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1.
J Invasive Cardiol ; 34(11): E825, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2093175

ABSTRACT

Left ventricular (LV) unloading has been associated with improved survival in patients treated with venoarterial extracorporeal membrane oxygenation. This case describes a patient with a COVID-19 infection who subsequently developed non-ischemic cardiomyopathy with an LV ejection fraction of 10% to 15% (baseline echocardiography). He did poorly in the outpatient setting and was admitted to an outside hospital with heart failure symptoms and was subsequently transferred to our hospital for escalation of care and consideration of advanced heart failure therapies. This clinical image and related video series help to visually demonstrate the effect of LV unloading in a 30-year-old male with a history of COVID-19 myocarditis.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Heart Failure , Heart-Assist Devices , Male , Humans , Adult , Extracorporeal Membrane Oxygenation/methods , Heart Ventricles , Ventricular Function, Left , Shock, Cardiogenic/therapy
2.
Ann Cardiol Angeiol (Paris) ; 71(4): 228-231, 2022 Oct.
Article in French | MEDLINE | ID: covidwho-2048892

ABSTRACT

A 45 years old female patient was admitted to our facility for COVID -19 infection complicated by fulminant cardiac injury and refractory cardiogemic shock. She had echographic findings of reverse takotsubo cardiomyopathy. She was successfully treated by VA-ECMO allowing complete revocery of the left ventricule function and weaning from support.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Takotsubo Cardiomyopathy , COVID-19/complications , Extracorporeal Membrane Oxygenation/adverse effects , Female , Humans , Middle Aged , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Takotsubo Cardiomyopathy/complications , Takotsubo Cardiomyopathy/therapy
4.
Catheter Cardiovasc Interv ; 100(4): 568-574, 2022 10.
Article in English | MEDLINE | ID: covidwho-2013401

ABSTRACT

OBJECTIVES: To evaluate characteristics and outcomes of patients presenting with acute myocardial infarction and cardiogenic shock (AMICS) during the coronavirus disease 2019 (COVID-19) pandemic. BACKGROUND: The COVID-19 pandemic has created challenges in delivering acute cardiovascular care. Quality measures and outcomes of patients presenting with AMICS during COVID-19 in the United States have not been well described. METHODS: We identified 406 patients from the National Cardiogenic Shock Initiative (NCSI) with AMICS and divided them into those presenting before (N = 346, 5/9/2016-2/29/2020) and those presenting during the COVID-19 pandemic (N = 60, 3/1/2020-11/10/2020). We compared baseline clinical data, admission characteristics, and outcomes. RESULTS: The median age of the cohort was 64 years, and 23.7% of the group was female. There were no significant differences in age, sex, and medical comorbidities between the two groups. Patients presenting during the pandemic were less likely to be Black compared to those presenting prior. Median door to balloon (90 vs. 88 min, p = 0.38), door to support (88 vs. 78 min, p = 0.13), and the onset of shock to support (74 vs. 62 min, p = 0.15) times were not significantly different between the two groups. Patients presented with ST-elevation myocardial infarction more often during the COVID-19 period (95.0% vs. 80.0%, p = 0.005). In adjusted logistic regression models, COVID-19 period did not significantly associate with survival to discharge (odds ratio [OR] 1.09, 95% confidence interval [CI] 0.54-2.19, p = 0.81) or with 1-month survival (OR 0.82, 95% CI 0.42-1.61, p = 0.56). CONCLUSIONS: Care of patients presenting with AMICS has remained robust among hospitals participating in the NCSI during the COVID-19 pandemic.


Subject(s)
COVID-19 , Heart-Assist Devices , Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , COVID-19/complications , Female , Heart-Assist Devices/adverse effects , Humans , Middle Aged , Myocardial Infarction/diagnosis , Myocardial Infarction/etiology , Myocardial Infarction/therapy , Pandemics , Percutaneous Coronary Intervention/adverse effects , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/therapy , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Treatment Outcome , United States/epidemiology
5.
Heart Fail Rev ; 27(6): 2033-2043, 2022 11.
Article in English | MEDLINE | ID: covidwho-1942219

