scholarly journals Pulmonary thromboembolism and pericardial effusion as cardiovascular complications of COVID-19 infection

2021 ◽  
Vol 26 (80) ◽  
pp. 34-57
Author(s):  
Aleksandar Đenić
Keyword(s):  
Pericardial Effusion ◽  
Anticoagulant Therapy ◽  
Respiratory Symptoms ◽  
Clinical Symptoms ◽  
Pulmonary Thromboembolism ◽  
Cardiovascular Complications ◽  
Pulmonary Angiography ◽  
Current Therapy ◽  
Complete Regression ◽  
D Dimer

Systemic activation of coagulation and pulmonary thrombo-inflammation with local vascular damage caused by SARS-CoV-2 infection increases the risk of developing thromboembolic complications: stroke, pulmonary arterial thrombosis (pulmonary thromboembolism) and deep vein thrombosis. Myopericarditis may occurs in COVID-19 patients as part of or after the onset of respiratory symptoms. Minor pericardial effusions up to 1 cm that accompany pericardial involvement are common. In our patient during hospitalization due to bilateral pneumonia caused by SARS-Cov-2 virus during a routine control of D-dimer, elevated values 2.3 fold higher than the reference range were observed, with elevated biomarkers of inflammation. She had symptoms of a respiratory infection and no pronounced clinical symptoms that would indicate pulmonary thromboembolism. MSCT pulmonary angiography was performed and low-risk thromboembolism was confirmed. Anticoagulant therapy was started - therapeutic doses of low molecular weight heparin (enoxaparin), which was extended after discharge from the hospital with DOAC (Rivaroxaban) according to the protocol for the treatment of pulmonary thromboembolism. At the control examination after 3 weeks, pericarditis with moderate pericardial effusion was determined. Anticoagulant therapy (DOAC) was extended with the inclusion of colchicine in the therapy according to the protocol for the treatment of pericarditis with effusion. After 3 months of hospitalization in our patient with mild respiratory symptoms, bronchopneumonia of the right lung developed with slightly elevated biomarkers of inflammation and normal values of D-dimer. With prescribed antibiotic therapy and current therapy (DOAC and colchicine), there was a withdrawal of symptoms and regression of pericardial effusion and a reduction in right ventricular overload. At the follow-up examination 5 months after hospitalization, complete regression of pericardial effusion was confirmed with normal biomarkers of inflammation and D-dimer values. It is advisable to exclude anticoagulant therapy (DOAC) with continued low-dose aspirin therapy.

Troponin I and D-Dimer for Discriminating Acute Pulmonary Thromboembolism from Myocardial Infarction

Cardiology ◽  
2016 ◽  
Vol 136 (4) ◽  
pp. 222-227 ◽  
Author(s):  
Soo Jin Kim ◽  
Moo Hyun Kim ◽  
Kwang Min Lee ◽  
Tae Hyung Kim ◽  
Sun Yong Choi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Clinical Characteristics ◽  
Troponin I ◽  
Clinical Symptoms ◽  
Pulmonary Thromboembolism ◽  
Laboratory Data ◽  
Cardiac Biomarkers ◽  
Acute Pulmonary Thromboembolism ◽  
D Dimer

