Pulmonary embolism in COVID-19. When nothing is what it seems

Observations on echocardiographic findings in patients with COVID-19

“…Our study corroborates with other literature which suggests that elevated PASP was related to morbidity (32). A case series also noted elevated PASP in their patients, which could be explained by pulmonary hypertension or recurrent pulmonary-embolic disease (37,40). High PASP relates to pulmonary hypertension, whether underlying or as a consequent result of SARS-CoV-2-related lung injury, pulmonary hypercoagulable state or cardiomyopathy, confers signi cant mortality and morbidity (41,42).…”

Acute Right Ventricular Dysfunction in a Critically Ill Patient with COVID-19

“…Patients with SARS-CoV-2 infection are thought to be at a lower risk for ACP because of blunted hypoxic pulmonary vasoconstriction and higher lung compliance. 14 However, a recent case series reported the presence of ACP in critically patients with COVID-19 with increased risk for cardiac arrest and mortality. 15 It is plausible that the combination of thromboembolism, viral myocardial injury, and high transpulmonary pressure from severe ARDS could place a subgroup of patients with SARS-CoV-2 infection at an increased risk for RV dysfunction; however, the true prevalence of ACP in hospitalized patients with SARS-CoV-2 infection is unknown.…”

ST segment elevation in COVID-19-related pulmonary embolism

“…When ST segment elevation occurs in a patient with COVID-19 infection clinicians must be vigilant for the possibility that the underlying cause may either be AMI, PE, or the association of AMI and PE. Persistent hypotension [4], and persistent hypoxemia should also raise the index of suspicion for PE [5]. Point-of-care TTE should be routine practice in a patient with ST segment elevation, especially in the presence of either hypotension and/or persistent hypoxemia because those stigmata are also the hallmarks of life-threatening PE.…”

“…Point-of-care TTE should be routine practice in a patient with ST segment elevation, especially in the presence of either hypotension and/or persistent hypoxemia because those stigmata are also the hallmarks of life-threatening PE. TTE can be rewarding when it generates images that support the diagnosis of PE, thereby facilitating timely thrombolysis even in the absence of confirmatory CTPA [5]. The important cardiac implication is that, in the context of COVID-19 infection the differential diagnosis ST segment elevation encompasses, not only PE, but also coexistence of PE and AMI, coexistence of COVID-19 and TTC, and COVID-19-related myocarditis.…”

“…CT also showed diffuse bilateral ground glass opacities consistent with COVD-19 infection. The patient also tested positive for SARS-Cov-2 on reverse transcriptase polymerase chain reaction evaluation [5].…”