Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 21
Filter
1.
BMJ Case Rep ; 15(3)2022 Mar 07.
Article in English | MEDLINE | ID: covidwho-1731266

ABSTRACT

The SARS-CoV-2 virus has caused a global pandemic with serious impact around the world. Patients most commonly present with severe lung involvement and acute respiratory failure; however, multisystem inflammatory syndrome in adults (MIS-A) is a known-although rare-complication. We present a case of a 49-year-old patient who presented with combined cardiogenic and vasodilatory shock and was diagnosed with MIS-A. He initially required venoarterial extracorporeal membrane oxygenation and Impella for haemodynamic support but was able to be weaned off these devices with complete recovery of left ventricular systolic function. This case demonstrates that MIS-A may present as haemodynamic collapse in adults, but complete recovery is possible with proper haemodynamic support.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Adult , Extracorporeal Membrane Oxygenation/adverse effects , Humans , Male , Middle Aged , SARS-CoV-2 , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/therapy
2.
Trials ; 23(1): 4, 2022 Jan 03.
Article in English | MEDLINE | ID: covidwho-1606541

ABSTRACT

BACKGROUND: Cardiogenic shock (CS) is a life-threatening condition characterized by circulatory insufficiency caused by an acute dysfunction of the heart pump. The pathophysiological approach to CS has recently been enriched by the tissue consequences of low flow, including inflammation, endothelial dysfunction, and alteration of the hypothalamic-pituitary-adrenal axis. The aim of the present trial is to evaluate the impact of early low-dose corticosteroid therapy on shock reversal in adults with CS. METHOD/DESIGN: This is a multicentered randomized, double-blind, placebo-controlled trial with two parallel arms in adult patients with CS recruited from medical, cardiac, and polyvalent intensive care units (ICU) in France. Patients will be randomly allocated into the treatment or control group (1:1 ratio), and we will recruit 380 patients (190 per group). For the treatment group, hydrocortisone (50 mg intravenous bolus every 6 h) and fludrocortisone (50 µg once a day enterally) will be administered for 7 days or until discharge from the ICU. The primary endpoint is catecholamine-free days at day 7. Secondary endpoints include morbidity and all-cause mortality at 28 and 90 days post-randomization. Pre-defined subgroups analyses are planned, including: postcardiotomy, myocardial infarction, etomidate use, vasopressor use, and adrenal profiles according the short corticotropin stimulation test. Each patient will be followed for 90 days. All analyses will be conducted on an intention-to-treat basis. DISCUSSION: This trial will provide valuable evidence about the effectiveness of low dose of corticosteroid therapy for CS. If effective, this therapy might improve outcome and become a therapeutic adjunct for patients with CS. TRIAL REGISTRATION: ClinicalTrials.gov , NCT03773822 . Registered on 12 December 2018.


Subject(s)
COVID-19 , Shock, Cardiogenic , Adult , Humans , Hypothalamo-Hypophyseal System , Multicenter Studies as Topic , Pituitary-Adrenal System , Randomized Controlled Trials as Topic , SARS-CoV-2 , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/drug therapy , Treatment Outcome
3.
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
4.
BMC Cardiovasc Disord ; 21(1): 522, 2021 10 29.
Article in English | MEDLINE | ID: covidwho-1486551

ABSTRACT

BACKGROUND: With the high prevalence of COVID-19 infections worldwide, the multisystem inflammatory syndrome in adults (MIS-A) is becoming an increasingly recognized entity. This syndrome presents in patients several weeks after infection with COVID-19 and is associated with thrombosis, elevated inflammatory markers, hemodynamic compromise and cardiac dysfunction. Treatment is often with steroids and intravenous immunoglobulin (IVIg). The pathologic basis of myocardial injury in MIS-A, however, is not well characterized. In our case report, we obtained endomyocardial biopsy that revealed a pattern of myocardial injury similar to that found in COVID-19 cardiac specimens. CASE PRESENTATION: A 26-year-old male presented with fevers, chills, headache, nausea, vomiting, and diarrhea 5 weeks after his COVID-19 infection. His SARS-CoV-2 PCR was negative and IgG was positive, consistent with prior infection. He was found to be in cardiogenic shock with biventricular failure, requiring inotropes and diuretics. Given concern for acute fulminant myocarditis, an endomyocardial biopsy (EMB) was performed, showing an inflammatory infiltrate consisting predominantly of interstitial macrophages with scant T lymphocytes. The histologic pattern was similar to that of cardiac specimens from COVID-19 patients, helping rule out myocarditis as the prevailing diagnosis. His case was complicated by persistent hypoxemia, and a computed tomography scan revealed pulmonary emboli. He received IVIg, steroids, and anticoagulation with rapid recovery of biventricular function. CONCLUSIONS: MIS-A should be considered as the diagnosis in patients presenting several weeks after COVID-19 infection with severe inflammation and multi-organ involvement. In our case, EMB facilitated identification of MIS-A and guided therapy. The patient's biventricular function recovered with IVIg and steroids.


