Cardiac sequelae of novel coronavirus disease 2019 (COVID-19): a clinical case series
Cardiac sequelae of novel coronavirus disease 2019 (COVID-19): a clinical case series
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DOI：
10.1093/ehjcr/ytaa179
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发表时间：
2020-10-01
影响因子：
1
通讯作者：
Suleyman, Geehan
中科院分区：
文献类型：
--
作者：
Demertzis, Zachary D.;Dagher, Carina;Suleyman, Geehan
背景由严重急性呼吸综合征冠状病毒2引起的COVID-19最常见的表现是发热和呼吸道疾病。心血管表现已变得更加普遍，但可能无法识别。我们使用心肌酶、心电图和超声心动图来描述三名COVID-19患者的心脏表现。病例摘要第一名患者是一名67岁的白人女性，患有非缺血性扩张型心肌病，在COVID-19检测阳性后1周出现劳力性呼吸困难和端坐呼吸。超声心动图显示大量心包积液，结果与心包填塞一致。放置心包引流管，液体检查与病毒性心包炎一致，用秋水仙碱、羟氯喹和甲基强的松龙治疗。随访超声心动图显示心尖运动功能减退，后来消退，符合Takotsubo综合征。第二名患者是一名46岁的非洲裔美国男性，患有肥胖症和2型糖尿病，因COVID-19出现发热、咳嗽和呼吸困难。临床病程并发无脉性电活动停止;发现患者D-二聚体和肌钙蛋白升高，ECG显示下壁ST段抬高，与微栓子引起的STEMI有关。病人死于疾病。第三名患者是一名76岁的非洲裔美国女性，患有高血压，出现腹泻、发热和肌痛，并被发现为COVID-19阳性。临床过程复杂，急性肌钙蛋白升高，心脏指数下降，基底壁严重运动功能减退提示反向Takotsubo综合征。旋前和非STEMI治疗后，心脏指数有所改善;然而，患者因呼吸状态恶化而死亡。讨论这些病例报告表明了COVID-19的心血管表现，需要监测和紧急干预。
Background COVID-19 caused by severe acute respiratory syndrome coronavirus 2 most commonly manifests with fever and respiratory illness. The cardiovascular manifestations have become more prevalent but can potentially go unrecognized. We look to describe cardiac manifestations in three patients with COVID-19 using cardiac enzymes, electrocardiograms, and echocardiography.Case summaries The first patient, a 67-year-old Caucasian female with non-ischaemic dilated cardiomyopathy, presented with dyspnoea on exertion and orthopnoea 1 week after testing positive for COVID-19. Echocardiogram revealed large pericardial effusion with findings consistent with tamponade. A pericardial drain was placed, and fluid studies were consistent with viral pericarditis, treated with colchicine, hydroxychloroquine, and methylprednisolone. Follow-up echocardiograms showed apical hypokinesis, that later resolved, consistent with Takotsubo syndrome. The second patient, a 46-year-old African American male with obesity and type 2 diabetes mellitus presented with fevers, cough, and dyspnoea due to COVID-19. Clinical course was complicated with pulseless electrical activity arrest; he was found to have D-dimer and troponin elevation, and inferior wall ST elevation on ECG concerning for STEMI due to microemboli. The patient succumbed to the illness. The third patient, a 76-year-old African American female with hypertension, presented with diarrhoea, fever, and myalgia, and was found to be COVID-19 positive. Clinical course was complicated, with acute troponin elevation, decreased cardiac index, and severe hypokinesis of the basilar wall suggestive of reverse Takotsubo syndrome. The cardiac index improved after pronation and non-STEMI therapy; however, the patient expired due to worsening respiratory status.Discussion These case reports demonstrate cardiovascular manifestations of COVID-19 that required monitoring and urgent intervention.