Browsing by Author "Guglin, Maya"

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    A case report of constrictive pericarditis following COVID-19 vaccination
    (Oxford University Press, 2023-11-06) Bain, Eric; Guglin, Maya; Medicine, School of Medicine
    Background: COVID-19 infection and the COVID-19 vaccines have been associated with rare cases of pericarditis. We present a case of constrictive pericarditis (CP) following the vaccine. Case summary: A 19-year-old healthy male started having progressive abdominal pain, emesis, dyspnoea, and pleuritic chest pain 2 weeks after the second dose of Pfizer vaccine. Computed tomography angiography chest revealed bilateral pleural effusions and pericardial thickening with effusion. Cardiac catheterization showed ventricular interdependence. Cardiac magnetic resonance (CMR) showed septal bounce and left ventricular tethering suggestive of CP. A total pericardiectomy was performed with significant symptom improvement. Pathology showed chronic fibrosis without amyloid, iron deposits, or opportunistic infections. Patient had Epstein-Barr Virus (EBV) viraemia 825 IU/mL and histoplasmosis complement-fixation positive with negative serum and urine antigen. Hypercoagulable panel and infectious workup were otherwise negative. The patient had resolution of cardiac symptoms at 3 months of follow-up. Discussion: The patient developed progressive symptoms within 2 weeks of his second Pfizer vaccine. Echocardiogram and CMR had classic signs of CP, and pericardial pathology confirmed fibrotic pericardium. The patient had no prior surgery, thoracic radiation, or bacterial infection. Epstein-Barr Virus viraemia was thought to be reactionary, and histoplasmosis complement likely represented chronic exposure. The timing of symptoms and negative multidisciplinary workup raises the suspicion for COVID vaccine-induced CP. The COVID vaccines benefits far exceed the risks, but complications still can occur. Practitioners should have a high index of suspicion to allow prompt diagnosis of CP.
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    Acute Biventricular Heart Failure After COVID-19 Infection in an Orthotropic Heart Transplant Patient: A Case Report
    (Elsevier, 2021-05) Berg, Nicholas; Ilonze, Onyedika; Bajpai, Vatsal; Guglin, Maya; Rao, Roopa; Medicine, School of Medicine
    The cardiac effects of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) include myocarditis, takotsubo cardiomyopathy, pericardial effusion, and cardioembolic events in the general population. The effects of SARS-CoV-2 in heart transplant patients are unclear. We describe a case of myocarditis in the transplanted heart that responded to methylprednisolone.
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    Aortic root thrombosis leading to STEMI in a Heartmate 3 patient
    (Springer, 2023-03) Ilonze, Onyedika J.; Torabi, Asad; Guglin, Maya; Saleem, Kashif; Rao, Roopa; Medicine, School of Medicine
    Despite left ventricular assist device (LVAD) therapy becoming established for end-stage heart failure (HF), complications remain. Thromboembolic complications are rare with the newest iteration of LVADs. We managed a case of a continuous-flow LVAD-related thromboembolic event that presented as an acute myocardial infarction. A 64-year-old male who underwent Heartmate III® LVAD implantation had crushing substernal chest pain and ventricular tachycardia with acute anterolateral myocardial infarction on electrocardiogram on post-operative day 9. Echocardiography showed closed aortic valve and mild aortic regurgitation, but CT angiography showed thrombus within the left coronary cusp despite full anticoagulation. Continuous suction of blood from the left ventricle despite pulsatile flow into the ascending aorta resulted in a minimally opening aortic valve and stagnation of blood leading to thrombosis on the coronary cusp. Apart from post-operative ventricular tachycardia and right ventricular failure, he had adequate body size (body surface area 2.13 m2) and no post-operative or coagulopathy which could predispose him to thrombosis. Coronary angiography revealed stable severe three-vessel disease and thrombus in left main and proximal circumflex artery, and he had aspiration thrombectomy, and international normalized ratio target was increased to 3–3.5 with aspirin 325 mg daily. He survived to discharge but died 60 days after LVAD implant with multiple low flow alarms, and cardiac arrest. We review the literature and propose a management algorithm for patients with impaired AV opening and aortic root thrombosis.
