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1.
BMC Cardiovasc Disord ; 21(1): 528, 2021 11 08.
Article in English | MEDLINE | ID: covidwho-1505900

ABSTRACT

BACKGROUND: The value of mechanical circulatory support (MCS) in cardiogenic shock, especially the combination of the ECMELLA approach (Impella combined with ECMO), remains controversial. CASE PRESENTATION: A previously healthy 33-year-old female patient was submitted to a local emergency department with a flu-like infection and febrile temperatures up to 39 °C. The patient was tested positive for type-A influenza, however negative for SARS-CoV-2. Despite escalated invasive ventilation, refractory hypercapnia (paCO2: 22 kPa) with severe respiratory acidosis (pH: 6.9) and a rising norepinephrine rate occurred within a few hours. Due to a Horovitz-Index < 100, out-of-centre veno-venous extracorporeal membrane oxygenation (vv-ECMO)-implantation was performed. A CT-scan done because of anisocoria revealed an extended dissection of the right vertebral artery. While the initial left ventricular function was normal, echocardiography revealed severe global hypokinesia. After angiographic exclusion of coronary artery stenoses, we geared up LV unloading by additional implantation of an Impella CP and expanded the vv-ECMO to a veno-venous-arterial ECMO (vva-ECMO). Clinically relevant bleeding from the punctured femoral arteries resulted in massive transfusion and was treated by vascular surgery later on. Under continued MCS, LVEF increased to approximately 40% 2 days after the initiation of ECMELLA. After weaning, the Impella CP was explanted at day 5 and the vva-ECMO was removed on day 9, respectively. The patient was discharged in an unaffected neurological condition to rehabilitation 25 days after the initial admission. CONCLUSIONS: This exceptional case exemplifies the importance of aggressive MCS in severe cardiogenic shock, which may be especially promising in younger patients with non-ischaemic cardiomyopathy and potentially reversible causes of cardiogenic shock. This case impressively demonstrates that especially young patients may achieve complete neurological restoration, even though the initial prognosis may appear unfavourable.


Subject(s)
Extracorporeal Membrane Oxygenation/methods , Heart-Assist Devices , Influenza A virus/isolation & purification , Influenza, Human , Respiration, Artificial/methods , Respiratory Insufficiency , Ventricular Dysfunction, Left , Adult , COVID-19/diagnosis , Clinical Deterioration , Critical Care/methods , Echocardiography/methods , Female , Heart Failure/physiopathology , Heart Failure/therapy , Humans , Influenza, Human/complications , Influenza, Human/diagnosis , Influenza, Human/physiopathology , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , SARS-CoV-2 , Serologic Tests/methods , Severity of Illness Index , Shock, Cardiogenic/etiology , Shock, Cardiogenic/physiopathology , Shock, Cardiogenic/therapy , Treatment Outcome , Ventricular Dysfunction, Left/etiology , Ventricular Dysfunction, Left/physiopathology , Ventricular Dysfunction, Left/therapy
2.
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.
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
4.
J Cardiothorac Surg ; 16(1): 226, 2021 Aug 09.
Article in English | MEDLINE | ID: covidwho-1463257

ABSTRACT

BACKGROUND: Inferior vena cava thrombosis is cited to be a complication of inferior vena cava filter placement and post coronary artery bypass surgery. Often only mild symptoms arise from these thrombi; however, due to the chronic nature of some thrombi and the recanalization process, more serious complications can arise. Although anticoagulation remains the gold standard of treatment, some patients are unable to be anticoagulated. In this case, we present a 65-year-old male who underwent IVC filter placement and open-heart surgery who later developed extensive femoral and iliocaval thrombosis leading to right heart failure, which required thrombus extraction with an AngioVac suction device. CASE PRESENTATION: We present a 65-year-old male who presented with bilateral pulmonary emboli with extensive right lower extremity deep vein thrombosis. Upon investigation he had ischemic heart disease and underwent a five-vessel coronary artery bypass for which he had an IVC filter placed preoperatively. On post operative day 3 to 4, he was decompensated and was diagnosed with an IVC thrombus. He progressed to right heart failure and worsening cardiogenic shock despite therapeutic anticoagulation and was taken for a suction thrombectomy using the AngioVac (AngioDynamics, Latham, NY) aspiration thrombectomy device. The thrombectomy was successful and he was able to recover and was discharged from the hospital. CONCLUSION: Despite being a rare complication, IVC thrombosis can have detrimental effects. This case is an example of how IVC thrombus in the post-operative setting can lead to mortality. The gold standard is therapeutic anticoagulation but despite that, this patient continued to have worsening cardiogenic shock. Other therapies have been described but because of its rarity, they are only described in case reports. This case shows that the AngioVac device is a successful treatment option for IVC thrombus and can have the possibility of future use.


