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2.
Open Heart ; 8(1)2021 01.
Artículo en Inglés | MEDLINE | ID: covidwho-1052327

RESUMEN

AIMS: It was predicted internationally that transthoracic echocardiography (TTE) would be vital during the SARS-CoV-2 outbreak. We therefore, designed a study to report the demand for TTE in two large District General Hospitals during the rise in the first wave of the SARS-CoV-2 pandemic in the UK. A primary clinical outcome of 30-day mortality was also assessed. METHODS: The TTE service across two hospitals was reconfigured to maximise access to inpatient scanning. All TTEs of suspected or confirmed SARS-CoV-2 patients over a 3-week period were included in the study. All patients were followed up until at least day 30 after their scan at which point the primary clinical outcome of mortality was recorded. Comparative analysis based on mortality was conducted for all TTE results, biochemical markers and demographics. RESULTS: 27 patients with confirmed SARS-CoV-2 had a TTE within the inclusion window. Mortality comparative analysis showed the deceased group were significantly older (mean 68.4, SD 11.9 vs 60.5, SD 13.0, p=0.03) and more commonly reported fatigue in their presenting symptoms (29.6% vs 71.4%, p=0.01). No other differences were identified in the demographic or biochemical data. Left ventricular systolic dysfunction was noted in 7.4% of patients and right ventricular impairment or dilation was seen in 18.5% patients. TTE results were not significantly different in mortality comparative analysis. CONCLUSION: This study demonstrates an achievable approach to TTE services when under increased pressure. Data analysis supports the limited available data suggesting right ventricular abnormalities are the most commonly identified echocardiographic change in SARS-CoV-2 patients. No association can be demonstrated between mortality and TTE results.


Asunto(s)
/mortalidad , Enfermedades Cardiovasculares/mortalidad , Ecocardiografía/métodos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , /diagnóstico por imagen , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/fisiopatología , Enfermedades Cardiovasculares/virología , Ecocardiografía/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reino Unido/epidemiología , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/epidemiología , Disfunción Ventricular Izquierda/fisiopatología , Disfunción Ventricular Derecha/diagnóstico por imagen , Disfunción Ventricular Derecha/epidemiología , Disfunción Ventricular Derecha/fisiopatología
3.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artículo en Inglés | MEDLINE | ID: covidwho-963649

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a public health emergency and a pandemic of international concern. As of April 31st,  the reported cases of COVID-19 are three million in 186 countries. Reported case fatality has crossed 200 thousand among which more than fifty thousand has been in the USA. Most patients present with symptoms of fever, cough, and shortness of breath following exposure to other COVID-19 patients. Respiratory manifestations predominate in patients with mild, moderate, severe illness. Imaging of patients with COVID-19 consistently reports various pulmonary parenchymal involvement. In this article we wanted to reinforce and review the various reported imaging patterns of cardiac and mediastinal involvement in COVID-19 patients. Among patients with COVID 19 who underwent various imaging of chest various cardiac findings including pericardial effusion, myocarditis, cardiomegaly has been reported. Most of these findings have been consistently reported in patients with significant acute myocardial injury, and fulminant myocarditis. Acute biventricular dysfunction has also been reported with subsequent improvement of the same following clinical improvement. Details of cardiac MRI is rather limited. In a patient with clinical presentation of acute myocarditis, biventricular myocardial interstitial edema, diffuse biventricular hypokinesia, increased ventricular wall thickness, and severe LV dysfunction has been reported. Among patients with significant clinical improvement in LV structure and function has also been documented. With increasing number of clinical cases, future imaging studies will be instrumental in identifying the various cardiac manifestations, and their relation to clinical outcome.


Asunto(s)
Cardiomegalia/diagnóstico por imagen , Infecciones por Coronavirus/diagnóstico por imagen , Corazón/diagnóstico por imagen , Isquemia Miocárdica/diagnóstico por imagen , Miocarditis/diagnóstico por imagen , Derrame Pericárdico/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Betacoronavirus , Cardiomegalia/fisiopatología , Angiografía Coronaria , Infecciones por Coronavirus/fisiopatología , Ecocardiografía , Edema/diagnóstico por imagen , Edema/fisiopatología , Corazón/fisiopatología , Humanos , Imagen por Resonancia Magnética , Isquemia Miocárdica/fisiopatología , Miocarditis/fisiopatología , Pandemias , Derrame Pericárdico/fisiopatología , Neumonía Viral/fisiopatología , Radiografía Torácica , Recuperación de la Función , Tomografía Computarizada por Rayos X , Disfunción Ventricular/diagnóstico por imagen , Disfunción Ventricular/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología
4.
Monaldi Arch Chest Dis ; 90(4)2020 Nov 09.
Artículo en Inglés | MEDLINE | ID: covidwho-918289

