Dear Sir in your explanation one is interesting point that is Myocarditis, because a viral infection usually causes myocarditis, but it can result from a reaction to a drug or be part of a more general inflammatory condition, SARS-CoV-2 myocarditis varies among cases. Some patients may present with relatively mild symptoms, such as fatigue and dyspnea, whereas others report chest pain or chest tightness on exertion. Many patients do deteriorate, showing symptoms of tachycardia and acute-onset heart failure with cardiogenic shock. In these severe cases, patients may also present with signs of right-sided heart failure, including raised jugular venous pressure, peripheral edema, and right upper quadrant pain. The most emergent presentation is fulminant myocarditis, defined as ventricular dysfunction and heart failure within 2–3 weeks of contracting the virus. The early signs of fulminant myocarditis usually resemble those of sepsis: the patient often presents febrile with low pulse pressure, cold or mottled extremities, and sinus tachycardia.
Nicely narrated sir, thanks a lot. After reading so many articles in different sites either published by Indian experts or from experts from different corners of world I could understand this much that this novel corona virus is yet to explored, many things still remaining obscured still toady and this also I could understand this tiny virus does not spare any system rather any cell of our body.
Due to blood leakage that form clots it is common in covid 19 patients ,few pt already suffering from CAD or heart ailments and other comorbadities are more prone to death as in case of HCQ given in COVID pt disturbed ST segment and ECG conduction leads to sudden death in COVID Infection pt.
Sir, is there any study regarding sudden cardiac deaths in known atherosclerotic coronary vessels? (Those are known CAD with awaiting PCI or surgery). Thanks for sharing information.
Informative update elaborated very nicely with case presentation. Thanks Dr Parveen Yogiraaj for sharing this post
Very informative & useful post with elaborate case presentation
HIGHLY USEFUL AND NICELY ILLUSTRATED UPDATE..
Valuable and informative post.
Cases that would interest you
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30 year old male, 10 day history of diarrhoea and reduced oral intake, presented with lethargy and ongoing abdominal cramps. No respiratory symptoms, but O2 sats noted to be on the lower side, exertional O2 sats dropped to 86%. No past medical history of note, normal white cell count, not lymphopenic, urea 18.9 mmol/L, creatinine: 489 µmol/L, amylase 600 (30-118), ALT: 65, CRP: 100, Trop I 267 (0-46). Chest X-ray as shown. What do you think the patient is suffered from?Dr. Somi Suyal2 Likes17 Answers
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In pathogenesis of COVID-19, hands play an important role by transporting virus from fomites mainly to nose and mouth. From mouth and nose virus spreads in the body. Saline wash of the nasal passage, mouth, and throat would probably eliminate or reduce viral load in the body mechanically at least in the initial stage of the pathogenesis. This could be similar to hand washing to contain the spread of the infection. Therefore, hypertonic saline gargles and nasal wash may work in preventing the disease and may also be useful in reducing nasopharyngeal viral load to provide symptomatic relief. Further, it may reduce viral shedding and reduce the transmission of the illness. This may break the chain of infection. COVID 19 disease is mild in eighty percent of patients and resolves spontaneously. Therefore, nasopharyngeal wash may be useful especially in subgroup of the population at high risk such as subjects with comorbid conditions and above 60 years of age. In this rapid systematic review to evaluate effect of nasopharyngeal wash majority of studies had methodological limitations. However, few studies using hypertonic saline gargles and nasal wash showed to prevent symptoms and reduce transmission, symptoms, need for symptomatic medication, and viral loads in patients of the common cold. Its utility, however, has to be studied for SARS-CoV-2 which has significant mutations from the coronaviruses that causes the common cold. Since it has been shown to work for a multitude of common viruses, logically, it should work for SARS-CoV-2 as well. The therapy could be studied as an easily available, and affordable add on modality to curb the transmission of the SARS-CoV-2. As we await definitive therapy to fight the pandemic this relative safe technique may give a ray of hope especially in prevention. COVID 19 infection starts in nasopharynx but involves lungs and other organs of the body. Therefore the effect of nasopharyngeal wash may have a limited action at nasopharynx; however, it may be more useful in prevention. The