A Severe COVID-19 Case Complicated by Right Atrium Thrombus
Autor: | Irene Karampela, Olympia Apostolopoulou, Dimitrios Konstantonis, Stavroula Patsilinakou, Georgia Konstantopoulou, Apostolos Armaganidis, George Dimopoulos, Anastasia Anthi, Maria Theodorakopoulou |
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Rok vydání: | 2020 |
Předmět: |
Male
medicine.medical_treatment 030204 cardiovascular system & hematology Severe Acute Respiratory Syndrome Severity of Illness Index law.invention 0302 clinical medicine law Greece medicine.diagnostic_test Articles General Medicine Combined Modality Therapy Thrombosis Intensive care unit Intensive Care Units Treatment Outcome Echocardiography 030220 oncology & carcinogenesis Disease Progression Cardiology Coronavirus Infections Emergency Service Hospital medicine.medical_specialty Critical Care Fever Heart Diseases Pneumonia Viral Transesophageal echocardiogram 03 medical and health sciences Internal medicine medicine Humans Heart Atria Platelet activation Thrombus Pandemics Aged Mechanical ventilation Past medical history business.industry Anticoagulants COVID-19 Length of Stay medicine.disease Cough Transthoracic echocardiogram business Echocardiography Transesophageal Follow-Up Studies |
Zdroj: | The American Journal of Case Reports |
ISSN: | 1941-5923 |
Popis: | Patient: Male, 73-year-old Final Diagnosis: Severe COVID-19 pneumonia complicated by right atrium thrombus Symptoms: Fever • dyspnea • cough Medication:— Clinical Procedure: — Specialty: Critical Care Medicine Objective: Educational purpose Background: Recent studies demonstrated evidence of coagulation dysfunction in hospitalized patients with severe coronavirus disease 2019 (COVID-19) due to excessive inflammation, hypoxia, platelet activation, endothelial dysfunction, and stasis. Effective anticoagulation therapy may play a dominant role in the management of severe COVID-19 cases. Case Report: A 73-year-old man with a 6-day history of fever up to 38.5°C, dyspnea, cough, and fatigue was diagnosed with COVID-19. He had a past medical history significant for hypertension and coronary artery bypass grafting. Two days after hospital admission, the patient developed acute respiratory failure, requiring intubation, mechanical ventilation, and transfer to the intensive care unit (ICU). He received treatment including antibiotics, hydroxychloroquine, tocilizumab, vasopressors, prone positioning, and anticoagulation with enoxaparin at a prophylactic dose. After a 15-day ICU stay, the patient was hemodynamically stable but still hypoxemic; a transthoracic echocardiogram at that time, followed by a transesophageal echocardiogram for better evaluation, revealed the presence of a right atrium thrombus without signs of acute right ventricular dilatation and impaired systolic function. Since the patient was hemodynamically stable, we decided to treat him with conventional anticoagulation under close monitoring for signs of hemodynamic deterioration; thus, the prophylactic dose of enoxaparin was replaced by therapeutic dosing, which was a key component of the patient’s successful outcome. Over the next few days he showed significant clinical improvement. The follow-up transesophageal echo-cardiogram 3 weeks after effective therapeutic anticoagulation revealed no signs of right heart thrombus. Conclusions: The presented COVID-19 case, one of the first reported cases with evidence of right heart thrombus by transesophageal echocardiography, highlights the central role of diagnostic imaging strategies and the importance of adequate anticoagulation therapy in the management of severe COVID-19 cases in the ICU. |
Databáze: | OpenAIRE |
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