COVID-19 hastasının nadir bir prezentasyonu: Kardiyak tamponat
Kemal Emrecan Parsova, Levent Pay, Yusuf Oflu, Ramil Hacıyev, Göksel ÇinierDr.Siyami Ersek Göğüs, Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Kardiyoloji Bölümü, İstanbulSARS-CoV-2’nin neden olduğu Coronavirus hastalığı 2019 (COVID-19) sadece hafif grip benzeri semptomlardan ağır progresif pnömoniye kadar değişen geniş bir klinik prezentasyona sahiptir. Enfeksiyonun seyrinde miyokardit, akut miyokart enfarktüsü, kalp yetersizliği, kardiyak ritim bozukluklarını içeren kardiyak tutulum gözlenebilir; ama önceden COVID-19 tanısı almış çok nadir sayıda hastada kardiyak tamponat tanımlanmıştır. Elli sekiz yaşında kadın hasta iki hafta önce başka bir hastanede atipik pnömoni nedeniyle hastaneye yatırılmış. Nazofaringeal sürüntü incelemesinde COVID-19 pozitif saptanmış. Hasta komplikasyonsuz bir hospitalizasyon süreci geçirmiş ve bir hafta önce taburcu edilmiş. Hasta acil servisimize nefes darlığı ve bacaklarda şişme şikayeti ile geldi. Yatak başı yapılan transtorasik ekokardiyografide (TTE) global olarak azalmış sol ventrikül sistolik fonksiyonları ile birlikte ejeksiyon fraksiyonu (EF) %30 ve tüm kalbi çepeçevre saran ve diyastolik doluşta restriksiyona yol açan ciddi perikardiyal effüzyon görüldü. Hasta perikardiyal tamponat tanısı ile koroner yoğun bakım ünitesine (KYBU) kabul edildi. Yatakbaşı perikardiyosentez yapıldı ve serohemorajik sıvı drene edildi. COVID-19 enfeksiyonu olan hastalarda dispne gelişmesi veya dispnenin kötüleşmesi durumunda perikardiyal effüzyon ve perikardiyal tamponat ayırıcı tanıda düşünülmelidir
Anahtar Kelimeler: Kardiyak tamponat, COVID-19, perikardiyal effüzyon.A rare presentation of a patient with COVID-19: Cardiac tamponade
Kemal Emrecan Parsova, Levent Pay, Yusuf Oflu, Ramil Hacıyev, Göksel ÇinierDepartment of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, TurkeyThe clinical presentation of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2, can range from only mild, flu-like symptoms to severe progressive pneumonia. Cardiac involvement may be observed during the course of the infection and may include myocarditis, acute myocardial infarction, heart failure, and cardiac rhythm disturbances, but cases describing cardiac tamponade in patients previously diagnosed with COVID-19 are very rare. A 58-year-old female had been hospitalized in another hospital 2 weeks prior to the currently described presentation due to atypical pneumonia. A nasopharyngeal swab specimen was positive for COVID-19. The hospitalization was uncomplicated and she was discharged after a week. She presented at our emergency department with symptoms of shortness of breath and swelling in both legs. A bedside transthoracic echocardiography showed globally depressed left ventricular contraction with an ejection fraction of 30% and there was significant pericardial effusion, which surrounded the entire heart and restricted diastolic filling. The patient was admitted to the coronary intensive care unit with the diagnosis of pericardial tamponade. Bedside pericardiocentesis was performed and serohemorrhagic fluid was drained. Pericardial effusion and pericardial tamponade should be considered in the differential diagnosis of patients with COVID-19 exhibiting dyspnea or worsening of dyspnea. A 58-year-old female has been hospitalized in another hospital two weeks ago due to atypical pneumonia. Her nasopharyngeal swab specimen was positive for COVID-19. She had an uncomplicated course during the hospitalization and was discharged a week ago. She presented to our emergency department (ED) with symptoms of shortness of breath and swelling in both legs. We performed bedside transthoracic echocardiography (TTE) which showed globally depressed left ventricular contraction with ejection fraction (EF) of 30% and there was significant pericardial effusion which surrounded the entire heart and restricted diastolic filling. The patient was admitted to the coronary intensive care unit (CICU) with the diagnosis of pericardial tamponade. Bedside pericardiosentesis was performed and serohemorrhagic fluid was drained.
Patients with COVID-19 infection who develops or have worsening dyspnea, pericardial effusion and pericardial tamponade should be considered in differential diagnosis.
Sorumlu Yazar: Kemal Emrecan Parsova, Türkiye
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