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Cardiac memory refers to T-wave inversions (TWI) on electrocardiograms (ECGs) after an episode of abnormal ventricular activation or wide electrical activity of ventricular muscles (QRS complex). We present the case of a 62-year-old woman with symptomatic bradycardia due to sinus pause. She immediately underwent temporary transvenous ventricular pacing. In the following days, intrinsic normal sinus rhythm was resumed at 69 bpm and a narrow QRS was observed (97 ms). Additionally, deep TWI was observed in leads II, III, aVF, and V3-V6. The distribution of TWI, normal echocardiogram and laboratory results, non-significant coronary angiogram, and recent right ventricular pacing correspond to possible cardiac T-wave memory. Follow-up 12-lead ECG four weeks later showed that T-wave morphology returned to normal baseline. This further confirmed the final diagnosis of cardiac memory-induced TWI. Recognizing cardiac memory-induced TWI is important for physicians to facilitate proper evaluation and management of TWI and prevent unnecessary further cardiac diagnostic tests. [ABSTRACT FROM AUTHOR]

Various ECG patterns can help determine the location of the occluded coronary artery and the extent of threatened myocardium. The reported positive predictive value for de Winter ECG in predicting acute left anterior descending artery occlusion is inconsistent. Additionally, the morphology of ST depression and other ECG findings may have varying degrees of severity and prognostic significance. This case demonstrates the importance of integrating multiple ECG findings, such as ST elevation, Q waves, and the R/S ratio, with the location of the de Winter pattern on various ECG leads to accurately predict the culprit artery and assess the anatomical extent of myocardial ischemia. [ABSTRACT FROM AUTHOR]

Vasoplegia is defined by hypotension and low systemic vascular resistance despite the normal or elevated cardiac index, a complication frequently following cardiac surgery, carrying high morbidity and mortality rate. Vasoplegia is related with a profound systemic inflammatory response and is mainly mediated by cellular hyperpolarization, a relative vasopressin deficiency, and high levels of inducible nitric oxide, following cardiopulmonary bypass. Cardiopulmonary bypass is a distinct precipitant of vasoplegia, generally due to its association with nitric oxide production and severe vasopressin depletion. Postoperative vasoplegia is usually managed with vasopressors, of which catecholamines are the traditional agents of choice. Recent studies promote the use of non-catecholamine vasopressor (vasopressin) in restoring systemic vascular resistance. Alternative agents are also able to restore vascular tone and improve vasoplegia, including methylene blue, angiotensin II, hydroxocobalamin, and ascorbic acid; however, their effect on patient outcomes is still unclear. [ABSTRACT FROM AUTHOR]

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Background: Hypertension (HTN) remains a serious risk factor for cardiovascular mortality across the world. Hypertensive state has been shown to be associated with autonomic nervous function. This study aimed to explore the association between autonomic nervous impairment assessed by heart rate variability (HRV) and HTN. Methods: A total of 52 hypertensive and 55 non‐hypertensive patients were consecutively studied using 24‐hour Holter. The hypertensive patients were grouped into controlled blood pressure (BP) and uncontrolled BP. This study compared HRV in non‐hypertensive and hypertensive patients; and hypertensive patients with controlled and uncontrolled BP. HRV parameters include time and frequency domain. Results: Mean age for hypertensive and non‐hypertensive patients were 53.58 ± 14.31 and 44.89 ± 16.63 years old, respectively. Median (IQR) SDNN for hypertensive and non‐hypertensive group were 109.00 (90.00‐145.00) and 129.00 (107.00‐169.00), respectively. SDNN, ASDNN, rMSSD, pNN50, BB50, VLF, and HF values were significantly lower in the hypertensive group compared to non‐hypertensive group (all P <.05). A multiple regression analysis showed that HRV parameters: SDANN, ASDNN, rMSSD, and LF values were independent risk factors of HTN. SDNN, SDANN, ASDNN, VLF, LF, and HF values were significantly lower in the uncontrolled BP compared to controlled BP group (all P <.05). A multiple regression analysis showed that HRV parameters: SDNN, SDANN, rMSSD, and HF values were independent risk factors of uncontrolled BP in hypertensive patients. Conclusions: Our study showed that cardiac autonomic nervous impairment, as demonstrated by reduced HRV, is significantly associated with HTN. Decreased HRV was more evident in uncontrolled BP than in controlled BP group. [ABSTRACT FROM AUTHOR]

Introduction: The novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has caused a pandemic. Many studies have shown that several laboratory parameters are related to disease severity and mortality in SARS‐CoV‐2 cases. This meta‐analysis aimed to determine the relationship of a prognostic factor, D‐dimer, with disease severity, need for intensive care unit (ICU) care, and mortality in SARS‐CoV‐2 patients. Methods: A systematic search for all observational studies and trials involving adult patients with SARS‐CoV‐2 that had any data related to D‐dimer on admission was conducted using PubMed, Science Direct, Scopus, ProQuest, and MedRxiv databases. We performed random‐effects inverse‐variance weighting analysis using mean difference (MD) of D‐dimer values for outcomes such as disease severity, mortality, and need for ICU care. Results: A total of 29 studies (4,328 patients) were included in this meta‐analysis, which revealed a higher mean of D‐dimer levels on admission in severe patients than in nonsevere patients (MD = 0.95, [95% confidence interval (CI): 0.61‐1.28], P <.05; I2 = 90%). The nonsurvivor group had a higher pooled MD of D‐dimer values on admission (MD = 5.54 [95% CI: 3.40‐7.67], P <.05; I2 = 90%). Patients who needed ICU admission had insignificantly higher D‐dimer values than patients who did not need ICU admission (MD = 0.29, [95% CI: −0.05 to 0.63], P =.10; I2 = 71%). Conclusion: Elevated D‐dimer levels on admission were associated with an increased risk of disease severity and mortality in patients with SARS‐CoV‐2 infection. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to compare the outcomes of the administration of LMWH and UFH in hospitalized COVID-19 patients., Methods and Results: We systematically searched several databases and included observational studies or clinical trials that compared the outcomes of the administration of LMWH and UFH in hospitalized COVID-19 patients. A total of nine studies comprising 9637 patients were included. Metanalysis showed that LMWH administration was associated with a lower in-hospital mortality and 28/30-day mortality compared with UFH administration {[relative risk (RR) 0.44; 95% confidence interval (95% CI) 0.32-0.61; I2: 87.9%] and (RR 0.45; 95% CI 0.24-0.86; I2: 78.4%), respectively}. Patient with LMWH had shorter duration of hospital and ICU length of stay compared with UFH {[weighted mean difference (WMD) -2.20; 95% CI -3.01 to -1.40; I2:0%] and (WMD -1.41; 95% CI -2.20 to -0.63; I2: 0%), respectively}. The risk of ICU admission or mechanical ventilation was lower in patients who received LMWH than in those who received UFH (RR 0.67; 95% CI 0.55-0.81; I2: 67.3%). However, there was no difference in the incidence of bleeding with LMWH compared with UFH (RR 0.27; 95% CI 0.07-1.01; I2: 64.6%)., Conclusion: Our meta-analysis showed that administration of LMWH was associated with better outcomes compared with UFH in hospitalized COVID-19 patients. Prospective cohorts and RCTs are urgently needed to explore the definitive effect of LMWH to provide direct high-certainty evidence. PROSPERO registration number: CRD42021271977., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.)