the general population.
Topics: Adult; Aged; Cohort Studies; Female; Humans; Male; Myocardial Infarction; Pulmonary Embolism; Renal Dialysis; Stroke
PubMed: 35435972
DOI: 10.1001/jamanetworkopen.2022.7624 -
BMJ Case Reports Oct 2021
Topics: Humans; Pulmonary Embolism; Pulmonary Heart Disease; Pulmonary Infarction; Staphylococcal Infections
PubMed: 34625446
DOI: 10.1136/bcr-2021-246306 -
British Journal of Clinical Pharmacology Oct 2021The intracellular tyrosine kinase inhibitor nintedanib has shown great efficacy for the treatment of idiopathic pulmonary fibrosis (IPF) and other interstitial lung... (Review)
Review
The intracellular tyrosine kinase inhibitor nintedanib has shown great efficacy for the treatment of idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases. However, the incidence rate of myocardial infarction (MI) among participants in landmark IPF trials was remarkable, peaking at 3/100 patient-years. Although subjects with IPF often have a high cardiovascular (CV) risk profile, the occurrence of MI in nintedanib-treated patients may not be fully explained by clustering of CV risk factors. Nintedanib inhibits the vascular endothelial growth factor, platelet-derived growth factor and fibroblast growth factor pathways, which play important roles in the biology of the atherosclerotic plaque and in the response of the heart to ischaemia. Hence, unwanted CV effects may partly account for nintedanib-related MI. We review the evidence supporting this hypothesis and discuss possible actions for a safe implementation of nintedanib in clinical practice, building on the experience with tyrosine kinase inhibitors acquired in cardio-oncology.
Topics: Humans; Idiopathic Pulmonary Fibrosis; Indoles; Protein Kinase Inhibitors; Vascular Endothelial Growth Factor A
PubMed: 33620103
DOI: 10.1111/bcp.14793 -
Internal and Emergency Medicine Jan 2020Whether there is a link between venous and arterial thrombotic disorders is still a matter of debate. They share common risk factors, such as old age, male sex and... (Review)
Review
Whether there is a link between venous and arterial thrombotic disorders is still a matter of debate. They share common risk factors, such as old age, male sex and obesity. Endothelial dysfunction and inflammation are likely to play a role in determining the simultaneous involvement of the two vascular compartments. Unlike subclinical atherosclerosis, symptomatic complications of atherosclerosis such as myocardial infarction, ischemic stroke and atrial fibrillation are likely to predict the subsequent development of venous thromboembolic (VTE) complications. Patients with VTE, especially those with apparently unprovoked episodes, have a definitely increased risk of subsequent arterial thrombotic disorders. Drugs that reduce the risk of arterial thrombosis are likely to reduce the risk of venous thrombosis and vice versa. In particular, the direct oral anticoagulants have recently been shown to reduce the risk of both vascular disorders. In conclusion, recent evidence provides compelling evidence in support of the link between venous and arterial thrombosis. Future studies are needed to clarify the nature of this association, to assess its extent, and to evaluate its implications for clinical practice.
Topics: Arteries; Atherosclerosis; Atrial Fibrillation; Humans; Pulmonary Embolism; Risk Factors; Stroke; Thrombosis; Veins
PubMed: 31773560
DOI: 10.1007/s11739-019-02238-6 -
Anaesthesia Apr 2021Cardiovascular disease is the worldwide leading cause of death in women. Biological differences between the sexes, a result of genetic, epigenetic and sex... (Review)
Review
Cardiovascular disease is the worldwide leading cause of death in women. Biological differences between the sexes, a result of genetic, epigenetic and sex hormone-mediated factors, are complex and incompletely understood. These differences are compounded by socio-cultural factors and together account for the variation in the prevalence, presentation and natural history of cardiovascular disease between men and women. Although there is growing recognition of sex-specific determinants of outcomes, women remain under-represented in clinical trials, and sex-disaggregated diagnostic and management strategies are not currently recommended in clinical guidelines. Women remain more likely to experience delays in diagnosis, to be treated less aggressively and to have worse outcomes. As a consequence, cardiovascular disease in women remains understudied, underdiagnosed and undertreated. This review will focus on female-specific characteristics of cardiovascular disease and how these may impact on anaesthetic and peri-operative risk assessment and care. We highlight significant differences between the sexes in the natural history of cardiovascular disease, including those disease entities that are more common in women, such as sudden coronary artery dissection or microvascular dysfunction. Given the rapidly rising incidence of maternal cardiovascular disease and associated complications, special consideration is given to the risk assessment and management of these conditions during pregnancy. Increased awareness of these issues has the potential to improve the effectiveness of the multidisciplinary heart team and ultimately improve the care provided to women.
