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1.
BMJ Case Rep ; 14(10)2021 Oct 19.
Article in English | MEDLINE | ID: covidwho-1501689

ABSTRACT

Previous reports have described non-ischaemic cardiomyopathy related to a variety of autoimmune diseases. However, very few case reports describe Sjögren disease as a contributing factor to cardiomyopathy. We report the case of a 69-year-old woman with a history of Sjögren disease who presented with cardiogenic shock. Laboratory testing and cardiac MRI revealing apical septal late gadolinium enhancement were consistent with an autoimmune aetiology. After ruling out ischaemic, infectious and other possible causes, the patient's clinical presentation was thought to be related to underlying Sjögren disease. She was treated with intravenous steroids and evidence-based heart failure therapy, but she eventually died after having declined heart transplantation. Given the rarity of Sjögren disease, no diagnostic criteria or standard treatment has been established for cardiomyopathy related to this disease. Diagnosis should be considered in patients who show evidence of autoimmune processes after other possible causes are ruled out.


Subject(s)
Cardiomyopathies , Sjogren's Syndrome , Aged , Cardiomyopathies/complications , Cardiomyopathies/diagnosis , Contrast Media , Female , Gadolinium , Humans , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Sjogren's Syndrome/complications , Sjogren's Syndrome/diagnosis , Sjogren's Syndrome/drug therapy
3.
Monaldi Arch Chest Dis ; 92(1)2021 Sep 14.
Article in English | MEDLINE | ID: covidwho-1410356

ABSTRACT

We report a COVID-19 case with acute heart and kidney failure in a healthy young male. Echocardiography showed severe systolic and diastolic left ventricle dysfunction, with diffuse myocardial thickening. Cardiac MRI showed aspects of focal myocarditis, and hypertensive cardiomyopathy. Renal biopsy demonstrated limited acute tubular injury, and hypertensive kidney disease. Coronary angiography excluded critical stenoses. Unlike what we initially suspected, myocardial inflammation had a limited extent in our patient; severe hypertension causing cardiomyopathy and multi-organ damage, not diagnosed before, was primarily responsible for severe illness. Correct diagnosis and guidelines-directed treatment allowed a favorable course.


Subject(s)
COVID-19 , Cardiomyopathies , Heart Failure , Hypertension , Myocarditis , COVID-19/complications , Cardiomyopathies/diagnosis , Cardiomyopathies/diagnostic imaging , Heart Failure/diagnosis , Heart Failure/etiology , Humans , Hypertension/complications , Male , Myocarditis/diagnostic imaging , Myocarditis/etiology
5.
Curr Probl Cardiol ; 46(10): 100926, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1293689

ABSTRACT

The effects of COVID-19 on the cardiovascular system remains understudied given the early stage of the pandemic. Several case series and case reports have been published on COVID-19 related cardiomyopathies; however, there is often a lack of baseline echocardiographic data confirming a normal cardiac health prior to infection. Here we examine four patients with preserved left ventricular systolic function on prior echocardiogram who developed de novo cardiomyopathies which following COVID-19 infection. The study comprised of four individuals with an average age of 80.5 years, 75% of which were white males. 50% of cases were suspected to have Takotsubo CM vs. myocarditis while the remaining half were diagnosed as myocarditis. Left ventricular systolic function dropped from a normal range to an average of 30% during COVID-19 infection in these individuals. Moreover, half of the cases later died. In conclusion, the COVID-19 pandemic has demonstrated its ability to cause several serious cardiovascular complications with associated worsening of prognosis. Repeat TTE showed recovery of systolic function in 50% of the patients included. There does not appear to be any correlation between COVID-19 related treatments, age, or level of inflammatory markers in those who recovered systolic function versus those who remained depressed. Given the minimal literature on this topic, it is evident more information is needed to help advance treatment and understanding of COVID-19 induced cardiomyopathies; particularly if the vaccination fails to protect against novel strains of COVID-19 and the virus becomes endemic.