Background: Acute pulmonary thromboembolism (APTE) is a life-threatening condition, often manifesting with chest pain, dyspnea, and increased cardiac biomarkers including cardiac troponin I (CTI) and D-dimer. Therefore, APTE is often misdiagnosed with classical non-ST elevation myocardial infarction (NSTEMI), resulting in unnecessary coronary interventions and a delay of therapy. Objectives: Our aim was to distinguish APTE from NSTEMI based on CTI and D-dimer levels. Methods: Complete clinical and laboratory data sets from APTE patients (n = 123) were compared with matched NSTEMI patients (n = 123) who presented with chest pain. The APTE diagnosis was confirmed by chest tomography, angiography, or radionuclide ventilation-perfusion scan, while NSTEMI was established by clinical symptoms, cardiac biomarkers, and coronary angiography. Clinical characteristics, CTI (initial and peak), and D-dimer levels at presentation were retrospectively analyzed. Results: The clinical characteristics were not different between APTE and NSTEMI patients. However, significantly lower initial CTI (0.2 ± 0.5 vs. 4.4 ± 9.5 ng/ml) and peak CTI (0.7 ± 2.7 vs. 17.1 ± 20.4 ng/ml), but higher initial D-dimer (9.8 ± 9.4 vs. 1.6 ± 3.6 ng/ml), distinguished APTE from NSTEMI. By receiver operating characteristic curve analysis, the cutoff values for initial CTI, peak CTI, and D-dimer were 0.25, 0.98, and 3.18 ng/ml, respectively. Conclusion: Patients with APTE exhibited lower initial and peak CTI but higher D-dimer levels than NSTEMI patients. Assessing cardiac biomarkers is useful for differentiating APTE from NSTEMI. Further large randomized biomarker studies are urgently needed to facilitate a better APTE diagnosis since clinical characteristics are not particularly helpful.

scholarly journals Pulmonary thromboembolism in COVID-19 Patients on CT Pulmonary Angiography - A Single-Centre Retrospective Cohort Study in the United Arab Emirates

2021 ◽  
Author(s):  
Ghufran Aref Saeed ◽  
Waqar Haider Gaba ◽  
Abd Al Kareem Mohd Adi ◽  
Reima Obaid Al Marshoodi ◽  
Safaa Saeed Al Mazrouei ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
United Arab Emirates ◽  
Pulmonary Thromboembolism ◽  
Pulmonary Angiography ◽  
Rt Pcr ◽  
Ct Pulmonary Angiography ◽  
Exclusion Criteria ◽  
The Mean ◽  
Positive Groups ◽  
D Dimer

Purpose. Our aim is to identify the prevalence and distribution of pulmonary thromboembolism in COVID-19 infected patients in our hospital. Materials and Methods. Data of all patients with COVID-19 infection either on RT-PCR testing or non-contrast high resolution CT(HRCT) who had CT pulmonary angiography (CTPA) from April to June 2020 were included. 133 patients were initially included in the study, 7 were excluded according to exclusion criteria, leaving a total number of 126 patients. Results. Twenty (15.8%) patients had evidence of pulmonary embolism (PE) on CTPA with mean age of 50 years (range 31-85) of which 95% were males. The mean D-dimer was 5.61mcg/mL among the PE-negative and 14.49 mcg/mL in the PE-positive groups respectively. Among the patients with evidence of pulmonary embolism on CTP, almost half required admission to intensive care unit in comparison to only one-fifth with negative CTPA. One-fourth died among the PE positive group with only 5% died among the PE negative group. There was a 33% reduction in the development of PE in the COVID-19 patients who had received low molecular weight heparin (LMWH) prior to their CTPA study versus those who had not. Conclusion. D-dimer correlates well with the incidence of pulmonary embolism among COVID-19 patients. Our data suggest that majority of our patients, developed pulmonary embolisms within 5 days into their hospital stay, accounting to almost two thirds of all positive cases diagnosed by CTPA. Those with PE among COVID-19 patients have high chances of ICU admission and mortality. Use of thromboprophylaxis early on might reduce the incidence of PE.

scholarly journals Investigation of the Need for Computed Tomography Pulmonary Angiography in the Decision to Discontinue Treatment for Pulmonary Thromboembolism

2021 ◽  
Author(s):  
Eda Çelik ◽  
Ömer Araz ◽  
Buğra Kerget ◽  
Elif Yılmazel Uçar ◽  
Metin Akgün ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Artery ◽  
Sensitivity And Specificity ◽  
Outpatient Clinic ◽  
Pulmonary Thromboembolism ◽  
Pulmonary Angiography ◽  
Treatment Discontinuation ◽  
Computed Tomography Pulmonary Angiography ◽  
Pulmonary Artery Obstruction ◽  
D Dimer

