Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in a considerable amount of morbidity and mortality worldwide since December 2019. Patients with coronavirus disease (COVID-19) most commonly present with respiratory manifestations, while cardiac manifestations were reported as a complication and seldom as a presenting feature. We report two cases of new-onset atrial fibrillation occurring in middle-aged men with no significant past medical history. The first patient presented with symptomatic atrial fibrillation; however, during his hospitalization course, he developed a fever, which led to the diagnosis of infection with SARS-CoV-2. The second patient presented from urgent care after being diagnosed with COVID-19 associated with newly diagnosed atrial fibrillation. Both patients were treated symptomatically for COVID-19 and discharged home after reverting to sinus rhythm. Physicians should be aware of the variable clinical presentations of COVID-19, especially in new or worsening cardiac illnesses, in order to practice the appropriate personal protection practices. More studies are needed to identify the viral mechanisms leading to the dysregulation of cardiac rhythm.

Assessment of chronic obstructive pulmonary disease (COPD) severity in nursing home (NH) residents is limited by data requirements and lack of specialty staff, equipment, or resident ability. The Minimum Data Set (MDS) is a clinical assessment of functional capabilities and health needs completed for all NH residents in Medicare and/or Medicaid-certified long-term care homes. The objective of this study was to develop a map from the MDS to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) AD staging of COPD severity to aid the selection of COPD treatment for NH residents.

Introduction: An aberrant right subclavian artery (ARSA) in an anomalous artery that arises from the descending aorta distal to the left subclavian. Although most ARSA are discovered incidentally given the absence of symptoms, they may be associated with significant morbidity and mortality. We sought to determine features associated with symptoms in adult patients diagnosed with an aberrant right subclavian artery. Methods: In this single-center, retrospective study, 386 adult patients were diagnosed with ARSA on chest CT scans performed between June 2016 and April 2021. Patients were grouped by the presence of symptoms, which included dysphagia, shortness of breath, cough, and upper airway wheezing. Four cardiothoracic radiologists reviewed the chest CT scans to measure features of ARSA. Agreement and multivariable logistic regression analyses were performed to determine interobserver variability and features associated with the presence of symptoms, respectively. Results: The prevalence of ARSA was 1.02% and 81.3% of patients were asymptomatic. Shortness of breath (74.6%) and dysphagia (18.6%) were the most common symptom. Interobserver agreement amongst the reading radiologists was acceptable with most variables having an interclass correlation coefficient or kappa . 0.80. A patient's height . 158 cm (OR: 2.50, P50.03), cross-sectional area . 60 mm 2 of ARSA at the level of the esophagus (OR: 2.39, P50.046), distance increase per 1 mm between ARSA and trachea (OR: 0.85, P50.02), and angle . 108 degrees formed with the aortic arch (OR: 1.99, P50.03) were associated with symptoms. (Table ) (Figure) Conclusion: In our single center study, we found being taller, having a larger cross-sectional area of ARSA at the level of the esophagus, a greater angle at the junction with the aortic arch, and a shorter distance between the ARSA and trachea, were associated with the presence of symptoms, while having a dilated esophagus, and/or atherosclerosis was not. Importantly, the absence of dysphagia should not rule out an ARSA. These findings may help to predict which patients will develop symptoms and potentially become candidates for surgical consideration.