Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)
Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)
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DOI：
10.1001/jamacardio.2020.1096
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发表时间：
2020-07-01
期刊：
影响因子：
24
通讯作者：
Metra, Marco
中科院分区：
文献类型：
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作者：
Inciardi, Riccardo M.;Lupi, Laura;Metra, Marco
问：与2019年新爆发的冠状病毒病相关的心脏并发症有哪些(新冠肺炎)？在此病例报告中，一名原本健康的53岁患者在发热和新冠肺炎干咳发作一周后出现急性肌包炎，心脏磁共振成像证实有收缩功能障碍。患者接受了肌力支持、抗病毒药物、皮质类固醇和氯喹的治疗，临床病程逐渐稳定。这意味着新出现的新冠肺炎的爆发可能与心脏受累有关，即使在上呼吸道感染缓解后也是如此。这份病例报告描述了一名2019年冠状病毒病(新冠肺炎)患者的急性心肌炎表现，他从类似流感的综合征中康复，在上呼吸道症状出现一周后出现疲劳和心力衰竭的体征和症状。重要病毒感染已被广泛描述为心肌炎的最常见原因之一。然而，心脏损害作为严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染的并发症却知之甚少。目的描述1例冠状病毒病2019(新冠肺炎)患者的急性心肌炎表现，该患者从流感样综合征中康复，并在上呼吸道症状出现一周后出现疲劳和心力衰竭的体征和症状。设计、地点和参与者本病例报告描述了一名原本健康的53岁女性，她的新冠肺炎检测呈阳性，于2020年3月因急性心包炎伴收缩功能障碍而住进心脏监护病房，心脏磁共振成像证实，即新冠肺炎引起发烧和干咳后一周。患者在临床过程中没有表现出任何呼吸系统损害。暴露心脏介入新冠肺炎。主要结果和指标检测心脏受累，N末端脑利钠肽原(NT-proBNP)和高敏肌钙蛋白T水平升高，超声心动图改变，心脏磁共振成像弥漫性双室心肌水肿和晚期Gd强化。结果一名健康的53岁白人女性因严重疲劳来到急诊科就诊。她描述了前一周的发烧和干咳。她发热但低血压；心电图显示弥漫性ST段抬高，并检测到高敏感性肌钙蛋白T和NT-proBNP水平升高。胸部X光检查结果正常。冠状动脉造影术未发现梗阻性冠状动脉疾病的证据。针对新冠肺炎暴发疫情，进行了鼻咽拭子检测，实时定量逆转录聚合酶链式反应检测结果为SARS-CoV-2阳性。心脏磁共振成像显示室壁厚度增加，弥漫性双室运动减退，尤其是心尖段，以及严重的左心室功能不全(左心室射血分数为35%)。短tau反转恢复序列和T2标测序列显示明显的双室心肌间质水肿，也有弥漫性的晚期Gd强化累及整个双室壁。右心腔周围有明显的周围性心包积液。这些发现都与急性心包炎相一致。她接受了多巴酚丁胺、抗病毒药物(洛比那韦/利托那韦)、类固醇、氯喹和心力衰竭的内科治疗，取得了逐步的临床和工具稳定。结论和相关性：此病例强调心脏受累是新冠肺炎相关的并发症，即使没有间质性肺炎的症状和体征。
Question What are the cardiac complications associated with the emerging outbreak of coronavirus disease 2019 (COVID-19)? Findings In this case report, an otherwise healthy 53-year-old patient developed acute myopericarditis with systolic dysfunction confirmed on cardiac magnetic resonance imaging a week after onset of fever and dry cough due to COVID-19. The patient was treated with inotropic support, antiviral drugs, corticosteroids, and chloroquine, with progressive stabilization of the clinical course. Meaning The emerging outbreak of COVID-19 can be associated with cardiac involvement, even after the resolution of the upper respiratory tract infection.This case report describes the presentation of acute myocardial inflammation in a patient with coronavirus disease 2019 (COVID-19) who recovered from influenzalike syndrome and developed fatigue and signs and symptoms of heart failure a week after upper respiratory tract symptoms.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.