Login
Search
Search
0 Dates
2024
2023
2022
2021
2020
2019
2018
0 Events
CPC 2018
CPC 2019
Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
CPC 2020
CPC 2021
CPC 2022
CPC 2023
CPC 2024
0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
0 Resources
Abstract
Slides
Vídeo
Report
CLEAR FILTERS
COVID-19 related myopericarditis and spontaneous coronary artery dissection
Session:
Casos Clínicos: Insuficiência Cardíaca e Cuidados Intensivos Cardíacos
Speaker:
Francisco Barbas de Albuquerque
Congress:
CPC 2024
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.6 Chronic Heart Failure - Clinical
Session Type:
Sessão de Casos Clínicos
FP Number:
---
Authors:
Francisco Barbas De Albuquerque; André Paulo Ferreira; Ana Raquel Santos; Alexandra Castelo; Vera Ferreira; Boban Thomas; Luís Morais; Sílvia Aguiar Rosa; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">The authors present a full-vaccinated for COVID-19, 47-year-old woman with a past medical history of anti-phospholipid syndrome, on oral anticoagulation with warfarin for a previous deep venous thromboembolism and a history of arterial hypertension. She had a 4-day asymptomatic Sars-Cov 2 infection and presented to the ED with a 24h evolution of squeezing chest pain. Physical examination was unremarkable. ECG did not show any sign of acute ischemia. Laboratory analysis revealed a hs-TnI elevated at 1709 ng/L. In the 3-and 6-hoursamples, TnI was 780 ng/Land 1280 ng/L, respectively. NT-proBNP was 1720 ng/Land INR was 5,49. PCR test for Sars-Cov2was positive. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Patient was transferred to COVID-19 Internal Medicine ward with Cardiology in-patient consultation for further management. A first transthoracic echocardiography (TTE)showed a moderate circumferential pericardial effusion (20mm) that rapidly evolved into hemodynamic instability with cardiac tamponade and obstructive shock. Emergent successful pericardiocentesis was performed.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"> On day 10 after admission, she developed chest pain and ECG showed a ST-segment elevation in V4 to V6. Hs-TnI increased from463 to 73582 ng/L. The patient was admitted at the cath lab for emergent coronary angiography. Angiography revealed a type 4 anterior descending spontaneous coronary artery dissection (SCAD) with occlusion at its distal end. The Interventional cardiology team opted not to perform neither IVUS nor OCT. Cardiac Magnetic Resonance (CMR) was performed, and confirmed both myopericarditis and acute MI in anterior descending coronary artery territory, consistent with the SCAD detected. Left Ventricular ejection fraction (LVEF) was estimated at 36%. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Initial management included aspirin and therapeutic-dose enoxaparin (after INR normalization) for presumed acute coronary syndrome. After the first TTE was performed, the patient was treated with anti-inflammatory-dose ASA and colchine for presumed myopericarditis. A conservative medical approach to SCAD was performed given the absence of high-risk features. The authors opted to maintain ASA 500mg q8h for 3weeks followed by ASA 100mg once daily, colchicine 0.5mg once daily for 3months and varfarin indefinitely. Patient also began GDMT for HFrEF. Patient education for physical activity restriction at least for 6months, daily arterial pressure monitoring and clinical alarm signs were encouraged. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Patient was reevaluated within short-term at Cardiology, Cardiac Rehabilitation and Auto-immunity disease consultation. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">CMR was repeated within 6months and 12months to reassess myocardial inflammation and decide further management. Left ventricular ejection fraction recovered to 48% and no myocardial edema was observed after one year. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Abdominopelvic CTA did not confirm renal fibromuscular dysplasia. Cranial, neck and thoracic excluded other extra-renal arteriopathies.</span></span></p>
Slides
Our mission: To reduce the burden of cardiovascular disease
Visit our site