Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia.
Institute for Emergency Medical Services Novi Sad, 21000 Novi Sad, Serbia.
Medicina (Kaunas). 2023 Dec 25;60(1):39. doi: 10.3390/medicina60010039.
The relationship between coronavirus disease 2019 (COVID-19) and myocardial injury was established at the onset of the COVID-19 pandemic. An increase in the incidence of out-of-hospital cardiac arrest was also observed. This case report aims to point to the prothrombotic and proinflammatory nature of coronavirus infection, leading to simultaneous coronary vessel thrombosis and subsequently to out-of-hospital cardiac arrest. During the COVID-19 pandemic, a 46-year-old male patient with no comorbidities suffered out-of-hospital cardiac arrest (OHCA) with ventricular fibrillation as the first recorded rhythm. The applied cardiopulmonary resuscitation (CPR) measures initiated by bystanders and continued by emergency medical service (EMS) resulted in the return of spontaneous circulation. The stabilized patient was transferred to the tertiary university center. Electrocardiogram (ECG) revealed "lambda-like" ST-segment elevation in DI and aVL leads, necessitating an immediate coronary angiography, which demonstrated simultaneous occlusion of the left anterior descending (LAD) and right coronary artery (RCA). Primary percutaneous coronary intervention (PCI) with the implantation of one drug-eluting stent (DES) in LAD and two DES in RCA was done. Due to the presence of cardiogenic shock (SCAI C), an intra-aortic balloon pump (IABP) was implanted during the procedure, and due to the comatose state and shockable cardiac arrest, targeted temperature management was initiated. The baseline chest X-ray revealed bilateral interstitial infiltrates, followed by increased proinflammatory markers and a positive polymerase chain reaction (PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) demasking underlying COVID-19-related pneumonia. Within the following 48 h, the patient was hemodynamically stable, which enabled weaning from IABP and vasopressor discontinuation. However, due to the worsening of COVID-19 pneumonia, prolonged mechanical ventilation, together with antibiotics and other supportive measures, was needed. The applied therapy resulted in clinical improvement, and the patient was extubated and finally discharged on Day 26, with no neurological sequelae and with mildly reduced left ventricle ejection fraction.
新型冠状病毒病 2019（COVID-19）与心肌损伤的关系在 COVID-19 大流行开始时就已确立。也观察到院外心脏骤停的发生率增加。本病例报告旨在指出冠状病毒感染的促血栓形成和促炎特性，导致冠状动脉血管同时血栓形成，随后发生院外心脏骤停。在 COVID-19 大流行期间，一名无合并症的 46 岁男性患者发生院外心脏骤停（OHCA），最初记录的节律为室颤。由旁观者启动并由紧急医疗服务（EMS）继续进行的心肺复苏（CPR）措施导致自主循环恢复。稳定的患者被转至三级大学中心。心电图（ECG）显示 DI 和 aVL 导联呈“lambda 样”ST 段抬高，需要立即进行冠状动脉造影，结果显示左前降支（LAD）和右冠状动脉（RCA）同时闭塞。立即进行经皮冠状动脉介入治疗（PCI），在 LAD 中植入 1 个药物洗脱支架（DES），在 RCA 中植入 2 个 DES。由于存在心源性休克（SCAI C），在手术过程中植入主动脉内球囊泵（IABP），由于昏迷状态和可电击性心脏骤停，启动了目标温度管理。基线胸部 X 线显示双侧间质性浸润，随后炎症标志物升高，严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）聚合酶链反应（PCR）检测呈阳性，提示潜在的 COVID-19 相关肺炎。在接下来的 48 小时内，患者血流动力学稳定，能够撤机并停用升压药。然而，由于 COVID-19 肺炎恶化，需要长时间机械通气以及抗生素和其他支持措施。应用的治疗方法导致临床改善，患者于第 26 天拔管并最终出院，无神经后遗症，左心室射血分数略降低。