Subject(s)
COVID-19 , Cardiomyopathies , Aged, 80 and over , Cardiomyopathies/diagnosis , Cardiomyopathies/epidemiology , Cardiomyopathies/etiology , Echocardiography , Humans , Male , Pandemics , SARS-CoV-2
6.
Eur J Heart Fail ; 23(6): 895-905, 2021 06.
Article in English | MEDLINE | ID: covidwho-1206759

ABSTRACT

Transthyretin amyloid cardiomyopathy (ATTR-CM) is a life-threatening condition with a heterogeneous clinical presentation. The recent availability of treatment for ATTR-CM has stimulated increased awareness of the disease and patient identification. Stratification of patients with ATTR-CM is critical for optimal management and treatment; however, monitoring disease progression is challenging and currently lacks best-practice guidance. In this report, experts with experience in treating amyloidosis and ATTR-CM developed consensus recommendations for monitoring the course of patients with ATTR-CM and proposed meaningful thresholds and frequency for specific parameters. A set of 11 measurable features across three separate domains were evaluated: (i) clinical and functional endpoints, (ii) biomarkers and laboratory markers, and (iii) imaging and electrocardiographic parameters. Experts recommended that one marker from each of the three domains provides the minimum requirements for assessing disease progression. Assessment of cardiac disease status should be part of a multiparametric evaluation in which progression, stability or improvement of other involved systems in transthyretin amyloidosis should also be considered. Additional data from placebo arms of clinical trials and future studies assessing ATTR-CM will help to elucidate, refine and define these and other measurements.


Subject(s)
Amyloid Neuropathies, Familial , Cardiomyopathies , Heart Failure , Amyloid Neuropathies, Familial/diagnosis , Cardiomyopathies/diagnosis , Consensus , Humans , Prealbumin/genetics
7.
Clin Chem ; 67(8): 1080-1089, 2021 08 05.
Article in English | MEDLINE | ID: covidwho-1189445

ABSTRACT

BACKGROUND: Limited data exist on high-sensitivity cardiac troponin (hs-cTn) for risk-stratification in COVID-19. METHODS: We conducted a multicenter, retrospective, observational, US-based study of COVID-19 patients undergoing hs-cTnT. Outcomes included short-term mortality (in-hospital and 30-days post-discharge) and a composite of major adverse events, including respiratory failure requiring mechanical ventilation, cardiac arrest, and shock within the index presentation and/or mortality during the index hospitalization or within 30-days post-discharge. RESULTS: Among 367 COVID-19 patients undergoing hs-cTnT, myocardial injury was identified in 46%. They had a higher risk for mortality (20% vs 12%, P < 0.0001; unadjusted HR 4.44, 95% CI 2.13-9.25, P < 0.001) and major adverse events (35% vs. 11%, P < 0.0001; unadjusted OR 4.29, 95% CI 2.50-7.40, P < 0.0001). Myocardial injury was associated with major adverse events (adjusted OR 3.84, 95% CI 2.00-7.36, P < 0.0001) but not mortality. Baseline (adjusted OR 1.003, 95% CI 1.00-1.007, P = 0.047) and maximum (adjusted OR 1.005, 95% CI 1.001-1.009, P = 0.0012) hs-cTnT were independent predictors of major adverse events. Most (95%) increases were due to myocardial injury, with 5% (n = 8) classified as type 1 or 2 myocardial infarction. A single hs-cTnT <6 ng/L identified 26% of patients without mortality, with a 94.9% (95% CI 87.5-98.6) negative predictive value and 93.1% sensitivity (95% CI 83.3-98.1) for major adverse events in those presenting to the ED. CONCLUSIONS: Myocardial injury is frequent and prognostic in COVID-19. While most hs-cTnT increases are modest and due to myocardial injury, they have important prognostic implications. A single hs-cTnT <6 ng/L at presentation may facilitate the identification of patients with a favorable prognosis.


