A 63 year-old female with multiple atherosclerotic risk factors presented with newly diagnosed heart failure. Clinical presentation and initial work-up studies (e.g. laboratory findings, ECG, and echocardiography) were indeterminate for ischemic or non-ischemic etiology. As she developed contrast-induced nephropathy, coronary angiography was initially deferred and cardiac MRI was performed instead. Cardiac MRI elegantly demonstrated non-ischemic cardiomyopathy that was subsequently confirmed by invasive coronary angiography. This case emphasizes the important role of cardiac MRI in establishing the etiology of cardiomyopathy, ultimately altering the clinical management of the patient with newly diagnosed heart failure.

We herein report an unusual case of a patient developing both cardiovascular and cerebrovascular sequelae to COVID-19 pneumonia. While COVID patients have been reported to experience one or the other, there has been little discussion of the presentation and pathophysiology of a patient presenting with injury to both organ systems. This article will consider the pathophysiology common to cardiovascular and cerebrovascular injury in the setting of COVID as well mechanisms that affect each system separately. It also discusses useful investigations which may assist in diagnosis and treatment of patients presenting as such.

Introduction: Congenital cardiac disorders are the most prevalent congenital disorders which require interventional or surgical treatments. The most common causes of complete heart block (CHB) are degeneration of cardiac conduction system, acute myocardial infarction and congenital cardiac disorders. CHB after congenital heart surgery is of paramount importance which causes post-operation death and heart failure. Application of a pacemaker is a standard treatment for CHB. The purpose of this paper is to study the frequency of early postoperative CHB in patients with congenital cardiac diseases and also the need for temporary (TPM) and permanent (PPM) pacemakers. Materials and methods: This descriptive-analytical and cross-sectional study was conducted on children with congenital heart defects who had undergone open-heart surgery in Tabriz’s Shahid Madani Hospital from 2011 to 2016. Patients with early postoperative CHB were included in the study. Those who had improved on their own and those who needed TPM and PPM were identified and at the end, the frequency of CHB and the need for TPM and PPM were assessed. Results: Of the 2100 operated patients, 109 patients developed early postoperative heart block. The frequency of early CHB after open heart surgery was 5.19%. Of the 109 patients, 69 patients (63.3%) with early postoperative CHB needed TPM, 9 patients needed PPM and 22 patients improved without pacemaker. Conclusion: The prevalence of early CHB in patients operated for congenital cardiac diseases was 5.19%. The need for TPM was high and most of the patients had improved cardiac rhythm with no need for PPM or TPM.

Introduction: Cannabinoid users are at high risk of developing atrial arrhythmias. We sought to investigate the outcomes and the economic impact of marijuana use on patients with atrial fibrillation utilizing the National Inpatient Sample. Materials and Methods: Patients with atrial fibrillation were identified in the National Inpatient Sample (NIS) database between 2012 and 2014 using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), who subsequently were divided into two groups, those with and without marijuana smoking. The primary outcome was all-cause in-hospital mortality in the two groups. Secondary outcomes were in-hospital morbidities, required procedures and complications. We also evaluated the length of hospital stay and the cost of hospitalization. Logistic regression model was performed to address potential confounding factors. Results: The marijuana-users group had no significant increase of in-hospital mortality (OR: 1.24; 95% CI: 0.51 - 3.01, p = 0.632). However, marijuana users were predominantly younger males and less likely to undergo cardiac surgery (OR: 0.54, 95% CI 0.37 - 0.78, p = 0.001). Moreover, marijuana users are more likely to have a lower cost of hospitalization when compared to non-users ($28,916 vs $32,303, p = 0.001). Conclusion: Cannabinoid use was not associated with an increase in mortality among patients admitted with atrial fibrillation. However, marijuana users were younger, had fewer comorbidities, and cardiac surgeries with associated lower hospitalization costs. Admittedly, given the growing popularity of these products, further large prospective studies are needed to investigate the safety and evaluate different integral associations of cannabis use with worse cardiac outcomes in atrial arrhythmias patients, particularly those with atrial fibrillation.