Subject(s)
Coronary Artery Bypass/adverse effects , Shock, Cardiogenic/surgery , Thrombectomy , Vena Cava Filters/adverse effects , Vena Cava, Inferior , Venous Thrombosis/surgery , Aged , Anticoagulants/therapeutic use , COVID-19/diagnosis , Coronary Artery Bypass/methods , Heart Failure/drug therapy , Heart Failure/etiology , Heart Failure/surgery , Humans , Male , Pandemics , Prosthesis Implantation/adverse effects , Pulmonary Embolism/drug therapy , Pulmonary Embolism/etiology , Pulmonary Embolism/surgery , SARS-CoV-2 , Shock, Cardiogenic/drug therapy , Shock, Cardiogenic/etiology , Thrombectomy/instrumentation , Treatment Outcome , Vena Cava, Inferior/diagnostic imaging , Vena Cava, Inferior/surgery , Venous Thrombosis/drug therapy , Venous Thrombosis/etiology
5.
J Card Surg ; 36(12): 4783-4785, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1443298

ABSTRACT

BACKGROUND: Acute decompensated heart failure in patients with coronavirus disease 2019 (COVID-19) is becoming increasingly common. AIMS: In this case report, we describe the successful use of an Impella 5.5 (Abiomed) to treat cardiogenic shock refractory to inotropic therapy. MATERIALS & METHODS: Transthoracic and transesophageal echocardiography confirmed severely diminished left ventricular ejection fraction and a reverse-transcription polymerase chain reaction test revealed that the patient was COVID-19 positive during his hospital admission. RESULTS: Following initiation of inotropic therapy, we placed an Impella 5.5 for further cardiac support. The patient's LVEF and cardiac index improved after 21 days on the Impella 5.5 and was maintained following explant. DISCUSSION & CONCLUSION: The findings reported here demonstrate successful use of an Impella 5.5 to improve native heart function in refractory cardiogenic shock and further indicate its use as an option for those in acute decompensated heart failure who have tested positive for COVID-19 infection.


Subject(s)
COVID-19 , Heart-Assist Devices , Humans , Retrospective Studies , SARS-CoV-2 , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Stroke Volume , Treatment Outcome , Ventricular Function, Left
7.
J Card Surg ; 36(11): 4396-4399, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1354504

ABSTRACT

Cardiovascular system involvement and its negative prognostic impact have been increasingly identified in coronavirus disease 2019 (COVID-19) patients. Optimal medical treatment allows for safe management of most of these cardiovascular presentations while COVID-19-associated refractory cardiogenic shock could be rescued by veno-arterial extracorporeal membrane oxygenation (VA-ECMO). We present a case of acute myocardial injury related to COVID-19 complicated by refractory cardiogenic shock and treated by VA-ECMO implantation.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Humans , Retrospective Studies , SARS-CoV-2 , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy
8.
Indian Heart J ; 73(5): 565-571, 2021.
Article in English | MEDLINE | ID: covidwho-1312426

