Importance: Coronavirus disease 2019 is associated with a variety of arrhythmias. However, there are limited data regarding bradyarrhythmias and cardiac pauses in COVID-19. Objective: The objective was to characterize significant cardiac pauses in critically ill COVID-19 patients. Design: This was a case series of 26 consecutive patients with confirmed COVID-19 at an academic medical center in Shreveport, Louisiana. Setting: The study was conducted in the intensive care unit (ICU) and step-down ICU. Participants: Patients were either on mechanical ventilation or high-flow oxygen by nasal cannula. Main Outcomes and Measures: Demographic, clinical, laboratory, and medication data were analyzed. Continuous telemetry monitoring was utilized to record number, type, and duration of bradyarrhythmic events as well as their risk determinants. Results: The median age of the 26 patients was 49.5 years (range 33–78). Fifteen (57.7%) were men. Incidence of significant bradycardia and cardiac pauses, defined as an event, occurred in 11 (42.3%) patients. The median age of patients with an event was 57 years (range 33–66) and 5 (45.5%) were men. The average pause duration was 6.77 s with a range of 1.6–30 s. Five of 11 (45.5%) patients had high-grade atrioventricular (AV) nodal block. One patient required temporary pacemaker insertion for complete heart block and recurrent asystole arrests. A trend toward higher troponin I level in bradyarrhythmia patients was noted (mean troponin I was 2.72 ng/mL, [standard deviation] 4.48) compared to patients without event(s) (mean 0.42 ng/mL 0.52, P = 0.07). Conclusions and Relevance: Significant bradycardic events in critically ill patients with COVID-19 occurred in 42.3% of patients. This is the first case series of such events in COVID-19 patients. Increased awareness of these findings could affect management techniques and call for enhanced monitoring of such patients.

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Cerebrospinal fluid drainage is recommended for spinal cord protection in open and endovascular thoracoabdominal aortic aneurysm (TAAA) repairs. We report a case of spinal hematoma following lumbar drain removal in a patient who underwent thoracic endovascular aortic repair for DeBakey type III aortic dissection. There is always a debate concerning placement of lumbar drain on the day of the procedure, postponement of the procedure if a traumatic tap is encountered and type of spinal catheter to avoid spinal hematoma in TAAA repairs. The practice of timing of catheter placement and choice of the type of catheter for lumbar varies with institutional practice, and there has been no recommendation regarding the safe practice for avoiding spinal hematoma. Avoiding traumatic tap during lumbar drain placement, team approach of an anesthesiologist, an interventional cardiologist, and a surgeon for decision-making to continue or postpone the procedure and timing of anticoagulation, meticulous neurological monitoring throughout the hospital stay of the patient can avoid spinal hematoma and sequelae.

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Background: Anxiety and depression are common after an acute cardiac event. While many studies have investigated the predictors of anxiety and depression, few have focused on the role of rumination. The aim of this study was to identify the ruminative styles that predict anxiety and depression in the 2 years' postcardiac event. Methods: A total of 426 cardiac patients, 210 admitted for acute coronary syndrome (ACS), and 216 to undergo coronary artery bypass graft surgery were recruited from three metropolitan hospitals in Melbourne, Australia. Participants completed self-report questionnaires at the time of their event and at 12- and 24-months postevent. Anxiety and depression were assessed at all three time points, whereas ruminative styles were assessed at 24 months. Clinical information was retrieved from the participants' medical records. Bivariate and multivariate analyses were undertaken to identify the factors associated with and predictive of anxiety and depression at 24-months postevent. Results: A diagnosis of ACS, history of depression, smoking, and brooding and intrusive rumination were associated with both anxiety and depression, while female gender was associated with anxiety only. Brooding and intrusive rumination were the unique predictors of anxiety and depression, after controlling for other factors. Limitations: Generalizability of the findings is limited by the preponderance of men in the sample and by participant attrition over the study period. Conclusion: The findings indicate the importance of screening for rumination styles after a cardiac event to enhance targeting of psychological treatments for cardiac patients at risk of persistent anxiety or depression.

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Displacement of leads due to coiling around the pacemaker in the sagittal axis can result in Reel syndrome. Rotation of pulse generator can be due to self-manipulation, ratchet-like mechanism, or due to enlarged pocket. Our case presented with complete heart block with lead displacement and protrusion of pulse generator. Chest X-ray was suggestive of Reel syndrome. The pacemaker was explanted and implanted on the other side. To prevent recurrence, adequate pocket size was created with proper suturing to the underlying fascia and adequate compression for 5–7 days was applied after implantation.

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Situs inversus totalis denotes that the heart and all body organs are the mirror image of one another. Understanding the surgical anatomy is crucial for the proper surgical plan, as the surgeon needs to tailor any operative procedure to improve surgical exposure. Here, we are reporting a rare case of emergency mitral valve replacement for acute severe mitral insufficiency secondary to infective endocarditis in a previously known case of dextrocardia with situs inversus totalis.

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