Janus Scott E, Hajjari Jamal, Cunningham Michael J, Hoit Brian D
Harrington Heart and Vascular Institute, University Hospital Cleveland Medical Center, Cleveland OH, USA.
Department of Medicine, Case Western Reserve University, Cleveland, OH, USA.
Eur Heart J Case Rep. 2020 Jun 17;4(FI1):1-4. doi: 10.1093/ehjcr/ytaa189. eCollection 2020 Oct.
The global pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused significant morbidity and mortality, not only through devastating lung injury, but also due to multiple malfunctions in the cardiovascular system. The primary aetiology is believed to be mediated through lung alveolar injury; however, a few published reports have linked SARS-CoV-2 to significant organ dysfunction, venous thrombo-embolism, and coagulopathy. In view of the fact that the utility of tissue plasminogen activator in this population is not well studied, we present this case of rapid improvement in oxygenation after successful lytic therapy for thrombus in transit in this patient with SARS-CoV-2.
We discuss a patient admitted with SARS-CoV-2 pneumonia. Due to the development of dramatic hypoxia, he underwent echocardiography which demonstrated extensive thrombus in transit. He received successful thrombolytic therapy with tissue plasminogen activator, with subsequent improvement in oxygenation. The patient was successfully discharged home on 2 L of oxygen via nasal cannula, and continues to improve at follow-up with his cardiologist and primary care physician.
This case not only highlights embolic causes of hypoxia in SARS-CoV-2, but demonstrates the important utility of an echocardiogram and tissue plasminogen activator in this population.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的全球大流行已导致显著的发病率和死亡率，不仅是因为造成严重的肺损伤，还由于心血管系统的多种功能障碍。其主要病因被认为是通过肺泡损伤介导的；然而，一些已发表的报告将SARS-CoV-2与显著的器官功能障碍、静脉血栓栓塞和凝血病联系起来。鉴于组织纤溶酶原激活剂在这一人群中的效用尚未得到充分研究，我们在此呈现这例成功进行溶栓治疗后，SARS-CoV-2患者肺循环血栓溶解，氧合迅速改善的病例。
我们讨论了一名因SARS-CoV-2肺炎入院的患者。由于出现严重缺氧，他接受了超声心动图检查，结果显示有广泛的肺循环血栓。他接受了组织纤溶酶原激活剂的成功溶栓治疗，随后氧合得到改善。患者通过鼻导管吸氧2升成功出院回家，并在随访中继续接受心脏病专家和初级保健医生的治疗，情况持续改善。
本病例不仅突出了SARS-CoV-2患者缺氧的栓塞原因，还证明了超声心动图和组织纤溶酶原激活剂在这一人群中的重要作用。