RESUMEN

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection continues to be a public health emergency and a pandemic of international concern. As of April 31st,  the reported cases of COVID-19 are three million in 186 countries. Reported case fatality has crossed 200 thousand among which more than fifty thousand has been in the USA. Most patients present with symptoms of fever, cough, and shortness of breath following exposure to other COVID-19 patients. Respiratory manifestations predominate in patients with mild, moderate, severe illness. Imaging of patients with COVID-19 consistently reports various pulmonary parenchymal involvement. In this article we wanted to reinforce and review the various reported imaging patterns of cardiac and mediastinal involvement in COVID-19 patients. Among patients with COVID 19 who underwent various imaging of chest various cardiac findings including pericardial effusion, myocarditis, cardiomegaly has been reported. Most of these findings have been consistently reported in patients with significant acute myocardial injury, and fulminant myocarditis. Acute biventricular dysfunction has also been reported with subsequent improvement of the same following clinical improvement. Details of cardiac MRI is rather limited. In a patient with clinical presentation of acute myocarditis, biventricular myocardial interstitial edema, diffuse biventricular hypokinesia, increased ventricular wall thickness, and severe LV dysfunction has been reported. Among patients with significant clinical improvement in LV structure and function has also been documented. With increasing number of clinical cases, future imaging studies will be instrumental in identifying the various cardiac manifestations, and their relation to clinical outcome.


Asunto(s)
Cardiomegalia/diagnóstico por imagen , Infecciones por Coronavirus/diagnóstico por imagen , Corazón/diagnóstico por imagen , Isquemia Miocárdica/diagnóstico por imagen , Miocarditis/diagnóstico por imagen , Derrame Pericárdico/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Disfunción Ventricular Izquierda/diagnóstico por imagen , Betacoronavirus , Cardiomegalia/fisiopatología , Angiografía Coronaria , Infecciones por Coronavirus/fisiopatología , Ecocardiografía , Edema/diagnóstico por imagen , Edema/fisiopatología , Corazón/fisiopatología , Humanos , Imagen por Resonancia Magnética , Isquemia Miocárdica/fisiopatología , Miocarditis/fisiopatología , Pandemias , Derrame Pericárdico/fisiopatología , Neumonía Viral/fisiopatología , Radiografía Torácica , Recuperación de la Función , Tomografía Computarizada por Rayos X , Disfunción Ventricular/diagnóstico por imagen , Disfunción Ventricular/fisiopatología , Disfunción Ventricular Izquierda/fisiopatología
5.
Clin Rheumatol ; 39(9): 2811-2815, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: covidwho-679749

RESUMEN

In the midst of the COVID-19 pandemic, further understanding of its complications points towards dysregulated immune response as a major component. Systemic lupus erythematosus (SLE) is also a disease of immune dysregulation leading to multisystem compromise. We present a case of new-onset SLE concomitantly with COVID-19 and development of antiphospholipid antibodies. An 18-year-old female that presented with hemodynamic collapse and respiratory failure, progressed to cardiac arrest, and had a pericardial tamponade drained. She then progressed to severe acute respiratory distress syndrome, severe ventricular dysfunction, and worsening renal function with proteinuria and hematuria. Further studies showed bilateral pleural effusions, positive antinuclear and antidouble-stranded DNA antibodies, lupus anticoagulant, and anticardiolipin B. C3 and C4 levels were low. SARS-Cov-2 PCR was positive after 2 negative tests. She also developed multiple deep venous thrombosis, in the setting of positive antiphospholipid antibodies and lupus anticoagulant. In terms of pathophysiology, COVID-19 is believed to cause a dysregulated cytokine response which could potentially be exacerbated by the shift in Th1 to Th2 response seen in SLE. Also, it is well documented that viral infections are an environmental factor that contributes to the development of autoimmunity; however, COVID-19 is a new entity, and it is not known if it could trigger autoimmune conditions. Additionally, it is possible that SARS-CoV-2, as it happens with other viruses, might lead to the formation of antiphospholipid antibodies, potentially contributing to the increased rates of thrombosis seen in COVID-19.


