Concomitant renal and splenic infarctions in a COVID-19-patient with a catastrophic thrombotic syndrome.

Since the outbreak of the COVID-19 pandemic, thrombotic events have been accurately described in patients infected by the SARS-CoV-2, especially venous thromboembolism. However, the mystery of arterial thrombosis is still unclear. Here, we report the case of a 59-year-old man with diabetes mellitus, admitted for COVID-19-pneumonia complicated by pulmonary embolism, a thrombus in the aortic isthmus, the descending thoracic aorta associated with splenic and left renal infarctions, and an acute right limb ischemia. The etiological assessment of this catastrophic thrombotic syndrome showed no evidence for preexisting inherited or acquired thrombophilia. Our case emphasizes the hypercoagulability state in COVID-19-patient leading to both arterial and venous thromboembolisms and the need to establish adequate strategies for the diagnosis and management of thrombo-embolisms to prevent these potentially fatal complications.

COVID-19 complicated by infective endocarditis or concomitant infection? a case report.

Coronavirus disease 2019 (COVID-19) is a global pandemic and public health emergency. With a high infectivity and dissemination rate, cardiovascular complications have been observed and associated with a poorer prognosis. COVID-19 appears to be both a risk and prognosis factor for infective endocarditis. In this report, we present the case of a 53-year-old woman with a non-productive cough, progressive dyspnea and fatigue, diagnosed with COVID-19 four weeks earlier. The patient was referred to our department displaying the same symptoms. She was diagnosed with infective endocarditis of the mitral valve based on clinical symptoms, as well as radiological and analytical investigations. The patient was given appropriate medical treatment before admission based on azithromycin, corticosteroids for two weeks, during the hospitalization, she underwent treatment with antibiotics based on Teicoplanin and gentamicin. Outcome was good; the disappearance of the vegetative lesion on the weekly transthoracic echocardiogram (TTE). This rare case highlights questions about considering other coexisting diagnoses as well as possible complications a long with COVID-19.

Pericarditis complicating COVID-19 infection: a report of two cases.

COVID-19 infection is responsible for many complications, which can lead to a high risk of mortality. Respiratory manifestations are the most encountered, while that cardiovascular complications are classified as the most severe. We report two cases of COVID-19 infection complicated by pericarditis. In the absence of other etiology of pericarditis, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was considered as the behind cause. The treatment in these two cases was corticosteroids with colchicine, with good outcomes. In the presence of any cardiovascular symptoms, pericarditis related to COVID-19 should be suspected, in order to act swiftly and avoid complications as well as contamination.

A cardiac arrest on a spiked helmet electrocardiographic sign in anterior leads in a patient with a diagnosis of acute myocardial infarction: A case report.

In patients with critical heart disease, such as acute coronary syndrome, aortic dissection, and other diseases, ST-segment elevation is a relatively common finding on the electrocardiogram (ECG). There are various other well-known signs described in heart diseases, such as negative T waves and q waves of necrosis. The "spiked helmet sign" is a novel electrocardiographic sign described first in 2011, whose pathophysiology and clinical applicability remain uncertain at this time. Herein we report the case of a cardiac arrest in a patient who developed the "spiked helmet electrocardiographic sign" concomitantly with acute myocardial infarction, leading to the patient's death from ventricular fibrillation. This case report aims to discuss the "spiked helmet electrocardiographic sign", and to detail the prognostic and diagnostic interest of this sign, wich seems to be different from a standard ST segment elevation.

Upper-extremity deep venous thrombosis and bilateral pulmonary embolism in a patient with COVID-19 under prophylactic anticoagulation: A case report.

The COVID-19 infection induces coagulation dysfunction resulting in an increased incidence of pulmonary embolism (PE) and deep venous thrombosis (DVT), mostly in the lower extremities. While upper-extremity DVT is less frequent than lower-extremity DVT, the thrombosis of internal jugular vein or brachiocephalic (innominate) vein is an uncommon presentation. All the current studies concerning the thrombotic risk linked to hospital COVID-19 indicate that therapeutic anticoagulation does not improve the clinical prognosis in the intensive care unit. Standard prophylactic anticoagulation is therefore recommended. But again, thrombotic complications of COVID-19 infection are still frequently reported nowadays despite anticoagulation therapy, as we can see in this case report. Here we report a rare case of a 50-year-old woman with a previous history of dyslipidemia, admitted for COVID-19 related acute respiratory failure. The patient developed during hospitalization an acute bilateral PE, with upper-extremity DVT including thrombosis of the left brachiocephalic vein extended to the left internal jugular vein, while under prophylactic anticoagulation since hospital admission, leading finally to the patient's death from respiratory failure. At present, the pathophysiology of the hypercoagulable state related to COVID-19 infection is poorly understood. The significant rate of thrombosis despite preventive and therapeutic dosage anticoagulation raises the possibility of a pathophysiology unique to COVID-19. This rare case highlights the importance of thrombotic morbidity and mortality associated with the SARS-CoV-2 epidemic, and the need for further studies to better understand the physiopathology behind the thrombotic state of COVID 19 infection and establish a more efficient way to deal with these complications.

