Department of Emergency Medicine, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo Ward, Kyoto City, Japan.
Department of Intensive Care, Kyoto Prefectural University of Medicine, 465 Kajiicho, Kamigyo Ward, Kyoto City, Japan.
J Infect Chemother. 2021 Feb;27(2):364-368. doi: 10.1016/j.jiac.2020.09.023. Epub 2020 Oct 6.
Coronavirus disease (COVID-19) can lead to severe disease or death and is characterized by a wide range of mild to severe symptoms. In addition to the lungs, studies have reported the involvement of the stomach, intestine, and angiotensin-converting enzyme 2 receptors in the heart.
We present a case of a patient with COVID-19 who died soon after developing multi-organ failure and myocardial injury due to COVID-19-associated pneumonia. A 71-year-old man who contracted COVID-19 was admitted to the hospital after presenting with fever for 7 days and developed dyspnea. Following treatment, his respiratory status worsened. Thus, he was transferred to our hospital for intensive care on day 11. Physical examination revealed fever, dyspnea, respiratory distress, and no chest pain. Invasive positive pressure ventilation was initiated for acute respiratory distress syndrome on day 14. On day 15, we observed renal, liver, and coagulation dysfunction, indicating multi-organ failure. Chest radiography did not show clear signs of an increased cardiothoracic ratio or pulmonary congestion. An electrocardiogram (ECG) showed signs of myocardial infarction, which was confirmed by elevated troponin I and creatine kinase levels. The patient's circulatory dynamics did not improve on medication, and he died on day 16.
We report the case of a patient with severe COVID-19 who died from an exacerbation of myocardial injury. Clinicians should not only evaluate respiration but also assess the heart by performing a 12-lead ECG, echocardiogram, and myocardial injury marker examination. Together, these tools can help predict which patients will develop severe COVID-19.
冠状病毒病（COVID-19）可导致严重疾病或死亡，其特征是一系列从轻度到重度的症状。除了肺部，研究还报告了胃、肠和血管紧张素转换酶 2 受体在心脏中的参与。
我们报告了一例 COVID-19 患者的病例，该患者因 COVID-19 相关肺炎导致多器官衰竭和心肌损伤，很快死亡。一名 71 岁的男性因感染 COVID-19 出现发热 7 天，并出现呼吸困难而入院。治疗后，他的呼吸状况恶化。因此，他在第 11 天转入我们医院进行重症监护。体格检查显示发热、呼吸困难、呼吸窘迫，无胸痛。第 14 天开始因急性呼吸窘迫综合征进行有创正压通气。第 15 天，我们观察到肾、肝和凝血功能障碍，表明多器官衰竭。胸部 X 线检查未显示心胸比增加或肺充血的明确迹象。心电图（ECG）显示心肌梗死迹象，肌钙蛋白 I 和肌酸激酶水平升高证实了这一点。患者的循环动力学在药物治疗后没有改善，他于第 16 天死亡。
我们报告了一例严重 COVID-19 患者的病例，该患者因心肌损伤恶化而死亡。临床医生不仅要评估呼吸，还要通过进行 12 导联心电图、超声心动图和心肌损伤标志物检查来评估心脏。这些工具可以帮助预测哪些患者会发展为严重的 COVID-19。
