Severe acute respiratory syndrome coronavirus-2- or pregnancy-related cardiomyopathy, a differential to be considered in the current pandemic: a case report

Abstract Background There are limited data on cardiovascular complications of coronavirus disease 2019 in pregnancy, and there are only a few case reports on coronavirus disease 2019 related cardiomyopathy in pregnancy. Differentiation between postpartum cardiomyopathy and coronavirus disease 2019 related cardiomyopathy in pregnant women who develop severe acute respiratory syndrome coronavirus-2 infection during peripartum could be challenging. Here, we present a case of possible coronavirus disease 2019 related cardiomyopathy in a pregnant patient, followed by a discussion of potential differential diagnosis. Case presentation In this case report, we present the case of a young pregnant Iranian woman who developed heart failure with pulmonary edema after cesarean section. She was treated because of low left ventricular ejection fraction and impression of postpartum cardiomyopathy, and her severe dyspnea improved by intravenous furosemide. On day 3, she exhibited no orthopnea or leg edema, but she was complaining of severe and dry cough. Further evaluation showed severe acute respiratory syndrome coronavirus-2 infection. Conclusions The possibility of severe acute respiratory syndrome coronavirus-2 infection should be considered in any pregnant woman who develops cardiomyopathy and pulmonary edema.

Download Full-text

Alveolar epithelial fluid transport and the resolution of clinically severe hydrostatic pulmonary edema

Journal of Applied Physiology ◽

10.1152/jappl.1999.87.4.1301 ◽

1999 ◽

Vol 87 (4) ◽

pp. 1301-1312 ◽

Cited By ~ 125

Author(s):

G. M. Verghese ◽

L. B. Ware ◽

B. A. Matthay ◽

M. A. Matthay

Keyword(s):

Pulmonary Edema ◽

Fluid Transport ◽

Simplified Acute Physiology Score ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Alveolar Fluid Clearance ◽

Ventricular Ejection Fraction ◽

Mechanically Ventilated ◽

Alveolar Epithelial ◽

Edema Fluid

To characterize the rate and regulation of alveolar fluid clearance in the uninjured human lung, pulmonary edema fluid and plasma were sampled within the first 4 h after tracheal intubation in 65 mechanically ventilated patients with severe hydrostatic pulmonary edema. Alveolar fluid clearance was calculated from the change in pulmonary edema fluid protein concentration over time. Overall, 75% of patients had intact alveolar fluid clearance (≥3%/h). Maximal alveolar fluid clearance (≥14%/h) was present in 38% of patients, with a mean rate of 25 ± 12%/h. Hemodynamic factors (including pulmonary arterial wedge pressure and left ventricular ejection fraction) and plasma epinephrine levels did not correlate with impaired or intact alveolar fluid clearance. Impaired alveolar fluid clearance was associated with a lower arterial pH and a higher Simplified Acute Physiology Score II. These factors may be markers of systemic hypoperfusion, which has been reported to impair alveolar fluid clearance by oxidant-mediated mechanisms. Finally, intact alveolar fluid clearance was associated with a greater improvement in oxygenation at 24 h along with a trend toward shorter duration of mechanical ventilation and an 18% lower hospital mortality. In summary, alveolar fluid clearance in humans may be rapid in the absence of alveolar epithelial injury. Catecholamine-independent factors are important in the regulation of alveolar fluid clearance in patients with severe hydrostatic pulmonary edema.

Download Full-text

Abstract 145: Use of Bromocriptine in the Management of Peripartum Cardiomyopathy: A Systematic Review

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.10.suppl_3.145 ◽

2017 ◽

Vol 10 (suppl_3) ◽

Author(s):

Garly Rushler Saint Croix ◽

Michel Ibrahim ◽

Sandra Chaparro

Keyword(s):

