MERS Virus in South Korea Causing Concern

Recently, South Korean authorities have increased the number of people quarantined and have temporarily closed many schools due to fears of the Middle Eastern Respiratory Syndrome (MERS) spreading. As of June 4, 35 South Koreans had tested positive for the virus including 2 deaths. Click on the link below to read about this from The New York Times.

Middle Eastern Respiratory Syndrome – Coronavirus

  • Coronavirus first isolated in 2012
  • Camels and bats established as a reservoir
  • Range of disease includes “common cold” type symptoms/signs to severe pulmonary illness
  • Majority of cases identified in regions near Arabian Peninsula: Saudi Arabia, United Arab Emirates, Qatar, Oman, Jordan, Kuwait
  • Human-human spread likely requiring close-contact
  • Symptoms: fever, cough, and dypsnea most common; also includes nausea, vomiting, and diarrhea
  • Mortality: 50-65%
  • Molecular diagnostics are the method of choice: PCR assays of respiratory, stool, blood specimens
  • Treatment:
    • Cases should be reported immediately to the local and state health department
    • No antiviral therapy identified
    • Supportive care including mechanical ventilation

(Hopkins ABX Guide)

Fears of MERS Virus Prompt Broadening of Cautions in South Korea

Myocardial Infarction Complicated by Heart Block

  • Acute coronary syndrome (ACS) involves rupture or erosion of a coronary plaque with exposure of the subendothelial matrix to circulating blood and subsequent platelet adhesion, platelet activation, and platelet aggregation
  • A thrombus forms, resulting in partial or complete occlusion of the lumen of the coronary artery
  • The initial ECG is nondiagnostic in up to 50% of patients presenting with chest pain, but remains a critical part of the evaluation
  • Complete heart block (CHB) may be associated with an anterior or inferior wall MI
  • High degree AV block is associated with an increase in mortality in patients with an inferior or anterior myocardial infarction
  • Complete heart block with inferior MI generally results from an intranodal lesion and isassociated with a narrow QRS complex and develops in a progressive fashion from 1st to 2nd to 3rd degree block
  • Patients with inferior MI and CHB may be resistant to atropine and its use during active ischemia may cause ventricular fibrillation!
  • Temporary transvenous pacing is recommended
  • Patients with inferior MI and CHB typically don’t need permanent pacing as the rhythm is transient and resolves within 5-7 days

Click on the link below to see an ECG of inferior MI with complete heart block!

ECG (courtesy of Life in the Fast Lane)