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Introduction and Objectives: Digital health (DH) is a broad concept, bringing together technology and healthcare, that is playing an increasingly important role in the daily routine of healthcare professionals (HCPs) and promises to contribute to the prevention and treatment of cardiovascular disease. There are no solid data on the position of Portuguese HCPs toward the implementation of DH in cardiovascular medicine. This national cross-sectional study aims to provide a snapshot of DH implementation in Portuguese cardiovascular HCP routines and to identify both expectations and barriers to its adoption. Methods: An 18-question survey was created specifically for this study and distributed to 1174 individuals on the Portuguese Society of Cardiology mailing list. Results: We collected 117 valid responses (response rate 10%). Almost all participants had smartphones and laptops, and two-thirds had tablets. Electronic medical information systems were the most used DH tool (84% of respondents) and were considered the most important for improving cardiovascular care. Implantable technologies (sensors and devices), telemedicine and social media were used by more than two out of three respondents and considered «very important» or «extremely important» by most of them. Most participants showed positive expectations regarding the impact of DH in cardiovascular medicine: 78% agreed that DH could improve health outcomes, 64% that it promotes health literacy and 63% that it could decrease healthcare costs. The top-rated barriers were patients’ inability to use smartphones, limited access to electronic devices, and lack of legal regulation of DH. Conclusion: Most Portuguese cardiovascular HCPs had at least three electronic devices (mainly smartphones, laptops and tablets) and showed positive expectations regarding DH's current and future impact on cardiovascular medicine. Patient DH literacy, technology adoption, and DH regulation were identified as the most important barriers to increasing the adoption of DH tools in cardiovascular medicine. Resumo: Introdução e objetivos: A saúde digital é um conceito amplo, que junta a tecnologia aos cuidados de saúde, desempenhando um papel cada vez mais importante na prática clínica diária dos profissionais de saúde e promissor na prevenção e tratamento de doenças cardiovasculares. Não existem dados consistentes que avaliem a posição dos profissionais de saúde portugueses em relação à implementação da saúde digital na medicina cardiovascular. Por conseguinte, este estudo visa compreender o panorama geral da implementação da saúde digital na rotina diária dos profissionais de saúde cardiovascular em Portugal e identificar tanto as expectativas como os obstáculos à sua adoção. Métodos: Um inquérito de 18 perguntas foi construído para as necessidades específicas deste estudo e distribuído a 1174 potenciais respondedores da mailing list da Sociedade Portuguesa de Cardiologia. Resultados: Foram obtidas 117 respostas válidas (taxa de resposta ao inquérito de 10%). Quase todos os respondedores tinham um smartphone e um computador portátil e dois terços tinham um tablet. Os sistemas eletrónicos de informação médica foram a ferramenta mais utilizada (84% dos inquiridos) e considerada a mais relevante para melhorar os cuidados de saúde cardiovasculares. Mais de dois terços dos inquiridos relataram utilizar tecnologias implantáveis (sensores ou dispositivos), telemedicina e as redes sociais e todas estas ferramentas foram consideradas «muito relevantes» ou «totalmente relevantes» pela maioria. A maior parte dos respondedores demonstrou expectativas positivas relativamente ao impacto da saúde digital na medicina cardiovascular: 78% concordaram que esta pode melhorar os outcomes em saúde, 64% que promove a literacia em saúde e 63% que pode diminuir os custos dos cuidados de saúde. A incapacidade dos pacientes de utilizar smartphones, o acesso limitado a dispositivos eletrónicos e a falta de regulamentação legal da saúde digital foram as barreiras mais cotadas. Conclusão: Globalmente, a maioria dos profissionais de saúde cardiovascular em Portugal tinha pelo menos três dispositivos eletrónicos (principalmente smartphones, computadores portáteis e tablet) e mostrou expectativas positivas relativamente ao impacto atual e futuro da saúde digital na medicina cardiovascular. A literacia e a adoção de tecnologia relacionada com a saúde digital pelos pacientes, bem como a falta de regulamentação jurídica, foram identificados como os obstáculos mais importantes para aumentar a adoção de ferramentas de saúde digital na medicina cardiovascular.

