Chronic diseases are the cause of the highest mortality worldwide. Its prevalence is increasing, especially in middle- and low-income countries, in populations with a longer life expectancy that have adopted, among others, healthier lifestyles and diets. On the other hand, there are no therapeutic strategies focused exclusively on this population when they occur. respiratory virus epidemics such as coronaviruses. This review presents evidence that shows the main cardiovascular manifestations associated with infection by respiratory viruses and especially by coronaviruses.

Introduction: Dobutamine increases cardiac contractility and causes vasodilation with little change in heart rate. It has been used in management of acute heart failure. It has also been document for use in management of chronic heart failure. We reported 86 year old man with refractory heart on long term dobutamine. Case Summary: A 86-year-old retired civil servant living with hypertension for 26 years, type 2 Diabetes Mellitus (T2DM) for 14 years and hyperlipidemia for 10 years. He was diagnosed with biventricular failure 4 ago and had cardiac resynchronization therapy (CRT-D) implanted 3 years ago. He presented to the emergency department with 3 weeks history of bilateral leg swelling, dyspnea, orthopnea, paroxysmal nocturnal dyspnea and oliguria. He has more than 12 repeated hospital admission for heart failure in the past 4 years despites CRT-D. He was noted to be anxious and diaphoretic with a respiratory rate of 36 breaths/minute, blood pressure of 84/52 mm Hg, heart rate 80 beats/minute. Peripheral pulses were threated and diminished in amplitude, and his hands and feet were cool and moist. A summation gallop was noted over the precordium. Fine crepitations were heard over the posterobasal regions of both lungs. The electrocardiogram showed a pacemaker rhythms. He was treated for NYHA class IV heart failure with digoxin, and dobutamine. He was discharged home on long term dobutamine infusion. CONCLUSION: Home dobutamine is a simple and effective in term treatment for end-stage heart failure. Its widespread use may be restricted by cost and expertise considerations in Nigeria

Bradycardia is commonly encountered in emergency department. Hyperkalemia may sometime cause bradycardia with block and also synergize with AV node blockers to cause bradycardia and hypoperfusion. We report a 53 years old male with history of hypertension, congestive heart failure and coronary artery disease was admitted to hospital for sudden onset of breathlessness. He underwent percutaneous coronary intervention (PCI) to left anterior descending (LAD) artery and left circumflex (LCx) artery one year ago and taking Aspilet 80 mg for daily, Clopidogrel 75 mg daily, Ramipril 5 mg daily, Atorvastatin 20 mg daily, Metoprolol 25 mg daily, Spironolactone 25 mg daily and Frusemide 40 mg daily. Significant physical examination was remarkable for a temperature 97.5’F, blood pressure of 110/70 mmHg, heart rate of 40 beats per minute, oxygen saturation was 99% on air and both lung were full with audible crepitation by auscultation. He was given atropine 0.6 mg bolus and transcutanaeous pacing with unimproved heart rate and then a transvenous pacing was immediately placed before the blood investigation results were returned. His relevant laboratory values were significant for a potassium of 7.99 mmol/L( ref range : 3.5-5.2 mmo/l) , creatinine of 458 micmol/L ( ref range : 59-104 micmol/L) , Urea of 33.9 mmol/L ( ref range : 2.7 – 8.0 mmol/l), random blood glucose of 233mg/dl , sodium 126.8 mmol/L ( ref range 135-145 mmol/L ) , anion gap of 13.5 mmol/? (ref range : 3.6 -11.0 mmo/L) and bicarbonate of 15.6 mmil/L ( ref range: 22-29 mmol/L). He was given calcium glucoronate , insulin with dextrose , kaexylate , nebulizer salbutamol with significant improvement in his potassium levels to 4.6 in 24 hours . In Cardiac intensive care unit his heart rate was improved and the transvenous pacemaker was turned off the next day.

Transvenous implantable cardioverter-defibrillators (TV-ICD) have electrode failure rates as high as 20% over a 10 year followup with 12% as a result of lead fractures. The development of the Boston Scientific subcutaneous ICD (S-ICD) promoted the benefit of significantly reduced post-implant complication rates. We present the first reported case of a S-ICD electrode failure secondary to partial fracture as a result of mechanical trauma.

Balloon-uncrossable lesions present a particularly challenging situation to the interventional cardiologist. They are increasingly encountered with the more complex cases performed and the aging population undergoing coronary intervention. Method All procedures where a Turnpike Gold micro-catheter was used to cross a balloon-uncrossable lesion (defined as any lesion uncrossable by a balloon < 1.5mm in diameter or an alternative micro-catheter with adequate guide catheter and guidewire support) between September 2016 and September 2018 were included. Clinical demographics, procedural details and peri-procedural complications were recorded. Results Twenty one cases were included. The average age was 77 +/- 9.6 years (61 – 93) and 13 (62 %) were male. Fourteen (67%) lesions were mildly to moderately calcified, six (32%) were severely tortuous and all coronary arteries were involved, LAD (8 cases), CX or OM (8 cases), RCA (5 cases). The Turnpike Gold successfully crossed 14 (67%) lesions that other devices failed to cross (low profile balloons (7 cases), Corsair micro-catheter (9 cases), Turnpike Spiral (3 cases), CrossBoss (1 case). In three cases, multiple devices had failed to cross the lesion and a Guideliner extension catheter was used in 4 cases. Conclusion The Turnpike Gold can be safely and effectively used to cross lesions that low-profile balloons and other micro-catheters have failed to cross, and would help in achieving a successful procedural outcome.