Subject(s)
COVID-19/diagnosis , Cardiomyopathies/diagnosis , Myocardial Infarction/diagnosis , Troponin T/blood , Biomarkers/blood , COVID-19/complications , COVID-19/epidemiology , Cardiomyopathies/blood , Cardiomyopathies/etiology , Cohort Studies , Female , Humans , Male , Middle Aged , Myocardial Infarction/blood , Myocardial Infarction/etiology , Pandemics , Prognosis , Retrospective Studies , Risk Assessment , SARS-CoV-2
8.
J Med Case Rep ; 15(1): 143, 2021 Mar 19.
Article in English | MEDLINE | ID: covidwho-1143254

ABSTRACT

BACKGROUND: There are limited data on cardiovascular complications of coronavirus disease 2019 in pregnancy, and there are only a few case reports on coronavirus disease 2019 related cardiomyopathy in pregnancy. Differentiation between postpartum cardiomyopathy and coronavirus disease 2019 related cardiomyopathy in pregnant women who develop severe acute respiratory syndrome coronavirus-2 infection during peripartum could be challenging. Here, we present a case of possible coronavirus disease 2019 related cardiomyopathy in a pregnant patient, followed by a discussion of potential differential diagnosis. CASE PRESENTATION: In this case report, we present the case of a young pregnant Iranian woman who developed heart failure with pulmonary edema after cesarean section. She was treated because of low left ventricular ejection fraction and impression of postpartum cardiomyopathy, and her severe dyspnea improved by intravenous furosemide. On day 3, she exhibited no orthopnea or leg edema, but she was complaining of severe and dry cough. Further evaluation showed severe acute respiratory syndrome coronavirus-2 infection. CONCLUSIONS: The possibility of severe acute respiratory syndrome coronavirus-2 infection should be considered in any pregnant woman who develops cardiomyopathy and pulmonary edema.


Subject(s)
COVID-19/diagnosis , Cardiomyopathies/diagnosis , Heart Failure/diagnosis , Puerperal Disorders/diagnosis , Pulmonary Edema/diagnosis , Adult , Anti-Bacterial Agents/therapeutic use , Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , COVID-19/physiopathology , COVID-19/therapy , Cardiomyopathies/drug therapy , Cardiomyopathies/physiopathology , Cesarean Section , Cough/physiopathology , Diagnosis, Differential , Diuretics/therapeutic use , Dyspnea/physiopathology , Echocardiography , Electrocardiography , Female , Furosemide/therapeutic use , Heart Failure/drug therapy , Heart Failure/physiopathology , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Interferon-beta/therapeutic use , Lung/diagnostic imaging , Pre-Eclampsia , Pregnancy , Puerperal Disorders/drug therapy , Puerperal Disorders/physiopathology , Pulmonary Edema/drug therapy , Pulmonary Edema/physiopathology , SARS-CoV-2 , Stroke Volume , Tomography, X-Ray Computed
9.
Cardiol Young ; 31(8): 1348-1349, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1123113

ABSTRACT

As the United States' original epicenter of the COVID-19 pandemic and one of the leading national paediatric heart failure/cardiomyopathy programs, we describe our experience with the spectrum of COVID-19 in the paediatric heart failure population.


Subject(s)
COVID-19 , Cardiomyopathies , Heart Failure , Cardiomyopathies/diagnosis , Child , Humans , Pandemics , SARS-CoV-2 , United States/epidemiology
10.
Am J Obstet Gynecol MFM ; 2(2): 100113, 2020 05.
Article in English | MEDLINE | ID: covidwho-1064728

ABSTRACT

At our institution, 2 of the initial 7 pregnant patients with confirmed coronavirus disease 2019 severe infection (28.6%; 95% CI, 8.2%-64.1%) developed cardiac dysfunction with moderately reduced left ventricular ejection fractions of 40%-45% and hypokinesis. Viral myocarditis and cardiomyopathy have also been reported in nonpregnant coronavirus disease 2019 patients. A case series of nonpregnant patients with coronavirus disease 2019 found that 33% of those in intensive care developed cardiomyopathy. More data are needed to ascertain the incidence of cardiomyopathy from coronavirus disease 2019 in pregnancy, in all pregnant women with coronavirus disease 2019, and those with severe disease (eg, pneumonia). We suggest an echocardiogram in pregnant women with coronavirus disease 2019 pneumonia, in particular those necessitating oxygen, or those who are critically ill, and we recommend the use of handheld, point-of-care devices where possible to minimize contamination of staff and traditional large echocardiogram machines.


