Systemic thrombolysis and anticoagulation improved biomarker measurements in massive-like pulmonary embolism and severe COVID-19 pneumonia: a case report
| Autor: | Yoezer Z Flores-Sayavedra, Mauricio Castillo-Perez, Francisco Moreno-Abril Hoyos, Carlos Jerjes-Sánchez, Hector Guillermo Betancourt Del Campo, Hector Lopez de la Garza, Marcos Ibarra-Flores, José Gildardo Paredes-Vázquez |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment 030204 cardiovascular system & hematology Asymptomatic 03 medical and health sciences 0302 clinical medicine Internal medicine Case report medicine Pulmonary angiography Grand Round AcademicSubjects/MED00200 030212 general & internal medicine Thrombus Mechanical ventilation SARS-CoV-2 business.industry Cardiogenic shock Pulmonary embolism COVID-19 medicine.disease Thrombolysis Pulmonary hypertension Pneumonia Cardiology Other medicine.symptom business Cardiology and Cardiovascular Medicine |
| Zdroj: | European Heart Journal-Case Reports European Heart Journal: Case Reports |
| ISSN: | 2514-2119 |
| DOI: | 10.1093/ehjcr/ytaa448 |
| Popis: | Background From asymptomatic patients to severe acute respiratory distress syndrome, COVID-19 has a wide range of clinical presentations, and venous thromboembolism has emerged as a critical and frequent complication. Case summary We present a case of a 69-year-old man with a clinical presentation of massive-like pulmonary embolism (PE) overlapping with severe COVID-19 pneumonia. The diagnosis was made based on hypotension, severe oxygen desaturation (33%), and right ventricular dysfunction (RVD). We used alteplase and low-molecular-weight heparin, obtaining immediate clinical improvement. Also, we identified an extremely elevated D-dimer (31.2 mcg/mL), and computed tomography pulmonary angiography (CTPA) revealed an unexpected low thrombus burden and a crazy-paving pattern. Considering this, we decided to discontinue the alteplase. Therefore, the mechanisms of pulmonary hypertension and RVD could be multifactorial. Despite the patient’s respiratory status worsening and ongoing mechanical ventilation, biomarkers kept lowering to normal ranges. It appears a favourable outcome was related to early PE diagnosis and a multimodal therapeutic approach. Discussion Physicians in the ER should be warned about extremely high D-dimer measurements and severe oxygen desaturation as possible markers of severe COVID-19 pneumonia in patients with high-clinical suspicion of PE. Although ESC guidelines recommend immediate reperfusion in cardiogenic shock secondary to PE, we suggest initial CTPA in patients with high-clinical suspicion of severe COVID-19. |
| Databáze: | OpenAIRE |
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