Demertzis Zachary D, Dagher Carina, Malette Kelly M, Fadel Raef A, Bradley Patrick B, Brar Indira, Rabbani Bobak T, Suleyman Geehan
Department of Internal Medicine, Henry Ford Hospital, Detroit, MI, USA.
Division of Pulmonary Disease, Henry Ford Hospital, Detroit, MI, USA.
Eur Heart J Case Rep. 2020 Jun 13;4(FI1):1-6. doi: 10.1093/ehjcr/ytaa179. eCollection 2020 Oct.
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.
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.
These case reports demonstrate cardiovascular manifestations of COVID-19 that required monitoring and urgent intervention.
由严重急性呼吸综合征冠状病毒2引起的2019冠状病毒病（COVID-19）最常见的表现为发热和呼吸道疾病。心血管表现变得更加普遍，但可能未被识别。我们希望通过心脏酶、心电图和超声心动图来描述3例COVID-19患者的心脏表现。
首例患者是一名67岁患有非缺血性扩张型心肌病的白人女性，在COVID-19检测呈阳性1周后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，结果符合心包填塞。放置了心包引流管，液体检查结果符合病毒性心包炎，采用秋水仙碱、羟氯喹和甲泼尼龙进行治疗。后续超声心动图显示心尖运动减弱，随后缓解，符合应激性心肌病。第二例患者是一名46岁患有肥胖症和2型糖尿病的非裔美国男性，因COVID-19出现发热、咳嗽和呼吸困难。临床过程因无脉电活动心脏骤停而复杂化；发现其D-二聚体和肌钙蛋白升高，心电图显示下壁ST段抬高，因微栓子引起，怀疑为ST段抬高型心肌梗死（STEMI）。该患者因病死亡。第三例患者是一名76岁患有高血压的非裔美国女性，出现腹泻、发热和肌痛，COVID-19检测呈阳性。临床过程复杂，急性肌钙蛋白升高，心脏指数降低，基底壁严重运动减弱，提示为反向应激性心肌病。俯卧位和非ST段抬高型心肌梗死（NSTEMI）治疗后心脏指数有所改善；然而，患者因呼吸状况恶化而死亡。
这些病例报告展示了COVID-19需要监测和紧急干预的心血管表现。
