Sandbox:AyeshaFJ

# Cardiovascular Disorders and COVID-19

### In-hospital SCD
- Drug induced:
Since the COVID-19 pandemic, several pharmacological therapies have been proposed, one of them is of two anti-malarial and antirheumatic drugs called Chloroquine or Hydroxychloroquine. Due to their cost-effectiveness and easy availability, there is a surge in the use of Chloroquine and Hydroxychloroquine, with or without Azithromycin. The clinical trials in order to estimate their efficacy are still in the preliminary stage, however, a notable concern is of their cardiac adverse effects. This includes QT prolongation and Torsade de pointes (TdP) leading to sudden cardiac death. The risk is there when these drugs are prescribed separately, however it increases several folds when these drugs are administered together, especially in patients with underlying hepatic disease or renal failure.
- Genetic susceptibility:
Epidemiological studies have shown that African Americans have higher COVID-19 associated morbidity and mortality as compared to people from other ethnic groups. Recent studies show that this ethnic predilection is due to the genetics factors which contribute to a common ion channel variant p.Ser1103Tyr-SCN5A which confer an increased risk of drug-induced long QT syndrome (DI-LQTS) and drug-induced sudden cardiac death (DI-SCD). p.Ser1103Tyr-SCN5A generates late or persistent sodium current which is further aggravated by hypoxia or respiratory acidosis secondary to lungs involvement in COVID-19. This has and has been linked to an increased risk of ventricular arrhythmia (VA) such as torsade de pointes  and sudden cardiac death (SCD) in African Americans.

### Out of hospital Sudden cardiac arrest and death

### Epidemiology
- Incidence
- There is a two-times rise in the incidence of Out of hospital Sudden cardiac arrest (OHCA) during the COVID-19 pandemic as compared to the non-pandemic time period.
- Mortality
There is a significant increase in the mortality rate of the OHCA patients.
- Age
Mean age 697 years is observed among patients who experienced Out of hospital Sudden cardiac arrest (OHCA) . .
- Gender
Studies show that males have a slightly higher incidence of Out of hospital Sudden cardiac arrest (OHCA) as compared to the females.
- Race
A higher incidence is seen among Blacks as compared to whites.

### =Diagnosis
- EKG
- Pulseless electrical activity
- Cardiopulmonary resuscitation
- Immediate basic life support or advanced cardiac life support with an automatic external defibrillator is essential to safe the life of the patient. If the COVID-19 infection was confirmed, the EMS personnel is instructed to wear personal protective equipment (PPE) before performing cardiopulmonary resuscitation..
- Implantable Cardioverter Defibrillator (ICD)
- An implantable cardioverter-defibrillator (ICD) is the preferred therapeutic modality in most survivors of SCA. This device does not prevent the recurrence of arrhythmia, instead, it terminates them  in case if they do recur.
- Pharmacologic therapy in survivors of sudden cardiac arrest
- Antiarrhythmic drugs:Amiodarone is the most effective for preventing recurrent ventricular tachyarrhythmias, It is recommended to immediately give Amiodarone following an event of sudden cardiac arrest in patients with recurrent ventricular tachyarrhythmias as well as for those who have refused Implantable Cardioverter Defibrillator(ICD).
- Beta blocker:It is recommended that almost all patients who survive an episode of sudden cardiac arrest should receive a beta-blocker as part of their therapy in combination with an antiarrhythmic drug, particularly in those patients who have survived sudden cardiac death due to ventricular tachycardia or ventricular fibrillation.  Beta-blockers has shown to reduce the future incidence of sudden death.
- Identification and treatment of acute reversible causes.
- Evaluation and management of structural heart disease and arrhythmia.

# Spontaneous coronary dissection
Pathophysiology
In patients with an inflammatory overload, a localized inflammation of the coronary adventitia and periadventitial fat can occur. This could lead to the development of sudden coronary artery dissection in a susceptible patient.
Signs and symptoms
Treatment
- Erythematous raised patches with adherent keratotic scarring and follicular plugging.
-  Jump up to: 1.0 1.1 1.2 1.3 Marijon E, Karam N, Jost D, Perrot D, Frattini B, Derkenne C;  et al. (2020). "Out-of-hospital cardiac arrest during the COVID-19 pandemic in Paris, France: a population-based, observational study". Lancet Public Health. doi:10.1016/S2468-2667(20)30117-1. PMC 7255168 Check |pmc= value (help). PMID 32473113 PMID: 32473113 Check |pmid= value (help).CS1 maint: Multiple names: authors list (link) .mw-parser-output cite.citation{font-style:inherit}.mw-parser-output q{quotes:"\"""\"""'""'"}.mw-parser-output code.cs1-code{color:inherit;background:inherit;border:inherit;padding:inherit}.mw-parser-output .cs1-lock-free a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-limited a,.mw-parser-output .cs1-lock-registration a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-lock-subscription a{background:url("")no-repeat;background-position:right .1em center}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration{color:#555}.mw-parser-output .cs1-subscription span,.mw-parser-output .cs1-registration span{border-bottom:1px dotted;cursor:help}.mw-parser-output .cs1-hidden-error{display:none;font-size:100%}.mw-parser-output .cs1-visible-error{display:none;font-size:100%}.mw-parser-output .cs1-subscription,.mw-parser-output .cs1-registration,.mw-parser-output .cs1-format{font-size:95%}.mw-parser-output .cs1-kern-left,.mw-parser-output .cs1-kern-wl-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right,.mw-parser-output .cs1-kern-wl-right{padding-right:0.2em}
-  Lai PH, Lancet EA, Weiden MD, Webber MP, Zeig-Owens R, Hall CB;  et al. (2020). "Characteristics Associated With Out-of-Hospital Cardiac Arrests and Resuscitations During the Novel Coronavirus Disease 2019 Pandemic in New York City". JAMA Cardiol. doi:10.1001/jamacardio.2020.2488. PMC 7305567 Check |pmc= value (help). PMID 32558876 PMID: 32558876 Check |pmid= value (help).CS1 maint: Multiple names: authors list (link)