potential disadvantages of the nasal wash therapy are the discomfort in performing the procedure, however, in previous studies, it has been shown to be accepted in around 87% individuals. The second disadvantage would be the possible transmission of viral infection through the equipment used for the wash and the area where the procedure is performed. This limitation could be addressed easily by maintaining strict measures with each person use one's own equipment with no sharing amongst each other. Further, the washbasin/sink where the procedure is performed can be cleaned postprocedure. Certain precautions should be followed prior to the procedure including the use of clean water which can be ensured by boiling and subsequently cooling it. The technique of learning of nasopharyngeal wash should be supervised initially. To read more- http://www.lungindia.com/article.asp?issn=0970-2113;year=2020;volume=37;issue=3;spage=246;epage=251;aulast=SinghDr. Somesh Sharma19 Likes26 Answers
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THE COVID-19 SYMPTOMS WE DID NOT KNOW ABOUT As the pandemic spreads around the world, doctors are beginning to scope the coronavirus’s damage. Seen initially as a cause of viral pneumonia during the chaos of an explosion of cases in China, it’s now emerging as an enigmatic pathogen capable of harming the body in a myriad of unexpected, and sometimes lethal, ways. Clinical manifestations range from common cold-like symptoms and bronchitis to more severe disease such as pneumonia, severe acute respiratory distress syndrome, multi-organ failure and even death. The illness may occur as a direct result of viral infection, as well as the body’s response to it. Here’s a snapshot of some of the symptoms Covid-19 causes, including some you might not have heard about. Blood Fever and inflammation may disrupt blood vessels, rendering blood cells more prone to clumping while interfering with the body’s ability to dissolve clots. That may trigger a clotting cascade that can lead to blood-vessel blockages in tissues and organs throughout the body. Life-threatening clots in the arteries of the lung, known as pulmonary emboli, may occur even after symptoms of the infection have resolved. Damaged blood vessels may become leaky and prone to bleeding. In children, inflammation of veins and arteries triggered by excessive immune activation may cause an illness similar to Kawasaki disease, an inflammatory disorder. Brain Dysfunction in the lining of blood vessels and associated bleeding and clotting disorders may cause strokes and bleeding in the brain. Patients may also experience headache, dizziness, confusion, impaired consciousness, poor motor control, delirium and hallucinations. Eyes Red, puffy eyes, sometimes referred to as pink eye, may result from infection in the conjunctiva, the tissue that lines the inside of the eyelids and covers the white part of the eye. Gastrointestinal tract Infection of cells lining the digestive tract may cause diarrhea, nausea, vomiting and abdominal pain. Blood-vessel blockages caused by abnormal clotting have been found to damage the bowel, requiring emergency surgery and resection. Hands Prickling or burning sensation in the hands and limbs may indicate Guillain-Barré syndrome, a rare nervous-system disorder that may be triggered by aberrant immune responses to viral infection. Other symptoms of the syndrome include poor coordination, muscle weakness and temporary paralysis. Heart Cardiac injury, sometimes leading to irregular heartbeat, heart failure, and cardiac arrest, may occur as a result of excess strain, inflammation of the heart muscle and coronary artery, blood clots, and overwhelming multi-organ illness. Infection, fever, and inflammation in people with existing heart-vessel blockages may cause their fatty plaques to break off, blocking or stopping blood flow in organs and tissues. Limbs Obstructions in large blood vessels may cause insufficient flow, or acute ischemia, in the limbs. Severe vascular complications can be lethal. At least one reported cases resulted in lower limb amputation. Liver Liver dysfunction may occur as a direct result of the viral infection, or more likely because of immune-mediated, systemic inflammation and circulatory blockages cutting blood flow to the organ. Lungs The virus targets the epithelial cells that line and protect the respiratory tract as well as the walls of the tiny grape-like air sacs, or alveoli, through which gas exchange occurs to oxygenate the blood. Damage to alveoli and inflammation in the lungs can cause pneumonia, characterized by chest pain and shortness of breath. In severe cases, the lack of oxygen can trigger acute respiratory distress syndrome, leading to multi-organ-system failure. Kidneys Acute kidney injury may result from clots and impaired blood supply, or as a direct result of