ABSTRACT

Clinical course and outcomes of myocarditis after COVID-19 vaccination remain variable. We retrospectively collected data on patients > 12 years old from 01/01/2021 to 12/30/2021 who received COVID-19 messenger RNA (mRNA) vaccination and were diagnosed with myocarditis within 60 days of vaccination. Myocarditis cases were based on case definitions by authors. We report on 238 patients of whom most were male (n = 208; 87.1%). The mean age was 27.4 ± 16 (range 12-80) years. Females presented at older ages (41.3 ± 21.5 years) than men 25.7 ± 14 years (p = 0.001). In patients > 20 years of age, the mean duration from vaccination to symptoms was 4.8 days ± 5.5 days, but in < 20, it was 3.0 ± 3.3 days (p = 0.04). Myocarditis occurred most commonly after the Pfizer-BioNTech mRNA vaccine (n = 183; 76.45) and after the second dose (n = 182; 80%). Symptoms started 3.95 ± 4.5 days after vaccination. The commonest symptom was chest pain (n = 221; 93%). Patients were treated with non-steroidal anti-inflammatory drugs (n = 105; 58.3%), colchicine (n = 38; 21.1%), or glucocorticoids (n = 23; 12.7%). About 30% of the patients had left ventricular ejection fraction but more than half recovered the on repeat imaging. Abnormal cardiac MRIs were common; 168 patients (96% of 175 patients that had MRI) had late gadolinium enhancement, while 120 patients (68.5%) had myocardial edema. Heart failure guideline-directed medical therapy use was common (n = 27; 15%). Eleven patients had cardiogenic shock; and 4 patients required mechanical circulatory support. Five patients (1.7%) died; of these, 3 patients had endomyocardial biopsy/autopsy-confirmed myocarditis. Most cases of COVID-19 vaccine myocarditis are mild. Females presented at older ages than men and duration from vaccination to symptoms was longer in patients > 20 years. Cardiogenic shock requiring mechanical circulatory support was seen and mortality was low. Future studies are needed to better evaluate risk factors, and long-term outcomes of COVID-19 mRNA vaccine myocarditis.


Subject(s)
COVID-19 Vaccines , COVID-19 , Myocarditis , Adolescent , Adult , Aged , Aged, 80 and over , Child , Female , Humans , Male , Middle Aged , Young Adult , Anti-Inflammatory Agents/therapeutic use , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , mRNA Vaccines/adverse effects , Myocarditis/chemically induced , Retrospective Studies , RNA, Messenger , Shock, Cardiogenic/therapy , Stroke Volume , Vaccination/adverse effects , Ventricular Function, Left
6.
Zhonghua Yi Xue Za Zhi ; 102(25): 1874-1877, 2022 Jul 05.
Article in Chinese | MEDLINE | ID: covidwho-1911759

ABSTRACT

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a salvage therapy for critical patients with refractory cardiogenic shock caused by various reasons. It can temporarily replace cardiopulmonary function, and rapidly improve hypoxemia, increase systemic oxygen content and remove carbon dioxide. Although the Extracorporeal Life Support Organization (ELSO) guideline proposed clear indication for VA-ECMO, the heterogeneity of cardiac pathogeny is large, so the clear timing of ECMO initiation is still vague. We discuss the timing of ECMO initiation for external cardiopulmonary resuscitation (ECPR) and cardiogenic shock which is caused by fulminant myocarditis, acute myocardial infarction, acute pulmonary embolism, acute right heart failure related to lung transplantation, corona virus disease 2019 (COVID-19)-associated cardiovascular collapse. Also, we look forward to making more suggestions for clinicians' judgment and choice for VA-ECMO.


Subject(s)
COVID-19 , Cardiopulmonary Resuscitation , Extracorporeal Membrane Oxygenation , Pulmonary Embolism , Extracorporeal Membrane Oxygenation/adverse effects , Humans , Retrospective Studies , Shock, Cardiogenic/therapy
7.
Curr Probl Cardiol ; 47(9): 101268, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-1867027