Subject(s)
COVID-19/therapy , Cardiomyopathies/therapy , Cesarean Section , Heart Failure/therapy , Pregnancy Complications, Cardiovascular/therapy , Pregnancy Complications, Infectious/therapy , Respiration, Artificial , Adult , Anti-Arrhythmia Agents/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Anticonvulsants/therapeutic use , Blood Gas Analysis , COVID-19/complications , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19 Nucleic Acid Testing , Cardiomyopathies/diagnosis , Cardiomyopathies/etiology , Cardiomyopathies/physiopathology , Diabetes, Gestational , Diuretics/therapeutic use , Echocardiography , Enzyme Inhibitors/therapeutic use , Female , Fever , Furosemide/therapeutic use , Heart Arrest/etiology , Heart Arrest/therapy , Heart Failure/diagnosis , Heart Failure/etiology , Heart Failure/physiopathology , Humans , Hydroxychloroquine/therapeutic use , Hypoxia/etiology , Hypoxia/therapy , Intubation, Intratracheal , Magnesium Sulfate/therapeutic use , Metoprolol/therapeutic use , Middle Aged , Obesity, Maternal/complications , Oxygen Inhalation Therapy , Point-of-Care Systems , Pre-Eclampsia/drug therapy , Pre-Eclampsia/physiopathology , Pregnancy , Pregnancy Complications, Cardiovascular/diagnosis , Pregnancy Complications, Cardiovascular/physiopathology , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/physiopathology , Return of Spontaneous Circulation , SARS-CoV-2 , Severity of Illness Index , Stroke Volume , Tachycardia/drug therapy , Tachycardia/physiopathology , Tachycardia, Supraventricular/drug therapy , Tachycardia, Supraventricular/etiology
11.
BMC Infect Dis ; 21(1): 33, 2021 Jan 07.
Article in English | MEDLINE | ID: covidwho-1035153

ABSTRACT

BACKGROUND: Septic cardiomyopathy has been observed in association with influenza, indicating that not only bacteria but also other infective agents can cause this condition. There has been no systematic study as to whether Treponema pallidum infection induces septic cardiomyopathy, and we are the first to report this possibility. CASE PRESENTATION: We report two cases of a 48-year-old man and a 57-year-old man who were diagnosed with syphilis-related septic cardiomyopathy. The diagnosis of cardiomyopathy was made based on elevation of cardiogenic markers and decrease in ejection fraction evaluated by echocardiography. Screen for infective pathogens was negative except for syphilis, which supported our diagnosis. The two patients recovered following effective anti-syphilis treatment and advanced life support technology. Syphilis serology became negative after treatment. CONCLUSION: Syphilis has the potential to cause septic cardiomyopathy. Clinicians should consider Treponema pallidum in cases of septic cardiomyopathy with unknown pathogens. However, the specific pathophysiological mechanism of syphilis-associated septic cardiomyopathy has not been elucidated, and more specific studies are needed.


Subject(s)
Bacteremia/etiology , Cardiomyopathies/etiology , Syphilis/complications , Anti-Bacterial Agents/therapeutic use , Bacteremia/complications , Bacteremia/drug therapy , Biomarkers/blood , Cardiomyopathies/diagnosis , Cardiomyopathies/microbiology , Echocardiography , Humans , Imipenem/therapeutic use , Male , Middle Aged , Syphilis/diagnosis , Syphilis/drug therapy , Syphilis Serodiagnosis , Treponema pallidum/immunology
15.
Nat Rev Cardiol ; 18(3): 169-193, 2021 03.
Article in English | MEDLINE | ID: covidwho-851285

