Orthostatic and Exercise Intolerance in Recreational and Competitive Athletes With Long COVID.

Post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (PASC) infection is particularly concerning to athletes who place a high premium on cardiovascular performance and competition. This initial case series shows the overlap between PASC and orthostatic intolerance in athletes, reveals the diagnostic challenges, and highlights the role of graded exercise training in this population. ().

Cardiac Mechanics in Altered Hormonal States as a Surrogate for Understanding the Effects of Transgender Hormone Therapy.

Transgender individuals are increasingly seeking the care of physicians to physically transition to their self-identified gender identity. Gender-affirming hormone therapy (GAHT) has significant endocrine effects which may have cardiovascular consequences, and cardiovascular disease in transgender individuals is a growing area of study. The effects of GAHT on cardiac mechanics have yet to be characterized, but there is existing literature regarding changes to cardiac mechanics in similar altered hormonal states.

High-intensity endurance training is associated with left atrial fibrosis.

Introduction: Endurance athletes are at higher risk for developing atrial fibrillation as compared to the general population. The exact mechanism to explain this observation is incompletely understood. Our study aimed to determine whether degree of left atrial fibrosis detected by late gadolinium-enhancement magnetic resonance imaging (LGE-MRI) differed between Masters athletes and non-athlete controls.

Etiology and Resource Use of Fever of Unknown Origin in Hospitalized Children.

Background: Fever of unknown origin (FUO) is a well-known pediatric presentation. The primary studies determining the causes of prolonged fever in children were performed 4 decades ago, before major advances in laboratory and diagnostic testing. Given that the distribution of diagnosed causes of adult FUO has changed in recent decades, we hypothesized that the etiology of FUO in children has concordantly changed and also may be impacted by a definition that includes a shorter required duration of fever.

Implementation of Real-Time Assessment of Patient-Reported Outcomes in a Heart Failure Clinic: A Feasibility Study.

Background: Patient-reported outcomes (PROs) quantify, from patients' perspectives, their symptoms, function, and quality of life. Our aim was to determine the feasibility of integrating PRO capture into routine clinical practice at a large heart failure (HF) clinic.

Methods: We examined the practicality of PRO completion at the time of clinic visit, the time required to complete the selected instruments, the completion rate, and the feasibility of immediate PRO scoring and integration of the results into the electronic health record (EHR).

Left ventricular perforation after Impella® placement in a patient with cardiogenic shock.

Mechanical cardiovascular support devices are now widely used both in the setting of cardiogenic shock as well as during high risk cardiac catheterization procedures. We report a case of a young female patient who presented with presumed myocarditis and rapidly deteriorating decompensated heart failure requiring the implantation of an Impella Circulatory Support System. Upon transfer to our facility it was discovered that during transport, the Impella device had migrated through the left ventricle.

Criteria for evaluating rSr' patterns due to high precordial ECG lead placement accurately confirm absence of a Brugada ECG pattern.

Background: An rSr' pattern in leads V1-V2 can be observed when ECG leads are placed in the 2nd intercostal space. Recently, three criteria analyzing the ST segment and r' width to identify true Brugada pattern ECGs have been described.

Objectives: To assess the feasibility and reliability of using high precordial lead ECGs in conjunction with three new criteria for identifying true Brugada pattern ECGs.

Smartphone ECG aids real time diagnosis of palpitations in the competitive college athlete.

Importance: Rapidly detecting dangerous arrhythmias in a symptomatic athlete continues to be an elusive goal. The use of handheld smartphone electrocardiogram (ECG) monitors could represent a helpful tool connecting the athletic trainer to the cardiologist.

Observations: Six college athletes presented to their athletic trainers complaining of palpitations during exercise.

Left atrial appendage closure: An emerging option in atrial fibrillation when oral anticoagulants are not tolerated.

Atrial fibrillation is associated with a risk of stroke, primarily from embolization of clots that form in the left atrial appendage. This structure has been targeted to reduce stroke risk in patients who have contraindications to oral anticoagulation. This article appraises the current literature describing surgical and percutaneous isolation of the left atrial appendage.

Hypertrabeculation vs left ventricular noncompaction on echocardiogram: a reason to restrict athletic participation?

Importance: Left ventricular noncompaction (LVNC) is a rare cause of progressive cardiomyopathy thought to result from incomplete myocardial development. It has been associated with an increased risk of sudden death, especially in those with a depressed left ventricular ejection fraction. Thus, the current recommendation for patients with this diagnosis is restriction from participation in competitive sports.

Visceral varicella zoster virus (VZV) after allogeneic hematopoietic stem cell transplant (HSCT) in pediatric patients with chronic graft-versus-host disease (cGVHD).

Reactivation of latent varicella zoster virus is one infectious complication associated with the extensive immunosuppression necessary for hematopoietic stem cell transplant. Most cases are limited to skin and mortality is low. Isolated visceral zoster is rare, presenting with ileus/abdominal pain, hepatitis, and/or hyponatremia.