An Echocardiographic Insight Into Post-COVID-19 Symptoms.

INTRODUCTION AND OBJECTIVES: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has frequent acute cardiovascular manifestations, but long-term sequelae are yet to be described. Our main objective is to describe the echocardiographic findings of patients with a previous SARS-CoV-2 infection. METHODS: A single-center prospective study was conducted. Patients who tested positive for SARS-CoV-2 were selected and submitted to a transthoracic echocardiogram six months after infection. A complete echocardiographic assessment was performed, including tissue Doppler, E/E' ratio, and ventricular longitudinal strain. Patients were divided into two subgroups according to their need for admission to the ICU. RESULTS: A total of 88 patients were enrolled. The mean values and respective standard deviations of the echocardiographic parameters were as follows: left ventricular ejection fraction 60.8 ± 5.9%; left ventricular longitudinal strain 17.9 ± 3.6%; tricuspid annular plane systolic excursion 22.1 ± 3.6 mm; a longitudinal strain of the free wall of the right ventricle 19.0 ± 6.0%. We found no statistically significant differences between subgroups. CONCLUSIONS: At the six-month follow-up, we found no significant impact of past SARS-CoV-2 infection on the heart using echocardiography parameters.

Management of Pulmonary Arterial Hypertension in Pregnancy: Experience from a Nationally Accredited Center.

(1) Background: In pulmonary arterial hypertension (PAH), pregnancy is regarded a contraindication due to high maternal and fetal morbidity and mortality. We report our experience in the management of pregnancies in PAH. (2) Methods: retrospective observational study in a nationally accredited pulmonary hypertension (PH) center from 2013 to 2021. (3) Results: seven pregnancies in six women with PAH, ranging from low to high risk and 21 to 37 years old. Half had known pre-existing PAH before pregnancy. One had a multifetal gestation, and one was pregnant twice under our care. PH medical therapy and serial clinical assessment throughout pregnancy were implemented with focused attention on optimizing right heart function. Delivery was planned by a multidisciplinary team involving PH cardiology, maternal fetal medicine, and obstetric anesthesiology. Patients delivered between 31 and 40 weeks of gestation; five of the seven were via cesarean section. All received regional anesthesia and were monitored in the PH intermediate step-down unit after delivery until discharge. In all cases, delivery was without complications with excellent outcomes for the mother and child. (4) Conclusions: Multidisciplinary and tailored management of PAH in pregnancy, emphasizing optimized right heart function prior to delivery, can result in excellent clinical outcomes in a referral PH center.

Massive pulmonary embolism complicating mild Covid 19 pneumonia: Successful systemic thrombolysis using rt-PA in an elderly patient: A case report.

INTRODUCTION: and importance: Pulmonary embolism (PE) is still a major health concern around the world, and its link with SARS Cov-2 has led to an increase in morbidity, mortality, and ICU hospitalizations. CASE PRESENTATION: We present the case of a 92-year-old man with no prior medical history who admitted to our hospital in a state of acute respiratory failure, echocardiography revealed an acute right heart syndrome with a thrombus in the right atrium, computed tomography pulmonary angiogram revealed bilateral massive pulmonary embolism as well as Covid-19 pneumonia. He was treated with systemic thrombolysis using intravenous rt-PA (recombinant tissue plasminogen activator) with immediate clinical improvement and no hemorrhagic complications. CLINICAL DISCUSSION: In the presence of the SARs Cov-2 infection, several reports have indicated considerable procoagulant events, including life-threatening pulmonary embolism. There are still no current guidelines for the treatment of VTE in COVID-19 patients, but they are largely consistent with non-COVID-19 recommendations. Elderly patients are considered to be at high risk of developing thromboembolic complications, and also and above all are vulnerable to bleeding complications from anticoagulant treatments. CONCLUSION: This case highlight the importance of considering thromboembolic complications despite the severity of the associated SARS-cov-2 pneumonia and the role of prophylactic anticoagulation for Covid-19 patients hospitalized or not.

Pulmonary Embolism and Acute Psychosis, a Case Report of an Outpatient with a Mild Course of COVID-19.

