Right Heart Thrombus in an Adult COVID-19 Patient: A Case Report

Sudden cardiac death due to isolated right ventricle thromboembolism in a young male

Sudden cardiac death due to an isolated right ventricular thromboembolism is an uncommon cause of death. In the reported case, a healthy, asymptomatic young male with no past medical history outside of obesity and his age was found unresponsive by a family member who suspected him to be sleeping. Examination of the heart at autopsy revealed a large serpiginous, organized and obstructive blood clot compromising most of the right ventricle with no other cardiac abnormalities and without any evidence of a pulmonary embolism. The patient was found to not have any history of substance abuse, genetic predispositions, kidney disease, or COVID-19 infection which has all been linked to ventricular thrombi.

A case of persistent severe sequelae of COVID-19 infection: potential role in sudden death?

Depending on the stage of the disease, autopsy findings of COVID-19 may include a spectrum of cardiopulmonary pathologies including alveolar hyaline membrane formation, vascular thrombosis, and intracardiac thrombi. Identification of a COVID-19 positive decedent in the absence of clinical history relies primarily on post-mortem nasopharyngeal (NP) or oropharyngeal (OP) swabs for real time polymerase chain reaction (RT-PCR). In the absence of definitive microbiology testing, post-mortem computed tomography (PMCT) may be a powerful adjunct tool for screening. Persistence of pathological changes may prolong physiological alterations and increase the risk of cardiopulmonary compromise. This current case outlines the forensic presentation, utilization of screening tools including PMCT, and the autopsy findings of a recent toxicology related sudden death case in the context of severe sequelae of COVID-19 pneumonia. This case demonstrates the limitation of NP and OP swabs in the post-mortem setting, the value of PMCT as an adjunct screening tool, and raises the consideration of COVID-19 sequelae as a potential contributing risk factors in sudden death cases in the community.

Intra cardiac thrombus in critically ill patient with coronavirus disease 2019: Case report

Introduction

With the outbreak of COVID-19, the number of cardiac manifestations related to this virus was more remarquable, among them heart thrombus (HTh) which is considered as a rare and severe complication associated with thromboembolic phenomena.

Methods

We present case report of 4 patients who presented heart thrombus as a complication of COVID-19.

Cases report management

During the pandemic, these patients were presented to our center for respiratory symptoms related to COVID-19 infection. All of them was hemodynamically unstable. On further assessment, Diagnosis was confirmed by trans -thoracic echography, one patient (1/4) had left ventricle thrombus, one patient (1/4) had right atrium thrombus and right ventricle thrombus was dominated in the rest of patients (2/4). Therapeutic component was based on unfractionated heparin and fibrinolytic.

Conclusion

COVID-19 patients could represent a population at high risk of HTh. Multidisciplinary approach and bed routine transthoracic echography can enhance the management of this cardiac complication.

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Indracradiac thrombus is a rare severe complication of Covid-19 infection.

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Bed routine transthoracic echocardiography is essential for surveillance of this condition.

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Patients with thrombosis presents a high death rate, it is therefore a major prognostic factor.

[Myocarditis and in situ thrombosis in the right ventricle in a COVID-19 patient]

A pesar de que el SARS-CoV-2 afecta principalmente al aparato respiratorio, se está evidenciando cada vez más la afectación de otros sistemas. Uno de los que más relevancia ha tomado es el cardiovascular tanto por daño miocárdico agudo (DMA) como por complicaciones tromboembólicas debidas al estado de hipercoagulabilidad que produce la infección. Este caso clínico presenta la coexistencia de complicaciones cardiovasculares en un paciente joven, sin enfermedades previas e infección reciente por COVID-19. Así mismo, plantea la necesidad de realizar cribado de complicaciones cardiovasculares mediante técnicas de imagen por el aumento en su incidencia.

Personalisation of Therapies in COVID-19 Associated Acute Respiratory Distress Syndrome, Using Electrical Impedance Tomography

INTRODUCTION

Each patient suffering from severe coronavirus COVID-19-associated acute respiratory distress syndrome (ARDS), requiring mechanical ventilation, shows different lung mechanics and disease evolution. Therefore, lung protective strategies should be personalised for the individual patient.

CASE PRESENTATION

A 64-year-old male patient was intubated ten days after the symptoms of COVID-19 infection presented. He was placed in the prone position for sixteen hours, resulting in a marked improvement in oxygenation. However, after being returned to the supine position, his SpO2 rapidly dropped from 98% to 91%, and electrical impedance tomography showed less ventilation at the dorsal region and a ventral shift of ventilation distribution. An incremental and decremental PEEP trial under electrical impedance tomography monitoring was carried out, confirming that the dependent lung regions were recruited with increased pressures and homogenous ventilation distribution could be provided with 14 cmH2O of PEEP. The optimal settings were reassessed next day after returning from the second session of the prone position. After four prone position-sessions in five days, oxygenation was stabilised and eventually the patient was discharged.

CONCLUSIONS

Patients with COVID-19 associated ARDS require individualised ventilation support depending on the stage of their disease. Daily PEEP trial monitored by electrical impedance tomography can provide important information to tailor the respiratory therapies.