Cardiac sequelae of novel coronavirus disease 2019 (COVID-19): a clinical case series

Abstract

Background COVID-19 caused by severe acute respiratory syndrome coronavirus 2 most commonly manifests with fever and respiratory illness. The cardiovascular manifestations have become more prevalent but can potentially go unrecognized. We look to describe cardiac manifestations in three patients with COVID-19 using cardiac enzymes, electrocardiograms, and echocardiography. Case summaries The first patient, a 67-year-old Caucasian female with non-ischaemic dilated cardiomyopathy, presented with dyspnoea on exertion and orthopnoea 1 week after testing positive for COVID-19. Echocardiogram revealed large pericardial effusion with findings consistent with tamponade. A pericardial drain was placed, and fluid studies were consistent with viral pericarditis, treated with colchicine, hydroxychloroquine, and methylprednisolone. Follow-up echocardiograms showed apical hypokinesis, that later resolved, consistent with Takotsubo syndrome. The second patient, a 46-year-old African American male with obesity and type 2 diabetes mellitus presented with fevers, cough, and dyspnoea due to COVID-19. Clinical course was complicated with pulseless electrical activity arrest; he was found to have D-dimer and troponin elevation, and inferior wall ST elevation on ECG concerning for STEMI due to microemboli. The patient succumbed to the illness. The third patient, a 76-year-old African American female with hypertension, presented with diarrhoea, fever, and myalgia, and was found to be COVID-19 positive. Clinical course was complicated, with acute troponin elevation, decreased cardiac index, and severe hypokinesis of the basilar wall suggestive of reverse Takotsubo syndrome. The cardiac index improved after pronation and non-STEMI therapy; however, the patient expired due to worsening respiratory status. Discussion These case reports demonstrate cardiovascular manifestations of COVID-19 that required monitoring and urgent intervention.

Clinical sequelae of COVID-19 survivors in Wuhan, China: a single-centre longitudinal study

“… Data are shown as n (%). P values were calculated by χ 2 test, or Fisher’s exact test, as appropriate. …”

“… Data are n (%) or median (interquartile range, IQR). p values were calculated by Mann-Whitney U test, χ 2 test, or Fisher’s exact test, as appropriate. …”

“…Continuous and categorical variables are presented as the median (IQR) and n (%), respectively. We used the χ 2 test or Fisher’s exact test to compare differences between the survivor cohort and the comparison group where appropriate. We used the Mann-Whitney U test, χ 2 test, or Fisher’s exact test to compare differences between patients with and without sequelae where appropriate.…”

“…We used the χ 2 test or Fisher’s exact test to compare differences between the survivor cohort and the comparison group where appropriate. We used the Mann-Whitney U test, χ 2 test, or Fisher’s exact test to compare differences between patients with and without sequelae where appropriate. To explore the risk factors associated with the occurrence of sequelae, multivariable logistic regression models were used.…”

“…There were also a large number of patients who had been cured and discharged from the hospital, and the follow-up time of COVID-19 survivors from China was longer than those in other countries around the world 1 . Early clinical sequelae associated with COVID-19, such as cardiac sequelae, are known to exist in some survivors 2 . The clinical characteristics, treatment and prognosis of COVID-19 have been extensively studied; however the prevalence, nature, duration and related factors of sequelae in convalescent COVID-19 survivors have not been studied 3 , 4 , 5 .…”