Clinical case of SARS-CoV-2 infection with the development of acute myocardial infarction, myomalacia and hemopericardium.

The COVID-19 pandemic has affected hundreds of thousands of people and poses a serious health threat on an international scale. The aim of the work is to present a clinical case of infection with the SARS-CoV-2 virus with the development of acute myocardial infarction, myomalacia, and hemopericardium. A 63-year-old patient complained of burning pain behind the sternum of a pressing, compressive nature, without irradiation, a feeling of lack of air that arose suddenly on January 16, 2022. An ambulance was called due to persistent pain syndrome. The electrocardiogram revealed sinus tachycardia with a heart rate of 127 beats per minute, ST elevation in leads II, III, troponin level (rapid diagnostics) — 14.92 ng/ml. Blood pressure level — 60/10 mm Hg. Art.;SpO2 — 53%;PaO2 /FiO2 — 100 mmHg Art. Rapid test for coronavirus infection is positive. He was taken to the cardiology department of the Republican Cardiology Dispensary of the Chuvash Republic, where he underwent urgent recanalization of acute thrombotic occlusion, thromboextraction, and implantation of a coronary stent. The introduction of a repolarizing mixture and reperfusion therapy were started. The condition remained relatively severe. Taking into account the positive test for COVID-19, for further treatment (after 5 hours) he was transferred to a repurposed department. There were signs of progression of respiratory failure — a decrease in the level of SatO2 to 53%, the appearance of tachypoea up to 28 respiratory movements per minute. When performing echocardiography, an aggravation of hypokinesis along the anterior-lateral wall of the left ventricle with a decrease in ejection fraction up to 37% was found. A break in the echo signal between the pericardium and the walls of the heart was revealed. Accumulated blood in the volume of 200—250 ml was determined in the pericardial cavity. Blood pressure level — 70/40 mm Hg. Art. entered norepinephrine. Despite the measures taken, the patient died. Pathological examination of the lungs revealed alternation of moderately airy alveoli with areas of dystelectasis. The myocardium is flabby, on the anterior-lateral wall of the left ventricle there was a softening area up to 2.7×2.5×1 cm in size. Histological examination in the myocardial tissue revealed fields of non-nuclear necrotic cardiomyocytes. The cause of death of the patient was a new coronavirus infection COVID-19, complicated by bilateral viral pneumonia, acute myocardial infarction with myomalacia and the development of cardiac tamponade. (English) [ FROM AUTHOR] Пандемия COVID-19 затронула сотни тысяч людей и представляет собой серьезную угрозу здоровью в международном масштабе. Цель работы — представить клинический случай инфицирования вирусом SARS-CoV-2 с развитием острого инфаркта миокарда, миомаляции и гемоперикарда. Больной, 63 года, предъявлял жалобы на жгучую боль за грудиной давящего, сжимающего характера, без иррадиации, чувство нехватки воздуха, возникшие внезапно 16.01.22. Ð’ связи с сохраняющимся болевым синдромом вызвана бригада скорой медицинской помощи. На электрокардиограмме выявлена синусовая тахикардия с частотой сердечных сокращений 127 ударов в минуту, подъем ST во II, III отведениях, уровень тропонина (экспресс-диагностика) — 14,92 нг/мл. Уровень артериального давления — 60/10 мм рт.ст.;SpO2 — 53%;PaO2 /FiO2 — 100 мм рт.ст. Экспресс-тест на коронавирусную инфекцию положительный. Доставлен в кардиологическое отделение БУ Чувашской Республики «Республиканский кардиологический диспансер», где экстренно проведена реканализация острой тромботической окклюзии, тромбоэкстракция, имплантация коронарного стента. Начато введение реполяризующей смеси, выполнение реперфузионной терапии. Состояние оставалось относительно тяжелым. С учетом положительного теста на COVID-19 для дальнейшего лечения (через 5 ч) переведен в перепрофилированное отделение. Появились признаки прогрессирования респираторной недостаточности — снижение уровня SatO2 до 53%, появление тахипноэ до 28 дыхательных движений в минуту. При эхокардиографии обнаружено усугубление гипокинеза по переднебоковой стенке левого желудочка со снижением фракции выброса до 37%. Выявлен разрыв эхосигнала между перикардом и стенками сердца. Ð’ полости перикарда определялась скопившаяся кровь в объеме 200—250 мл. Уровень артериального давления — 70/40 мм рт.ст. Введен норэпинефрин. Несмотря на принятые меры, наступил летальный исход. При патоморфологическом исследовании в легких выявлено чередование умеренно воздушных альвеол с участками дистелектаза. Миокард дряблый, на переднебоковой стенке левого желудочка имелся участок размягченияразмерами до 2,7×2,5×1 см. При гистологическом исследовании в ткани миокарда выявлены поля безъядерных некротизированных кардиомиоцитов. Причиной смерти пациента явилась новая коронави €ÑƒÑÐ½Ð°Ñ инфекция COVID-19, осложненная двусторонней вирусной пневмонией, острым инфарктом миокарда с миомаляцией и развитием тампонады сердца. (Russian) [ FROM AUTHOR] Copyright of Profilakticheskaya Meditsina is the property of Media Sphere Publishing House and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Clinically Ambiguous Hemorrhagic Cardiac Tamponade Associated with Apixaban.

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.

SAFETY OF SAME DAY DISCHARGE AFTER LEAD EXTRACTION PROCEDURES

Background: Lead extraction procedures historically involve overnight hospital observation to detect delayed manifestation of procedural complications. The need for routine hospitalization patients after uncomplicated lead extractions remains to be determined. A desire to limit hospitalization during the COVID 19 pandemic provided an opportunity to assess the appropriateness of same-day discharge (SDD) after lead extraction. Objective: To determine the appropriateness of SDD and identify characteristics that identify potential candidates for SDD in a selected cohort after lead extraction. Methods: We reviewed procedural outcomes in consecutive patients undergoing lead extraction between Jan 2020 and October 2021. Events identified as complications during the first 30 days after the procedure include death, the need for rescue cardiac/chest surgery, hemopericardium with or without tamponade, venous tear, septic embolism, hematoma or pneumothorax requiring intervention, and access-associated AV fistula. Results: One-hundred eighty-four patients, 53% women of mean age 65.6± 14 years, underwent lead extraction at our institution during the specified interval. We discharged seventy-three patients (40%) on the same day;we chose to observe another 111 (60%) in the hospital at least one night. Table 1 shows the baseline and procedural characteristics in both groups. The SDD cohort preferentially included older (68 ± 12 vs. 63.2 ± 16.7, p=0.02) patients, women (59% vs. 44%, p=0.02), those with fewer (1.4 vs. 1.9, p<0.001) leads requiring extraction, a shorter lead dwell time (3.5 ± 4.2 years vs.7.4 ± 12 years, p=0.01), and an indication for extraction other than infection (4% vs. 54%, p<0.0001). The SDD patients suffered fewer complications (0 vs. 6%, p<0.001). Complications observed in the non-SDD group include one femoral AV fistula requiring surgical intervention, three pocket hematoma, and three septic emboli causing hemodynamic instability. Four patients died from underlying sepsis during their hospitalization. Conclusion: SDD appears appropriate in selected patients following lead extraction. Women with relatively fewer leads, shorter lead dwell times, and indications other than infection appear reasonable candidates for SDD. Age alone does not identify better candidates for SDD. [Formula presented]