ABSTRACT

Coronavirus Disease 2019 (COVID-19) has been a significant cause of global mortality and morbidity since it was first reported in December 2019 in Wuhan, China. COVID19 like previous coronaviruses primarily affects the lungs causing pneumonia, interstitial pneumonitis, and severe acute respiratory distress syndrome (ARDS). However, there is increasing evidence linking COVID-19 to cardiovascular complications such as arrhythmias, heart failure, cardiogenic shock, fulminant myocarditis, and cardiac death. Given the novelty of this virus, there is paucity of data on some cardiovascular complications of COVID-19, specifically myocarditis. Myocarditis is an inflammatory disease of the heart muscle with a heterogenous clinical presentation and progression. It is mostly caused by viral infections and is the result of interaction of the virus and the host's immune system. There have been several case reports linking COVID-19 with myocarditis, however the true mechanism of cardiac injury remains under investigation. In this paper we review the clinical presentation, proposed pathophysiology, differential diagnoses and management of myocarditis in COVID-19 patients.


Subject(s)
COVID-19 , Myocarditis , Arrhythmias, Cardiac , COVID-19/complications , Humans , Myocarditis/diagnosis , Myocarditis/etiology , Myocarditis/therapy , SARS-CoV-2 , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy
8.
Cardiol Clin ; 40(3): 365-373, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1850768

ABSTRACT

The aggressive inflammatory response to COVID-19 can result in airway damage, respiratory failure, cardiac injury, and multiorgan failure, which lead to death in susceptible patients. Cardiac injury and acute myocardial infarction (AMI) secondary to COVID-19 disease can lead to hospitalization, heart failure, and sudden cardiac death. When serious collateral damage from tissue necrosis or bleeding occurs, mechanical complications of myocardial infarction and cardiogenic shock can ensue. While prompt reperfusion therapies have decreased the incidence of these serious complications, patients who present late following the initial infarct are at increased for mechanical complications, cardiogenic shock, and death. The health outcomes for patients with mechanical complications are dismal if not recognized and treated promptly. Even if they survive serious pump failure, their CICU stay is often prolonged, and their index hospitalization and follow-up visits may consume significant resources and impact the health care system.


Subject(s)
COVID-19 , Heart Failure , Myocardial Infarction , COVID-19/complications , Heart Failure/complications , Hospital Mortality , Humans , Myocardial Infarction/complications , Myocardial Infarction/epidemiology , Shock, Cardiogenic/therapy
9.
Catheter Cardiovasc Interv ; 100(1): 175-178, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1802098

ABSTRACT

Left ventricular (LV) unloading is an important concept in patients undergoing peripheral venoarterial extracorporeal membrane oxygenation (VA-ECMO). We present a case of a 32-year-old male in acute cardiorespiratory collapse due to coronavirus disease (COVID-19) who underwent VA-ECMO cannulation in the setting of cardiogenic shock and acute respiratory distress syndrome. Due to inability to utilize percutaneous LV assist device (pLVAD) for LV unloading due to small end diastolic dimension, alternative strategies were explored. A traditionally utilized right ventricular support device, the ProTek Duo (TandemLife, Pittsburgh, PA), was utilized to drain the pulmonary artery, leading to improvement in parameters for cardiogenic shock. To our knowledge, this is the first case in which a ProTek Duo has been utilized in conjunction with VA-ECMO to provide LV unloading in support of a patient in cardiogenic shock. This method can be employed in future challenging situations where pLVAD is not feasible.


Subject(s)
COVID-19 , Drainage , Heart Failure , Respiratory Insufficiency , Adult , COVID-19/complications , Drainage/methods , Heart Failure/therapy , Heart Failure/virology , Humans , Male , Pulmonary Artery , Respiratory Insufficiency/therapy , Respiratory Insufficiency/virology , Shock, Cardiogenic/therapy , Treatment Outcome
10.
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
11.
Medicina (Kaunas) ; 58(2)2022 Feb 01.
Article in English | MEDLINE | ID: covidwho-1715542

ABSTRACT

Fulminant myocarditis is characterized by life threatening heart failure presenting as cardiogenic shock requiring inotropic or mechanical circulatory support to maintain tissue perfusion. There are limited data on the role of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the management of fulminant myocarditis. This review seeks to evaluate the management of fulminant myocarditis with a special emphasis on the role and outcomes with VA-ECMO use.


