Background Coronavirus disease 2019 (COVID-19) is a syndrome that has been associated with multiple cardiac complications including myopericarditis. The pathophysiology and treatment for myopericarditis in the setting of COVID-19 infection is still under investigation. Case summary We present a case of a 60-year-old male admitted for dyspnoea due to COVID-19. He developed new ST-segment elevation, elevated cardiac enzymes, severe left ventricular dysfunction, and high inflammatory markers in the setting of haemodynamic and respiratory collapse from the viral illness. He was diagnosed with COVID-19-induced myopericarditis. He showed rapid clinical improvement with a rapid wean off pressure support, resolution of electrocardiogram (ECG) findings, and recovery of left ventricular systolic function following treatment with intravenous immunoglobulin (IVIG) and methylprednisolone. Discussion COVID-19’s complex and devastating complications continue to create new challenges for clinicians. Cardiac complications, specifically, have been shown to be a signal for worse prognosis in these patients. IVIG and steroids can inhibit the inflammatory cascade and decrease myocardial injury, with implications in treatment of severe myopericarditis.

No abstract

Purpose: Retrospective studies show that high dose aspirin (ASA) during Heart Mate (HM) II support is associated with more hemorrhagic events; however, limited prospective data exist on the impact of switching to reduced antiplatelet therapy. Methods: We implemented a clinical protocol to place all patients with HM II implantation (n= 26) from November 2014 to September 2015 on low dose aspirin (ASA) 81 mg daily. Concomitant anticoagulation with warfarin (target INR: 2-2.5) was maintained. Adverse events (AEs) were compared to a historical cohort of HM II patients (n= 69) on high dose ASA 325 mg daily and warfarin therapy (target INR: 2-3). Excluding perioperative events, initial hemorrhagic (gastrointestinal, intracranial, epistaxis), thrombotic (ischemic stroke, surgically confirmed pump thrombosis) and hemolysis (LDH > 2.5x upper limit of normal) events were retrieved up to 100 days after implantation. GI bleeding was defined by requiring a blood transfusion and a drop in hemoglobin of > 2g/dL. Survival free from AEs was calculated by Kaplan-Meier curves. Results: Patients in both groups had similar distributions of major demographics including age, gender and history of hypertension. The actual INR was similar across groups throughout HM II support. Hemorrhagic events occurred in only 3 patients on ASA 81 mg daily (12%, 0.17 events/100d) in comparison to 30 patients on ASA 325 (43%, 0.64 events/100d, p= 0.02, figure 1). Thrombotic events occurred in 2 patients on ASA 81 mg (8%, 0.1 events/100d) and in 4 patients on ASA 325 mg (6%; 0.07 events/100d, p= 0.70). Hemolysis occurred in 2 patients on ASA 81 daily (8%, 0.1 events/100d) and in 4 patients on ASA 325 mg daily (6%; 0.07 events/100d, p= 0.75). Conclusion: Low dose ASA in HM II patients treated concomitantly with warfarin is associated with a reduced risk of bleeding without increased thrombotic and hemolysis events.

When crab spiderlings Misumena vatia (Clerck 1757) emerge from their natal nests their small resource reserve makes them vulnerable to starvation, while their small size makes them vulnerable to many predators. Choosing substrates that allow hunting opportunities as well as protection from predators may thus be life or death decisions. Here we investigate the substrate choice of crab spiderlings on goldenrod Solidago canadensis and Solidago juncea inflorescences in relation to a frequently encountered predator, the jumping spider Pelegrina insignis (Banks 1892). Flower heads of 5. canadensis are smaller and more densely packed on branches of the inflorescences than the heads of S. juncea , but the two species attract similar numbers of small flies, the major prey of the spiderlings and jumping spiders. Crab spiderlings significantly preferred S', canadensis , both in initial choice and length of time occupied, as did their jumping spider predator. However, capture times of spiderlings by small jumping spiders (< 5 mg) did not significantly differ on the two goldenrods, although the preferred goldenrod, S. canadensis, provided superior protection from larger jumping spiders (>5 mg). Thus, although occupancy on the preferred goldenrod does not make spiderlings safer from all jumping spiders, it provides superior protection from large ones and may be the basis for the substrate preference of the spiderlings.