key: cord-0908395-eo9vhv8d
authors: Tran, Jasmine; Wan, Siu-Hin
title: Maskophobia As A Cause Of Non-exertional Dyspnea In The Era Of Covid-19
date: 2022-04-30
journal: Journal of Cardiac Failure
DOI: 10.1016/j.cardfail.2022.03.248
sha: 6c8946a000250b170a26af0adcf21d1142f69a59
doc_id: 908395
cord_uid: eo9vhv8d

Introduction COVID-19 can cause dyspnea through many mechanisms, and uncovering the underlying etiology greatly affects management. Diagnostic examinations can help uncover pulmonary, cardiac, or hematologic conditions that can contribute to post-viral COVID dyspnea. Hypothesis Non-exertional dyspnea could be caused by maskophobia and not cardiopulmonary conditions. Methods A 59-year-old woman with no history of heart failure and a history of mild exercise-induced asthma, hyperlipidemia, anxiety, depression, and migraines was hospitalized for resting dyspnea. Three months prior, she tested positive for SARS-CoV-2, and a repeat test was positive a week prior to presentation. Upon exercise, oxygen saturation improves. The patient does not endorse dyspnea regularly, with shortness of breath only when wearing a mask. Orthopnea and paroxysmal nocturnal dyspnea were absent. Vital signs were normal. The patient was treated with antivirals, and because of her asthma history, was prescribed 10 days of oral steroids. Supplemental O2 was given for initial mild hypoxia, and the patient was discharged with an oxygen prescription at 1 L/min throughout the day. Upon follow-up, diagnostic testing was performed to assess the etiology of her dyspnea symptoms. D-dimer, complete blood count and basic metabolic panel were unremarkable. Electrocardiogram (EKG) did not demonstrate any evidence of infarction or cardiomyopathy. Chest X-ray did not show pulmonary infiltrate or cardiomegaly. Transthoracic echocardiogram showed normal left ventricular ejection fraction. Nuclear stress testing did not demonstrate any cardiac ischemia. Pulmonary function testing showed mild reactive airway disease consistent with prior asthma history. The symptoms of dyspnea would resolve once the patient removes her mask. Results Dyspnea can be caused by dysfunction anywhere along the pathway from environment oxygen intake to oxygen delivery to the end organs. The most common organ systems involved are pulmonary, cardiac, or hematologic. Anxiety can also cause dyspnea in the absence of a physiologic mismatch between oxygen supply and demand. Cardiopulmonary evaluation is the initial step in the workup of exertional dyspnea. Chest X-ray can assess for the presence of pneumonia, and labs such as D dimer indicate the likelihood of blood clots and pulmonary embolism. Exertional symptoms are evaluated by cardiopulmonary exercise testing. Heart failure can be suspected with abnormal systolic or diastolic function on an echocardiogram. However, if the diagnostic exams do not show any exertional abnormalities of the heart related to dyspnea, and symptoms only occur with the use of a mask, this may reflect an unusual case of non-exertional dyspnea from maskophobia. Conclusions Because masks are becoming a norm during the COVID-19 era, non-exertional dyspnea may represent maskophobia. In the absence of significant laboratory, imaging, and cardiopulmonary investigation, wearing masks could be a cause of non-exertional dyspnea during the era of COVID-19.

Background: The COVID pandemic presented many challenges to providing care to our HF patients. One of our challenges was the closure of our sleep lab for sleep apnea testing and CPAP titration. We also encountered patient reluctance to perform sleep testing with re-usable home equipment. In attempt to address these issues, we employed the WatchPAT TM ONE device (Itamar Medical) -a disposable Bluetooth-enabled technology that uses peripheral arterial tonometry -to assess patients for sleep-disordered breathing (SDB) without an in-person visit or a facemask. At-home CPAP initiation and auto-titration was performed in appropriate patients to create a fully contactless testing and treatment program. Methods: From March 2020 -March 2021 patients with suspected SDB during a virtual HF Clinic visit were referred for home sleep testing using the Watch-PAT TM ONE device. Suspicion for SDB breathing was based on meeting at least 1 of 5 screening criteria used in our HF Clinic and a STOP-BANG score > 3. After insurance approval, a device was mailed to the patient for overnight testing. Results were uploaded into the CloudPAT platform and read by our Center's sleep cardiologist. Patients without complex SDB, underwent remote device fitting via an online DME company followed by CPAP auto-titration. Time to therapy and compliance with CPAP was assessed using the cloud-based system.