ABSTRACT

OBJECTIVE: To evaluate the prevalence and impact of respiratory infections in cardiogenic shock complicating acute myocardial infarction (AMI-CS). METHODS: Using the National Inpatient Sample (2000-2017), this study identified adult (≥18 years) admitted with AMI-CS complicated by respiratory infections. Outcomes of interest included in-hospital mortality of AMI-CS admissions with and without respiratory infections, hospitalization costs, hospital length of stay, and discharge disposition. Temporal trends of prevalence, in-hospital mortality and cardiac procedures were evaluated. RESULTS: Among 557,974 AMI-CS admissions, concomitant respiratory infections were identified in 84,684 (15.2%). Temporal trends revealed a relatively stable trend in prevalence of respiratory infections over the 18-year period. Admissions with respiratory infections were on average older, less likely to be female, with greater comorbidity, had significantly higher rates of NSTEMI presentation, and acute non-cardiac organ failure compared to those without respiratory infections (all p < 0.001). These admissions received lower rates of coronary angiography (66.8% vs 69.4%, p < 0.001) and percutaneous coronary interventions (44.8% vs 49.5%, p < 0.001), with higher rates of mechanical circulatory support, pulmonary artery catheterization, and invasive mechanical ventilation compared to AMI-CS admissions without respiratory infections (all p < 0.001). The in-hospital mortality was lower among AMI-CS admissions with respiratory infections (31.6% vs 38.4%, adjusted OR 0.58 [95% CI 0.57-0.59], p < 0.001). Admissions with respiratory infections had longer lengths of hospital stay (127-20 vs 63-11 days, p < 0.001), higher hospitalization costs and less frequent discharges to home (27.1% vs 44.7%, p < 0.001). CONCLUSIONS: Respiratory infections in AMI-CS admissions were associated with higher resource utilization but lower in-hospital mortality.


Subject(s)
Myocardial Infarction , Percutaneous Coronary Intervention , Respiratory Tract Infections , Adult , Female , Hospital Mortality , Humans , Myocardial Infarction/complications , Myocardial Infarction/epidemiology , Myocardial Infarction/therapy , Respiratory Tract Infections/complications , Respiratory Tract Infections/epidemiology , Shock, Cardiogenic/epidemiology , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy
9.
Arch Cardiovasc Dis ; 114(5): 426-433, 2021 May.
Article in English | MEDLINE | ID: covidwho-1240132

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been characterized by high transmission rates and high mortality in adults with predisposing factors, including age>70 years, obesity, diabetes, systemic hypertension and other underlying diseases. During the second week of viral pneumonia, acute respiratory distress syndrome can occur and carries high mortality. Unlike most common respiratory viruses, children seem to be less susceptible to SARS-CoV-2 infection, and generally develop mild disease with low mortality. However, clusters of severe shock associated with high levels of cardiac biomarkers and unusual vasoplegia requiring inotropes, vasopressors and volume loading have recently been described. Both the clinical symptoms (i.e. high and persistent fever, gastrointestinal disorders, skin rash, conjunctival injection and dry cracked lips) and the biological signs (e.g. elevated C-reactive protein/procalcitonin and high levels of ferritinaemia) mimicked Kawasaki disease. In most cases, intravenous immunoglobin therapy improved cardiac function and led to full recovery within a few days. Adjunctive steroid therapy and sometimes biotherapy (e.g. anti-interleukin 1Ra and anti-interleukin 6 monoclonal antibodies) were often necessary. Although almost all children fully recovered within a week, some of them later developed coronary artery dilation or aneurysm. Thus, a new "multisystem inflammatory syndrome in children" related to SARS-CoV-2 has recently been described. Similarities with Kawasaki disease and the physiopathology of this syndrome still need further exploration.