Abstract Purpose: Acute pulmonary thromboembolism (PTE) is an important cause of morbidity and mortality that can reduce quality of life due to long-term complications during and after treatment discontinuation. The aim of this study was to evaluate patients for these complications before discontinuing treatment and determine the necessity of computed tomography pulmonary angiography (CTPA) imaging.Methods: This retrospective study included 116 patients over the age of 18 who received anticoagulant treatment for at least 3 months and presented for treatment discontinuation to the Atatürk University Research Hospital Chest Diseases Outpatient Clinic between January 2015 and September 2019. Results: CTPA performed at treatment discontinuation showed complete thrombus resolution with treatment in 73 patients (62.9%). High pulmonary artery obstruction index (PAOI) at diagnosis was statistically associated with findings of residual or chronic thrombus on CTPA at treatment discontinuation (p=0.001). In the differentiation of patients with residual/chronic thrombus and those with thrombus resolution, D-dimer at a cut-off value of 474 µg/L had 60% sensitivity and 70% specificity. At a cut-off value of 35.5 mmHg, mean pulmonary artery pressure on echocardiography had sensitivity and specificity of 72% and 77%, respectively. At a cut-off of 23.75, PAOI had sensitivity and specificity of 93% and 69%, respectively.Discussion: In addition to physical examination findings, D-dimer and echocardiography were guiding parameters in the evaluation of treatment discontinuation and thrombus resolution in patients presenting to the outpatient clinic for discontinuation of treatment for acute PTE. PAOI at diagnosis may be another important guiding parameter in addition to these examinations.

scholarly journals Diagnosis of suspected venous thromboembolism

Hematology ◽  
2016 ◽  
Vol 2016 (1) ◽  
pp. 397-403 ◽  
Author(s):  
Clive Kearon
Keyword(s):  
Venous Thromboembolism ◽  
Anticoagulant Therapy ◽  
Diagnostic Testing ◽  
Pulmonary Angiography ◽  
Test Results ◽  
Computed Tomography Pulmonary Angiography ◽  
Vein Thrombosis ◽  
Imaging Test ◽  
Deep Vein ◽  
D Dimer

Abstract The primary goal of diagnostic testing for venous thromboembolism (VTE) is to identify all patients who could benefit from anticoagulant therapy. Test results that identify patients as having a ≤2% risk of VTE in the next 3 months are judged to exclude deep vein thrombosis (DVT) or pulmonary embolism (PE). Clinical evaluation, with assessment of: (1) clinical pretest probability (CPTP) for VTE; (2) likelihood of important alternative diagnoses; and (3) the probable yield of D-dimer and various imaging tests, guide which tests should be performed. The combination of nonhigh CPTP and negative D-dimer testing excludes DVT or PE in one-third to a half of outpatients. Venous ultrasound of the proximal veins, with or without examination of the distal veins, is the primary imaging test for leg and upper-extremity DVT. If a previous test is not available for comparison, the positive predictive value of ultrasound is low in patients with previous DVT. Computed tomography pulmonary angiography (CTPA) is the primary imaging test for PE and often yields an alternative diagnosis when there is no PE. Ventilation-perfusion scanning is associated with less radiation exposure than CTPA and is preferred in younger patients, particularly during pregnancy. If DVT or PE cannot be “ruled-in” or “ruled-out” by initial diagnostic testing, patients can usually be managed safely by: (1) withholding anticoagulant therapy; and (2) doing serial ultrasound examinations to detect new or extending DVT.

Prevalence of COVID-19-like Symptoms among People Living with HIV, and Using Antiretroviral Therapy for Prevention and Treatment

2020 ◽  
Vol 18 (5) ◽  
pp. 373-380 ◽  
Author(s):  
SeyedAhmad SeyedAlinaghi ◽  
Maryam Ghadimi ◽  
Mahboubeh Hajiabdolbaghi ◽  
Mehrnaz Rasoolinejad ◽  
Ladan Abbasian ◽  
...  
Keyword(s):  
Respiratory Symptoms ◽  
Antiretroviral Treatment ◽  
Clinical Symptoms ◽  
Cross Sectional Study ◽  
People Living With Hiv ◽  
Shortness Of Breath ◽  
Sectional Study ◽  
Limited Data ◽  
Cross Sectional ◽  
Living With Hiv