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    Calcineurin-Inhibitor Induced Pain Syndrome in a Heart Transplant Patient
    (Elsevier, 2021-10) Ilonze, Onyedika J.; Giovannini, Marina; Jones, Mark A.; Rao, Roopa; Ballut, Kareem; Guglin, Maya; Medicine, School of Medicine
    Calcineurin-inhibitor induced pain syndrome (CIPS) also called the "symmetrical bone syndrome" is a condition describing reversible lower extremity pain in patients after organ transplantation who are receiving calcineurin inhibitors, especially tacrolimus. We present a case of CIPS after orthotopic heart transplant complicated with concurrent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We emphasize the presentation; diagnostic evaluation, and findings. We then discuss the proposed pathophysiologic mechanisms of CIPS and conclude with discussion of management strategies. Additionally, we present a table to guide clinicians in assessing posttransplant bone pain syndromes. To our knowledge, this is the first article to describe a case of CIPS with concurrent SARS-CoV-2 infection.
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    Cardiac Rehabilitation for Patients With Heart Failure: JACC Expert Panel
    (Elsevier, 2021) Bozkurt, Biykem; Fonarow, Gregg C.; Goldberg, Lee R.; Guglin, Maya; Josephson, Richard A.; Forman, Daniel E.; Lin, Grace; Lindenfeld, JoAnn; O'Connor, Chris; Panjrath, Gurusher; Piña, Ileana L.; Shah, Tina; Sinha, Shashank S.; Wolfel, Eugene; ACC’s Heart Failure and Transplant Section and Leadership Council; Medicine, School of Medicine
    Cardiac rehabilitation is defined as a multidisciplinary program that includes exercise training, cardiac risk factor modification, psychosocial assessment, and outcomes assessment. Exercise training and other components of cardiac rehabilitation (CR) are safe and beneficial and result in significant improvements in quality of life, functional capacity, exercise performance, and heart failure (HF)-related hospitalizations in patients with HF. Despite outcome benefits, cost-effectiveness, and strong practice guideline recommendations, CR remains underused. Clinicians, health care leaders, and payers should prioritize incorporating CR as part of the standard of care for patients with HF.
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    Cardiogenic shock following cardiac tamponade and Takotsubo in COVID-19
    (Future Medicine, 2020) Torabi, Asad J.; Villegas-Galaviz, Josue; Guglin, Maya; Frick, Kyle; Rao, Roopa; Medicine, School of Medicine
    Introduction: Takotsubo is often described as stress-induced cardiomyopathy and is a known cause of heart failure. Objective: Review the clinical course of a young coronavirus disease 2019 (COVID-19) patient who developed Takotsubo following cardiac tamponade. Case presentation: A 42-year-old woman presented to the emergency department with fever, altered mental status and hypoxia. She was ultimately found to be in cardiac tamponade and within 2 hours of a pericardiocentesis she developed Takotsubo and was in cardiogenic shock. Her family decided to place her on comfort measures and she died the same day. Discussion: This case illustrates the increasing number of cardiovascular complications being reported in COVID-19 and highlights the importance of clinicians to be aware of these challenges. Conclusion: Here, we report a distinct presentation of cardiogenic shock in a young COVID-19 patient. The rapid onset of her suspected Takotsubo and the severity of her disease were striking features in this case.
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    CardioMEMS Heart Failure System: An Up-to-Date Review
    (Springer Nature, 2025-01-22) Tolu-Akinnawo, Oluwaremilekun; Akhtar, Naveed; Zalavadia, Nirav; Guglin, Maya; Medicine, School of Medicine
    Heart failure (HF) continues to represent a significant public health concern. While patients with HF with reduced ejection fraction (HFrEF) face a high risk of arrhythmias, both patients with HFrEF and HF with preserved ejection fraction (HFpEF) experience fluid overload, leading to repeated hospitalizations. Traditional monitoring methods have limited ability to manage HF exacerbations preemptively. However, the CardioMEMS™ (Abbott Laboratories, Chicago, IL) HF system, an implantable microelectromechanical sensor, has emerged as an innovative solution, enabling real-time remote monitoring of pulmonary artery pressures (PAPs). CardioMEMS has significantly reduced HF-related hospitalizations and improved patient quality of life (QOL) by facilitating early intervention before clinical symptoms. This article explores the technical specifications, clinical efficacy, integration into clinical practice, and economic impact of the CardioMEMS system. Furthermore, we discuss the challenges and limitations associated with its widespread adoption and propose considerations for future research to enhance its cost-effectiveness and accessibility in diverse healthcare settings.
