Cardiac involvement in cancer patients under chemotherapy and diagnosed with COVID-19: case report and literature review.

Many cases of severe cardiac complications due to Coronavirus disease 2019 (COVID-19) were reported. Cancer and chemotherapy appear to be risk and prognostic factors for COVID-19. A 49-year-old Female, with a history of breast cancer treated by tumorectomy and anthracycline-based chemotherapy was admitted with acute respiratory distress syndrome (ARDS) confirmed as COVID-19. She also had elevated troponin I level (up to 43 g/L), and diffuse myocardial hypokinesia along with severe left ventricle dysfunction on echocardiography. Initial treatment included hydroxychloroquine, azithromycin, corticosteroids and mechanical ventilation. The evolution was marked by QT interval prolongation (QTc=523 ms) and occurrence of cardiogenic shock. The patient died of hemodynamic instability reluctant to resuscitation measures at the 2ndday of hospitalization. COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. Receiving chemotherapy especially anthracyclines may be a precipitating and prognostic factor of cardiac manifestations in COVID-19 cancer patients.

Bacterial co-infections and superinfections in COVID-19: a case report of right heart infective endocarditis and literature review.

Coronavirus disease of 2019 (COVID-19) is a worldwide pandemic with significant morbidity and mortality. Patients with severe forms of the disease are usually managed in the Intensive Care Unit (ICU), where they can develop secondary infections particularly bacterial, favored by prolonged intubation and central venous catheterization (CVC), hence increasing the disease's mortality. Infectious endocarditis (IE) represents a rare and severe cardiovascular complication in patients with CVC. We report the case of a patient admitted to the ICU for an acute respiratory distress syndrome (ARDS) due to COVID19. Her management included intubation and mechanical ventilation, CVC and treatment with Hydroxychloroquine and azithromycin, and echocardiography findings were unremarkable. On the 10th day of onset, the patient developed septic shock and both echocardiography and blood cultures were in favor of A positive diagnosis of tricuspid valve infective endocarditis, accordingly to the modified Duke criteria. Specific treatment was started with a good clinical evolution. Our case outlines the difficulty of management of bacterial co-infections and superinfections in COVID-19 ICU patients, and particularly rare infections such as right-heart IE, which usually require a multidisciplinary approach and coordination between intensivits, cardiologists and infectiologists.