Introduction and objectives: Social media (SoMe) has a flourishing role in cardiovascular (CV) medicine as a facilitator of academic communication not only during conferences and congresses, but also by scientific societies and journals. However, there is no solid data illustrating the use of SoMe by CV healthcare professionals (CVHP) in Portugal.Hence, the main goal of this national cross-sectional survey was to accurately characterize SoMe use by Portuguese CVHPs. Methods: A 35-item questionnaire was specifically developed for this study, approved by the Digital Health Study Group of the Portuguese Society of Cardiology (SPC), and sent, by e-mail, to the mailing list of the SPC (including 1293 potential recipients). Results and conclusion: There were 206 valid answers. Fifty-two percent of respondents were female and 58% were younger than 44 years of age with almost two out of three participants being physicians. Ninety-two percent of the survey participants reported that they are currently using SoMe; LinkedIn was the most common platform used for professional purposes. Sixty-four percent believed SoMe had had a positive impact on their clinical practice; 77% and 49% had used SoMe for acquiring and sharing information related to COVID-19, respectively.In conclusion, the majority of Portuguese CVHPs that participated in this survey are actively using SoMe, with a greater participation of those

Acute myocarditis (especially) and pericarditis have been consistently associated with the administration of vaccines against SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), generating anxiety in the general population, uncertainty in the scientific community and obstacles to ambitious mass vaccination programs, especially in foreign countries.Like some of its European counterparts, the Portuguese Society of Cardiology (SPC), through its Studies Committee, decided to take a position on some of the most pressing questions related to this issue: (i) How certain are we of this epidemiological association? (ii) What is the probability of its occurrence? (iii) What are the pathophysiological bases of these inflammatory syndromes? (iv) Should their diagnosis, treatment and prognosis follow the same steps as for typical idiopathic or post-viral acute myopericarditis cases? (v) Is the risk of post-vaccine myocarditis great enough to overshadow the occurrence of serious COVID-19 disease in unvaccinated individuals? In addition, the SPC will issue clinical recommendations and offer its outlook on the various paths this emerging disease may take in the future. Resumo: Quadros de miocardite (sobretudo) e de pericardite agudas têm vindo a ser consistentemente relacionados com a administração das vacinas anti-SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), gerando ansiedade na população geral, incerteza na comunidade científica e entraves aos ambiciosos programas de vacinação maciça, sobretudo em países estrangeiros.À semelhança de algumas das suas congéneres europeias, pretende a Sociedade Portuguesa de Cardiologia (SPC), por intermédio da sua Comissão de Estudos, tomar posição em relação a algumas da questões mais prementes a si associadas: (i) Quão certos estamos desta associação epidemiológica?; (ii) Qual a probabilidade da sua ocorrência?; (iii) Quais as bases fisiopatológicas destas síndromes inflamatórias?; (iv) Deverão os seus diagnóstico, tratamento e prognóstico seguir os mesmos trâmites dos restantes casos de miopericardite aguda idiopática ou de etiologia pós-vírica?; (v) Será o risco de miocardite pós-vacinal bastante o suficiente a ponto de sobrepujar o da instalação de doença grave por Covid-19 em indivíduos não vacinados? Adicionalmente, serão avançadas recomendações clínicas e perspetivados os diversos trilhos de evolução futura, no respeitante a esta emergente entidade nosológica.