Coronary ectasia due to primary aldosteronism in an exceptional presentation.

Primary aldosteronism as a cause of coronary ectasia has been reported only once in the literature and was associated with an aortic aneurysm. Here, we report a second presentation in our cardiology department - a 59-year-old female patient who was admitted for unstable angina. Coronary angiography revealed an ectasia of two major coronary arteries. An etiological assessment revealed an idiopathic primary aldosteronism.

An uncommon presentation of COVID-19: concomitant acute pulmonary embolism, spontaneous tension pneumothorax, pneumomediastinum and subcutaneous emphysema (a case report).

The presenting symptoms and features of COVID-19 are non-specific and may be extrapulmonary complications such as thrombotic disorders but also pneumothorax, pneumomediastinum and subcutaneous emphysema; which are well-known complications of mechanical ventilation. Nevertheless, pneumothorax and/or pneumomediastinum, could complicate the course of a COVID-19 disease even in the absence of barotrauma involved. Herein, we report the case of a 55-year-old man with a previous history of erythroblastopenia due to thymoma admitted for COVID-19-related acute respiratory distress syndrome (ARDS) who simultaneously developed spontaneous tension pneumothorax, pneumomediastinum, subcutaneous emphysema and acute bilateral pulmonary embolism as presenting features of COVID-19 while on high-flow nasal cannula. This rare case highlights the importance of screening for other coexisting alternative diagnoses at the initial presentation of a patient suspected of COVID-19.

Concomitant acute limb ischemia and multiple acute ischemic strokes complicating COVID-19: a case report.

Since the spread of the coronavirus disease 2019 (COVID-19) pandemic, cardiovascular complications are interestingly increasing, particularly thrombotic events, especially in those requiring intensive care. Venous thromboembolism is well known to occur in patients infected by the SARS-CoV-2, but only a few arterial thromboembolism cases have been previously reported. Herein, we report the case of a COVID-19 complicated by a concomitant acute right limb ischemia and multiple acute ischemic strokes. This rare case emphasizes the hypercoagulable state described in COVID-19 patients and the need for anticoagulation therapy to prevent these severe complications.

Late-onset of pulmonary embolism following hospitalization for COVID-19 despite thromboprophylaxis: a report of two cases.

The global pandemic caused by the SARS-CoV-2 has resulted in an increased incidence of venous thromboembolism among hospitalized COVID-19-patients, especially those who required intensive care, despite thromboprophylaxis. This has resulted in the use of higher doses of thromboprophylaxis or therapeutic anticoagulation therapy even in the absence of thrombotic events. However, after their hospital discharge, authors and current guidelines are not unanimous about extended anticoagulant therapy in patients with COVID-19. Here, we report two pulmonary embolism cases following hospitalization for COVID-19, despite intermediate doses of thromboprophylaxis. These rare cases suggest that there may be a residual thrombotic risk following hospitalization for COVID-19 and highlight questions about extended prophylactic-anticoagulation therapy after hospital discharge of patients with COVID-19.

Acute myocardial infarction in a 41-year-old woman due to elevated factor VIII: a case report.

Myocardial infarction is a life-threatening emergency with a high mortality rate. A high plasma level of factor VIII is an established risk for both arterial and venous thrombotic events. In this mini-review, we report the case of a 41-year-old woman without cardiovascular risk factors or a previous history of thrombotic events, admitted for ST-elevation myocardial infarction, in whom coronary angiography showed a thrombotic occlusion in the left anterior descending artery. The patient underwent primary percutaneous coronary intervention (PCI), with GPIIB-IIIA antagonist, then, a pre-dilation with a semi-compliant balloon-catheter, followed by implantation of 2 stents. The etiological assessment revealed a high level of coagulation factor VIII (FVIII). She underwent anticoagulation therapy (with acenocoumarol) with well-controlled international normalised ratio (INR).