Conclusions: Sleep apnea is a common comorbidity in HF patients The WatchPAT TM ONE system was an effective way to continue to test our HF patients for SDB in a virtual setting with a disease prevalence similar to standard in-lab testing and had the ability to discern between obstructive and central sleep apnea In our initial virtual sleep apnea program, nearly 1/3 of patients with SDB went onto CPAP treatment via a remote DME Turnkey service with a favorable time to treatment and a completely contactless workflow T a g g e d P 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. Introduction: COVID-19 can cause dyspnea through many mechanisms, and uncovering the underlying etiology greatly affects management. Diagnostic examinations can help uncover pulmonary, cardiac, or hematologic conditions that can contribute to post-viral COVID dyspnea. Hypothesis: Non-exertional dyspnea could be caused by maskophobia and not cardiopulmonary conditions. Methods: A 59-year-old woman with no history of heart failure and a history of mild exercise-induced asthma, hyperlipidemia, anxiety, depression, and migraines was hospitalized for resting dyspnea. Three months prior, she tested positive for SARS-CoV-2, and a repeat test was positive a week prior to presentation. Upon exercise, oxygen T a g g e d E n d Profil e  3  3  3  3  3  3  Time from +SARS-COV- Days from implant to extubation 7 3 0 7 1 5 5 1 6 7 3 saturation improves. The patient does not endorse dyspnea regularly, with shortness of breath only when wearing a mask. Orthopnea and paroxysmal nocturnal dyspnea were absent. Vital signs were normal. The patient was treated with antivirals, and because of her asthma history, was prescribed 10 days of oral steroids. Supplemental O 2 was given for initial mild hypoxia, and the patient was discharged with an oxygen prescription at 1 L/min throughout the day. Upon follow-up, diagnostic testing was performed to assess the etiology of her dyspnea symptoms. D-dimer, complete blood count and basic metabolic panel were unremarkable. Electrocardiogram (EKG) did not demonstrate any evidence of infarction or cardiomyopathy. Chest X-ray did not show pulmonary infiltrate or cardiomegaly. Transthoracic echocardiogram showed normal left ventricular ejection fraction. Nuclear stress testing did not demonstrate any cardiac ischemia. Pulmonary function testing showed mild reactive airway disease consistent with prior asthma history. The symptoms of dyspnea would resolve once the patient removes her mask. Results: Dyspnea can be caused by dysfunction anywhere along the pathway from environment oxygen intake to oxygen delivery to the end organs. The most common organ systems involved are pulmonary, cardiac, or hematologic. Anxiety can also cause dyspnea in the absence of a physiologic mismatch between oxygen supply and demand. Cardiopulmonary evaluation is the initial step in the workup of exertional dyspnea. Chest X-ray can assess for the presence of pneumonia, and labs such as D dimer indicate the likelihood of blood clots and pulmonary embolism. Exertional symptoms are evaluated by cardiopulmonary exercise testing. Heart failure can be suspected with abnormal systolic or diastolic function on an echocardiogram. However, if the diagnostic exams do not show any exertional abnormalities of the heart related to dyspnea, and symptoms only occur with the use of a mask, this may reflect an unusual case of non-exertional dyspnea from maskophobia. Conclusions: Because masks are becoming a norm during the COVID-19 era, non-exertional dyspnea may represent maskophobia. In the absence of significant laboratory, imaging, and cardiopulmonary investigation, wearing masks could be a cause of non-exertional dyspnea during the era of COVID-19. 

9% Medicare insured, 31.0% private insured, 27.0% were elective admissions, unadjusted in-hospital mortality was 2.4%, mean length of stay was 6.6 days and mean hospitalization charge was $147

Background: : Sparse data exists describing the characteristics of patients utilizing short term mechanical circulatory support (MCS) devices (intraaortic balloon pumps, percutaneous ventricular assist devices, extracorporeal membrane oxygenation devices) during ventricular tachycardia (VT) ablation related hospitalizations. The purpose of this study was to characterize the demographics, in-hospital mortality, length of stay and hospital charges for MCS use. Methods: : In this serial cross-sectional study, we analyzed all VT ablation related hospitalizations who received short-term MCS in the United States from 2010 to 2017 by using the Nationwide Readmission Database. Results: : Among 384,742 hospitalizations with primary diagnosis of VT, 41,075 (10.7%) underwent ablation procedures (4,919 in