Topics: Anesthetics; Biomarkers; Cardiovascular Diseases; Female; Humans; Hypertension, Pulmonary; Myocardial Infarction; Pregnancy; Risk Factors; Sex Factors
PubMed: 33682102
DOI: 10.1111/anae.15376 -
Portuguese Journal of Cardiac Thoracic... Jul 2022Pulmonary embolism (PE) is a potentially fatal disorder that occurs as a result of a thrombus formed in the deep venous system that detaches and obstructs the pulmonary... (Review)
Review
INTRODUCTION
Pulmonary embolism (PE) is a potentially fatal disorder that occurs as a result of a thrombus formed in the deep venous system that detaches and obstructs the pulmonary artery or one of its branches. Herein we report a rare, bilateral PE after surgical correction of the Achilles tendon.
OBJECTIVES
To report a bilateral PE after calcaneus tendon repair, and to review the literature on this rare condition.
MATERIALS AND METHODS
A search of the literature was carried out in electronic databases and a review of medical records.
CONCLUSION
PTE, although rare, is a serious and potentially fatal complication, requiring adequate and early treatment. Pharmacological prophylaxis in these situations is still controversial in the medical literature; however, there is consensus for the use of intermittent pneumatic compression in the postoperative period.
Topics: Achilles Tendon; Humans; Postoperative Complications; Pulmonary Embolism; Pulmonary Infarction; Plastic Surgery Procedures
PubMed: 35780410
DOI: 10.48729/pjctvs.280 -
Clinical Nuclear Medicine Jun 2022This study aimed to summarize the clinical and 18F-FDG PET/CT manifestations of hilar tumor-induced pulmonary infarction.
PURPOSE
This study aimed to summarize the clinical and 18F-FDG PET/CT manifestations of hilar tumor-induced pulmonary infarction.
METHODS
A retrospective analysis was performed on patients with hilar masses who underwent FDG PET/CT scans between July 2015 and January 2021 and had complete clinical data. Pulmonary infarction was confirmed by concurrent chest CT and imaging follow-up or pathology.
RESULTS
A total of 58 patients (mean age, 56 [SD, 13] years; 44 males) with 122 infarcts were included in the study. Hilar masses were mostly associated with small cell lung cancer (64%). The most common clinical manifestations were cough (64%) and hemoptysis (36%). Most patients (62%) had multiple pulmonary infarcts. The CT findings of pulmonary infarcts included the "Hampton hump" (48%) and patchy consolidation (52%). The density of infarcts included "bubbly consolidation" (61%) and "homogenous consolidation" (39%). The metabolic activity of 95 infarcts (78%) was higher than lung parenchyma, with the SUVmax of 3.3 (SD, 1.1). The metabolic patterns on PET/CT were "rim sign," "mismatch between PET and CT," and "no metabolism." Pulmonary vein involvement was found in 25 patients (43%), pleural effusion in 22 patients (38%), and the pleural curvilinear sign in 8 patients (14%).
CONCLUSIONS
The clinical manifestations of hilar tumor-induced pulmonary infarction are not specific, and 18F-FDG PET/CT could be an effective diagnostic tool.
Topics: Female; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Male; Middle Aged; Positron Emission Tomography Computed Tomography; Pulmonary Infarction; Radiopharmaceuticals; Retrospective Studies; Small Cell Lung Carcinoma
PubMed: 35426843
DOI: 10.1097/RLU.0000000000004180 -
Revue Des Maladies Respiratoires Jan 2020Cocaine can be responsible for many psychiatric and/or somatic disorders. The aim of this systematic literature review of data was to expose relations between cocaine...
Cocaine can be responsible for many psychiatric and/or somatic disorders. The aim of this systematic literature review of data was to expose relations between cocaine use and pulmonary complications. Cocaine can be responsible for acute respiratory symptoms (cough, black sputum, hemoptysis, dyspnea, wheezing, chest pain) and for various pulmonary disorders including barotrauma (pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumopericardium), airway damage, asthma, bronchiolitis obliterans with organizing pneumonia, acute pulmonary edema, alveolar hemorrhage, alveolar pneumonia with carbonaceous material, bullous emphysema, acute eosinophilic pneumonia, pulmonary granulomatosis caused by talc or cellulose, interstitial pneumonitis and pulmonary fibrosis, vasculitis, pulmonary hypertension, pulmonary embolism and pulmonary infarction, mycotic pulmonary arterial aneurysms, septic emboli, aspiration pneumonia, community-acquired pneumonia, HIV-related opportunistic infections, latent tuberculosis infection, pulmonary tuberculosis, lung cancer and crack lung. Some of these complications are serious and may have a fatal outcome. Pulmonary function tests, thoracic tomodensitometry, bronchial fibroscopy with bronchoalveolar lavage and lung scintigraphy may be an aid to the diagnosis of these pulmonary compications. Cocaine use must be sought in case of respiratory symptoms in young persons.
Topics: Cocaine; Cocaine-Related Disorders; Drug Users; Humans; Lung Diseases
PubMed: 31883817
DOI: 10.1016/j.rmr.2019.11.641