Clinical Outcomes ◽

Case Reports ◽

Thrombotic Event ◽

Case Control ◽

Left Ventricular ◽

Peripartum Cardiomyopathy ◽

The Other ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Multicenter Rct

Background: Prolactin metabolites have been shown to possibly be cardio-toxic in humans and play a role in the pathogenesis of Peripartum Cardiomyopathy (PPCM). Some studies have demonstrated medical treatment with bromocriptine, a dopamine agonist able to inhibit prolactin, associated with standard therapy to be beneficial not only in managing symptomatology but also in the reversal of disease process. The present study was performed to systematically review the PPCM literature and determine the therapeutic effect of bromocriptine on left ventricular function and clinical outcomes. Methods: We performed a literature review to identify randomized, nonrandomized clinical studies, case series and case reports that reported the use of bromocriptine in the management of PPCM. A total of 9 databases including MEDLINE, Embase, Cochrane, DARE and Scopus containing articles from January 1, 1945 to July 31, 2016 were analyzed. Results: We were able to identify and screen 410 potentially eligible publications through the databases. Based on our exclusion criterias, 8 studies were selected: one randomized control trial (RCT), two case control studies and five case reports. We found that Bromocriptine improved left ventricular ejection fraction (LVEF) and clinical outcomes in women with acute severe PPCM and no thrombotic event was reported. The RCT (n = 20) showed an improvement of composite end point of death, NYHA Class III/IV and LVEF < 35% (35 of 100) at 6 months. LVEF went from 27% (27 of 100) to 58% (58 of 100) in the group taking bromocriptine vs 36% (36 of 100) in the other group . One of the case controls (n = 51) showed LVEF improvement of 85% (43 of 51) and full recovery in 47% (24 of 51) after 6 months +/- 3 of treatment. The other case control study (n = 115) failed to suggest a beneficial effect of bromocriptine. However, all the five case reports (n = 7) showed LV improvement. Conclusion: Peripartum Cardiomyopathy is a rare but serious condition that affects childbearing women. Targeted therapies like bromocriptine have shown promising results but a large multicenter RCT is needed to evaluate furthermore the benefits and harms of bromocriptine before it can be adopted in routine clinical use.

Download Full-text

Takotsubo Syndrome in Patients with COVID-19: a Systematic Review of Published Cases

SN Comprehensive Clinical Medicine ◽

10.1007/s42399-020-00557-w ◽

2020 ◽

Vol 2 (11) ◽

pp. 2102-2108 ◽

Cited By ~ 2

Author(s):

Sandeep Singh ◽

Rupak Desai ◽

Zainab Gandhi ◽

Hee Kong Fong ◽

Shriya Doreswamy ◽

...

Keyword(s):

Case Reports ◽

Hypertensive Crisis ◽

Apical Ballooning ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Cardiac Complications ◽

Time Interval ◽

Takotsubo Syndrome ◽

Ventricular Ejection Fraction ◽

Successful Recovery

AbstractTakotsubo syndrome (TTS) is caused by catecholamine surge, which is also observed in COVID-19 disease due to the cytokine storm. We performed a systematic literature search using PubMed/Medline, SCOPUS, Web of Science, and Google Scholar databases to identify COVID-19-associated TTS case reports and evaluated patient-level demographics, clinical attributes, and outcomes. There are 12 cases reported of TTS associated with COVID-19 infection with mean age of 70.8 ± 15.2 years (range 43–87 years) with elderly (66.6% > 60 years) female (66.6%) majority. The time interval from the first symptom to TTS was 8.3 ± 3.6 days (range 3–14 days). Out of 12 cases, 7 reported apical ballooning, 4 reported basal segment hypo/akinesia, and 1 reported median TTS. Out of 12 cases, during hospitalization, data on left ventricular ejection fraction (LVEF) was reported in only 9 of the cases. The mean LVEF was 40.6 ± 9.9% (male, 46.7 ± 5.7%, and female, 37.7 ± 10.6%). Troponin was measured in all 12 cases and was elevated in 11 (91.6%) without stenosis on coronary angiography except one. Out of 11 cases, 6 developed cardiac complications with 1 case each of cardiac tamponade, heart failure, myocarditis, hypertensive crisis, and cardiogenic shock in 2. Five patients required intubation, 1 patient required continuous positive airway pressure, and 1 patient required venovenous extracorporeal membrane oxygenation. The outcome was reported in terms of recovery in 11 (91.6%) out of 12 cases, and a successful recovery was noted in 10 (90.9%) cases. COVID-19-related TTS has a higher prevalence in older women. Despite a lower prevalence of cardiac comorbidities in COVID-19 patients, direct myocardial injury, inflammation, and stress may contribute to TTS with a high complication rate.

Download Full-text

Paroxysmal supraventricular tachycardia in patient with dilated cardiomyopathy and concomitant cardiac conduction defects: a case report and discussion

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2020-2368 ◽

2020 ◽

Vol 19 (3) ◽

pp. 2368 ◽

Cited By ~ 1

Author(s):

M. D. Utsumueva ◽

N. Yu. Mironov ◽

N. B. Shlevkov ◽

V. G. Kiktev ◽

E. M. Gupalo ◽

...