Subject(s)
COVID-19/complications , Mucocutaneous Lymph Node Syndrome/diagnosis , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/diagnosis , Adolescent , Biomarkers , COVID-19/blood , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/etiology , Child , Diagnosis, Differential , Disease Susceptibility , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Length of Stay/statistics & numerical data , Male , Mucocutaneous Lymph Node Syndrome/blood , Mucocutaneous Lymph Node Syndrome/physiopathology , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Shock, Septic/diagnosis , Symptom Assessment , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/etiology
10.
Sci Rep ; 11(1): 9959, 2021 05 11.
Article in English | MEDLINE | ID: covidwho-1225515

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a global pandemic impacting nearly 170 countries/regions and millions of patients worldwide. Patients with acute myocardial infarction (AMI) still need to be treated at percutaneous coronary intervention (PCI) centers with relevant safety measures. This retrospective study was conducted to assess the therapeutic outcomes of PCI performed under the safety measures and normal conditions. AMI patients undergoing PCI between January 24 to April 30, 2020 were performed under safety measures for COVID-19. Patients received pulmonary computed tomography (CT) and underwent PCI in negative pressure ICU. Cardiac catheterization laboratory (CCL) staff and physicians worked with level III personal protection. Demographic and clinical data, such as door-to-balloon (DTB) time, operation time, complications for patients in this period (COVID-19 group) and the same period in 2019 (2019 group) were retrieved and analyzed. COVID-19 and 2019 groups had 37 and 96 patients, respectively. There was no significant difference in age, gender, BMI and comorbidity between the two groups. DTB time and operation time were similar between the two groups (60.0 ± 12.39 vs 58.83 ± 12.85 min, p = 0.636; 61.46 ± 9.91 vs 62.55 ± 10.72 min, p = 0.592). Hospital stay time in COVID-19 group was significantly shorter (6.78 ± 2.14 vs 8.85 ± 2.64 days, p < 0.001). The incidences of malignant arrhythmia and Takotsubo Syndrome in COVID-19 group were higher than 2019 group significantly (16.22% vs 5.21%, p = 0.039; 10.81% vs 1.04% p = 0.008). During hospitalization and 3-month follow-up, the incidence of major adverse cardiovascular events and mortality in the two groups were statistically similar (35.13% vs 14.58%, p = 0.094; 16.22% vs 8.33%, p = 0.184). The risk of major adverse cardiac events (MACE) was associated with cardiogenic shock (OR, 11.53; 95% CI, 2.888-46.036; p = 0.001), malignant arrhythmias (OR, 7.176; 95% CI, 1.893-27.203; p = 0.004) and advanced age (≥ 75 years) (OR, 6.718; 95% CI, 1.738-25.964; p = 0.006). Cardiogenic shock (OR, 17.663; 95% CI, 5.5-56.762; p < 0.001) and malignant arrhythmias (OR, 4.659; 95% CI, 1.481-14.653; p = 0.008) were also associated with death of 3 months. Our analysis showed that safety measures undertaken in this hospital, including screening of COVID-19 infection and use of personal protection equipment for conducting PCI did not compromise the surgical outcome as compared with PCI under normal condition, although there were slight increases in incidence of malignant arrhythmia and Takotsubo Syndrome.


Subject(s)
COVID-19/pathology , Percutaneous Coronary Intervention , Treatment Outcome , Age Factors , Aged , Aged, 80 and over , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/etiology , COVID-19/complications , COVID-19/transmission , COVID-19/virology , Female , Humans , Incidence , Kaplan-Meier Estimate , Length of Stay , Male , Middle Aged , Myocardial Infarction/complications , Myocardial Infarction/mortality , Myocardial Infarction/therapy , Percutaneous Coronary Intervention/adverse effects , Retrospective Studies , SARS-CoV-2/isolation & purification , Shock, Cardiogenic/epidemiology , Shock, Cardiogenic/etiology , Takotsubo Cardiomyopathy/epidemiology , Takotsubo Cardiomyopathy/etiology
11.
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
12.
BMJ Case Rep ; 14(1)2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1066840

