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      Sudden cardiac death in COVID-19 patients, a report of three cases

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          The mortality rate of coronavirus disease-19 (COVID-19) has been reported as 1–6% in most studies. The cause of most deaths has been acute pneumonia. Nevertheless, it has been noted that cardiovascular failure can also lead to death. Three COVID-19 patients were diagnosed based on reverse transcriptase-polymerase chain reaction of a nasopharyngeal swab test and radiological examinations in our hospital. The patients received medications at the discretion of the treating physician. In this case series, chest computed tomography scans and electrocardiograms, along with other diagnostic tests were used to evaluate these individuals. Sudden cardiac death in COVID-19 patients is not common, but it is a major concern. So, it is recommended to monitor cardiac condition in selected patients with COVID-19.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Transient complete heart block in a patient with critical COVID-19

            A 54-year-old man came to the Imam Khomeini hospital complex, Tehran, Iran due to shaking chills, dry cough, nausea, and vomiting during the outbreak of COVID-2019. In the emergency room, he had tachypnoea (respiratory rate 32/min), temperature 37.3°C, and O2 saturation of 76%, so he was admitted to the ward. Baseline ECG was normal (Panel A). High-resolution computed tomography showed bilateral ground-glass appearance (Panel B). PCR of the nasopharyngeal swab documented coronavirus infection. He was administered an antiviral and hydroxychloroquine. On the 13th day of hospital stay, due to aggravation of tachypnoea, he was intubated and transferred to the intensive care unit. Next morning, the patient suddenly developed complete heart block (CHB) (Panel C). Cardiopulmonary resuscitation (CPR) was performed for ∼10 min until resumption of normal sinus rhythm (Pancel D). Echocardiography showed normal left ventricular size and function with ejection fraction up to 50% without pericardial effusion. The patient remained in sinus rhythm until 30 March 30 when he died due to severe respiratory failure. (A) A 12-lead ECG shows no atrioventricular block. (B) High-resolution computed tomography shows diffuse bilateral ground-glass opacities with some foci of consolidation formation in almost all lung lobes. (C) ECG of lead II shows CHB. (D) Acquired ECG of lead II at the rate of 6.25 cm/s. The upper part shows normal sinus rhythm, then proceeding to CHB. CPR was performed in the middle part of Holter monitoring with resultant artefacts. In the lower part of the Holter, the sinus rhythm returns.
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              Considerations for drug interactions on QTc interval in exploratory COVID-19 treatment


                Author and article information

                Future Cardiol
                Future Cardiol
                Future Cardiology
                Future Medicine Ltd (London, UK )
                03 July 2020
                June 2020
                03 July 2020
                1Assistant Professor of Cardiology, Department of Cardiology, School of Medicine, Shahid Mostafa Khomeini Hospital, Ilam University of Medical sciences, Ilam, Iran
                2Assistant Professor of Medical Immunology, Department of Immunology, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
                3Assistant Professor of Infectious Disease, School of Medicine, Shahid Mostafa Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
                4Assistant Professor of Pulmonary Diseases, Department of Internal Medicine, School of Medicine, Ilam University of Medical Sciences, Ilam, Iran
                5MSC of Medical Surgical Nursing, Clinical Research Development Unit, Shahid Mostafa Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
                6MSC of Critical care Nursing, Clinical Research Development Unit, Shahid Mostafa Khomeini Hospital, Ilam University of Medical Sciences, Ilam, Iran
                7Associate Professor of Cardiology, Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
                Author notes
                [* ]Author for correspondence: Tel.: +98 918 747 4221, Fax: +98 841 222 7134; hamedtavan@
                [** ]Author for correspondence: Tel.: +98 912 733 4136, Fax: +98 216 693 9537; mollazar@
                © 2020 Future Medicine Ltd

                This work is licensed under the Creative Commons Attribution 4.0 License

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