Keyword(s):

Case Report ◽

Left Ventricular Ejection Fraction ◽

Ejection Fraction ◽

Cardiac Pacing ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Av Block ◽

Bundle Branch Block ◽

Ventricular Ejection Fraction ◽

Conduction Disorders

Patients with dilated cardiomyopathy (DCM) often have intraventricular conduction disorders, which contribute to aggravation of heart failure, are progressive in most cases and can specify the prognosis of the disease. Paroxysmal supraventricular arrhythmias in such patients proceed with severe clinical manifestations, often accompanied by hemodynamic instability and syncope. A case report of patient (59 years old) with DCM, reduced left ventricular ejection fraction (35-37%), left bundle branch block, and paroxysmal orthodromic reciprocating tachycardia is presented. When an electrode was inserted on the right ventricular (RV) apex during the radiofrequency ablation, a third-degree atrioventricular (AV) block was recorded. This was maintained during the operation and was recurrent when trying to remove the electrode from the RV apex, and therefore there was a need for temporary and then permanent cardiac pacing therapy. Given DCM, reduced left ventricular ejection fraction, left bundle branch block, and the expected high percentage of RV pacing, a decision was made to implant a cardiac resynchronization therapy defibrillator. The literature review considers risk factors for formation of third-degree AV block during cardiac catheterization, methods of its prevention, as well as discusses the prognostic significance of catheter-induced conduction disorders, and indications for temporary and permanent cardiac pacing therapy.

Download Full-text

Case Report: Malignant Pheochromocytoma Without Hypertension Accompanied by Increment of Serum VEGF Level and Catecholamine Cardiomyopathy

Frontiers in Endocrinology ◽

10.3389/fendo.2021.688536 ◽

2021 ◽

Vol 12 ◽

Author(s):

Hideaki Kaneto ◽

Shinji Kamei ◽

Fuminori Tatsumi ◽

Masashi Shimoda ◽

Tomohiko Kimura ◽

...

Keyword(s):

Case Report ◽

Adrenal Gland ◽

Tumor Resection ◽

Left Ventricular ◽

Malignant Pheochromocytoma ◽

Left Ventricular Ejection ◽

Normal Range ◽

Ventricular Ejection Fraction ◽

The Right ◽

Vegf Level

IntroductionPheochromocytoma is a catecholamine-producing tumor in the adrenal medulla and is often accompanied by hypertension, hyperglycemia, hypermetabolism, headache, and hyperhidrosis, and it is classified as benign and malignant pheochromocytoma. In addition, persistent hypertension is often observed in subjects with malignant pheochromocytoma.Case PresentationA 52-year-old Japanese male was referred and hospitalized in our institution. He had a health check every year and no abnormalities had been pointed out. In addition, he had no past history of hypertension. In endocrinology markers, noradrenaline level was as high as 7,693 pg/ml, whereas adrenaline level was within normal range. Abdominal contrast-enhanced computed tomography revealed a 50-mm hyper-vascularized tumor with calcification in the right adrenal gland and multiple hyper-vascularized tumors in the liver. In 131I MIBG scintigraphy, there was high accumulation in the right adrenal gland and multiple accumulation in the liver and bone. In echocardiography, left ventricular ejection fraction was as low as 14.3%. In coronary angiography, however, there was no significant stenosis in the coronary arteries. Based on these findings, we finally diagnosed him as malignant pheochromocytoma accompanied by multiple liver and bone metastases and catecholamine cardiomyopathy. However, blood pressure was continuously within normal range without any anti-hypertensive drugs. Right adrenal tumor resection was performed together with left hepatic lobectomy and cholecystectomy. Furthermore, serum levels of vascular endothelial growth factor (VEGF) and parathyroid (PTH)-related protein were very high before the operation but they were markedly reduced after the operation.ConclusionsThis is the first report showing the time course of serum VEGF level in a subject with malignant pheochromocytoma, clearly showing that malignant pheochromocytoma actually secreted VEGF. In addition, this case report clearly shows that we should bear in mind once again that malignant pheochromocytoma is not necessarily accompanied by hypertension.