Subject(s)
Anticoagulants/administration & dosage , COVID-19 , Myocarditis/diagnosis , Shock, Cardiogenic , Systemic Inflammatory Response Syndrome , Adult , Biopsy/methods , COVID-19/complications , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/immunology , COVID-19/physiopathology , Cardiotonic Agents/administration & dosage , Diagnosis, Differential , Diuretics/administration & dosage , Electrocardiography/methods , Humans , Immunoglobulins, Intravenous/administration & dosage , Male , Myocardium/pathology , Radiography, Thoracic/methods , SARS-CoV-2 , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/drug therapy , Shock, Cardiogenic/etiology , Shock, Cardiogenic/physiopathology , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/drug therapy , Systemic Inflammatory Response Syndrome/physiopathology , Treatment Outcome
7.
Pan Afr Med J ; 38: 174, 2021.
Article in English | MEDLINE | ID: covidwho-1173703

ABSTRACT

Since late April 2020, a syndrome now termed Multisystem Inflammatory Syndrome in Children (MIS-C) has been seen in children and adolescents in association with COVID-19 infection. The definition of MIS-C involves fever, organ dysfunction and laboratory confirmation of inflammation in the context of laboratory or epidemiological evidence of SARS-CoV-2 infection in a patient under 21 years of age. Notably, cases are now being identified in adults termed Multisystem Inflammatory syndrome in Adults (MIS-A). Few cases have been reported in sub-Saharan Africa. We report a case of a young African male presenting with a maculopapular rash, persistent fever, elevation in inflammatory markers and a sudden, significant deterioration in cardiac function resulting in cardiogenic shock. The patient responded to intravenous steroids, intravenous immunoglobulin and background inotropic support. The recognition of this disease entity proves even more crucial now amidst the ongoing global wave of COVID-19 infection. It is paramount to identify these patients early, leading to prompt treatment avoiding further morbidity and mortality.


Subject(s)
COVID-19/diagnosis , Shock, Cardiogenic/diagnosis , Systemic Inflammatory Response Syndrome/diagnosis , Adolescent , Africa South of the Sahara , COVID-19/physiopathology , COVID-19/therapy , Humans , Immunoglobulins, Intravenous/administration & dosage , Male , Shock, Cardiogenic/virology , Steroids/administration & dosage , Systemic Inflammatory Response Syndrome/physiopathology , Systemic Inflammatory Response Syndrome/therapy
10.
Cardiol Young ; 30(9): 1346-1349, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1083646

ABSTRACT

We present our recent experience with a 6-month-old infant with a personal history of short bowel syndrome that presented with fever, cyanosis, and cardiogenic shock secondary to severe pulmonary hypertension and right ventricular failure without pulmonary thromboembolism. He did not present signs of toxin-mediated disease or Kawasaki disease. He was finally diagnosed with SARS-CoV-2 infection. If this presentation is confirmed in future research, the severe cardiovascular impairment in children with COVID-19 could be also attributable to the primary pulmonary infection, not only to a multisystem inflammatory syndrome but also in children without heart disease.


