Pulmonary thromboembolism and pericardial effusion as cardiovascular complications of COVID–19 infection

Systemic activation of coagulation and pulmonary thrombo-inflammation with local vascular damage caused by SARS-CoV-2 infection increases the risk of developing thromboembolic complications: stroke, pulmonary arterial thrombosis (pulmonary thromboembolism) and deep vein thrombosis Myopericarditis may occurs in COVID-19 patients as part of or after the onset of respiratory symptoms Minor pericardial effusions up to 1 cm that accompany pericardial involvement are common In our patient during hospitalization due to bilateral pneumonia caused by SARS-Cov-2 virus during a routine control of D-dimer, elevated values 2 3 fold higher than the reference range were observed, with elevated biomarkers of inflammation She had symptoms of a respiratory infection and no pronounced clinical symptoms that would indicate pulmonary thromboembolism MSCT pulmonary angiography was performed and low-risk thromboembolism was confirmed Anticoagulant therapy was started - therapeutic doses of low molecular weight heparin (enoxaparin), which was extended after discharge from the hospital with DOAC (Rivaroxaban) according to the protocol for the treatment of pulmonary thromboembolism At the control examination after 3 weeks, pericarditis with moderate pericardial effusion was determined Anticoagulant therapy (DOAC) was extended with the inclusion of colchicine in the therapy according to the protocol for the treatment of pericarditis with effusion After 3 months of hospitalization in our patient with mild respiratory symptoms, bronchopneumonia of the right lung developed with slightly elevated biomarkers of inflammation and normal values of D-dimer With prescribed antibiotic therapy and current therapy (DOAC and colchicine), there was a withdrawal of symptoms and regression of pericardial effusion and a reduction in right ventricular overload At the follow-up examination 5 months after hospitalization, complete regression of pericardial effusion was confirmed with normal biomarkers of inflammation and D-dimer values It is advisable to exclude anticoagulant therapy (DOAC) with continued low-dose aspirin therapy (English) [ABSTRACT FROM AUTHOR] Sistemska aktivacija koagulacije i pulmonalna trombo-inflamacija sa lokalnim vaskularnim ostecenjem uzrokovanim SARS-CoV-2 infekcijom povecava rizik za razvoj tromboembolijskih komplikacija: insulta, plucne arterijske tromboze (plucna tromboembolija) i duboke venske tromboze (venski tromboembolizam) Mioperikarditis se kod COVID-19 pacijenata može javiti u sklopu ili posle pojave respiratornih simptoma Ceste su manje perikardne efuzije do 1cm koje prate zahvacenost perikarda Kod nase pacijentkinje tokom hospitalizacije zbog obostrane upale pluca izazvane SARS-Cov-2 virusom tokom rutinske kontrole D-dimera uocene su povisene vrednosti 2 3 puta vece od referentnog opsega, uz povisene biomarkere inflamacije Imala je simptome respiratorne infekcije, a bez izražene klinicke simptomatologije koja bi ukazivala na plucnu tromboemboliju Urađena je MSCT pulmoangiografija i potvrđena je tromboembolija niskog stepena rizika Zapoceta je antikoagulantna terapija– terapijske doze niskomolekularnog heparina (enoxaparin), koja je produžena nakon otpusta iz bolnice sa DOAC (Rivaroxaban) prema protokolu za lecenje plucne tromboembolije Na kontrolnom pregledu nakon 3 nedelje utvrđen je perikarditis sa perikardnom efuzijom umerenog stepena Produžena je antikoagulantna terapija (DOAC) uz ukljucenje colchicin-a u terapiju prema protokolu za lecenje perikarditisa sa efuzijom Nakon 3 meseca od hospitalizacije kod nase pacijentkinje uz blažu respiratornu simptomatologiju doslo je do razvoja bronhopneumonije desnog plucnog krila uz lako povisene biomarkere zapaljenja i uredne vrednosti D- dimera Uz ordiniranu antibiotsku terapiju i tekucu terapiju (DOAC i colchicine) doslo je do povlacenja simptoma i regresije perikardne efuzije i smanjenja opterecenja desne komore Na kontrolnom pregledu nakon 5 meseci od hospitalizacije potvrđena je kompletna regresija perikardne efuzije uz uredne biomarkere zapaljenja i vrednosti D-dimera Savetovano je iskljucenje antikoagulantne terapije (DOAC) uz nastavak terapije malim dozama aspirina (Bosnian) [ABSTRACT FROM AUTHOR] Copyright of Medicinski Glasnik / Medical Gazette is the property of Specijalna bolnica za bolesti stitaste zlezde i bolesti metabolizma Zlatibor and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )