RESUMEN
The patient in case 1 was a 50-year-old man who presented to the emergency department of the local hospital with chest pain and syncope for 3 hours due to acute myocardial infarction. He underwent cardiopulmonary resuscitation (CPR) followed by extracorporeal membrane oxygenation (ECMO), and intestinal perforation was detected on day 9. The patient in case 2 was a 58-year-old man who was admitted to the hospital with abdominal pain lasting for 3 days. He also required CPR and ECMO for cardiogenic shock, and intestinal perforation was identified on day 7 of ECMO. We believe that this case report will be important to alert clinicians to the possibility of this complication and to encourage early detection and intervention to improve prognosis. Conventionally, the gastrointestinal tract has received secondary attention in patients receiving ECMO support because the vital organs tend to be considered first. However, this case report illustrates the importance of monitoring gastrointestinal function in patients undergoing ECMO.
Asunto(s)
Embolia , Oxigenación por Membrana Extracorpórea , Perforación Intestinal , Oxigenación por Membrana Extracorpórea/efectos adversos , Humanos , Perforación Intestinal/etiología , Perforación Intestinal/terapia , Contrapulsador Intraaórtico/efectos adversos , Masculino , Arterias Mesentéricas , Persona de Mediana EdadRESUMEN
Remote proctoring by advanced digital technologies may help to overcome pandemic, geographic, and resource-related constraints for mentoring and educating interventional cardiology skills. We present a case series of patients undergoing high-risk percutaneous coronary intervention (HR-PCI) with mechanical circulatory support (MCS) guided by remote proctoring to gain insights into a streaming technology platform with regard to video/audio quality, visibility of all structural and imaging details, and delay in transmission. According to our experience, remote proctoring appears to be a reliable, quick, and resource-conserving way to disseminate, educate and improve MCS-supported HR-PCI with implications far beyond the COVID-19 pandemic.
Asunto(s)
COVID-19/prevención & control , Control de Enfermedades Transmisibles , Enfermedad de la Arteria Coronaria/cirugía , Contrapulsador Intraaórtico , Intervención Coronaria Percutánea , Consulta Remota , Anciano , Anciano de 80 o más Años , COVID-19/epidemiología , COVID-19/transmisión , Estudios de Cohortes , Humanos , MasculinoRESUMEN
Mucormycosis is an invasive fungal infection (IFI) due to several species of saprophytic fungi, occurring in patients with underlying co-morbidities (including organ transplantation). During the ongoing Coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of bacterial and fungal co-infections occurring in COVID-19 patients, including COVID-19 associated pulmonary aspergillosis (CAPA). We describe a case of mucormycosis occurring after COVID-19, in an individual who received a recent heart transplant for severe heart failure. Two months after heart transplant, our patient developed upper respiratory and systemic symptoms and was diagnosed with COVID-19. He was managed with convalescent plasma therapy and supportive care. Approximately three months after COVID-19 diagnosis, he developed cutaneous mucormycosis at an old intravascular device site. He underwent extensive surgical interventions, combined with broad-spectrum antifungal therapy. Despite the aggressive therapeutic measures, he died after a prolonged hospital stay. In this case report, we also review the prior well-reported cases of mucormycosis occurring in COVID-19 patients and discuss potential mechanisms by which COVID-19 may predispose to IFIs. Similar to CAPA, mucormycosis with COVID-19 may need to be evaluated as an emerging disease association. Clinicians should be vigilant to evaluate for invasive fungal infections such as mucormycosis in patients with COVID-19 infection.
Asunto(s)
COVID-19/complicaciones , Trasplante de Corazón , Infecciones Fúngicas Invasoras/complicaciones , Mucormicosis/complicaciones , Complicaciones Posoperatorias/etiología , Rhizopus/aislamiento & purificación , Anciano , Antiinfecciosos/uso terapéutico , Bacteriemia/complicaciones , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , COVID-19/terapia , Infecciones Relacionadas con Catéteres/tratamiento farmacológico , Infecciones Relacionadas con Catéteres/etiología , Coinfección/tratamiento farmacológico , Coinfección/microbiología , Terapia Combinada , Contraindicaciones de los Medicamentos , Desbridamiento , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/etiología , Susceptibilidad a Enfermedades , Resultado Fatal , Insuficiencia Cardíaca/cirugía , Humanos , Hidroxicloroquina/uso terapéutico , Inmunización Pasiva , Inmunosupresores/efectos adversos , Inmunosupresores/uso terapéutico , Contrapulsador Intraaórtico/instrumentación , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Masculino , Mucormicosis/tratamiento farmacológico , Mucormicosis/microbiología , Terapia de Presión Negativa para Heridas , Infecciones Oportunistas/complicaciones , Infecciones Oportunistas/tratamiento farmacológico , Infecciones Oportunistas/microbiología , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/microbiología , Complicaciones Posoperatorias/virología , Infección de la Herida Quirúrgica/complicaciones , Infección de la Herida Quirúrgica/tratamiento farmacológico , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/cirugía , Sueroterapia para COVID-19Asunto(s)
COVID-19/epidemiología , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón/métodos , Corazón Auxiliar , Alaska , Bases de Datos Factuales , Oxigenación por Membrana Extracorpórea , Hawaii , Humanos , Idaho , Contrapulsador Intraaórtico , Montana , Oregon , Pandemias , Estudios Retrospectivos , WashingtónAsunto(s)
Infecciones por Coronavirus/epidemiología , Oxigenación por Membrana Extracorpórea/estadística & datos numéricos , Insuficiencia Cardíaca/terapia , Contrapulsador Intraaórtico/estadística & datos numéricos , Neumonía Viral/epidemiología , Betacoronavirus , COVID-19 , Bases de Datos Factuales , Insuficiencia Cardíaca/epidemiología , Trasplante de Corazón , Humanos , Pandemias , Estudios Retrospectivos , SARS-CoV-2 , Estados Unidos/epidemiologíaAsunto(s)
Infecciones por Coronavirus/terapia , Oxigenación por Membrana Extracorpórea , Contrapulsador Intraaórtico , Miocarditis/terapia , Neumonía Viral/terapia , Adulto , COVID-19 , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Oxigenación por Membrana Extracorpórea/instrumentación , Humanos , Contrapulsador Intraaórtico/instrumentación , Masculino , Miocarditis/diagnóstico por imagen , Miocarditis/etiología , Miocarditis/fisiopatología , Oxigenadores de Membrana , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Recuperación de la Función , Resultado del Tratamiento , Función Ventricular IzquierdaAsunto(s)
Infecciones por Coronavirus/virología , Coronavirus/aislamiento & purificación , Medicina Basada en la Evidencia , Miocarditis/virología , Paquetes de Atención al Paciente , Enfermedad Aguda , Terapia Combinada , Coronavirus/clasificación , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/terapia , Oxigenación por Membrana Extracorpórea , Femenino , Glucocorticoides/administración & dosificación , Interacciones Microbiota-Huesped , Humanos , Contrapulsador Intraaórtico , Metilprednisolona/administración & dosificación , Persona de Mediana Edad , Miocarditis/diagnóstico , Miocarditis/fisiopatología , Miocarditis/terapia , Quimioterapia por Pulso , Recuperación de la Función , Resultado del TratamientoRESUMEN
The novel coronavirus disease 2019, otherwise known as COVID-19, is a global pandemic with primary respiratory manifestations in those who are symptomatic. It has spread to >187 countries with a rapidly growing number of affected patients. Underlying cardiovascular disease is associated with more severe manifestations of COVID-19 and higher rates of mortality. COVID-19 can have both primary (arrhythmias, myocardial infarction, and myocarditis) and secondary (myocardial injury/biomarker elevation and heart failure) cardiac involvement. In severe cases, profound circulatory failure can result. This review discusses the presentation and management of patients with severe cardiac complications of COVID-19 disease, with an emphasis on a Heart-Lung team approach in patient management. Furthermore, it focuses on the use of and indications for acute mechanical circulatory support in cardiogenic and/or mixed shock.