Download Full-text

Histological evidence for the cardiac safety of high-dose pegylated liposomal doxorubicin in a patient with HIV-associated Kaposi sarcoma: a case report and literature review

BMC Infectious Diseases ◽

10.1186/s12879-019-4500-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 1

Author(s):

Ayaka Ishihara ◽

Shuji Hatakeyama ◽

Jun Suzuki ◽

Yusuke Amano ◽

Teppei Sasahara ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Cumulative Dose ◽

Liposomal Doxorubicin ◽

Cardiac Toxicity ◽

Pegylated Liposomal Doxorubicin ◽

Kaposi Sarcoma ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction

Abstract Background Pegylated liposomal doxorubicin plays an important role in the treatment of patients with severe refractory human immunodeficiency virus (HIV)-associated Kaposi sarcoma (KS). High cumulative doses of conventional doxorubicin exceeding 500 mg/m2 are known to cause cardiac toxicity. However, the safe cumulative dose of pegylated liposomal doxorubicin is unclear. Case presentation A 40-year-old Japanese man with HIV infection presented with pain, edema, and multiple skin nodules on both legs which worsened over several months. He was diagnosed with HIV-associated KS. He received long-term pegylated liposomal doxorubicin combined with antiretroviral therapy for advanced, progressive KS. The cumulative dose of pegylated liposomal doxorubicin reached 980 mg/m2. The patient’s left ventricular ejection fraction remained unchanged from baseline during treatment. After he died as a result of cachexia and wasting, caused by recurrent sepsis and advanced KS, an autopsy specimen of his heart revealed little or no evidence of histological cardiac damage. We also conducted a literature review focusing on histological changes of the myocardium in patients treated with a cumulative dose of pegylated liposomal doxorubicin exceeding 500 mg/m2. Conclusions This case report and literature review suggest that high (> 500 mg/m2) cumulative doses of pegylated liposomal doxorubicin may be used without significant histological/clinical cardiac toxicity in patients with HIV-associated KS.

Download Full-text

Association of Posterior Reversible Encephalopathy Syndrome and Transient Apical Ballooning Syndrome (Takotsubo): First Case Report of a Man and Review of the Literature

Case Reports in Neurology ◽

10.1159/000474933 ◽

2017 ◽

Vol 9 (2) ◽

pp. 173-178 ◽

Cited By ~ 2

Author(s):

Stephan Grimaldi ◽

Emilie Doche ◽

Caroline Rey ◽

Nadia Laksiri ◽

Salah Boussen ◽

...

Keyword(s):

Case Report ◽

Posterior Reversible Encephalopathy Syndrome ◽

Brain Mri ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Apical Ballooning Syndrome ◽

Ventricular Ejection Fraction ◽

Posterior Reversible Encephalopathy ◽

First Case ◽

Reversible Encephalopathy

Introduction: An association of posterior reversible encephalopathy syndrome (PRES) and takotsubo is rare. We present the first case of a male patient. Case Report: A 69-year-old man presented to the hospital in a persistent comatose state following a generalized tonic-clonic seizure with high blood pressure. The electrocardiogram revealed transient left bundle branch block. Troponin and BNP were elevated. Cardiac ultrasound showed large apical akinesia with altered left ventricular ejection fraction, and the left ventriculogram showed characteristic regional wall motion abnormalities involving the mid and apical segments. Brain MRI showed bilateral, cortical, and subcortical vasogenic edema predominant in the posterior right hemisphere. The lumbar puncture and cerebral angiography were normal. Paraclinical abnormalities were reversible within 2 weeks with a clinical recovery in 3 months, confirming the takotsubo and the PRES diagnoses. Discussion: Several theories hypothesize the underlying pathophysiology of takotsubo or PRES. Circulating catecholamines are up to 3 times higher in patients with takotsubo causing impaired microcirculation and apical hypokinesia. An association of both takotsubo and asthma crisis and PRES and asthma crisis underlines the role of catecholamines in the occurrence of these disorders. Conclusion: Early recognition of this rare association, in which heart and neurological damage may require rapid intensive care support, is needed.

Download Full-text

Cardiac manifestations of congenital LMNA-related muscular dystrophy in children: three case reports and recommendations for care

Cardiology in the Young ◽

10.1017/s1047951116002079 ◽

2016 ◽

Vol 27 (6) ◽

pp. 1076-1082 ◽

Cited By ~ 7

Author(s):

Felice Heller ◽

Ivana Dabaj ◽

Jean K. Mah ◽

Jean Bergounioux ◽

Aben Essid ◽

...