ABSTRACT

The ongoing SARS-CoV-2 (COVID-19) pandemic has presented many difficult and unique challenges to the medical community. We describe a case of a middle-aged COVID-19-positive man who presented with pulmonary oedema and acute respiratory failure. He was initially diagnosed with acute respiratory distress syndrome. Later in the hospital course, his pulmonary oedema and respiratory failure worsened as result of severe acute mitral valve regurgitation secondary to direct valvular damage from COVID-19 infection. The patient underwent emergent surgical mitral valve replacement. Pathological evaluation of the damaged valve was confirmed to be secondary to COVID-19 infection. The histopathological findings were consistent with prior cardiopulmonary autopsy sections of patients with COVID-19 described in the literature as well as proposed theories regarding ACE2 receptor activity. This case highlights the potential of SARS-CoV-2 causing direct mitral valve damage resulting in severe mitral valve insufficiency with subsequent pulmonary oedema and respiratory failure.


Subject(s)
COVID-19/complications , Mitral Valve Insufficiency/etiology , Acute Disease , Atrial Fibrillation/complications , Atrial Fibrillation/physiopathology , COVID-19/therapy , Chordae Tendineae/diagnostic imaging , Echocardiography , Electrocardiography , Heart Valve Prosthesis Implantation , Humans , Male , Middle Aged , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/physiopathology , Mitral Valve Insufficiency/surgery , Pulmonary Edema/etiology , Pulmonary Edema/physiopathology , Pulmonary Edema/therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , SARS-CoV-2 , Severity of Illness Index , Shock, Cardiogenic/etiology , Shock, Cardiogenic/physiopathology
13.
Heart Lung ; 50(2): 292-295, 2021.
Article in English | MEDLINE | ID: covidwho-1065104

ABSTRACT

The COVID 19 pandemic resulted in a total reduction in the number of hospitalizations for acute coronary syndromes. A consequence of the delay in coronary revascularization has been the resurgence of structural complications of myocardial infarctions. Ventricular septal rupture (VSR) complicating late presenting acute myocardial infarction (AMI) is associated with high mortality despite advances in both surgical repair and perioperative management. Current data suggests a declining mortality with delay in VSR repair; however, these patients may develop cardiogenic shock while waiting for surgery. Available options are limited for patients with VSR who develop right ventricular failure and cardiogenic shock. The survival rate is very low in patients with cardiogenic shock undergoing surgical or percutaneous VSR repair. In this study we present two late presenting ST elevation MI patients who were complicated by rapidly declining hemodynamics and impending organ failure. Both patients were bridged with venoarterial extracorporeal membrane oxygenation (ECMO) to cardiac transplant.


Subject(s)
COVID-19 , ST Elevation Myocardial Infarction , Ventricular Septal Rupture , Humans , Pandemics , SARS-CoV-2 , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/surgery , Shock, Cardiogenic/etiology , Treatment Outcome , Ventricular Septal Rupture/diagnosis , Ventricular Septal Rupture/epidemiology , Ventricular Septal Rupture/etiology
14.
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
15.
Multimed Man Cardiothorac Surg ; 20202020 Dec 23.
Article in English | MEDLINE | ID: covidwho-1007098

ABSTRACT

We describe the insertion of the Impella 5.0, a peripherally placed mechanical cardiovascular microaxial pump, in a patient with ischemic left ventricular dysfunction. The Impella is a 7 Fr device capable of achieving a flow of 4.0-5.0 L/min; its use necessitates an open arterial cut-down. A subclavicular incision is used to access the right or left axillary artery. A 10-mm tube graft is anastomosed to the artery through which the Impella 5.0 is inserted. The device traverses the tube graft and is advanced via the aorta, across the aortic valve, to its final position (inflow toward the ventricular apex and outflow above the aorta). The device may remain in situ for 10 days until recovery or until further supports are instituted. Our goal is to demonstrate the insertion of the Impella 5.0 device in a patient with cardiogenic shock whose situation was further complicated by coronavirus disease 2019.