Background: COVID-19 has spread globally with remarkable speed, and currently, there is limited data available exploring any aspect of the intersection between HIV and SARSCoV- 2 co-infection. Objective: To estimate the prevalence of clinical symptoms associated with COVID-19 among people living with HIV (PLWH) in Tehran, Iran. Design: Cross-sectional study. Methods: A total of 200 PLWH were recruited through the positive club via sampling, and completed the symptom-based questionnaire for COVID-19, which was delivered by trained peers. Results: Of 200 participants, respiratory symptoms, including cough, sputum, and shortness of breath, were the most prevalent among participants, but only one person developed symptoms collectively suggested COVID-19 and sought treatments. Conclusions: It appears that existing infection with HIV or receiving antiretroviral treatment (ART) might reduce the susceptibility to the infection with SARS-CoV-2 or decrease the severity of the infection acquired. Further research is needed to understand causal mechanisms.

953 Role of Routine Preoperative Echocardiograms in Adolescent Idiopathic Scoliosis Patients undergoing Deformity Correction Surgery

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Hassan ◽  
S Shah ◽  
M Patel
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Clinical Assessment ◽  
Clinical Symptoms ◽  
Deformity Correction ◽  
Cost Effective ◽  
Cardiovascular Complications ◽  
Anterior Correction ◽  
Perioperative Complication ◽  
Clinical Records

Abstract Introduction Patients with Adolescent Idiopathic Scoliosis (AIS) are often noted to have routine preoperative Echocardiograms (ECHO). The prevalence of ECHO abnormalities and their impact on perioperative outcome is not clear, especially balancing against its costs. The study aims at identifying the significance of routine preoperative ECHO for AIS patients. Methodology Clinical records of 295 adolescent AIS patients, >10years age (mean 15.64years), who underwent primary posterior corrective surgery in a tertiary spinal centre, between 2015-2020, were reviewed. Patients with revision surgery, anterior correction, syndromic/neuromuscular scoliosis and/or pre-existent known cardiac comorbidities were excluded. Results 139(47%) patients had preoperative ECHO. 21(15%) patients showed echocardiographic abnormalities (11 trivial valvular abnormalities, 5 mild root dilatation, 3 mild pericardial effusion and 2 septal defects). None of these patients showed any clinical symptoms/signs or required Cardiology assessment; and none had perioperative cardiovascular complications. Conversely, four(1.36%) patients demonstrated auscultatory murmurs on preoperative clinical assessment. None reported any perioperative complication. The average known cost of an echocardiogram was noted to be £363. Conclusions Routine preoperative Echocardiogram for all AIS patients is not recommended or deemed cost-effective. Positive clinical assessment finding could be used as a screening tool for performing ECHO in AIS patients.

The impact of using different age-adjusted cutoffs of D-dimer in the diagnosis of pulmonary thromboembolism

2021 ◽  
Vol 43 ◽  
pp. 118-122
Author(s):  
Melahat Uzel Şener ◽  
Sezgi Şahin Duyar ◽  
Zeynep Saral Öztürk ◽  
Alp Şener
Keyword(s):  
Pulmonary Thromboembolism ◽  
The Impact ◽  
D Dimer

scholarly journals Preoperative prevalence of deep vein thrombosis in patients scheduled to have surgery for degenerative musculoskeletal disorders

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Keigo Sato ◽  
Hideki Date ◽  
Takehiro Michikawa ◽  
Mitsuhiro Morita ◽  
Kazue Hayakawa ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Musculoskeletal Disorders ◽  
Pulmonary Thromboembolism ◽  
Elective Surgery ◽  
Knee Surgery ◽  
Care Providers ◽  
Cross Sectional ◽  
Cross Sectional Analysis ◽  
Sectional Analysis ◽  
D Dimer

