ABSTRACT
Hemorrhagic cardiac tamponade in the setting of direct oral anticoagulants (DOACs) is rare but life-threatening. Presentation in subacute cases can also be nonspecific, which can potentially delay diagnosis. A 60-year-old female with a history of heart failure and chronic obstructive pulmonary disease presented with shortness of breath, chest pain, and cough while on treatment with apixaban after a recent hospitalization for pulmonary embolism. Clinical presentation was consistent with multiple diagnoses, including pneumonia and heart failure exacerbation. However, there were several risk factors for hemopericardium with DOACs such as elevated creatinine, hypertension, elevated international normalized ratio (INR), and concomitant use of medications with similar metabolic pathways as apixaban. In addition, subtle findings on examination such as oximetry paradoxus and electrical alternans were crucial for an early diagnosis and management. In this case, we discuss key characteristics of hemopericardium with DOACs, as well as considerations on its management.
ABSTRACT
IMPORTANCE: As the Coronavirus disease 2019 (COVID-19) pandemic accelerates, our hospitals have become overwhelmed. OBJECTIVE: To describe detection of COVID-19 in asymptomatic hospitalized individuals awaiting advanced therapies for HF and the management of complications of COVID-19. DESIGN: We present a unique case report of hospital-acquired COVID-19 in a patient on temporary mechanical circulatory support. MAIN OUTCOME: Despite intensive care and monitoring, he developed rapid progression of hypoxic respiratory failure which led to his death. CONCLUSION: This case highlights various considerations for a patient with temporary MCS. It illustrates the high risk for development of COVID-19 for vulnerable hospitalized patients.
Subject(s)
Coronavirus Infections , Cross Infection , Heart Failure , Heart-Assist Devices , Pandemics , Pneumonia, Viral , Asymptomatic Infections , Betacoronavirus , COVID-19 , Clinical Deterioration , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Cross Infection/complications , Cross Infection/diagnosis , Fatal Outcome , Heart Failure/complications , Heart Failure/therapy , Hospitalization , Humans , Male , Middle Aged , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , SARS-CoV-2Subject(s)
Coronavirus Infections , Heart Failure , Pandemics , Pneumonia, Viral , Betacoronavirus , COVID-19 , Humans , New York City/epidemiology , Pulmonary Artery , SARS-CoV-2Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Pneumonia, Viral/complications , Shock, Cardiogenic/virology , Systemic Inflammatory Response Syndrome/virology , Adult , COVID-19 , Cohort Studies , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Humans , Male , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , SARS-CoV-2 , Sex Factors , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/therapy , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/therapy , Young AdultABSTRACT
As health systems worldwide grapple with the coronavirus disease-2019 (COVID-19) pandemic, patients with durable LVAD support represent a unique population at risk for the disease. This paper outlines the case of such a patient who developed COVID-19 complicated by a "cytokine storm" with severe acute respiratory distress syndrome and myocardial injury and describes the challenges that arose during management.
ABSTRACT
There is a desperate search to discover effective therapies against coronavirus disease-2019 (COVID-19). Patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) comprise a unique population whose clinical course may provide insights into the effects of antiretroviral therapy on COVID-19. We describe the case of a patient with HIV/AIDS on left ventricular assist device support who was hospitalized and recovered from COVID-19. (Level of Difficulty: Intermediate.).