Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19
In this article, we report a case of a 61-year-old male who was diagnosed with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), presenting with acute respiratory distress syndrome requiring intubation and hemodynamic support, marked D-Dimer and troponin I elevation, worsening ST-elevati...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
SAGE Publishing
2021-05-01
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| Series: | Journal of Investigative Medicine High Impact Case Reports |
| Online Access: | https://doi.org/10.1177/23247096211019559 |
| _version_ | 1831630251991498752 |
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| author | Ayman R. Fath MD Amro Aglan MBChB Kyle S. Varkoly BS Abdullah S. Eldaly MBChB Roxana N. Beladi BA Arnold Forlemu MD Nawfal Mihyawi MD Anup Solsi MD Sharjeel Israr MD Alexandra R. Lucas MD, FRCP |
| author_facet | Ayman R. Fath MD Amro Aglan MBChB Kyle S. Varkoly BS Abdullah S. Eldaly MBChB Roxana N. Beladi BA Arnold Forlemu MD Nawfal Mihyawi MD Anup Solsi MD Sharjeel Israr MD Alexandra R. Lucas MD, FRCP |
| author_sort | Ayman R. Fath MD |
| collection | DOAJ |
| description | In this article, we report a case of a 61-year-old male who was diagnosed with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), presenting with acute respiratory distress syndrome requiring intubation and hemodynamic support, marked D-Dimer and troponin I elevation, worsening ST-elevation myocardial infarction on repeat electrocardiograms, and a negative coronary angiogram ruling out a coronary artery thrombosis or occlusion. With worsening diffuse ST-segment elevation on electrocardiograms and reduced ejection fraction on echocardiography in the setting of systemic inflammation, fulminant myocarditis was highly suspected. Despite optimal medical treatment, the patient’s condition deteriorated and was complicated by cardiac arrest that failed resuscitation. Although myocarditis was initially suspected, the autopsy revealed no evidence of myocarditis or pericarditis but did demonstrate multiple microscopic sites of myocardial ischemia together with thrombi in the left atrium and pulmonary vasculature. Additionally, scattered microscopic cardiomyocyte necrosis with pathological diagnosis of small vessel micro-thrombotic occlusions. These findings are potentially exacerbated by inflammation-induced coagulopathy, hypoxia, hypotension, and stress, that is, a multifactorial etiology. Further research and an improved understanding are needed to define the precise pathophysiology of the coagulopathic state causing widespread micro-thrombosis with subsequent myocardial and pulmonary injury. |
| first_indexed | 2024-12-19T02:15:28Z |
| format | Article |
| id | doaj.art-6c62c426e1634b9d9bdeae590cde8c9d |
| institution | Directory Open Access Journal |
| issn | 2324-7096 |
| language | English |
| last_indexed | 2024-12-19T02:15:28Z |
| publishDate | 2021-05-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Journal of Investigative Medicine High Impact Case Reports |
| spelling | doaj.art-6c62c426e1634b9d9bdeae590cde8c9d2022-12-21T20:40:27ZengSAGE PublishingJournal of Investigative Medicine High Impact Case Reports2324-70962021-05-01910.1177/23247096211019559Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19Ayman R. Fath MD0Amro Aglan MBChB1Kyle S. Varkoly BS2Abdullah S. Eldaly MBChB3Roxana N. Beladi BA4Arnold Forlemu MD5Nawfal Mihyawi MD6Anup Solsi MD7Sharjeel Israr MD8Alexandra R. Lucas MD, FRCP9Creighton University, Phoenix, AZ, USABeth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USAKansas City University, Joplin, MO, USATanta University Hospitals, Tanta, EgyptKansas City University, Joplin, MO, USACreighton University, Phoenix, AZ, USACreighton University, Phoenix, AZ, USACreighton University, Phoenix, AZ, USACreighton University, Phoenix, AZ, USAArizona State University, Tempe, AZ, USAIn this article, we report a case of a 61-year-old male who was diagnosed with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), presenting with acute respiratory distress syndrome requiring intubation and hemodynamic support, marked D-Dimer and troponin I elevation, worsening ST-elevation myocardial infarction on repeat electrocardiograms, and a negative coronary angiogram ruling out a coronary artery thrombosis or occlusion. With worsening diffuse ST-segment elevation on electrocardiograms and reduced ejection fraction on echocardiography in the setting of systemic inflammation, fulminant myocarditis was highly suspected. Despite optimal medical treatment, the patient’s condition deteriorated and was complicated by cardiac arrest that failed resuscitation. Although myocarditis was initially suspected, the autopsy revealed no evidence of myocarditis or pericarditis but did demonstrate multiple microscopic sites of myocardial ischemia together with thrombi in the left atrium and pulmonary vasculature. Additionally, scattered microscopic cardiomyocyte necrosis with pathological diagnosis of small vessel micro-thrombotic occlusions. These findings are potentially exacerbated by inflammation-induced coagulopathy, hypoxia, hypotension, and stress, that is, a multifactorial etiology. Further research and an improved understanding are needed to define the precise pathophysiology of the coagulopathic state causing widespread micro-thrombosis with subsequent myocardial and pulmonary injury.https://doi.org/10.1177/23247096211019559 |
| spellingShingle | Ayman R. Fath MD Amro Aglan MBChB Kyle S. Varkoly BS Abdullah S. Eldaly MBChB Roxana N. Beladi BA Arnold Forlemu MD Nawfal Mihyawi MD Anup Solsi MD Sharjeel Israr MD Alexandra R. Lucas MD, FRCP Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19 Journal of Investigative Medicine High Impact Case Reports |
| title | Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19 |
| title_full | Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19 |
| title_fullStr | Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19 |
| title_full_unstemmed | Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19 |
| title_short | Distinct Coagulopathy With Myocardial Injury and Pulmonary Embolism in COVID-19 |
| title_sort | distinct coagulopathy with myocardial injury and pulmonary embolism in covid 19 |
| url | https://doi.org/10.1177/23247096211019559 |
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