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Background: COVID-19 vaccines are highly immunogenic but cardiovascular effects of these vaccines have not been properly elucidated. Objectives: To determine impact of COVID-19 vaccination on mortality following acute myocardial infarction (AMI). Methods: This was a single center retrospective observation study among patients with AMI enrolled in the the North India ST-Elevation Myocardial Infarction (NORIN-STEMI) registry. In all the enrolled patients, data regarding patient's vaccination status including details on type of vaccine, date of vaccination and adverse effects were obtained. All enrolled subjects were followed up for a period of six months. The primary outcome of the study was all-cause mortality both at one month and at six months of follow-up. Propensity-weighted score logistic regression model using inverse probability of treatment weighting was used to determine the impact of vaccination status on all-cause mortality. Results: A total of 1578 subjects were enrolled in the study of whom 1086(68.8%) were vaccinated against COVID-19 while 492(31.2%) were unvaccinated. Analysis of the temporal trends of occurrence of AMI post vaccination did not show a specific clustering of AMI at any particular time. On 30-day follow-up, all-cause mortality occurred in 201(12.7%) patients with adjusted odds of mortality being significantly lower in vaccinated group (adjusted odds ratio[aOR]: 0.58, 95% CI: 0.47–0.71). Similarly, at six months of follow-up, vaccinated AMI group had lower odds of mortality(aOR: 0.54, 95% CI: 0.44 to 0.65) as compared to non-vaccinated group. Conclusions: COVID-19 vaccines have shown to decrease all-cause mortality at 30 days and six months following AMI. [ABSTRACT FROM AUTHOR]

Recently, a new pattern of multisystem inflammatory syndrome following an infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has emerged globally. The initial cases were described in the adult population followed by sporadic cases in the pediatric population also. By the end of 2020, similar reports were recognised in the neonatal age group. The purpose of this study was to systematically review clinical characteristics, laboratory parameters, treatment, and outcomes of neonates with multisystem inflammatory syndrome in neonates (MIS-N). A systematic review was conducted after registering with PROSPERO and electronic databases including MEDLINE, EMBASE, PubMed, SCOPUS, Google Scholar, and Web of Science were searched from January 1st 2020 till September 30th 2022. A total of 27 studies describing 104 neonates were analysed. The mean gestation age and birth weight was 35.9 ± 3.3 weeks and 2255.7 ± 783.7 g respectively. A large proportion (91.3%) of the reported cases belonged to the South-East Asian region. The median age of presentation was 2 days (range: 1–28 days) with cardiovascular system being the predominant system involved in 83.65% followed by respiratory (64.42%). Fever was noted in only 20.2%. Commonly elevated inflammatory markers were IL-6 in 86.7% and D-dimer in 81.1%. Echocardiographic evaluation suggested ventricular dysfunction in 35.8% and dilated coronary arteries in 28.3%. Evidence of SARS-CoV-2 antibodies (IgG or IgM) was seen in 95.9% neonates and evidence of maternal SARS-CoV-2 infection, either as history of COVID infection or positive antigen or antibody test, was noted in 100% of the cases. Early MIS-N was reported in 58 (55.8%) cases, late MIS-N in 28 (26.9%), and 18 cases (17.3%) did not report the timing of presentation. There was a statistically increased proportion of preterm infants (67.2%, p < 0.001), and a trend towards increased low birth weight infants, in the early MIS-N group when compared to the infants with late MIS-N. Fever (39.3%), central nervous system (50%), and gastrointestinal manifestations (57.1%) were significantly higher in the late MIS-N group (p = 0.03, 0.02, 0.01 respectively). The anti-inflammatory agents used for the treatment of MIS-N included steroids 80.8% which were given for a median of 10 (range 3–35) days and IVIg in 79.2% with a median of 2 (range 1–5) doses. The outcomes were available for 98 cases, of whom 8 (8.2%) died during treatment in hospital and 90 (91.8%) were successfully discharged home. Conclusion: MIS-N has a predilection for late preterm males with predominant cardiovascular involvement. The diagnosis is challenging in neonatal period due to overlap with neonatal morbidities and a high risk of suspicion is warranted, especially in presence of supportive maternal and neonatal clinical history. The major limitation of the review was inclusion of case reports and case series, and highlights need of global registries for MIS-N. What is Known: • A new pattern of multisystem inflammatory syndrome following SARS-CoV-2 infection has emerged in adult population with sporadic cases now being reported in neonates. What is New: • MIS-N is an emerging condition with a heterogeneous spectrum and has a predilection for late preterm male infants. Cardiovascular system is the predominant system involved followed by respiratory, however fever remains an uncommon presentation unlike other age-groups. There are two subtypes based on timing of presentation, with early MIS-N being reported more in preterm and low-birth weight infants. [ABSTRACT FROM AUTHOR]