ABSTRACT

Inflammatory cardiomyopathy, characterized by inflammatory cell infiltration into the myocardium and a high risk of deteriorating cardiac function, has a heterogeneous aetiology. Inflammatory cardiomyopathy is predominantly mediated by viral infection, but can also be induced by bacterial, protozoal or fungal infections as well as a wide variety of toxic substances and drugs and systemic immune-mediated diseases. Despite extensive research, inflammatory cardiomyopathy complicated by left ventricular dysfunction, heart failure or arrhythmia is associated with a poor prognosis. At present, the reason why some patients recover without residual myocardial injury whereas others develop dilated cardiomyopathy is unclear. The relative roles of the pathogen, host genomics and environmental factors in disease progression and healing are still under discussion, including which viruses are active inducers and which are only bystanders. As a consequence, treatment strategies are not well established. In this Review, we summarize and evaluate the available evidence on the pathogenesis, diagnosis and treatment of myocarditis and inflammatory cardiomyopathy, with a special focus on virus-induced and virus-associated myocarditis. Furthermore, we identify knowledge gaps, appraise the available experimental models and propose future directions for the field. The current knowledge and open questions regarding the cardiovascular effects associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are also discussed. This Review is the result of scientific cooperation of members of the Heart Failure Association of the ESC, the Heart Failure Society of America and the Japanese Heart Failure Society.


Subject(s)
Cardiomyopathies/physiopathology , Inflammation/physiopathology , Myocarditis/physiopathology , Virus Diseases/physiopathology , Animals , Antiviral Agents/therapeutic use , Autoimmunity/immunology , Biopsy , COVID-19/physiopathology , COVID-19/therapy , Cardiomyopathies/diagnosis , Cardiomyopathies/immunology , Cardiomyopathies/therapy , Cardiomyopathy, Dilated , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Coxsackievirus Infections/immunology , Coxsackievirus Infections/physiopathology , Coxsackievirus Infections/therapy , Cytomegalovirus Infections/immunology , Cytomegalovirus Infections/physiopathology , Cytomegalovirus Infections/therapy , Disease Models, Animal , Echovirus Infections/immunology , Echovirus Infections/physiopathology , Echovirus Infections/therapy , Epstein-Barr Virus Infections/immunology , Epstein-Barr Virus Infections/physiopathology , Epstein-Barr Virus Infections/therapy , Erythema Infectiosum/immunology , Erythema Infectiosum/physiopathology , Erythema Infectiosum/therapy , HIV Infections/physiopathology , Hepatitis C/immunology , Hepatitis C/physiopathology , Hepatitis C/therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Inflammation/diagnosis , Inflammation/immunology , Inflammation/therapy , Influenza, Human/immunology , Influenza, Human/physiopathology , Influenza, Human/therapy , Leukocytes/immunology , Myocarditis/diagnosis , Myocarditis/immunology , Myocarditis/therapy , Myocardium/pathology , Prognosis , Roseolovirus Infections/immunology , Roseolovirus Infections/physiopathology
16.
Int J Cardiol ; 326: 230-236, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-803390

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) pneumonia tends to affect cardiovascular system and cause cardiovascular damage. This study aimed to explore the prevalence of myocardial injury and risk factors for mortality in patients with COVID-19 pneumonia. METHOD: Two hundred and twenty-four consecutive patients with confirmed diagnosis of SARS-CoV-2 infection and definite outcomes (discharge or death) were retrospectively analyzed. Laboratory results including myocardial biomarkers, oxygen saturation, inflammatory indicators and coagulation function were compared between survivors and non-survivors. Univariate and multivariate logistic regression model were used to explore risk factors for in-hospital mortality, and a chart with different combinations of risk factors was constructed to predict mortality. RESULTS: Two hundred and three patients were included in the final analysis, consisting of 145 patients who recovered and 58 patients who died. Compared with survivors, non-survivors were older, with more comorbidities, more severe inflammation and active coagulation function, higher levels of myocardial biomarkers and lower SaO2. 28 (50%) non-survivors and 9 (6%) survivors developed myocardial injury, which was associated with disease severity at admission. Elevated d-dimer (OR = 9.51, 95% CI [3.61-25.0], P < 0.001), creatinine kinase-myocardial band (OR = 6.93, 95% CI [1.83-26.2], P = 0.004), Troponin I (OR = 10.1, 95% CI [3.1-32.8], P < 0.001) and C-reactive protein (OR = 15.1, 95% CI [1.7-129.3], P = 0.013) were risk factors for mortality. Patients with abnormal levels of d-dimer, Troponin I and CRP were predicted to have significantly higher probability of death. CONCLUSIONS: Our results suggest that SARS-CoV-2 infection may induce myocardial injury and consequently exacerbate the clinical course and worsen prognosis. Abnormal d-dimer, CK-MB, Troponin I and CRP are risk factors for short-term mortality.