Subject(s)
Assisted Circulation , COVID-19 , Heart-Assist Devices , Prosthesis Implantation , ST Elevation Myocardial Infarction , Shock, Cardiogenic , Adult , Assisted Circulation/instrumentation , Assisted Circulation/methods , COVID-19/complications , COVID-19/therapy , Cardiac Catheterization/methods , Humans , Male , Prone Position/physiology , Prosthesis Implantation/instrumentation , Prosthesis Implantation/methods , SARS-CoV-2/isolation & purification , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/physiopathology , Shock, Cardiogenic/etiology , Shock, Cardiogenic/physiopathology , Shock, Cardiogenic/surgery , Treatment Outcome
16.
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
17.
Swiss Med Wkly ; 150: w20387, 2020 11 02.
Article in English | MEDLINE | ID: covidwho-922917

ABSTRACT

A 22-year-old male with a typical history of pauci-symptomatic COVID-19 3 weeks earlier, confirmed by positive serology for SARS-CoV-2 (IgG), was admitted to the intensive care unit because of severe myocarditis with refractory cardiogenic shock that required extracorporeal life support. Due to a clinical presentation suggestive of Kawasaki-like disease with coronary aneurysm and severe systemic inflammation, intravenous immunoglobulins were administered in combination with tocilizumab. The initial clinical course was favourable with these treatments. However, the patient subsequently developed a severe mononeuritis multiplex leading to bilateral foot drop, which required intensive immunosuppressive therapy (corticosteroids, cyclophosphamide and rituximab). The clinical presentation meets the criteria for multisystem inflammatory syndrome associated with SARS-CoV-2, but includes very severe organ damages. Early recognition, a multidisciplinary approach and aggressive therapeutic intervention can lead to a favourable outcome.


Subject(s)
COVID-19/complications , Mononeuropathies/etiology , Myocarditis/etiology , Shock, Cardiogenic/etiology , Systemic Inflammatory Response Syndrome/etiology , Extracorporeal Membrane Oxygenation , Humans , Male , SARS-CoV-2 , Young Adult
18.
Anatol J Cardiol ; 24(5): 334-342, 2020 11.
Article in English | MEDLINE | ID: covidwho-895744

ABSTRACT

OBJECTIVE: Delayed admission of myocardial infarction (MI) patients is an important prognostic factor. In the present nationwide registry (TURKMI-2), we evaluated the treatment delays and outcomes of patients with acute MI during the Covid-19 pandemic and compaired with a recentpre-pandemic registry (TURKMI-1). METHODS: The pandemic and pre-pandemic studies were conducted prospectively as 15-day snapshot registries in the same 48 centers. The inclusion criteria for both registries were aged ≥18 years and a final diagnosis of acute MI (AMI) with positive troponin levels. The only difference between the 2 registries was that the pre-pandemic (TURKMI-1) registry (n=1872) included only patients presenting within the first 48 hours after symptom-onset. TURKMI-2 enrolled all consecutive patients (n=1113) presenting with AMI during the pandemic period. RESULTS: A comparison of the patients with acute MI presenting within the 48-hour of symptom-onset in the pre-pandemic and pandemic registries revealed an overall 47.1% decrease in acute MI admissions during the pandemic. Median time from symptom-onset to hospital-arrival increased from 150 min to 185 min in patients with ST elevation MI (STEMI) and 295 min to 419 min in patients presenting with non-STEMI (NSTEMI) (p-values <0.001). Door-to-balloon time was similar in the two periods (37 vs. 40 min, p=0.448). In the pandemic period, percutaneous coronary intervention (PCI) decreased, especially in the NSTEMI group (60.3% vs. 47.4% in NSTEMI, p<0.001; 94.8% vs. 91.1% in STEMI, p=0.013) but the decrease was not significant in STEMI patients admitted within 12 hours of symptom-onset (94.9% vs. 92.1%; p=0.075). In-hospital major adverse cardiac events (MACE) were significantly increased during the pandemic period [4.8% vs. 8.9%; p<0.001; age- and sex-adjusted Odds ratio (95% CI) 1.96 (1.20-3.22) for NSTEMI, p=0.007; and 2.08 (1.38-3.13) for STEMI, p<0.001]. CONCLUSION: The present comparison of 2 nationwide registries showed a significant delay in treatment of patients presenting with acute MI during the COVID-19 pandemic. Although PCI was performed in a timely fashion, an increase in treatment delay might be responsible for the increased risk of MACE. Public education and establishing COVID-free hospitals are necessary to overcome patients' fear of using healthcare services and mitigate the potential complications of AMI during the pandemic. (Anatol J Cardiol 2020; 24: 334-42).