infection. Nose and tongue While the virus can cause the sneezing and runny nose typical of a common cold, it can also disrupt the olfactory system, causing an abrupt full or partial loss of the sense of smell known as anosmia. Taste may also become distorted in a condition known as dyguesia. Skin Hive-like rashes, small red dots and purplish discolorations on the legs and abdomen are part of a complex category of so-called paraviral dermatoses that may result from the body’s immune response to the virus or from benign, superficial blood-vessel damage beneath the skin. Toes Purple rashes that resemble chickenpox, measles or chilblains may appear on the feet, especially of children and younger adults.Dr. Prashant Ved17 Likes21 Answers
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AN UPDATE : COVID-19 CAN COVID-19 CAUSE DEAFNESS? A recent study, published in the journal JAMA Otolaryngology, suggests that the SARS-CoV-2 virus was isolated from the ears (particularly middle ear and mastoid bone) of two deceased COVID-19 patients. However, this is not the first time the virus has shown to affect ears. In an article, published in the American Journal of Otolaryngology in April, it was pointed out that an old female patient of COVID-19 in Thailand reported hearing loss which did not get better even after she recovered from the infection. The study suggested that it may have been due to the effect of the virus on the brain stem. As per the article, the virus can travel to the brain through blood cells. Our brain has a lot of ACE2 receptors, the cell surface protein that SARS-CoV-2 uses to enter healthy cells. The temporal lobe (present on either side of the head) of the brain, which controls hearing, also has plenty of ACE2 receptors. When the virus affects this area, it releases cytokines, which, in turn, damages the hearing centres in the brain. ANOTHER STUDY, conducted on 20 confirmed but asymptomatic COVID-19 patients, indicated that the virus damages the hair cells in the cochlea. The cochlea is a spiral bone inside the ear that helps in hearing. The bone is hollow from the inside and has tiny hairs. These hairs convert the sound vibrations into electrical signals that are sent to the brain for interpretation. A study done at the University of Ferrara, Italy, suggested that most drugs used for coronavirus treatment including hydroxychloroquine, chloroquine, remdesivir, azithromycin, favipiravir and lopinavir have toxic effects on the ears (ototoxic). Ototoxicity can lead to problems like imbalance, hearing loss, and tinnitus. As per this study, the effects can be reversible or irreversible and occur after weeks of regular use. The Iran study did mention that various drugs used for the treatment of the coronavirus disease have potential ototoxic side effects. However, most of the patients in this study did not have a history of use of any ototoxic drugs.Dr. Haritma Nigam7 Likes8 Answers
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Cardiac complications of COVID 19 Chronic cardiovascular disease may become unstable in the setting of viral infection as a consequence of imbalance between infection-induced increase in metabolic demand and reduced cardiac reserve. Patients with coronary artery disease and heart failure may be at particular risk as a result of coronary plaque rupture secondary to virally induced systemic inflammation, and rigorous use of plaque stabilizing agents (aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors) has been suggested as a possible therapeutic strategy. Pro-coagulant effects of systemic inflammation13 may increase the likelihood of stent thrombosis and assessment of platelet function and intensified anti-platelet therapy should be considered in those with a history of previous coronary intervention. The beta-coronavirus virus underlying COVID-19 strains from the same species as SARS and has recently been named SARS-CoV-2. SARS-CoV binds to cells expressing appropriate viral receptors, particularly angiotensin-converting enzyme 2 (ACE2).1 Angiotensin-converting enzyme 2 is also expressed in the heart, providing a link between coronaviruses and the cardiovascular system. Murine models and human autopsy samples demonstrate that SARS-CoV can down-regulate myocardial and pulmonary ACE2 pathways, thereby mediating myocardial inflammation, lung oedema, and acute respiratory failure. Pro-inflammatory cytokines are up-regulated in the lungs and other organs of SARS patients, and the systemic inflammatory response syndrome provides a possible mechanism for multi-organ failure (usually involving the heart) in severe cases. https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehaa231/5809453 https://www.youtube.com/watch?v=3qINtzH2PfI&feature=push-u-sub&attr_tag=1tXyks4rHBiYxOZm%3A6 Does the risk of cardiovascular disease perDr. Zaka Yusto M4 Likes6 Answers