Subject(s)
COVID-19/blood , COVID-19/mortality , Cardiomyopathies/blood , Cardiomyopathies/mortality , Inflammation Mediators/blood , Aged , Biomarkers/blood , COVID-19/diagnosis , Cardiomyopathies/diagnosis , China/epidemiology , Cohort Studies , Female , Follow-Up Studies , Humans , Male , Middle Aged , Mortality/trends , Retrospective Studies , Risk Factors
17.
Echocardiography ; 37(10): 1673-1677, 2020 10.
Article in English | MEDLINE | ID: covidwho-799148

ABSTRACT

We report the case of a healthy 35-year-old woman who had experienced a flu-like syndrome during the week before childbirth and heart failure symptoms 10 days before the current hospitalization and presented to our emergency department with clinical signs of congestive heart failure, echocardiographic evidence of a severely dilated and hypokinetic heart, laboratory evidence of SARS-CoV-2 disease, and radiologic findings consistent with both virus-related pneumonia and heart failure. Early cardiac magnetic resonance was crucial for the diagnosis of postpartum cardiomyopathy and for the exclusion of virus-related myocarditis, allowing us to decide on a prudent and supportive clinical approach.


Subject(s)
Betacoronavirus , Cardiomyopathies/diagnosis , Coronavirus Infections/complications , Electrocardiography/methods , Myocarditis/diagnosis , Peripartum Period , Pneumonia, Viral/complications , Pregnancy Complications, Cardiovascular/diagnosis , Acute Disease , Adult , COVID-19 , Cardiomyopathies/epidemiology , Comorbidity , Coronavirus Infections/epidemiology , Diagnosis, Differential , Echocardiography , Female , Humans , Magnetic Resonance Imaging, Cine/methods , Myocarditis/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Pregnancy , SARS-CoV-2 , Tomography, X-Ray Computed
18.
Cardiol J ; 27(5): 489-496, 2020.
Article in English | MEDLINE | ID: covidwho-614995

ABSTRACT

BACKGROUND: Despite being associated with worse prognosis in patients with COVID-19, systematic determination of myocardial injury is not recommended. The aim of the study was to study the effect of myocardial injury assessment on risk stratification of COVID-19 patients. METHODS: Seven hundred seven consecutive adult patients admitted to a large tertiary hospital with confirmed COVID-19 were included. Demographic data, comorbidities, laboratory results and clinical outcomes were recorded. Charlson comorbidity index (CCI) was calculated in order to quantify the degree of comorbidities. Independent association of cardiac troponin I (cTnI) increase with outcomes was evaluated by multivariate regression analyses and area under curve. In addition, propensity-score matching was performed to assemble a cohort of patients with similar baseline characteristics. RESULTS: In the matched cohort (mean age 66.76 ± 15.7 years, 37.3% females), cTnI increase above the upper limit was present in 20.9% of the population and was associated with worse clinical outcomes, including all-cause mortality within 30 days (45.1% vs. 23.2%; p = 0.005). The addition of cTnI to a multivariate prediction model showed a significant improvement in the area under the time-dependent receiver operating characteristic curve (0.775 vs. 0.756, DC-statistic = 0.019; 95% confidence interval 0.001-0.037). Use of renin-angiotensin-aldosterone system inhibitors was not associated with mortality after adjusting by baseline risk factors. CONCLUSIONS: Myocardial injury is independently associated with adverse outcomes irrespective of baseline comorbidities and its addition to multivariate regression models significantly improves their performance in predicting mortality. The determination of myocardial injury biomarkers on hospital admission and its combination with CCI can classify patients in three risk groups (high, intermediate and low) with a clearly distinct 30-day mortality.


