ABSTRACT
Background and Aim: Although pulmonary involvement is common in Covid 19 disease, sometimes concomitant cardiac involvement is seen as diastolic dysfunction. This case report describes a patient who received simultaneous treatment for severe acute respiratory failure and cardiac diastolic dysfunction due to Covid 19. Case report: A 40-year-old woman was transferred to the internal ICU of Ayatollah Rouhani Hospital in Babol because of severe respiratory distress. The patient was anxious, restless,and cyanotic. There was respiratory distress, hypoxia (72% oxygen saturation), and cardiac involvement as diastolic dysfunction. Heart rate was 134/min, blood pressure 122/78 mm Hg, and respiratory rate 38/min. The patient underwent non-invasive ventilation, and received beta-interferon, low-dose furosemide, bisoprolol, and spironolactone. During the course of treatment, despite receiving a prophylactic dose of subcutaneous heparin, the patient developed deep vein thrombosis of the left lower extremity and was treated with intravenous heparin. After two weeks, the patient was discharged in relatively good condition with non-invasive ventilation, spironolactone, and oral rivaroxaban. After three months, CT scan of the lungs and echocardiography became normal. Conclusion: Examination of the patients for cardiac diastolic dysfunction as a concomitant disease is recommended. In case of occurrence of this disorder in Covid 19 patients, treatment of cardiac diastolic dysfunction in addition to severe pulmonary involvement should be taken into concideation.
ABSTRACT
Aim: Despite concerns about cardiovascular implications in coronavirus disease-2019 (COVID-19) patients, not all COVID-19 patients are visited by cardiologists and recommended to perform comprehensive cardiovascular assessments including measurement of biomarkers and echocardiography. We aimed to investigate the reasons for seeking cardiology care and to assess our cardiologists' diagnostic approaches to COVID-19 patients with potential cardiovascular involvement. Methods and Results: In this prospective, observational study, data of all consecutive COVID-19 patients admitted to six designated hospitals for COVID-19 in Iran in whom bedside cardiology consultation was requested were collected. A total of 148 patients including 105 (71%) males were included. The mean age was 57 ± 17 years. The most common reasons for cardiology consultation were dyspnea (56.7%), chest pain (12.8%), and suspected arrhythmias (10.8%). The most common comorbidities were hypertension (40.5%), diabetes mellitus (19.6%), and coronary heart disease (18.9%). A 12-lead electrocardiography (ECG) was obtained in all patients. Point-of-care ultrasonography or limited transthoracic echocardiography (TTE) was performed in 106 (71.6%) patients, and complete TTE was performed in 35 (23.4%) patients. Cardiac troponin was measured in 63 (42.6%) patients, and N-terminal pro B-type natriuretic peptide level was measured in 34 (23%) patients. Overall, 51 (34.5%) patients underwent invasive mechanical ventilation, inotropes were used in 29 (19.6%) patients, and 40 (27%) patients died. Conclusions: While preventing unnecessary investigations, the cardiologists should not overlook the lifesaving role of ubiquitous diagnostic modalities (such as ECG and TTE) in early detection and management of cardiac involvement in COVID-19.
ABSTRACT
Introduction: Recent reports have indicated that a considerable portion of patients experiences a cardiac injury, ranging from 7.2% to 22.2%, which is linked to higher mortality. Nevertheless, previous studies have exclusively focused on the cardiac injury defined as a raised cardiac marker without a definitive diagnosis. To our knowledge, the present retrospective cohort study is the first study to comprehensively address cardiovascular (CV) complications and related outcomes in COVID-19 patients. Purpose: To address CV complications and their relationship to clinical outcomes in hospitalized patients with COVID-19. Methods: A total of 196 adult hospitalized patients admitted to our hospital with a confirmed diagnosis of COVID-19 and a consultation requested from the cardiology department were enrolled in this retrospective single-center cohort study from September 10, 2020, to December 10, 2020, with a median age of 65 years (IQR, 52-77). Cardiac examinations included cardiac biomarkers, electrocardiography, and echocardiography. Data regarding complications during hospitalization were extracted, and patients were categorized into two groups concerning the presence or absence of CV complications. All transthoracic echocardiographic (TTE) assessments were performed by a single cardiologist, who was provided with personal protective gear according to national guidelines. Follow-up continued for 3 months after hospital discharge. Results: CV complication was observed in 54 (27.6%) patients, with arrhythmia being the most prevalent (14.8%) followed by myocarditis, acute coronary syndromes, ST-elevation myocardial infarction, cerebrovascular accident, and deep vein thrombosis in 15 (7.7%), 12 (6.1%), 10 (5.1%), 8 (4.1%), and 4 (2%) patients, respectively. The proportion of patients with elevated hs-TpI, NT-proBPN, left ventricular diastolic dysfunction, and heart failure with preserved ejection fraction was greater in the CV complication group. Severe forms of COVID-19 comprised nearly two-thirds (64.3%) of our study population and constituted a significantly higher share of the CV complication group members (75.9% vs 59.9%;P = 0.036). Intensive care unit admission (64.8% vs 44.4%;P = 0.011) and stay (5.5 days vs 0 day;P = 0.032) were notably higher in patients with CV complications. Among 196 patients, 50 died during hospitalization and 10 died after discharge, yielding allcause mortality of 30.8%. However, there were no between-group differences concerning mortality. Heart failure, cancer/autoimmune disease, severity, interferon beta-1a, and arrhythmia were the independent predictors of all-cause mortality during and after hospitalization. Conclusion: CV complications occurred widely among COVID-19 patients. Moreover, arrhythmia, as the most common complication, was associated with increased mortality.