Aims: To describe clinical characteristics and outcomes for those with STEMI and reduced left ventricular ejection fraction (LVEF) in low‐income and middle‐income countries (LMICs). Methods and results: Adults presenting with STEMI to two government‐owned tertiary care centres in Delhi, India were prospectively enrolled in the North India ST‐elevation myocardial infarction (NORIN‐STEMI) registry. LVEF was evaluated at presentation and clinical characteristics were compared across LVEF categories. Overall, 3597 patients were included, of whom 468 (13%) had LVEF >50%, 1482 (41%) had mildly reduced LVEF (40–49%), 1357 (38%) had moderately reduced LVEF (30–39%), and 290 (8%) had severely reduced LVEF (<30%). Presentation delay >24 h, prior MI, and hyperlipidaemia were associated with decreasing LVEF category. Although most patients with reduced LVEF were discharged on appropriate guideline‐directed therapies, adherence at 1 year was low (ACE inhibitor/ARB 91% to 41%, beta blocker 98% to 78%, aldosterone receptor antagonist 69% to 6%). After multivariable adjustment, a Cox regression model showed moderately reduced LVEF (HR 1.77, 95% CI 1.20, 2.60) and severely reduced LVEF (HR 3.63, 95% CI 2.41, 5.48) were associated with increased risk of all‐cause mortality compared with LVEF ≥50%. Conclusions: On presentation for STEMI, almost 90% of NORIN‐STEMI participants had at least mildly reduced LVEF and almost half had LVEF <40%. Patients with LVEF <40% had significantly higher risk of mortality at 1 year, and adherence to guideline‐directed therapies at 1 year was poor. Systematic initiatives to improve access to timely revascularization and guideline‐directed therapies are essential in advancing STEMI care in LMICs. [ABSTRACT FROM AUTHOR]

Objective: Cardiac involvement in recovered COVID‐19 patients assessed by cardiac magnetic resonance imaging (MRI). Methods: Subjects recently recovered from COVID‐19 and with an abnormal left ventricular global longitudinal strain were enrolled. Cardiac MRI in all the enrolled subjects was done at baseline (within 30–90 days following recovery from COVID‐19) with a follow‐up scan at 6 months in individuals with an abnormal baseline scan. Additionally, 20 age‐and sex‐matched individuals were enrolled as healthy controls (HCs). Results: All the 30 enrolled subjects were symptomatic during active COVID‐19 disease and were categorized as mild: 11 (36.7%), moderate: 6 (20%), and severe: 13 (43.3%). Of the 30 patients, 16 (53.3%) had abnormal CMR findings. Myocardial edema was reported in 12 (40%) patients while 10 (33.3%) had late gadolinium enhancement (LGE). No difference was observed in terms of conventional left ventricular (LV) parameters; however, COVID‐19‐recovered patients had significantly lower right ventricular (RV) ejection fraction, RV stroke volume, and RV cardiac index compared to HCs. Follow‐up scan was abnormal in 4/16 (25%) with LGE persisting in three patients (who had severe COVID‐19 [3/4;75%]). Subjects with severe COVID‐19 had a greater frequency of LGE (53.8%) and myocardial edema (61.5%) as compared to mild and moderate cases. Myocardial T1 (1284 ± 43.8 ms vs. 1147.6 ± 68.4 ms; p <.0001) and T2 values (50.8 ± 16.7 ms vs. 42.6 ± 3.6 ms; p =.04) were significantly higher in post COVID‐19 subjects compared to HCs. Similarly, T1 and T2 values of severe COVID‐19 patients were significantly higher compared to mild and moderate cases. Conclusions: An abnormal CMR was seen in half of the recovered patients with persistent abnormality in one‐fourth at 6 months. Our study suggests a need for closer follow‐up among recovered subjects in order to evaluate for long‐term cardiovascular sequelae. COVID‐19 causes structural changes in the myocardium in a small segment of patients with partial spontaneous resolution. [ABSTRACT FROM AUTHOR]