Subject(s)
Computed Tomography Angiography , Coronavirus Infections , Heart Failure , Hypertension, Pulmonary , Pandemics , Pneumonia, Viral , Shock, Cardiogenic , Systemic Inflammatory Response Syndrome , Betacoronavirus/isolation & purification , COVID-19 , Computed Tomography Angiography/methods , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Critical Care/methods , Echocardiography/methods , Electrocardiography/methods , Heart Failure/diagnosis , Heart Failure/etiology , Heart Failure/physiopathology , Heart Failure/therapy , Humans , Hypertension, Pulmonary/diagnosis , Hypertension, Pulmonary/etiology , Infant , Male , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Radiography, Thoracic , Respiration, Artificial/methods , SARS-CoV-2 , Severity of Illness Index , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/physiopathology , Treatment Outcome
11.
Cardiovasc Revasc Med ; 28S: 50-53, 2021 07.
Article in English | MEDLINE | ID: covidwho-1046543

ABSTRACT

Takotsubo's syndrome (TTS) is a form of stress cardiomyopathy with a relatively benign long-term course, but may lead to arrhythmias and cardiogenic shock in the acute setting. Despite a recent rise in suspected stress-induced cardiomyopathy, the relationship between the novel coronavirus disease 19 (COVID-19) and TTS is not fully understood. Early recognition of TTS in these patients is important to guide management and treatment. We present 2 cases of TTS arising in the setting of COVID-19 with rapid progression to biventricular heart failure and cardiogenic shock.


Subject(s)
COVID-19 , Heart Failure , Takotsubo Cardiomyopathy , Humans , SARS-CoV-2 , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Takotsubo Cardiomyopathy/diagnosis , Takotsubo Cardiomyopathy/therapy
12.
Am Surg ; 88(2): 174-176, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-999385

ABSTRACT

Severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) is associated with multisystem inflammatory syndrome in children (MIS-C) that ranges from mild symptoms to cardiopulmonary collapse. A 5-year-old girl presented with shock and a rapid decline in left ventricular function requiring intubation. SARS-CoV-2 was diagnosed by viral Polymerase Chain Reaction (PCR), and she received remdesivir and COVID-19 convalescent plasma. Initial echocardiogram (ECHO) demonstrated low normal left ventricular function and mild left anterior descending coronary artery dilation. She remained hypotensive, despite high-dose epinephrine and norepinephrine infusions as well as stress-dose hydrocortisone. Admission SARS-CoV-2 IgG assay was positive, meeting the criteria for MIS-C. An ECHO 9 hours after admission demonstrated a severe decline in left ventricular function. Due to severe cardiogenic shock, she was cannulated for venoarterial extracorporeal support (ECMO). During her ECMO course, she was treated with remdesivir, intravenous methylprednisolone, intravenous immunoglobulin, and anakinra. She was decannulated on ECMO day 7, extubated the following day, and discharged home 2 weeks later without respiratory or cardiac support. The use of ECMO for cardiopulmonary support for pediatric patients with MIS-C is feasible and should be considered early as part of the treatment algorithm for patients with severe cardiopulmonary dysfunction.


Subject(s)
COVID-19/complications , Extracorporeal Membrane Oxygenation/methods , Systemic Inflammatory Response Syndrome/therapy , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Adrenergic alpha-Agonists/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Antiviral Agents/therapeutic use , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/therapy , Child, Preschool , Epinephrine/therapeutic use , Female , Humans , Hypotension/drug therapy , Immunization, Passive , Immunoglobulins, Intravenous/therapeutic use , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Methylprednisolone/therapeutic use , Norepinephrine/therapeutic use , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/drug therapy , Systemic Inflammatory Response Syndrome/diagnosis
13.
ESC Heart Fail ; 8(1): 766-773, 2021 02.
Article in English | MEDLINE | ID: covidwho-942346

ABSTRACT

In the context of the coronavirus disease 2019 pandemic, myocardial injury is a relatively frequent finding. Progression to cardiogenic shock has been rarely described, especially in healthy young patients. The underlying mechanisms are to date controversial. A previously healthy 18-year-old female teenager affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) developed fulminant cardiogenic shock requiring a prompt extracorporeal membrane oxygenation support. Cardiac involvement was predominant compared with the pulmonary one. Myocardial biopsies were performed; and in order to clarify the pathophysiology of the acute heart failure, optical and transmission electron microscopy study was realized. Two additional immunohistology techniques were developed in order to (i) detect a SARS-CoV-2 recombinant fusion nucleoprotein by using a specific antibody and (ii) study fractalkine expression induced by activated endothelium because this molecule is well known to be elevated in patients with severe cytokine release syndrome. SARS-CoV-2 genome was not detected in the myocardium. Even if the clinical presentation, laboratory markers, and cardiac imaging techniques strongly suggested fulminant myocarditis, histology and immunohistology were not fully consistent with this diagnosis according to the Dallas criteria. Although rare suspected coronavirus particles were found by transmission electron microscopy in the cardiac endothelium, neither significant immunoreactivity for the viral nucleocapsid protein nor image suggestive of endotheliitis was detected. Intense endothelial immunoreactivity pattern for fractalkine expression was observed. From a clinical point of view, the left ventricular systolic function gradually improved, and the patient survived after a long stay in the intensive care unit. Our observations suggest that a massive cytokine storm induced by SARS-CoV-2 infection was the main cause of the cardiogenic shock, making a direct viral injury pathway very unlikely.