The increased risk for thromboembolism in hospitalized COVID-19 patients has been communicated extensively. The fact that home quarantined patients can develop pulmonary embolism, however, has so far not been reported. Furthermore, attention should be brought to psychotic developments in COVID-19 patients. We report a 46-year-old previously healthy patient with a mild course of COVID-19, who developed a massive pulmonary embolism with right heart strain while being home quarantined. He was hospitalized and anticoagulant therapy was started. Nine days after admission, the patient appeared increasingly psychotic and suffered from hallucinations as well as paranoid thoughts. After treatment with risperidone and valproate, the patient's condition improved. At a follow-up 1 month after discharge, he was completely recovered regarding the respiratory, cardiac, and psychic situation. SARS-CoV-2 infection can not only increase the prevalence of thromboembolism in hospitalized patients but also in outpatients. COVID-19 also increases the risk of developing psychiatric reactions.

CGRP Receptor Antagonism in COVID-19: Potential Cardiopulmonary Adverse Effects.

Recently, the US FDA has authorized a drug repurposing trial with calcitonin gene-related peptide (CGRP) receptor antagonists to reduce lung inflammation in coronavirus 2019 (COVID-19). However, the well-established cardiopulmonary protective effects of CGRP raise concerns about the safety of antagonizing CGRP in COVID-19. Awareness regarding potential cardiopulmonary adverse effects may enable their early detection and prevent illness from worsening.

Right Atrial Thrombus in Transient in a COVID-19 Patient: Clinical Echocardiographic Features-Case Report and Literature Review.

A 54-year-old male is admitted with COVID-19 pneumonia and received prophylactic anticoagulation. On day 8, the patient rapidly deteriorated requiring urgent endotracheal intubation. Transthoracic echocardiography revealed large right atrial thrombus in transient, resulting in pulmonary embolism and severe RV failure; fibrinolytic therapy was not effective and the patient passed away.

The overlooked chamber in coronavirus disease 2019.

Coronavirus disease 2019 (COVID-19) causes a pandemic around the globe. Debilitating and even deadly complications have occurred to the millions. A recent study reported 31% of right ventricular dilation in the hospitalized COVID-19 patients, which is significantly associated with the mortality. Therefore, we sought to search for the lines of evidence in the literature that COVID-19 may contribute to right heart dysfunction. The relevant literature and data from PubMed, Embase, Cochrane Library databases, and Web of Science were searched using the MeSH terms including 'COVID-19', 'SARS-CoV-2', 'novel coronavirus pneumonia', 'novel coronavirus', 'right heart failure', 'right heart dysfunction', 'pulmonary hypertension', 'pulmonary embolism', and various combinations. The collected literature and data were sorted and summarized. Literature reports that angiotensin-converting enzyme 2 (ACE2) is the host receptor mediating the cell entry of severe acute respiratory syndrome coronavirus 2. Clinical and experimental evidence shows that loss of function of ACE2 aggravates pulmonary hypertension and gain of function of ACE2 exerts protection on cardiopulmonary circulation. Moreover, the patients with COVID-19 are more susceptible to pulmonary embolism and severe pneumonia-induced acute respiratory distress syndrome. Therefore, COVID-19 may cause right heart dysfunction by inducing pulmonary hypertension, pulmonary embolism, and acute respiratory distress syndrome. Particular attention should be paid to the function of the right heart, the overlooked chamber in COVID-19. Blood gas analysis, laboratory test of cardiac injury markers, physical examination, and echocardiography should be performed to identify right heart failure as early as possible. Once the right heart failure is confirmed, the therapeutic modalities following the guidelines of European Society of Cardiology should be employed to reduce mortality.

Mechanical circulatory support for cardiovascular complications in a young COVID-19 patient.

BACKGROUND: The current coronavirus (COVID-19) pandemic is associated with severe pulmonary and cardiovascular complications. CASE PRESENTATION: This report describes a young patient with COVID-19 without any comorbidity presenting with severe cardiovascular complications, manifesting with pulmonary embolism, embolic stroke, and right heart failure. CONCLUSION: Management with short-term mechanical circulatory support, including different cannulation strategies, resulted in a successful outcome despite his critical cardiovascular status.