Subject(s)
Extracorporeal Membrane Oxygenation , Heart Failure , Myocarditis , Heart Failure/therapy , Humans , Myocarditis/therapy , Shock, Cardiogenic/therapy
12.
J Card Surg ; 37(5): 1439-1443, 2022 May.
Article in English | MEDLINE | ID: covidwho-1685369

ABSTRACT

Emerging data suggest an association between severe acute respiratory syndrome coronavirus 2 and the development of acute myocarditis, with children and older adults being most at risk. We describe the clinical course of a previously healthy 12-year-old female who rapidly deteriorated into cardiogenic shock and arrest due to coronavirus disease 2019 induced fulminant myocarditis, necessitating venous-arterial extracorporeal membrane oxygenation as a bridge to full recovery. This case highlights the importance of early clinical recognition of myocardial involvement, and the benefits of taking a multidisciplinary approach in treating these patients.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Myocarditis , Adolescent , Aged , COVID-19/complications , COVID-19/therapy , Child , Female , Humans , Myocarditis/etiology , Myocarditis/therapy , Myocardium , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy
13.
J Card Fail ; 28(4): 675-681, 2022 04.
Article in English | MEDLINE | ID: covidwho-1627205

ABSTRACT

BACKGROUND: Acute heart failure (HF) is an important complication of coronavirus disease 2019 (COVID-19) and has been hypothesized to relate to inflammatory activation. METHODS: We evaluated consecutive intensive care unit (ICU) admissions for COVID-19 across 6 centers in the Critical Care Cardiology Trials Network, identifying patients with vs without acute HF. Acute HF was subclassified as de novo vs acute-on-chronic, based on the absence or presence of prior HF. Clinical features, biomarker profiles and outcomes were compared. RESULTS: Of 901 admissions to an ICU due to COVID-19, 80 (8.9%) had acute HF, including 18 (2.0%) with classic cardiogenic shock (CS) and 37 (4.1%) with vasodilatory CS. The majority (n = 45) were de novo HF presentations. Compared to patients without acute HF, those with acute HF had higher cardiac troponin and natriuretic peptide levels and similar inflammatory biomarkers; patients with de novo HF had the highest cardiac troponin levels. Notably, among patients critically ill with COVID-19, illness severity (median Sequential Organ Failure Assessment, 8 [IQR, 5-10] vs 6 [4-9]; P = 0.025) and mortality rates (43.8% vs 32.4%; P = 0.040) were modestly higher in patients with vs those without acute HF. CONCLUSIONS: Among patients critically ill with COVID-19, acute HF is distinguished more by biomarkers of myocardial injury and hemodynamic stress than by biomarkers of inflammation.


Subject(s)
COVID-19 , Cardiology , Heart Failure , Biomarkers , COVID-19/epidemiology , Critical Care , Critical Illness/epidemiology , Heart Failure/diagnosis , Heart Failure/epidemiology , Heart Failure/therapy , Hospital Mortality , Humans , Intensive Care Units , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/epidemiology , Shock, Cardiogenic/therapy , Troponin
14.
Kardiologiia ; 61(11): 104-107, 2021 Nov 30.
Article in Russian | MEDLINE | ID: covidwho-1558967

ABSTRACT

The conditions of the pandemic caused by the novel coronavirus infection (COVID-19) are associated with overloading intensive care units, conversion of hospitals, and changes in routing of patients with acute cardiovascular pathology. At the same time, medical practice is still challenged to provide medical care to patients with acute coronary syndrome (ACS). Patients with COVID-19 and acute myocardial infarction (AMI) are at a higher risk of death while the incidence of this combination of diseases will be growing. This article describes a case of diagnosis and treatment of COVID-19 in a 69-year-old patient who was urgently hospitalized with cardiogenic shock associated with ACS, electrocardiographic signs of complete left bundle branch block, and left ventricular ejection fraction of 19 %. Coronary angiography with stenting was successfully performed in the conditions of extracorporeal membrane oxygenation. The patient received long-term intensive therapy in the intensive care unit followed by symptomatic treatment in the cardiac surgery unit. The patient's condition gradually improved and he was discharged from the hospital on the 56th day. The strategy of intensive care and active follow-up helped saving life of the patient with COVID-19 and AMI.


Subject(s)
COVID-19 , Myocardial Infarction , Aged , Humans , Male , Myocardial Infarction/complications , SARS-CoV-2 , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Stroke Volume , Ventricular Function, Left
16.
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
17.
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
19.
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
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