Subject(s)
COVID-19/complications , Myocarditis/diagnosis , Shock, Cardiogenic/etiology , Adolescent , Diagnosis, Differential , Echocardiography , Electrocardiography , Female , Humans , Myocardium/pathology , Radiography, Thoracic , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/diagnostic imaging , Shock, Cardiogenic/pathology
15.
Cardiovasc Revasc Med ; 28S: 57-60, 2021 07.
Article in English | MEDLINE | ID: covidwho-841087

ABSTRACT

Coronavirus Disease-2019 (COVID-19) has been associated with potentially life threatening cardiovascular complications, including fulminant myocarditis and cardiac tamponade. Optimal management strategies are still unclear, including the role of immunomodulatory therapies and extracorporeal membrane oxygenation (ECMO) in the context of cardiogenic shock. We report a case of a middle-aged female with COVID-19 who developed respiratory distress and hemodynamic deterioration with elevated troponin levels on the seventh day of symptoms. Echocardiography demonstrated pericardial effusion with diastolic restriction of the right ventricle. Cardiac arrest developed during pericardiocentesis, resulting in emergency thoracotomy and pericardial drainage. Venoarterial ECMO was subsequently initiated due to refractory cardiogenic shock. Tocilizumab, immunoglobulin, methylprednisolone and convalescent plasma were added to supportive care, with progressive recovery of cardiac function and successful weaning from mechanical ventilation. This case highlights the potential role of ECMO, convalescent plasma and immunomodulatory therapies in the management of cardiogenic shock associated with COVID-19 myopericarditis.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Heart Arrest , Myocarditis , COVID-19/therapy , Female , Heart Arrest/diagnosis , Heart Arrest/etiology , Heart Arrest/therapy , Humans , Immunization, Passive , Middle Aged , Myocarditis/complications , Myocarditis/diagnosis , Myocarditis/therapy , SARS-CoV-2 , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy
19.
Catheter Cardiovasc Interv ; 97(3): E339-E342, 2021 Feb 15.
Article in English | MEDLINE | ID: covidwho-424352

ABSTRACT

We describe a patient presenting with chest discomfort, anterolateral ST elevation, and developing acute cardiogenic shock secondary to SARS-COV-2infection-patient zero presenting to our institution's cardiac catheterization laboratory. The emergent presentation with limited clinical information led to exposure of personnel. The diagnosis was complicated by two negative tests for SARS-COV-2, and high-clinical suspicion from the patient's occupational history led to additional testing in order to confirm the diagnosis.


Subject(s)
COVID-19/complications , COVID-19/diagnosis , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/virology , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/virology , COVID-19/therapy , Humans , Male , Middle Aged , ST Elevation Myocardial Infarction/therapy , Shock, Cardiogenic/therapy
20.
Catheter Cardiovasc Interv ; 97(5): E661-E666, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-306151

ABSTRACT

A patient with coronavirus disease 19 (COVID-19) developed acute myocardial infarction (AMI) complicated by extensive coronary thrombosis and cardiogenic shock. She underwent percutaneous coronary intervention and placement of a mechanical circulatory support device but subsequently died from shock. This report illustrates the challenges in managing patients with COVID-19, AMI, and cardiogenic shock.


Subject(s)
COVID-19/complications , Coronary Thrombosis/complications , Myocardial Infarction/complications , Shock, Cardiogenic/etiology , Adult , COVID-19/epidemiology , Coronary Angiography , Coronary Thrombosis/diagnosis , Electrocardiography , Fatal Outcome , Female , Humans , Myocardial Infarction/diagnosis , Radiography, Thoracic , Shock, Cardiogenic/diagnosis
SELECTION OF CITATIONS
SEARCH DETAIL