Subject(s)
Coronavirus Infections/prevention & control , Intensive Care Units/organization & administration , Internship and Residency/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Telemedicine/organization & administration , COVID-19 , Coronavirus Infections/therapy , Critical Care/methods , Humans , Internship and Residency/methods , Patient Care Team , Pneumonia, Viral/therapy , Professional Role , Telemedicine/methodsABSTRACT
BACKGROUND: SARS-CoV-2 is known to induce a cytokine storm, a hyperinflammatory state driven by up-regulation of interleukin 6 (IL-6) and immunomodulatory chemokines that may result in acute heart failure. CASE SUMMARY: A 65-year-old woman with confirmed SARS-CoV-2 developed shock with multiorgan system failure, including acute biventricular heart failure, 2 weeks after the initial onset of fever, cough, and shortness of breath. The patient experienced myocardial recovery within 48 h after administration of tocilizumab, a humanized monoclonal anti-IL-6 receptor antibody, and multiple supportive vasoactive medications. DISCUSSION: The differential diagnosis of acute heart failure in critically ill patients with COVID-19 infection is broad, including sepsis-induced cardiomyopathy, Takotsubo syndrome, viral lymphocytic myocarditis, and acute coronary syndrome. Immunomodulatory treatment with tocilizumab may benefit patients who develop cardiogenic shock associated with SARS-CoV-2-induced cytokine storm.