The COVID-19 outbreak has put severe pressure on healthcare systems worldwide. Even in these hard days we should not forget that cardiovascular diseases are not only the leading causes of mortality worldwide, but also the leading causes for COVID-19 infection related complications [1,2]. There are several potential explanations for significant reduction of acute

Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiomyopathy. An implantable cardioverter defibrillator (ICD) is an efficient way of preventing sudden cardiac death in these patients. Aim: Diagnosis and treatment of genetically associated hypertrophic cardiomyopathy. Case Report: We present a 28-year patient with a history of tachycardia, dizziness, transient chest pains, and anamnestic information on episodes of short-term loss of consciousness and fatigue. She has a positive family history of HCM and her uncle died young from sudden cardiac death (SCD). The electrocardiogram showed hypertrophy, which was confirmed with echocardiography and MRI. Genetic testing confirms PRKAG2 gene mutation. Holter24-hour ECG monitoring showed domination of sinus bradycardia after which it was recommended implantation of ICD. On implantation, persistent left superior vena cava (PLSVC) was discovered and the implantation side was changed. A bipolar Implantable Cardioverter Defibrillator was implanted. Conclusion: When HCM is confirmed at a young age, genetically associated HCM should always be considered. Early recognition of hereditary hypertrophic cardiomyopathy can facilitate better disease management and follow-up even before symptoms appear. Keywords: hypertrophic cardiomyopathy, PRKAG2 gene mutation, PLSVC, SCD, ICD.

Funding Acknowledgements Type of funding sources: None. Purpose We want to evaluate clinical, laboratory profiles and intra-hospital outcome in patients with acute PE treated in intensive care unit in the period of COVID-19 pandemic. Methods This is a single center, retrospective cohort study of patients with confirmed acute PE admitted in Intensive Cardiac Care Unit of a tertiary level university hospital between January and December 2020. Detailed history, risk factors, laboratory parameters and treatment strategy based on patient risk were assessed. All patients underwent 2-dimensional echocardiography, lower limb venous Doppler and CT pulmonary angiography (CTPA). sPESI score and intra-hospital outcomes were evaluated in all patients. Nasopharyngeal smear and real-time reverse transcriptase–polymerase chain reaction (RT-PCR) assay was performed in order to confirm COVID-19 infection. Results We studied 47 patients with acute PE treated in our ICU, with mean age 58.6 ± 19.4 years. Eight patients (17%) had massive PE (central thrombus) and 39 (83%) had sub massive PE (subsegmental thrombus) confirmed by CTPA. Six patients (12,7%) had history of deep vein thrombosis (DVT), 3 patients (6,3%) had history of prior PE, 4 patients (8,5%) were operated within 3 months, 7 patients (14,8%) had history of malignancy, 24 patient’s had increased body weight and obesity (51%). Twelve patients (25,5%) were tested for COVID 19 with real-time reverse transcriptase–polymerase chain reaction (RT-PCR) assay, and 3 come positive (12.5%). Eight patients were high risk with shock (17%), intermediate high risk were 29 patients (61.7%) and intermediate low risk were 10 patients (21.3%).  sPESI score was >1 in all 47 patients. Abnormal RV function with PAH was found in 32 patients (68%). Five high risk, unstable patients died within 72 hours of admission, resulting in an overall ICU mortality rate of 10,6% and 62.5% mortality rate in patients with cardiogenic shock. Patients with PE and COVID-19 had significantly higher D-dimer and hs-Troponin I levels comparing to the patients with patients negative for COVID-19. Multivariate logistic regression analysis showed thrombolytic therapy OR 2.145 (95% CI: 1.105−4,512), D-Dimers >4.500 ng/ml OR 1.893 (95% CI: 0.932–3.241), high risk PE OR 3.98 (95% CI: 1.396−5.641) and acute renal failure OR 2.421 (95% CI: 1.105−4.762) as independent mortality predictors. Eight patients have been treated with fibrinolysis (t-PA), and 39 patients with Heparin therapy. 40 survived patients were discharged with NOAC treatment (95,2%). Conclusions Pulmonary embolism cardiology clinic ICU admission in the period of COVID-19 pandemic decreased, with increase of PE severity, patients risk and mortality rate. Thrombolytic therapy, D-Dimers >4.500 ng/ml, high risk PE and acute renal failure were independent mortality predictors. Thrombolysis was successful treatment for high risk patients with low bleeding risk.

Coarctation of aorta is a congenital vascular malformation which occurs as a discrete stenosis or as a long, hypoplastic aortic segment. It accounts for 5-8% of all congenital heart defects. In most cases it is diagnosed during infancy and childhood, while adult cases with aortic coarctation are rare. Clinical findings depend on the severity of the vascular lesion. Hypertension can be the only manifestation present and it may not become evident until adulthood.In this case report, we present the diagnosis of aortic coarctation in a 21-year-old female patient detected during the evaluation of hypertension. Transthoracic echocardiography findings revealed a coarctation of descendent aorta with dimension of 5mm and a mean systolic gradient of 60mmHg, which was confirmed by CT angiography of aorta. It was managed by percutaneous balloon angioplasty with stent placement.Although rare in adults, coarctation of aorta should be considered in differential diagnosis of secondary hypertension. Delayed diagnosis and management of aortic coarctation is associated with increased risk of serious cardiovascular complications and a high mortality rate.