IntroductionCOVID-19 is an ongoing pandemic that has lasted more than a year. Patients with multiple comorbidities such as diabetes, hypertension, and smoking have been shown to be at increased risk of a more severe course and lethal outcome. Since the disease can also lead to a hypercoagulable state, several cases of acute myocardial infarction (AMI) have also been recorded.Material and methodsWe searched PubMed/Medline for case reports of AMI occurring in COVID-19 positive patients using “acute myocardial infarction”, “COVID-19”, and “SARS-CoV-2” as keywords.ResultsThirty-three articles covering 37 patients were identified, among which 30 (81.1%) were male, and 7 (18.9%) were females. The mean age of these 37 patients was 52.8 ±15.6 years. Most cases were from the United States (17 cases, 45.9%). Several comorbidities such as hypertension (16 cases, 43.2%), diabetes (14 cases, 37.8%), smoking (8 cases, 21.6%), obesity (3 cases, 8.1%), morbid obesity (1 case, 2.7%), and elevated lipid levels (4 cases, 10.8%) were also identified. The most common symptom of AMI was chest tightness (22 cases, 59.5%), while the most common symptoms for COVID-19 were dyspnoea (25 cases, 67.6%) and fever (22 cases, 59.5%). The mortality rate was 35.1%.ConclusionsGiven the high mortality rate, physicians are encouraged to properly check for signs of cardiac dysfunction and possible AMI while treating COVID-19 positive patients with several comorbidities or previous history of AMI.
The ongoing pandemic of coronavirus disease 2019 (COVID-19) keeps infecting and causing more deaths daily [1, 2]. As of March 29th, 2021, the world had registered 127,674,594 confirmed cases with 2,793,319 deaths, amongst which 562,292 occurred in the United States alone [3]. Since the virus is contagious and spreads easily, many countries started issuing lockdown orders at the start of the pandemic [4]. People of all age groups experienced drastic changes in their daily lives. The economic well-being of several countries, especially those relying on travels and tourism, global social and political relationships, pedagogical, and educational systems have all been heavily influenced [1, 4, 5].
Background and objectiveThe recent emergence of new molecules like angiotensin receptor-neprilysin inhibitor (ARNI) has highlighted the need for an update in heart failure (HF) management, as they have proven to yield better patient outcomes compared to the traditional angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB) use. This study aimed to compare HF-related hospitalization and death in patients on either ACEI/ARBs or ARNI in a local setting.
MethodsThis two-arm interventional study was conducted in the cardiology and internal medicine units of a tertiary care hospital in Pakistan from July 2018 to December 2020. After enrollment, participants were randomized into two groups as per 1:1 ratio using an online research randomizer software (https://www.randomizer.org). Group A received 24/26 or 49/51 mg sacubitril/valsartan twice daily for HF. Group B received 2.5 or 5 mg enalapril twice daily. Patients were followed up for 12 months or till the development of an event.
ResultsThe sacubitril/valsartan group had significantly fewer HF-related hospitalizations compared to the enalapril group (13.8% vs. 22.4%; p-value: 0.03), with a relative risk reduction (RRR) of 38.3%. The sacubitril/valsartan group had 52% RRR for HF-related deaths compared to the enalapril group.
ConclusionBased on our findings, treatment with sacubitril/valsartan was superior to enalapril in reducing the risk of hospitalization and death related to HF. The magnitude of the beneficial effects of sacubitril/valsartan as compared to enalapril on cardiovascular mortality was at least as high as that of long-term treatment with enalapril.
The American Heart Association recently reported that stroke is currently the 5th most common cause of death among Americans as one in every 19 deaths is from stroke [1]. While some studies have shown a decline in the incidence and rate of acute ischemic stroke (AIS) hospitalizations among adults in the United States [2], its impact over the healthcare system in the United States is still a major burden. Several racial/ethnic and gender disparities have also been reported among AIS patients over the years. A rise in the incidence among younger individuals, which could be linked with the use of multiple drugs predisposing to stroke such as cocaine [3, 4], has also raised serious concerns about the condition [2]. Thus, we conducted a retrospective study on the incidence and mortality of AIS hospitalizations and understand its economic impact in the United States.
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