Keyword(s):

Heart Failure ◽

Muscular Dystrophy ◽

Case Reports ◽

Congenital Muscular Dystrophy ◽

Right Heart Failure ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Rapid Decline ◽

Ventricular Ejection Fraction ◽

Cardiac Manifestations

AbstractSkeletal and cardiac muscle laminopathies, caused by mutations in the lamin A/C gene, have a clinical spectrum from congenital LMNA-related muscular dystrophy to later-onset Emery–Dreifuss muscular dystrophy, limb girdle muscular dystrophy, and dilated cardiomyopathy. Although cardiac involvement is observed at all ages, it has only been well described in adults. We present the evolution of cardiac disease in three children with congenital muscular dystrophy presentation of LMNA-related muscular dystrophy. In this series, atrial arrhythmia was the presenting cardiac finding in all three patients. Heart failure developed up to 5 years later. Symptoms of right heart failure, including diarrhoea and peripheral oedema, preceded a rapid decline in left ventricular ejection fraction. Recommendations for cardiac surveillance and management in these patients are made.

Download Full-text

Case report of Takotsubo syndrome following seizures in a patient with pyruvate carboxylase deficiency

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab011 ◽

2021 ◽

Vol 5 (3) ◽

Author(s):

Nikhil Sahdev ◽

Onyedikachi Oji ◽

Aswin Babu ◽

Smita Dutta Roy

Keyword(s):

Case Report ◽

Pyruvate Carboxylase ◽

Acute Infection ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Clinical State ◽

Takotsubo Syndrome ◽

Ventricular Ejection Fraction ◽

Cardiac Symptoms ◽

Pyruvate Carboxylase Deficiency

Abstract Background Takotsubo syndrome (TS) is defined as transient left ventricular dysfunction, which is often related to an emotional or physically stressful event. We describe a case of TS in a lady with pyruvate carboxylase deficiency (PCD). Pyruvate carboxylase deficiency is rare condition with the majority of those affected demonstrating signs of failure to thrive, recurrent seizures, and metabolic acidosis. To our knowledge, this is the first documented case of TS in an individual with PCD. Case summary This 28-year-old female presented to the emergency department after a tonic-clonic seizure. For 4 days prior to the presentation, she had been suffering from cough and pyrexia. On Day 2, she developed abdominal pain associated with tachycardia and hypotension, and an elevated troponin (791 ng/L). The echocardiogram showed a severely impaired left ventricular systolic function, regional wall motion abnormalities (RWMAs), and a visually estimated left ventricular ejection fraction of 25–30%. Eight days following admission her clinical state significantly improved, with a reduction troponin to 60 ng/L. A repeat echocardiogram on Day 9 showed complete resolution of cardiac function with no RWMAs. Following this, she was discharged from hospital the next day with a diagnosis of TS. Discussion This is the first case report of TS in a patient with PCD. In this case, multiple aetiologies of TS such as emotional and physical stress, seizures, and acute infection were considered. This case also highlights that TS should be an important differential diagnosis in patients presenting with cardiac symptoms.

Download Full-text

Gemcitabine-induced dilated-cardiomyopathy in patient with platinum-refractory ovarian-cancer: A case report and literature review

Journal of Oncology Pharmacy Practice ◽

10.1177/1078155220982044 ◽

2021 ◽

pp. 107815522098204 ◽

Cited By ~ 1

Author(s):

Lucrezia Raimondi ◽

Filippo Maria Raimondi ◽

Rachele Lazzeroni ◽

Marta Pietranera ◽

Laura Di Benedetto ◽

...

Keyword(s):

Ovarian Cancer ◽

Case Report ◽

Dilated Cardiomyopathy ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Ventricular Ejection Fraction ◽

Cardiac Side Effects ◽

Platinum Resistant ◽

Imaging Results ◽

Objective Evidence

Introduction Gemcitabine is a nucleoside analog and pyrimidine antimetabolite that inhibits RNA synthesis, currently approved for use to treat a variety of cancers, among which ovarian cancers. Gemcitabine is considered relatively safe and it is generally well tolerated, with rarely reported cardiac side effects. Case report We report a case of gemcitabine induced dilated cardiomyopathy in a 41-year-old woman receiving gemcitabine as second line treatment for platinum-resistant ovarian cancer without pre-existing hypertension or significant cardiac history. Management and Outcome: The patient presented with clinical symptoms and laboratory and imaging results suggestive of congestive cardiac failure, with a left ventricular ejection fraction of 15%. Gemcitabine administration was stopped and Furosemide with ACE-inhibitors and Beta-blocker agents were initiated. At that point the clinical situation improved: symptoms and findings disappeared with gemcitabine cessation. Discussion Our case demonstrated for the first time objective evidence for dilated cardiomyopathy induced by gemcitabine in a young patient with platinum-resistant ovarian cancer without pre-existing significant cardiac history. Although rare, gemcitabine-induced cardiotoxicity should be promptly recognized in order to take appropriate measures to manage it.

Download Full-text