Subject(s)
Betacoronavirus , Cardiomyopathies/mortality , Cardiomyopathies/virology , Coronavirus Infections/complications , Coronavirus Infections/mortality , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Aged , COVID-19 , Cardiomyopathies/diagnosis , Coronavirus Infections/therapy , Critical Care , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/therapy , Predictive Value of Tests , ROC Curve , Retrospective Studies , Risk Factors , SARS-CoV-2 , Survival Rate , Troponin I/blood
19.
J Thromb Thrombolysis ; 51(1): 25-28, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-548286

ABSTRACT

Acute viral pneumonia, hypoxemic respiratory failure and severe inflammatory response are hallmarks of severe coronavirus disease 2019 (COVID-19). The COVID-19-associated inflammatory state may further lead to symptomatic thromboembolic complications despite prophylaxis. We report a 66-year-old female patient with post-mortem diagnosis of COVID-19 who presented progressive livedo racemosa, acute renal failure and myocardial injury, as well as an absence of respiratory symptoms. Transthoracic echocardiography showed severe spontaneous echo contrast in the right cardiac chambers and right-sided cardiac overload presumed to result from pulmonary microvascular thrombosis or embolism. D-dimer levels were increased. The patient developed an acute ischemic stroke and died 2 days following presentation despite therapeutic anticoagulation. Her predominantly thromboembolic presentation supports the concept of coronavirus infection of endothelial cells and hypercoagulability, or COVID-19 endotheliitis. The case we report highlights that COVID-19-associated hyperacute multi-organ thromboembolic storm may precede or present disproportionately to respiratory involvement.


Subject(s)
Anticoagulants/administration & dosage , COVID-19 , Cardiomyopathies , Echocardiography/methods , Ischemic Stroke , SARS-CoV-2/isolation & purification , Thromboembolism , Thrombophilia , Acute Kidney Injury/diagnosis , Acute Kidney Injury/etiology , Aged , Anticoagulants/classification , COVID-19/blood , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/therapy , Cardiomyopathies/diagnosis , Cardiomyopathies/etiology , Cardiomyopathies/physiopathology , Clinical Deterioration , Diagnosis , Fatal Outcome , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Ischemic Stroke/diagnosis , Ischemic Stroke/etiology , Livedo Reticularis/diagnosis , Livedo Reticularis/etiology , Lung/diagnostic imaging , Pneumonia, Viral/diagnosis , Pneumonia, Viral/etiology , Thromboembolism/diagnosis , Thromboembolism/drug therapy , Thromboembolism/etiology , Thrombophilia/blood , Thrombophilia/diagnosis , Thrombophilia/drug therapy , Thrombophilia/etiology , Tomography, X-Ray Computed/methods
20.
J Am Soc Echocardiogr ; 33(6): 676-682, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-380547

ABSTRACT

BACKGROUND: Three cases of the application of focused cardiac ultrasound in patients with coronavirus disease 2019 are presented. METHODS: Cardiac point-of-care ultrasound, limited transthoracic echocardiography, and critical care echocardiography were applied in cases of heart failure, pulmonary embolism, and myocarditis with thrombus respectively. RESULTS: The impact on patient management and the global context of each presentation are discussed. CONCLUSIONS: Focused cardiac point-of-care ultrasound played an important, front-line role in the bedside management of patients during the COVID-19 pandemic in Wuhan, China.


Subject(s)
Betacoronavirus , Cardiomyopathies/diagnosis , Coronavirus Infections/epidemiology , Critical Care/methods , Echocardiography/methods , Pneumonia, Viral/epidemiology , Point-of-Care Systems , Pulmonary Embolism/diagnosis , Aged , COVID-19 , Cardiomyopathies/complications , China/epidemiology , Coronavirus Infections/complications , Female , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/complications , Pulmonary Embolism/complications , SARS-CoV-2
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