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    Clinical characteristics, outcomes and immunosuppression strategies of heart transplant recipients infected with covid-19
    (Elsevier, 2021) Ilonze, Onyedika J.; Ballut, Kareem; Jones, Mark; Rao, Roopa; Guglin, Maya; Medicine, School of Medicine
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    Clinical variants of myocardial involvement in COVID-19-positive patients: a cumulative experience of 2020
    (Springer, 2021-07) Guglin, Maya; Ballut, Kareem; Ilonze, Onyedika; Jones, Mark; Rao, Roopa; Medicine, School of Medicine
    Myocardial injury, diagnosed by troponin elevation, is common in COVID-19 patients, but cardiac involvement with clinical manifestations occurs less frequently. We analyzed the literature on COVID-19 (2020) and systematically reviewed the cases where individual patient data were presented. We searched PubMed and Google Scholar for "COVID," "COVID-19," and "coronavirus" in combination with "myocarditis," "heart failure," "takotsubo," "cardiomyopathy," and "cardiogenic shock." We identified 90 cases of COVID-19 with myocardial involvement, mean age 52.9 ± 18.3 years, 54.5% males. Of them, 55 survived (61.1%), 20 died (22.2%), and in 15 (16.7%) the outcome was unknown at the time of publication. Among patients with known outcome, mortality was 26%. The nadir LVEF was 31.7 ± 13.1% and recovered to 50.1 ± 16.0%. Pericardial effusion was a common finding, reported in 21 (23.3%) of patients, including moderate size effusion in 8.9% and large in 7.8%. The effusion caused tamponade in 11 (12.2%) of patients. Out of 83 patients who experienced a decrease in LVEF, 30 could be classified as takotsubo syndrome. The takotsubo patients were older than those with myocarditis, and with relatively high proportion of males. About one third of the cases was complicated by cardiogenic shock. Myocardial involvement in COVID-19 patients most often presents as a new, rapid decrease in LVEF, although normal LVEF or takotsubo-like wall motion pattern does not rule out myocarditis. Moderate and large pericardial effusion is common, and cardiac tamponade occurs in 12.2% of patients. Cardiogenic shock develops in one third of the patients. Mortality appears to be high at 26%.
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    Covid 19 and Pericarditis: Should We Be Worried about Tamponade?
    (Elsevier, 2022) Arshad, Samiullah; Gul, Muhammad Hamdan; Guglin, Maya; Medicine, School of Medicine
    Introduction: Little is known about cardiac manifestations of COVID-19 infection, yet cases of pericarditis, pericardial effusion and with tamponade due to COVID-19 have been reported. Because of the life-threatening nature of this complication, we wanted to investigate the features of pericardial effusion and the rate of occurrence of tamponade in patients with COVID-19. Methods: This systematic review was conducted by searching for studies in Pubmed/Medline and Google Scholar for the search terms ‘COVID-19’, ‘SARS-COV-2’, ‘Pericarditis’, ‘Pericardial Effusion’ and ‘Cardiac Tamponade’, performed on December 7, 2020. Results: A total of 47 patients with COVID-19 with pericarditis were included in the review from 39 published cases. There were 29 (62%) males and 18 (38%) females and mean age of patients was 53 years. Pulmonary infiltrates were seen in 30 (64%) patients, while 17 (36%) patients did not have pulmonary manifestations. Concomitant myocarditis was present in 16 (34%) patients. 43 (91%) had pericardial effusion- 4 (9%) had small, 10 (21%) had moderate, 3 (6%) had a large pericardial effusion and 26 (55%) patients had cardiac tamponade. 7 (15%) patients with tamponade died. Pericardiocentesis was done in 27 (57%) patients and pericardial window was created in 5 (11%) patients. Off these 13 (27%) patients had an exudative effusion while 1 (2%) patient had a transudative effusion. Conclusion: We found that pericarditis in patients with COVID-19 infection can be present in patients with pulmonary infiltrates and without them, as well as with myocarditis or as an isolated feature of cardiac involvement. The effusion is predominantly exudative. More than half of the patients with pericardial involvement present with tamponade, and mortality in this subset is high. The pattern of patients presenting solely with pericarditis and effusion without pulmonary infiltrates warrants further investigation.