Colombier Sébastien, Mahendiran Thabodhan, Niclauss Lars, Kirsch Matthias
Department of Cardiovascular Surgery, Lausanne University Hospital CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
Department of Cardiology, Lausanne University Hospital CHUV, Rue du Bugnon 46, 1011 Lausanne, Switzerland.
Eur Heart J Case Rep. 2020 Dec 12;5(1):ytaa475. doi: 10.1093/ehjcr/ytaa475. eCollection 2021 Jan.
The new β-coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) appears to exhibit cardiovascular pathogenicity through use of angiotensin-converting enzyme 2 (ACE2) for cell entry and the development of a major systemic inflammation. Furthermore, cardiovascular comorbidities increase susceptibility to SARS-CoV-2 infection and the development of a severe form of COronaVIrus Disease 2019 (COVID-19).
We describe the case of a COVID-19 patient whose inaugural presentation was a refractory cardiac arrest secondary to the destabilization of known, non-significant coronary artery disease. Patient was supported by venoarterial extracorporeal life support. After 12 h of support, cardiac function remained stable on low vasopressor support but the patient remained in a coma and brainstem death was diagnosed.
Myocardial injury is frequently seen among critically unwell COVID-19 patients and increases the risk of mortality. This case illustrates several potential mechanisms that are thought to drive the cardiac complications seen in COVID-19. We present the potential role of inflammation and ACE2 in the pathophysiology of COVID-19.
新型β冠状病毒严重急性呼吸综合征冠状病毒2（SARS-CoV-2）似乎通过利用血管紧张素转换酶2（ACE2）进入细胞并引发严重的全身炎症而表现出心血管致病性。此外，心血管合并症会增加对SARS-CoV-2感染的易感性以及发展为重症2019冠状病毒病（COVID-19）的风险。
我们描述了一例COVID-19患者，其首次表现为已知的非严重冠状动脉疾病失稳继发的难治性心脏骤停。患者接受了静脉-动脉体外生命支持。支持12小时后，在低剂量血管升压药支持下心脏功能保持稳定，但患者仍处于昏迷状态，被诊断为脑死亡。
在病情严重的COVID-19患者中经常可见心肌损伤，这会增加死亡风险。本病例说明了几种被认为导致COVID-19中心脏并发症的潜在机制。我们阐述了炎症和ACE2在COVID-19病理生理学中的潜在作用。