Asunto(s)
Síndrome Antifosfolípido/inmunología , Infecciones por Coronavirus/inmunología , Lupus Eritematoso Sistémico/inmunología , Neumonía Viral/inmunología , Adolescente , Anemia/etiología , Anticuerpos Anticardiolipina/inmunología , Anticuerpos Antinucleares/inmunología , Anticuerpos Monoclonales Humanizados/uso terapéutico , Síndrome Antifosfolípido/complicaciones , Síndrome Antifosfolípido/diagnóstico , Síndrome Antifosfolípido/terapia , Anuria/etiología , Betacoronavirus , Taponamiento Cardíaco/diagnóstico por imagen , Taponamiento Cardíaco/etiología , Taponamiento Cardíaco/terapia , Complemento C3/inmunología , Complemento C4/inmunología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , ADN/inmunología , Ecocardiografía , Resultado Fatal , Femenino , Paro Cardíaco/etiología , Hematuria/etiología , Humanos , Inhibidor de Coagulación del Lupus/inmunología , Lupus Eritematoso Sistémico/sangre , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/diagnóstico , Pandemias , Posicionamiento del Paciente , Pericardiocentesis , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Posición Prona , Proteinuria/etiología , Diálisis Renal , Insuficiencia Renal/etiología , Insuficiencia Renal/terapia , Respiración Artificial , /terapia , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/terapia , Trombocitopenia/etiología , Trombosis de la Vena/etiología , Disfunción Ventricular Izquierda/diagnóstico por imagen
6.
Can J Cardiol ; 36(8): 1326.e5-1326.e7, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-549053
8.
JAMA Cardiol ; 5(7): 819-824, 2020 07 01.
Artículo en Inglés | MEDLINE | ID: covidwho-17622

RESUMEN

Importance: Virus infection has been widely described as one of the most common causes of myocarditis. However, less is known about the cardiac involvement as a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Objective: To describe the presentation of acute myocardial inflammation in a patient with coronavirus disease 2019 (COVID-19) who recovered from the influenzalike syndrome and developed fatigue and signs and symptoms of heart failure a week after upper respiratory tract symptoms. Design, Setting, and Participant: This case report describes an otherwise healthy 53-year-old woman who tested positive for COVID-19 and was admitted to the cardiac care unit in March 2020 for acute myopericarditis with systolic dysfunction, confirmed on cardiac magnetic resonance imaging, the week after onset of fever and dry cough due to COVID-19. The patient did not show any respiratory involvement during the clinical course. Exposure: Cardiac involvement with COVID-19. Main Outcomes and Measures: Detection of cardiac involvement with an increase in levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T, echocardiography changes, and diffuse biventricular myocardial edema and late gadolinium enhancement on cardiac magnetic resonance imaging. Results: An otherwise healthy 53-year-old white woman presented to the emergency department with severe fatigue. She described fever and dry cough the week before. She was afebrile but hypotensive; electrocardiography showed diffuse ST elevation, and elevated high-sensitivity troponin T and NT-proBNP levels were detected. Findings on chest radiography were normal. There was no evidence of obstructive coronary disease on coronary angiography. Based on the COVID-19 outbreak, a nasopharyngeal swab was performed, with a positive result for SARS-CoV-2 on real-time reverse transcriptase-polymerase chain reaction assay. Cardiac magnetic resonance imaging showed increased wall thickness with diffuse biventricular hypokinesis, especially in the apical segments, and severe left ventricular dysfunction (left ventricular ejection fraction of 35%). Short tau inversion recovery and T2-mapping sequences showed marked biventricular myocardial interstitial edema, and there was also diffuse late gadolinium enhancement involving the entire biventricular wall. There was a circumferential pericardial effusion that was most notable around the right cardiac chambers. These findings were all consistent with acute myopericarditis. She was treated with dobutamine, antiviral drugs (lopinavir/ritonavir), steroids, chloroquine, and medical treatment for heart failure, with progressive clinical and instrumental stabilization. Conclusions and Relevance: This case highlights cardiac involvement as a complication associated with COVID-19, even without symptoms and signs of interstitial pneumonia.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Miocarditis/virología , Pericarditis/virología , Neumonía Viral/complicaciones , Disfunción Ventricular Izquierda/virología , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Femenino , Humanos , Persona de Mediana Edad , Miocarditis/diagnóstico por imagen , Miocarditis/terapia , Pandemias , Pericarditis/diagnóstico por imagen , Pericarditis/terapia , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Disfunción Ventricular Izquierda/diagnóstico por imagen , Disfunción Ventricular Izquierda/terapia
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