Subject(s)
Coronavirus Infections/epidemiology , Myocardial Infarction/therapy , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Time-to-Treatment/statistics & numerical data , Aged , COVID-19 , Coronary Angiography/statistics & numerical data , Emergency Medical Services/statistics & numerical data , Female , Heart Failure/mortality , Heart Failure/therapy , Humans , Male , Middle Aged , Myocardial Infarction/mortality , Percutaneous Coronary Intervention/statistics & numerical data , Prognosis , Registries , Regression Analysis , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/therapy , Shock, Cardiogenic/etiology , Shock, Cardiogenic/mortality , Time Factors , Treatment Outcome , Turkey/epidemiology
19.
Am J Emerg Med ; 43: 292.e1-292.e3, 2021 May.
Article in English | MEDLINE | ID: covidwho-893417

ABSTRACT

The reduction in patients presenting with ST-elevation myocardial infarction (STEMI) during the COVID19 crisis could have resulted from fears about developing COVID-19 infection in hospital. Patients who delay presenting with STEMI are more likely to develop mechanical complications, including acute ischemic mitral regurgitation (MR). We present a 69-year-old women with an inferior STEMI and cardiogenic shock due to acute ischemic MR who delayed presenting to hospital due to the fear of COVID-19. Early identification of this mechanical complication using transthoracic echocardiography in the Emergency Department enabled the team to target her optimisation. Ultimately these patients require urgent surgery to repair the mitral valve and revascularize the myocardium but they are often too unwell to undergo surgery and even when it is feasible the outcomes are poor.


Subject(s)
COVID-19/epidemiology , Mitral Valve Insufficiency/complications , Pandemics , Shock, Cardiogenic/etiology , Acute Disease , Aged , Comorbidity , Echocardiography, Doppler, Color , Female , Humans , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/epidemiology , SARS-CoV-2 , Severity of Illness Index
20.
Cardiol Rev ; 28(6): 308-311, 2020.
Article in English | MEDLINE | ID: covidwho-867895

ABSTRACT

Cardiac involvement as a complication of severe acute respiratory syndrome coronavirus 2 infection in children is a relatively new entity. We present our initial experience managing children with coronavirus disease 2019-related acute myocardial injury. The 3 patients presented here represent a spectrum of the cardiac involvement noted in children with coronavirus disease 2019-related multisystem inflammatory syndrome, including myocarditis presenting as cardiogenic shock or heart failure with biventricular dysfunction, valvulitis, coronary artery changes, and pericardial effusion.


Subject(s)
Betacoronavirus , Coronavirus Infections , Heart Failure , Heart Valve Diseases , Myocarditis , Pandemics , Patient Care Management/methods , Pericardial Effusion , Pneumonia, Viral , Systemic Inflammatory Response Syndrome , Adolescent , Betacoronavirus/isolation & purification , Betacoronavirus/pathogenicity , COVID-19 , Cardiac Imaging Techniques/methods , Child , Child, Preschool , Coronary Vessels/diagnostic imaging , Coronary Vessels/pathology , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Heart Failure/etiology , Heart Failure/therapy , Heart Valve Diseases/diagnosis , Heart Valve Diseases/virology , Humans , Myocarditis/therapy , Myocarditis/virology , Pericardial Effusion/therapy , Pericardial Effusion/virology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , SARS-CoV-2 , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Systemic Inflammatory Response Syndrome/diagnosis , Systemic Inflammatory Response Syndrome/physiopathology , Systemic Inflammatory Response Syndrome/therapy , Treatment Outcome
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