scholarly journals Critically Ill Patients with Variable Heart Failure in Severe COVID-19 Disease: A Case Series

2021 ◽  
Vol 8 ◽  
Author(s):  
Joanne Michelle Gomez ◽  
Mary Potkonjak ◽  
Maria Isabel Planek ◽  
Prutha Lavani ◽  
Karolina Marinescu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Embolism ◽  
Early Diagnosis ◽  
Cardiogenic Shock ◽  
Critically Ill ◽  
Case Series ◽  
Cardiovascular Effects ◽  
Massive Pulmonary Embolism ◽  
System Disorder ◽  
Obstructive Shock

COVID-19 disease, while primarily a respiratory disease, has proven itself a multi-system disorder with profound cardiovascular sequelae. In patients with SARS-CoV-2 infection, effective early diagnosis and management of concomitant cardiovascular manifestations of the disease are key to favorable outcomes. Here we present a case series of three patients with varied cardiovascular presentations of severe COVID-19 illness: cardiogenic shock from Takotsubo cardiomyopathy, arrhythmia in a patient with suspected hydroxychloroquine-associated cardiomyopathy, and right-sided heart failure with obstructive shock in the setting of massive pulmonary embolism. Through our experience, we aim to provide a better understanding of the unique spectrum of the cardiovascular effects of severe COVID-19 disease to guide management of the critically ill.

scholarly journals Alteplase for Massive Pulmonary Embolism after Complicated Pericardiocentesis

2019 ◽  
Author(s):  
Ricardo Cleto Marinho ◽  
José Luis Martins ◽  
Susana Costa ◽  
Rui Baptista ◽  
Lino Gonçalves ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Pericardial Effusion ◽  
Thrombolytic Therapy ◽  
Cardiac Tamponade ◽  
Massive Pulmonary Embolism ◽  
Extensive Study ◽  
Life Saving ◽  
Obstructive Shock

Background: The occurrence of a high-risk pulmonary embolism (PE) within 48 hours of a complicated pericardiocentesis to remove a haemorrhagic pericardial effusion, is an uncommon clinical challenge. Case summary: The authors report the case of a 75-year-old woman who presented with signs of imminent cardiac tamponade due to recurring idiopathic pericardial effusion. The patient underwent pericardiocentesis that was complicated by the loss of 1.5 litres of blood. Within 48 hours, the patient had collapsed with clear signs of obstructive shock. This was a life-threating situation so alteplase was administered after cardiac tamponade and hypertensive pneumothorax had been excluded. CT chest angiography later confirmed bilateral PE. The patient achieved haemodynamic stability less than an hour after receiving the alteplase. However, due to the high risk of bleeding, the medical team suspended the thrombolysis protocol and switched to unfractionated heparin within the hour. The cause of the PE was not identified despite extensive study, but after 1 year of follow-up the patient remained asymptomatic. Discussion: Despite the presence of a contraindication, the use of thrombolytic therapy in obstructive shock after exclusion of hypertensive pneumothorax can be life-saving, and low-dose thrombolytic therapy may be a valid option in such cases.

scholarly journals MASSIVE PULMONARY EMBOLISM TREATED WITH THROMBOLYSIS IN COVID-19: A CASE SERIES

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A2126-A2127
Author(s):  
Amarilys Alarcon-Calderon ◽  
Diego Celli ◽  
Thomas Plate ◽  
Jason Galo ◽  
Roger Alvarez
Keyword(s):  
Pulmonary Embolism ◽  
Case Series ◽  
Massive Pulmonary Embolism

scholarly journals Systemic Thrombolysis for Treatment of Postpartum Saddle Embolism Complicated by Postpartum Hemorrhage: A Case Report and Brief Literature Review

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Kathy Mostajeran ◽  
Hillary Boswell ◽  
Ziad Haidar
Keyword(s):  
Pulmonary Embolism ◽  
Case Report ◽  
Postpartum Hemorrhage ◽  
Postpartum Period ◽  
Case Series ◽  
Massive Pulmonary Embolism ◽  
Thromboembolic Events ◽  
Systemic Thrombolysis ◽  
Venous Thromboembolic Events ◽  
In Pregnancy

Venous thromboembolic events (VTE), specifically pulmonary embolisms, account for a significant portion of maternal morbidity and mortality. Due to the procoagulant physiological changes that occur, pregnancy and the postpartum period are known risk factors for thromboembolic events. The risk is greatest during the first-week postpartum and remains elevated for up to six weeks as compared to the general population. Treatment guidelines regarding the use of thrombolytics for massive pulmonary embolism occurring in pregnancy and the postpartum are not well established. In nonpregnant populations, thrombolytic agents are well known to decrease the mortality in the setting of a massive pulmonary embolism. However, in the absence of management guidelines, thrombolysis in pregnancy remains guided by case reports and case series. We present a case of a massive pulmonary embolism (PE) causing hemodynamic instability during the postpartum period treated with tissue plasminogen activator (tPA). The case was complicated by delayed postpartum hemorrhage successfully managed with the uterotonic methylergometrine. The patient was started on oral anticoagulation and continued for six months without recurrent VTE. Our case demonstrates a rare occurrence of a saddle embolism after a vaginal delivery within the first postpartum week which was successfully managed with the use of systemic thrombolysis and minimal intervention to manage the iatrogenic delayed postpartum hemorrhage. To the authors’ knowledge, no other similar case report exists. This case highlights the need to develop guidelines for the use of thrombolysis in mothers who present with massive pulmonary embolus and a noninvasive means to manage adverse bleeding events in the puerperium.

Shortness of Breath: Pulmonary Embolism, Ischemic Heart Failure, or Both? The Role of Concomitant Surgery

2012 ◽  
Vol 15 (1) ◽  
pp. 56
Author(s):  
Michael S. Firstenberg ◽  
Erik Abel ◽  
Robert S. D. Higgins ◽  
John H. Sirak ◽  
Chittoor B. Sai-Sudhakar ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Embolism ◽  
Coronary Disease ◽  
Comprehensive Evaluation ◽  
Massive Pulmonary Embolism ◽  
The Other ◽  
Shortness Of Breath ◽  
Ischemic Heart Failure ◽  
Concomitant Surgery

We present a case of a patient who underwent successful concomitant surgical management of his massive pulmonary embolism and severe multivessel coronary disease. His presentation with shortness of breath prompted a comprehensive evaluation, which revealed both problems. This experience emphasizes the importance of considering both problems, because treating one but not the other could be catastrophic.

scholarly journals Acute heart failure in an adult with unrecognized congenital heart disease

2015 ◽  
Vol 76 (3) ◽  
Author(s):  
Michele Correale ◽  
Agostino Lopizzo ◽  
Francesco Santoro ◽  
Antonio Ruggero ◽  
Andrea Cuculo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Embolism ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Tetralogy Of Fallot ◽  
Acute Heart Failure ◽  
Congenital Heart ◽  
Massive Pulmonary Embolism

We report a case of 46 year-old man, admitted to our Department for a possible massive pulmonary embolism. Instead, diagnosis of Tetralogy of Fallot was established by echocardiography and cardiac catetherization.

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