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
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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