The emerging entity, long COVID -19 is characterised by long-lasting dyspnoea, fatigue, cognitive dysfunction and other symptoms. Cardiac involvement manifested as conduction abnormalities, left ventricle mechanical dyssynchrony, dyspnoea, palpitation and postural orthostatic tachycardia syndrome (POTS) are common in long COVID-19. The direct viral damage to the myocardium or immune-mediated inflammation are postulated mechanisms. A woman in her forties presented with a 2-month history of chest pain, functional dyspnoea, palpitation and an episode of syncope after having been home-isolated for mild COVID infection. During clinical workup, a clustering of ECG and echocardiographic abnormalities including left bundle branch block, septal flash, and presystolic wave on spectral Doppler echocardiography, and POTS were detected. The echocardiographic findings together with POTS and persistent dyspnoea indicated the presence of a long COVID-19 state. The prevalence and clinical significance of these finding, as well as the impact on long-term prognosis, should be investigated in future studies.

Myocarditis has numerous aetiologies, and Celiac Disease (CD) has been described as a rare cause. CD has received little attention in current guidelines and may be underdiagnosed. We report a case involving a 28-year-old male with myocarditis causing severe left ventricular dysfunction and dilatation that was probably related to CD. This case highlights the importance of screening for CD in patients presenting with myocarditis and signs of malabsorption when other common causes are excluded. Besides optimal medical treatment and cardiac resynchronization therapy, a gluten-free diet and immunosuppression may also be effective measures in the management of CD-related myocarditis.

doi: https://doi.org/10.12669/pjms.38.4.6129 How to cite this:Myrmel GMS, Lunde T, Saeed S. Clinical spectrum of Celiac disease from a cardiology perspective. Pak J Med Sci. 2022;38(4):782-784. doi: https://doi.org/10.12669/pjms.38.4.6129

A middle-aged man presented to the Department of Medicine of our hospital due to exertional dyspnoea, ascites and peripheral oedema. He was later transferred to the Department of Heart Disease as his echocardiography indicated constrictive pericarditis, confirmed by cardiac MRI and cardiac catheterisation. After a thorough investigation, his constrictive pericarditis was assumed to be caused by tuberculosis. He was treated with antituberculosis therapy followed by successful surgical subtotal pericardiectomy, leading to immediate improvement of haemodynamics, regression of symptoms and recovery of cardiac function. The patient remained stable at 5-year echocardiographic follow-up with no evidence of diastolic dysfunction.

Background: ECG is the initial diagnostic tool that in combination with typical symptoms often raises the suspicion of pericarditis. Echocardiography remains the first-line imaging modality for assessment of pericardial diseases, particularly effusion/tamponade, constrictive physiology, and assessment of regional wall motion abnormalities as differential diagnoses. However, cardiac CT and cardiac magnetic resonance may be necessary in complicated cases, and to identify pericardial inflammation in specific settings (atypical presentation, new onset constriction), as well as myocardial involvement and monitoring the disease activity. Summary: In acute pericarditis, the most commonly used ECG criteria recommended by international guidelines are the widespread ST segment elevation or PR depression. However, the classic ECG pattern of widespread ST segment elevation or PR depression can be seen in less than 60% of patients. In addition, ECG changes are often temporally dynamic, evolve rapidly during the course of disease and may be influenced by a number of factors such as disease severity, time (stage) of presentation, degree of myocardial involvement, and the treatment initiated. Overall, temporal dynamic changes on ECG during acute pericarditis or myopericarditis have received limited attention. Hence, the aim of this brief clinical review is to increase awareness about the various ECG changes observed during the course of acute pericarditis. Key messages: ECG may be normal at presentation or for days after the index episode of chest pain, but serial ECGs can reveal specific patterns of temporally dynamic ST elevation in patients with pericarditis or myopericarditis, particularly during new episodes of chest pain.