Cardiovascular effects of hypothyroidism include bradycardia, diastolic hypertension, atrial fibrillation, prolonged QT interval leading to torsades de pointes, varying degrees of AV block, accelerated coronary artery disease, and pericardial effusion. Cardiac tamponade is rare in patients with hypothyroidism because of pericardial distensibility and slow accumulation of fluid. The amount and rate of accumulation of pericardial effusion are related to the severity of hypothyroidism. Though rare, significant pericardial effusion can be a manifestation of subclinical hypothyroidism.
The preoperative differentiation of left ventricular aneurysm from pseudoaneurysm is a diagnostic challenge. This distinction is critical as the timing of surgical correction varies; elective for true aneurysm versus urgent for pseudoaneurysm. Our aim is to present a case report demonstrating these difficulties and to review imaging characteristics and the approach to distinguish the two entities.
108 Background: Cook County Health (CCH) is one of the largest public safety net hospitals in the United States. COVID-19 pandemic significantly affected patient care. Although hospitals took measures to keep patients safe, there is a general level of anxiety in patients about coming to the hospital. This study was undertaken to see the impact of COVID-19 and anxiety in patients actively receiving infusional therapy at our institution. Methods: All patients coming to our Infusion Center were offered an anonymous written questionnaire. The survey was given for 10 calendar days in June 2020 after Chicago moved into Phase-3 of re-opening that indicated significant control of COVID-19. The survey was offered in English, Spanish and Polish. It also included the GAD scale for anxiety assessment. Statistics were done using the t-test and z-test. Results: A total of 107 patients completed the survey. About 55% were women with 67% patients over 50 years old. Of the 90 people that specified their race, 44% were black and 42% were Hispanic, 9% whites, and 5% others. Overall 68% had high school or less level of education with Hispanics having significantly lower education than blacks. About 30% had testing for COVID-19 with 81% being negative. Treatment interruption occurred in 39% patients. Despite 75% finding our infusion center extremely or very safe for treatments 28% still felt moderately or severely anxious on the GAD scale. Blacks had similar levels of anxiety compared to Hispanics in March 2020 but no significant change over the months compared to Hispanics who had a significant reduction in anxiety over time. Blacks also had significantly higher rates of moderate to severe anxiety on the GAD scale (33%), while no Hispanic had severe anxiety and 18% had moderate anxiety. Despite a higher level of anxiety, blacks were less likely to have treatment interruptions compared to Hispanics (Table). Conclusions: Despite low levels of anxiety, Hispanics were more likely to have treatment interruptions during the COVID pandemic compared to blacks who had a higher level of anxiety but lower levels of treatment interruptions. The cause of this may be the level of education and awareness between the groups. However, overall there is still a significant amount of anxiety in the inner-city minority population regarding COVID-19. [Table: see text]
Introduction: Transcatheter aortic valve replacement (TAVR) is now firmly established as an alternative to surgical aortic valve replacement in the treatment of aortic stenosis in all risk groups. Sex differences may influence procedural outcomes. Our study aims to contribute further data on the impact of sex differences on patients who underwent TAVR using a nationally representative sample. Methods: Data were obtained from the combined National Inpatient Sample (NIS) 2016 and 2018. The NIS was searched for hospitalization for TAVR procedure using the ICD-10 PCS codes. Patients undergoing the TAVR procedure were then stratified by sex into male and female sex. Outcomes of interest include in-patient mortality, length of stay (LOS), Total hospital charge (THC), Post procedural complication, pacemaker implantation, cardiogenic shock, ischemic stroke, intra-aortic balloon pump insertion, post-procedural infection, and post-procedural kidney disease. Multivariate logistic and linear regression analysis was used accordingly to adjust for possible confounders. Results: There were over 105 million discharges in the combined 2016-2018 NIS database. The database contained hospitalizations for adult patients (aged ≥ 18 years) who were hospitalized for the TAVR procedure. Females had more TAVR procedures compared to men (54.1% vs 45.9%, P<0.0001 and were older than men who underwent TAVR. There was similar in-patient mortality in both group (1.7% vs 1.2%, AOR: 1.21, P=0.072, 95% CI 0.98- 1.51). Women had lower rate of cardiogenic shock (AOR: 0.78, P=0.009, 95% CI 0.65-0.94), pacemaker implantation (AOR: 0.84, P=0.001, 95% CI 0.76-0.93) compared to men. Women had higher odds of post-procedural complications compared to men (AOR: 1.18, P=0.001, 95% CI: 1.07-1.29. There were similar rates of ischemic stroke (AOR: 1.23, P=0.502, 95% CI 0.66-2.31), postprocedural kidney injury (AOR: 1.65, P=0.278, 95% CI 0.66-4.12) in women compared to men. In addition, there was no difference in total charge and length of hospital stay. Conclusions: Women had increased post-procedural complications compared to men in regard to TAVR, however, mortality is similar in both groups. There was no difference in resource utilization and length of stay between both sexes.
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