A case of COVID-19-associated fulminant myocarditis successfully treated with mechanical circulatory support.
Ryosuke AsakuraTatsuki KuroshimaNaohiro KokitaMotoi OkadaPublished in: Clinical case reports (2022)
A 49-year-old man, who had not been vaccinated against COVID-19 visited the hospital for fever and cough, and a PCR test for COVID-19 was positive on the Day X. Initially, there was no decrease in oxygen saturation and the patient was under observation as a mild case without medication. Five days after the onset (Day X + 5), chest pain appeared. Electrocardiogram showed widespread ST-segment elevation, and blood tests showed high levels of troponin I. However, given that there was no stenotic lesion on coronary computed tomography, myocarditis was suspected, and he was transferred to our hospital on the Day X + 6. We started treatment with lemdesivir and dexamethasone. On the Day X + 7, the patient developed decreased left ventricular ejection fraction, hypotension, and hyperlactatemia. We decided that mechanical circulatory support was necessary and an Impella 5.0 was inserted under ventilator management. The patient was successfully weaned from the Impella 5.0 on the Day X + 17, was transferred to the general ward on the Day X + 24, continued rehabilitation, and was discharged home on the Day X + 39 with no heart failure symptoms. In this case, we performed daily bedside echocardiography and chose the Impella 5.0 instead of extra corporeal membrane oxygenation (ECMO) because there were no findings of severe pneumonia or right heart failure. The Impella 5.0 device was inserted via an axillary artery approach, given that it provides more assisted flow than the Impella CP inserted through the inguinal route. Furthermore, early rehabilitation was possible due to the lack of restriction of the lower body.
Keyphrases
- extracorporeal membrane oxygenation
- heart failure
- left ventricular
- coronavirus disease
- acute respiratory distress syndrome
- sars cov
- ejection fraction
- computed tomography
- aortic stenosis
- healthcare
- case report
- left ventricular assist device
- respiratory failure
- magnetic resonance imaging
- cardiac resynchronization therapy
- coronary artery disease
- low dose
- atrial fibrillation
- coronary artery
- prostate cancer
- physical activity
- hypertrophic cardiomyopathy
- squamous cell carcinoma
- mechanical ventilation
- respiratory syndrome coronavirus
- acute myocardial infarction
- magnetic resonance
- transcatheter aortic valve replacement
- early onset
- acute heart failure
- contrast enhanced
- left atrial
- drug induced
- community acquired pneumonia
- smoking cessation
- image quality