Peripartum cardiomyopathy is a relatively rare condition, that usually presents with features of heart failure in the peripartum period. The ongoing pandemic caused by coronavirus disease 2019 (COVID-19) has been reported to be associated with myocarditis, with progression to dilated cardiomyopathy and heart failure. Dilated cardiomyopathy in a peripartum patient with COVID-19 infection may present a diagnostic dilemma. We report a case of dilated cardiomyopathy in a peripartum patient with COVID-19 infection. She presented with shortness of breath in the peripartum period. Chest X-ray showed a grossly enlarged heart with bilateral pulmonary infiltrates consistent with congestive heart failure or viral pneumonia. Echocardiography revealed dilated chambers with 22% left ventricular ejection fraction (LVEF) and global hypokinesis. Despite completing 5 days of remdesivir and dexamethasone, she had worsening dyspnea on postpartum day 10, a repeat echocardiogram showed further reduction in LVEF to 10-15% and was discharged with a life-vest after acute management. She had multiple hospital admissions for decompensated heart failure. Myocardial core biopsy showed marked acute inflammation and necrosis. She had an intra-aortic balloon pump, left ventricular and right ventricular assist devices placed on account of persistent hemodynamic instability, and is now scheduled to have a cardiac transplant.

We present a female patient with a history of systolic heart failure with an ejection fraction of 25–30%, and unprovoked pulmonary embolism on extended anticoagulation therapy with rivaroxaban who underwent a pericardial window for cardiac tamponade due to hemopericardium in the setting of direct oral anticoagulant (DOAC). The rivaroxaban was held following the pericardial window, and she experienced another episode of pulmonary embolism before the rivaroxaban could be restarted. Currently, there are no guidelines on when to restart anticoagulation postpericardial window for DOAC-associated hemopericardium. Studies are needed to help solve this dilemma.

Hyperthyroidism and thyrotoxicosis are common conditions in clinical practice. Untreated, they are associated with several co-morbidities. One of these conditions, and arguably the most lethal, is the thyroid storm. Our case presentation is one of a young female who had previously been diagnosed with thyroid illness but was lost to follow-up, subsequently given a clean bill of health, and emerged with what would eventually be diagnosed as a thyroid storm. While the thyroid storm may pose some diagnostic challenges, it has come a long way in securing diagnostic tools. What remains is a tool for physicians and patients to stratify patients by their risk of developing a storm in the outpatient setting.

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Introduction: Remote monitoring (RM) using implantable cardiac defibrillators (ICD) is a rapidly emerging alternative modality in heart failure management. Studies involving US cohorts have shown promising results with RM. We aim to perform a meta-analysis assessing the clinical outcomes of RM versus conventional follow-up among heart failure (HF) patients with an ICD in a European cohort. Methods: Electronic database and reference list searches were conducted to identify European studies assessing patient outcomes when managed with RM using ICD versus conventional follow up. After a review of abstracts and selected full-text articles, we identified four randomized trials (RCT) for inclusion. Quality was assessed using the Cochrane Risk of Bias Tool. The primary outcome was the incidence of HF hospitalization and the secondary outcome was all-cause mortality during the follow-up period. A random-effects model was used. All analysis was performed using Cochrane Revman version 5.3. Results: Four RCT’s were included, with a total of 4504 participants. Mean follow-up time was 22 months. Rate of HF hospitalization with RM was 678 versus 680 with conventional management (RR: 0.98, 95% CI: 0.88 to 1.10, p = 0.75). All-cause mortality with RM was 252 versus 284 with conventional management (RR: 0.88, 95% CI: 0.75 to 1.03, p =0.11). Conclusions: Our study found that in a European cohort, there was no difference in the incidence of HF hospitalization or all-cause mortality among patients managed with RM using ICD and those managed with conventional care. Further research is required to assess the feasibility and generalizability of HF management using ICD’s in different patient populations.