Coronary artery anomalies (CAAs) are a diverse group of disorders with varied clinical presentation and pathophysiological mechanisms. A majority of these anomalies are asymptomatic and often an incidental finding on coronary angiogram or autopsy. This retrospective study included 28,800 patients who underwent coronary angiography from 2016 to 2020. The coronary angiograms were reviewed by two independent reviewers and CAAs were documented. CAAs were classified into i) anomalies of coronary artery connection, ii) anomalies of intrinsic coronary arterial anatomy and iii) anomalies of myocardial/coronary artery interaction as proposed by the European Society of Cardiology. Of the 28,800 coronary angiograms, CAAs were present in 4.12% with anomalies in the left coronary artery (LCA) being most common. Anomalies of coronary artery connection were most common (48.48%) followed by anomalies of myocardial/coronary artery interaction (34.49%) and anomalies of intrinsic coronary artery anatomy (17.03%). Among anomalies of coronary artery connection, absent left main trunk or split LCA with separate origins of left anterior descending coronary artery and left circumflex coronary artery from the left coronary sinus of Valsalva (22.59%) was most common. An intramural course or "myocardial bridge" had an incidence of 1.16% while incidence of coronary artery fistulae (CAF) was 0.115%. [ABSTRACT FROM AUTHOR]

Aortic cuspal aneurysm is a rare clinical entity and often occurs as a complication of infective endocarditis. We report a case of a 30-year-old male with no prior comorbid conditions who presented with fever, acute onset shortness of breath, and chest pain along with multiple episodes of syncope. Electrocardiogram revealed complete heart block while two-dimensional echocardiogram was suggestive of perforated aortic cuspal aneurysm with aortic regurgitation. Blood cultures were positive for Streptococcus viridans. The patient was initiated on broad spectrum antibiotics, temporary pacemaker implantation, and subsequently underwent aortic valve replacement followed by permanent pacemaker implantation after 6 weeks. A diagnosis of perforated aortic cuspal aneurysm subsequent to infective endocarditis was made. This was based on clinical presentation, echocardiographic evaluation, blood cultures, and surgical as well as histopathological findings. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19), caused by SARSCoV-2 has varied manifestation with multisystem involvement. Acute coronary syndrome in COVID-19 as a result of stent thrombosis is an uncommon entity and is often due to hypercoagulable state. A 40-year-old male was referred to us with acute onset chest pain. He also reported fever, sore throat and dry cough for six days which mandated testing for COVID-19 which turned out to be positive. He had a prior history of coronary artery disease with a drug eluting stent implanted two years back. An electrocardiogram was suggestive of acute anterior wall myocardial infarction while echocardiogram revealed hypokinesia of left anterior descending (LAD) artery territory. Coronary angiogram revealed non-occlusive thrombus in proximal LAD stent. A Thrombolysis in Myocardial Infarction (TIMI) III flow was restored following balloon angioplasty with a noncompliant balloon and use of glycoprotein (GP) IIb-IIIa receptor antagonist. A diagnosis of very late stent thrombosis subsequent to COVID-19 was made. [ABSTRACT FROM AUTHOR]