Introduction and objectives: The coronavirus disease 2019 (COVID-19) spread quickly around the world. Although mainly a respiratory illness, there is growing interest in non-respiratory manifestations, particularly cardiovascular ones. At our center, mobilization of cardiologists with intensive care training was needed. Our aim is to describe patients with severe COVID-19 admitted to a Portuguese intensive care unit (ICU), the cardiovascular impact of the disease and the experience of cardiologists working in a COVID-19 ICU. Methods: Data from adult patients with COVID-19 admitted to the ICU of Centro Hospitalar de Vila Nova de Gaia/Espinho between 16 March 2020 and 21 April 2020 were analyzed retrospectively. Results: Thirty-five patients were admitted. Mean age was 62.6±6.0 years and 23 (65.7%) were male. Dyslipidemia was the most common cardiovascular risk factor (65.7%, n=23), followed by hypertension (57.1%, n=20). Mean ICU stay time was 15.9±10.0 days. Patients had high rates of mechanical ventilation (88.6%, n=31) and vasopressor support (88.6%, n=31). Low rates of new onset left systolic dysfunction were detected (8.5%, n=2). One patient required venoarterial extra-corporeal membrane oxygenation. Mortality was 25% (n=9). Acute myocardial injury and N-terminal pro-B-type natriuretic peptide (NT-proBNP) elevation was detected in 62.9% (n=22). Patients that died had higher NT-proBNP compared to those discharged alive (p

Acute severe mitral regurgitation (MR) because of secondary left ventricular impaired regional contractility can present with severe acute heart failure, associated with a high risk for rapid decompensation, pulmonary edema and cardiogenic shock. Frequently, in these highly unstable patients, surgical risk can be prohibitive. Evidence for percutaneous repair of acute MR is scarce, but a few case series show that this approach could be safe and effective for bailing out hemodynamically unstable patients.We report a case of an 84-year-old man with acute ischemic severe MR post-acute myocardial infarction (MI), who remained hemodynamically unstable despite coronary revascularization, positive pressure non-invasive ventilation, vasodilator therapy and intra-aortic balloon pump (IABP) support. In heart team discussions, he was considered a high risk surgical candidate. We decided on rescue off-label percutaneous mitral valve repair with a MitraClip device (Abbott Vascular, Santa Clara, California), with good clinical result, allowing weaning from the supports and discharge seven days after the procedure. At one-year follow-up, the patient maintained a MV repair results and had a good functional status. In unstable patients with acute ischemic MR, percutaneous MV repair could be a rescue therapeutic option to consider, allowing hemodynamic compensation with potential persistent MR improvement up to one-year follow-up. Resumo: A insuficiência mitral (IM) aguda grave causada por alterações isquémicas secundárias loco-regionais do ventrículo esquerdo associa-se a elevado risco de descompensação hemodinâmica com edema pulmonar e choque cardiogénico. Frequentemente, nestes doentes instáveis, o risco cirúrgico pode ser proibitivo. É escassa a evidência existente relativamente à abordagem percutânea da IM aguda neste contexto, existindo apenas algumas séries de casos que parecem mostrar segurança e eficácia no resgate de doentes instáveis.Reportamos o caso de um doente de 84 anos, género masculino, com IM aguda grave isquémica após enfarte agudo do miocárdio, que permaneceu com instabilidade hemodinâmica apesar de revascularização coronária, ventilação não invasiva com pressão positiva, terapêutica com vasodilatadores e suporte de balão intra-aórtico. Após discussão em reunião de Heart Team, o doente foi considerado de elevado risco cirúrgico, tendo sido orientado para tratamento percutâneo da válvula mitral com dispositivo MitraClip. O procedimento decorreu sem intercorrências imediatas, permitindo redução com critérios de sucesso da IM. A melhoria do perfil hemodinâmico com a correção percutânea da IM permitiu rápido desmame da terapêutica de suporte em curso, com evolução clínica favorável subsequente e alta ao sétimo dia após procedimento. No seguimento clínico e ecocardiográfico a um ano verificou-se a persistência do resultado do tratamento percutâneo da IM e o doente apresentava boa capacidade funcional.Em pacientes instáveis com MR isquémica aguda, a reparação percutânea da VM poderia ser uma opção terapêutica de salvamento a considerar, permitindo uma compensação hemodinâmica com potencial melhoria persistente da MR até 1 ano de seguimento.