Abstract Background Although the incidence of symptomatic pulmonary thromboembolism after elective surgery for degenerative musculoskeletal disorders is comparatively low, it is extremely detrimental to both patients and health-care providers. Therefore, its prevention is mandatory. We aimed to perform a cross-sectional analysis of deep venous thrombosis (DVT) before elective surgery for degenerative musculoskeletal disorders, including total knee arthroplasty (TKA), total hip arthroplasty (THA), and spinal surgery, and identify the factors associated with the incidence of preoperative DVT. Methods The clinical data of patients aged ≥ 30 years who underwent TKA or THA, and spine surgery for lumbar or cervical degenerative disorders at our institution were retrospectively collected. D-dimer levels were measured preoperatively in all the patients scheduled for surgery. For the patients with D-dimer levels ≥ 1 µg/mL or who were determined by their physicians to be at high risk of DVT, the lower extremity vein was preoperatively examined for DVT on ultrasonography. Results Overall, we retrospectively evaluated 1236 consecutive patients, including 701 men and 535 women. Of the patients, 431 and 805 had D-dimer levels ≥ 1 and < 1 µg/mL, respectively. Of 683 patients who underwent lower extremity ultrasonography, 92 had proximal (n = 7) and distal types (n = 85) of DVT. The preoperative prevalence of DVT was 7.4 %. No patient had the incidence of postoperative symptomatic venous thromboembolism. A multivariate analysis revealed that age ≥ 80 years (odds ratio [OR], 95 % confidence interval [CI]: 2.8, 1.1–7.3), knee surgery (2.1, 1.1–4.0), American Society of Anesthesiologists (ASA) grade 2 (2.8, 1.2–6.8), ASA grades 3 or 4 (3.1, 1.0–9.4), and malignancy (1.9, 1.1–3.2) were significantly associated with DVT incidence. Conclusions This is the first study to conduct a cross-sectional analysis of preoperative DVT data of patients scheduled for elective surgery for degenerative musculoskeletal disorders. Although whether screening for preoperative DVT is needed to prevent postoperative symptomatic pulmonary thromboembolism remains to be clarified, our data suggested that DVT should be noted before surgery in the patients with advanced age, knee surgery, high ASA physical status, and malignancy.

scholarly journals CT pulmonary angiography in COVID-19 pneumonia: relationship between pulmonary embolism and disease severity

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Aya Yassin ◽  
Maryam Ali Abdelkader ◽  
Rehab M. Mohammed ◽  
Ahmed M. Osman
Keyword(s):  
Pulmonary Embolism ◽  
Disease Severity ◽  
Laboratory Data ◽  
Pulmonary Angiography ◽  
Significant Relation ◽  
Ct Pulmonary Angiography ◽  
Laboratory Results ◽  
Severity Of The Disease ◽  
The Relationship ◽  
D Dimer

Abstract Background Pulmonary embolism (PE) is one of the known sequels of COVID-19 infection. We aimed to assess the incidence of PE in patients with COVID-19 infection and to evaluate the relationship between the CT severity of the disease and the laboratory indicators. This was a retrospective study conducted on 96 patients with COVID-19 infection proved by positive PCR who underwent CT pulmonary angiography (CTPA) with a calculation of the CT severity of COVID-19 infection. Available patients’ complaint and laboratory data at the time of CTPA were correlated with PE presence and disease severity. Results Forty patients (41.7%) showed positive PE with the median time for the incidence of PE which was 12 days after onset of the disease. No significant correlation was found between the incidence of PE and the patients’ age, sex, laboratory results, and the CT severity of COVID-19. A statistically significant relation was found between the incidence of PE and the patients’ desaturation, hemoptysis, and chest pain. A highly significant correlation was found between the incidence of PE and the rising in the D-dimer level as well as the progressive CT findings when compared to the previous one. Conclusion CT progression and the rising in D-dimer level are considered the most important parameters suggesting underlying PE in patients with positive COVID-19 infection which is commonly seen during the second week of infection and alert the use of CT pulmonary angiography to exclude or confirm PE. This is may help in improving the management of COVID-19 infection.

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