Introduction The incidence of acute cardiac injury in COVID-19 patients is frequently subclinical and can be identified by cardiac magnetic resonance imaging. Left ventricular global longitudinal strain (LV-GLS) using two-dimensional speckle-tracking echocardiography (2D-STE) provides an accurate validated method for early detection of subclinical myocardial dysfunction. So far, long-term cardiovascular complications of COVID-19 are undetermined therefore several validated methods should be used for early diagnosis and intervention in those patients. Purpose The aim of this work was to describe GLS as an indicator of myocardial injury in a case series of non-hospitalized COVID-19 patients complaining of persistent dyspnea after resolution of COVID-19 infection. Methods A total number of 18 patients who were diagnosed with COVID-19 and were not indicated for hospital admission due to mild symptoms presenting with residual persistent dyspnea following COVID-19 infection resolution. Through clinical examination and standard 2D transthoracic echocardiography with STE emphasizing on LV-GLS was performed using Philips Epic - Qlab 10 software. Results The mean age of the included patients was 37.44±6.33 years, the mean time from COVID-19 diagnosis was 48.1±15.45 days, all patients (100%) had persistent dyspnea grade II. The mean left ventricular ejection fraction (LVEF) was 62.9±3.46% while the mean LV-GLS was −15.55±2.16%. Clinical and echocardiographic data is presented in Table 1. Conclusion In a case series of non-hospitalized COVID-19 survivors who complained of persistent dyspnea, GLS was low in comparison to the normally reported values of LV-GLS although they had normal LVEF indicating the persistence of myocardial injury even in mild cases of COVID-19 long after infection resolution. Further close follow-up of even mild and moderate COVID-19 survivors is certainly required to detect long-term cardiovascular sequelae. 2D STE with LV-GLS can be used as a readily available validated technique to detect early or persistent myocardial dysfunction succeeding COVID-19 infection. Funding Acknowledgement Type of funding sources: None.

Background Subaortic obstruction by a membrane or systolic anterior motion of the mitral valve leaflets is usually suspected in young patients, especially if the anatomy of the aortic valve is not clearly stenotic and unexplained left ventricular hypertrophy exists in the context of high transaortic gradients. Main body In certain circumstances, some patients show both aortic and subaortic stenotic lesions of variable severity. Doppler echocardiography can help in grading severity in the case of single-level obstruction but not in patients with multilevel obstruction where the continuity equation is of no value. Three-dimensional (3D) echocardiography allows "en-face" visualization of each level of the aortic valve and subaortic tract; in addition, direct planimetry of the areas can be done using multiplanar reformatting. Conclusions Accordingly, 3D echocardiography plays a crucial role in the assessment in patients with multilevel left ventricular outflow tract obstruction as it can accurately delineate the location and size, and severity of the stenosis.

Ischemic heart disease is the single most common cause of mortality worldwide despite the widespread use of reperfusion. The in-hospital mortality rates of unselected patients with STEMI in national European registries vary between 4–12%.Although the incidence of mechanical complications has declined, these adverse events are still inevitable and constitute one of the major causes of death in the early phase after myocardial infarction. Dissecting interventricular hematoma is a rare life threatening mechanical complication following myocardial infarction. The resultant bleeding dissects along a plane beneath the endocardium. Case presentation A 57 year old male patient presented to the emergency room complaining of acute stabbing retrosternal chest pain radiating to both shoulders associated with nausea and vomiting that started 2 hours before presentation. He was known to be smoker and diabetic and had uncontrolled hypertension. Vital signs were stable and physical examination was unremarkable . Electrocardiography (ECG) revealed normal sinus rhythm at 80 bpm, 5 mm ST elevation in leads I, aVL, V1-V6, reciprocal ST depression in leads II, III,aVF. The patient received thrombolytic therapy within 15 minutes of presentation and it was uneventful. Follow up electrocardiography was done showing failed thrombolytic therapy. The patient was managed conservatively using dual antiplatelets, high dose atorvastatin, beta blockers, ACE inhibitors. The patient remained hemodynamically stable for 5 days after which he developed respiratory distress , heart rate was 110 bpm, blood pressure was 100/60 mmHg. Physical examination revealed clear chest ,S3 gallop. 2D/ 3D transthoracic echocardiography revealed akinesis of the apical segments and mid segment of the anterior septum. There was a dissecting hematoma seen starting at mid anterior septum and extending to the apical segment.Severe mitral valve regurgitation was seen. Conclusion Dissecting interventricular hematoma(DIH) is a rare yet underrecognized mechanical complication following STEMI. Transthoracic echocardiography is considered to be an important imaging modality for the bedside diagnosis. Treatment depends upon the rate of expansion of hematoma. Accordingly, stable patients with hematoma regressing gradually does not require any intervention .However, cases with rapidly expanding hematoma with hemodynamic instability will require urgent surgical intervention. Abstract P178 Figure. Dissecting interventricular hematoma

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Membranous interventricular septal (MIVS) aneurysm is a rare often asymptomatic, accidentally discovered congenital anomaly, which might be complicated with right ventricular obstruction, rupture, thromboembolism, and conduction abnormalities.