Asunto(s)
Vacunas contra la COVID-19/efectos adversos , COVID-19/prevención & control , Miocarditis , SARS-CoV-2/metabolismo , Vacunación/efectos adversos , Vacuna nCoV-2019 mRNA-1273 , Adulto , COVID-19/sangre , COVID-19/diagnóstico por imagen , COVID-19/epidemiología , Vacunas contra la COVID-19/administración & dosificación , Humanos , Masculino , Miocarditis/sangre , Miocarditis/inducido químicamente , Miocarditis/diagnóstico por imagen , Miocarditis/fisiopatologíaRESUMEN
COVID-19 has varied cardiovascular manifestations including microvascular and macrovascular thrombi leading to multiorgan system injury and failure. This case describes a patient presenting with acute hypoxaemic respiratory failure from COVID-19 who abruptly developed a large thrombus in the right coronary artery leading to myocardial infarction. This case report reviews the ECG, heart catheterisation images prepercutaneous and postpercutaneous coronary intervention, critical care management and outcome in the context of the height of the COVID-19 pandemic in the Virginia area. A brief review of relevant literature regarding cardiovascular complications of COVID-19 is also provided. Unfortunately, the patient ultimately passed after 2 weeks of inability to wean off the ventilator.
Asunto(s)
COVID-19/complicaciones , Trombosis Coronaria/etiología , Infarto del Miocardio con Elevación del ST/etiología , Angiografía , COVID-19/diagnóstico por imagen , Cateterismo Cardíaco , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/cirugía , Diagnóstico Diferencial , Stents Liberadores de Fármacos , Electrocardiografía , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pandemias , Radiografía , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , Infarto del Miocardio con Elevación del ST/cirugía , TrombectomíaRESUMEN
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.
Asunto(s)
COVID-19 , Infarto del Miocardio con Elevación del ST , Rotura Septal Ventricular , Humanos , Pandemias , SARS-CoV-2 , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/cirugía , Choque Cardiogénico/etiología , Resultado del Tratamiento , Rotura Septal Ventricular/diagnóstico , Rotura Septal Ventricular/epidemiología , Rotura Septal Ventricular/etiologíaRESUMEN
Although respiratory symptoms are the dominant features of COVID-19 infection, myocardial injury has been described in these patients. Reported cardiac manifestations of COVID-19 infection include myocarditis, arrhythmia and acute coronary syndrome including ST elevation myocardial infarction (STEMI). STEMI is a medical emergency and timely intervention is of utmost importance to prevent mortality and long-term morbidities. In this report, we present a wide spectrum of clinical presentations, management, and outcomes for five patients with COVID-19 infection and ST elevation on ECG.