Objectives: Myocardial injury during active coronavirus disease‐2019 (COVID‐19) infection is well described; however, its persistence during recovery is unclear. We assessed left ventricle (LV) global longitudinal strain (GLS) using speckle tracking echocardiography (STE) in COVID‐19 recovered patients and its correlation with various parameters. Methods: A total of 134 subjects within 30–45 days post recovery from COVID‐19 infection and normal LV ejection fraction were enrolled. Routine blood investigations, inflammatory markers (on admission) and comprehensive echocardiography including STE were done for all. Results: Of the 134 subjects, 121 (90.3%) were symptomatic during COVID‐19 illness and were categorized as mild: 61 (45.5%), moderate: 50 (37.3%) and severe: 10 (7.5%) COVID‐19 illness. Asymptomatic COVID‐19 infection was reported in 13 (9.7%) patients. Subclinical LV and right ventricle (RV) dysfunction were seen in 40 (29.9%) and 14 (10.5%) patients, respectively. Impaired LVGLS was reported in 1 (7.7%), 8 (13.1%), 22 (44%) and 9 (90%) subjects with asymptomatic, mild, moderate and severe disease, respectively. LVGLS was significantly lower in patients recovered from severe illness(mild: ‐21 ± 3.4%; moderate: ‐18.1 ± 6.9%; severe: ‐15.5 ± 3.1%; p < 0.0001). Subjects with reduced LVGLS had significantly higher interleukin‐6 (p < 0.0001), C‐reactive protein (p = 0.001), lactate dehydrogenase (p = 0.009), serum ferritin (p = 0.03), and troponin (p = 0.01) levels during index admission. Conclusions: Subclinical LV dysfunction was seen in nearly a third of recovered COVID‐19 patients while 10.5% had RV dysfunction. Our study suggests a need for closer follow‐up among COVID‐19 recovered subjects to elucidate long‐term cardiovascular outcomes. [ABSTRACT FROM AUTHOR]

Interruption of the aortic arch (IAA) is a rare congenital anomaly which has been infrequently documented in the adult population. Aortic dissection (AD) is an emergency often presenting as acute chest pain and warranting urgent intervention. A 32-year-old male presented to Emergency Department with acute chest pain. Clinical examination revealed feeble pulses in bilateral lower limbs with a blood pressure difference between upper and lower limbs. Two-dimensional Echocardiography was suggestive of IAA with AD in the descending thoracic aorta. This was confirmed on computed tomography scan of the aorta which revealed complete interruption of the aortic arch distal to left subclavian artery along with the presence of an intimo-medial flap in descending thoracic aorta. A diagnosis of IAA with AD was made. The patient underwent an urgent aortic repair surgery following which he has been largely asymptomatic. A suspicion of AD should always be made in any patient presenting with acute onset chest pain radiating to the back along with accelerated hypertension/feeble pulses in extremity. Occurrence of AD in an adult with IAA is a distinct rarity and has been documented only thrice. [ABSTRACT FROM AUTHOR]

A novel coronavirus, SARS-CoV-2, thought to have originated from bats causes COVID-19 infection which was first reported from Wuhan, China in December 2019. This virus has a high infectivity rate and has impacted a significant chunk of the population worldwide. The spectrum of disease ranges from mild to severe with respiratory system being the most commonly affected. Cardiovascular system often gets involved in later stages of the disease with acute cardiac injury, heart failure and arrhythmias being the common complications. In addition, the presence of cardiovascular co-morbidities such as hypertension, coronary artery disease in these patients are often associated with poor prognosis. It is still not clear regarding the exact mechanism explaining cardiovascular system involvement in COVID-19. Multiple theories have been put forward however, more robust studies are required to fully elucidate the “heart and virus” link. The disease has already made its presence felt on the global stage and its impact in the developing countries is going to be profound. These nations not only have a poorly developed healthcare system but there is also a huge burden of cardiovascular diseases. As a result, COVID-19 would adversely impact the already overburdened healthcare network leading to impaired cardiovascular care delivery especially for acute coronary syndrome and heart failure patients. [ABSTRACT FROM AUTHOR]

Diffuse alveolar hemorrhage (DAH) refers to the intra-alveolar accumulation of blood originating from the pulmonary microvasculature. This life-threatening condition is a medical emergency as patients often develop acute respiratory failure requiring invasive mechanical ventilation. This mandates for an early diagnosis with prompt and aggressive management strategies. A host of clinical disorders are known to cause DAH; however, warfarin-induced alveolar hemorrhage is a distinct clinical rarity. A search of the literature reveals few reports documenting this entity. A 27-year-old male presented with complaints of recent-onset hemoptysis and dyspnea. One month back, he was diagnosed with lower-limb deep-venous thrombosis and pulmonary embolism. He had been taking oral anticoagulants irregularly since then without monitoring of prothrombin time. Chest radiograph, done on presentation, revealed bilateral upper-lobe infiltrates, whereas computed tomography of the chest was suggestive of bilateral upper-lobe ground-glass opacities. Serial bronchoscopic alveolar lavage yielded samples which became progressively bloodier, whereas cytological evaluation of the sample revealed numerous alveolar macrophages with intracytoplasmic hemosiderin. A diagnosis of DAH due to warfarin was made, and the patient was administered Vitamin K followed by infusion of fresh frozen plasma. There was a marked clinical recovery, and the patient has been asymptomatic since then. [ABSTRACT FROM AUTHOR]

