Vedovati Maria Cristina, Giustozzi Michela, Conti Serenella, Becattini Cecilia
Department of Medicine, Vascular and Emergency Medicine - Stroke Unit, University of Perugia, Perugia, Italy.
Department of Cardiology, San Matteo Degli Infermi Hospital, Spoleto, Italy.
J Cardiovasc Echogr. 2020 Oct-Dec;30(4):223-226. doi: 10.4103/jcecho.jcecho_71_20. Epub 2021 Jan 20.
The infection by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with significant cardiovascular morbidity and mortality. Cardiac events require prompt diagnosis and management, also in the SARS-CoV-2 era. A 58-year-old male, heavy smoker and with known SARS-CoV-2 infection, abruptly developed severe hypotension and asthenia. At patients' home, emergency physicians found hemodynamic compromise with diffuse ST-elevation at electrocardiography. The patient was rapidly moved to the cardiac catheterization laboratory, and any contact with other health-care workers was avoided. Coronary angiography excluded coronary artery disease. At admission to the coronavirus disease-2019 unit, an increase in inflammatory markers and liver enzymes with normal troponin levels were observed. Bedside lung ultrasonography showed interstitial syndrome and bilateral pleural effusion, whereas echocardiography showed large and diffuse pericardial effusion with a swinging heart. The hemodynamic status improved after gentle fluid therapy such suggesting potential concomitant sepsis and pericardiocentesis was not performed. At this time, a computed tomography scan showed a widespread neoplasm in the right lung involving the subclavian artery and vein and the thoracic lymph nodes. The histology confirmed the diagnosis of a locally advanced pulmonary adenocarcinoma. One week after admission, the patient died for worsening respiratory failure. Not delayed primary PCI remains the standard of care for patients with suspected ST-elevation myocardial infarction (STEMI) in the SARS-CoV-2 era. A diagnostic deepening for potential STEMI-mimicker (known to be associated with SARS-CoV-2 infection and to patients' comorbidities) should be considered, and a multidisciplinary approach is needed in these patients.
新型冠状病毒严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染与显著的心血管发病率和死亡率相关。在SARS-CoV-2时代，心脏事件也需要及时诊断和处理。一名58岁男性，重度吸烟者，已知感染SARS-CoV-2，突然出现严重低血压和乏力。在患者家中，急诊医生发现血流动力学不稳定，心电图显示广泛ST段抬高。患者迅速被送往心导管实验室，并避免与其他医护人员接触。冠状动脉造影排除了冠状动脉疾病。在收治入2019冠状病毒病病房时，观察到炎症标志物和肝酶升高，肌钙蛋白水平正常。床旁肺部超声显示间质综合征和双侧胸腔积液，而超声心动图显示大量弥漫性心包积液伴心脏摆动。轻柔的液体治疗后血流动力学状态改善，提示可能合并脓毒症，未进行心包穿刺。此时，计算机断层扫描显示右肺广泛肿瘤，累及锁骨下动静脉和胸部淋巴结。组织学检查确诊为局部晚期肺腺癌。入院一周后，患者因呼吸衰竭加重死亡。在SARS-CoV-2时代，对于疑似ST段抬高型心肌梗死（STEMI）患者，不延迟的直接经皮冠状动脉介入治疗（PCI）仍然是治疗的标准。应考虑对可能模仿STEMI（已知与SARS-CoV-2感染和患者合并症相关）进行深入诊断，并且这些患者需要多学科方法。