Superior vena cava (SVC) syndrome due to pacemaker leads is a distinct diagnostic rarity. It is diagnosed clinically based on constellation of signs and symptoms supported by imaging evidence of SVC obstruction. A 70-year-old male, an ex-smoker, presented with facial and upper limb swelling along with exertional dyspnea. He had undergone transvenous dual chamber rate modulated (DDDR) pacemaker implantation four years back for symptomatic sinus node dysfunction. Imaging demonstrated a hypodense-filling defect in the SVC causing 70-80% luminal narrowing along with presence of collaterals. Patient was managed on anticoagulants and planned for SVC stenting with epicardial pacing which failed. Patient refused to undergo any further treatment and was subsequently lost to follow-up. To the best of our knowledge, this is the first detailed description of SVC syndrome due to pacemaker leads from India, which was managed medically. [ABSTRACT FROM AUTHOR]

Pulmonary thromboembolic complications are increasingly being recognised in Coronavirus Disease 2019 (COVID-19) infections. Most of the cases of Pulmonary Embolism (PE) are often missed in presence of non-specific symptoms. This report is about a 90-year-old COVID-19 positive male, asymptomatic on presentation, with no prior co-morbidities who developed acute onset shortness of breath along with elevated D-dimer levels four days post admission. Subsequently, a Computed Tomography Pulmonary Angiogram (CTPA) was done which revealed segmental and sub-segmental thromboembolism in upper and middle lobar branches of right pulmonary artery along with bilateral lower lobe ground-glass opacities consistent with COVID-19 pneumonia. As the patient was haemodynamically stable, he was managed conservatively on low molecular weight heparin and subsequently discharged on oral anti-coagulants. This report highlights the need for prompt evaluation of symptoms such as dyspnoea in COVID-19 patients and to rule out thromboembolic complications in them. In resource limited countries such as India with most of the COVID-19 centres having limited access to CT scans, triaging patients based on clinical suspicion and serially rising D-dimer levels may help identify those with thromboembolic complications. [ABSTRACT FROM AUTHOR]

Bronchial anthracofibrosis (BAF), caused by long-standing exposure to biomass fuel smoke, has emerged as a distinct pulmonary disease. It is usually seen in elderly females who have worked long hours in poorly ventilated kitchen full of smoke due to incomplete combustion of biomass fuel. The diagnosis is confirmed on bronchoscopic visualization of bluish-black anthracotic pigmentation along with narrowing/distortion of the affected bronchus. BAF has been associated with clinical conditions such as pulmonary tuberculosis, chronic obstructive pulmonary disease, pneumonia, and malignancy. Tuberculosis, once thought to be the causative agent for BAF, is now considered to be an association. BAF has a diverse radiological presentation and the presence of associated clinical conditions often confound the radiological picture. The imaging features of BAF include primary imaging characteristics, which pertains to the disease entity directly, and secondary features based on the presence of associated conditions. High-resolution computed tomography findings of multifocal bronchial narrowing and peribronchial cuffing are considered to be specific diagnostic features of BAF. In addition, the diagnostic probability is increased in the presence of mediastinal adenopathy and collapse/atelectasis with middle lobe syndrome being the most common presentation. This pictorial essay highlights the range of imaging appearances in patients with BAF. [ABSTRACT FROM AUTHOR]

The article presents a quiz related to a case-study of a 18-year-old female student who reported exertional breathlessness, cough with minimal mucoid sputum and fever of 1.5 years duration; and underwent high resolution computed tomography and bronchoalveolar lavage.

The article presents an instance where an high resolution computed tomography scan of patient suffering from Bronchioloalveolar Carcinoma presents a “Crazy-Paving" Pattern.