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   Table of Contents     
LETTERS TO EDITOR  
Year : 2021  |  Volume : 13  |  Issue : 4  |  Page : 200-201
Unexplained acute right ventricular dilatation and dysfunction in COVID-19


Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

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Date of Submission26-Aug-2021
Date of Acceptance23-Sep-2021
Date of Web Publication30-Nov-2021
 

How to cite this article:
Ezhilkugan G, Balamurugan N, Vivekanandan M, Ajai R, Dorje N. Unexplained acute right ventricular dilatation and dysfunction in COVID-19. J Global Infect Dis 2021;13:200-1

How to cite this URL:
Ezhilkugan G, Balamurugan N, Vivekanandan M, Ajai R, Dorje N. Unexplained acute right ventricular dilatation and dysfunction in COVID-19. J Global Infect Dis [serial online] 2021 [cited 2022 Jan 25];13:200-1. Available from: https://www.jgid.org/text.asp?2021/13/4/200/331574




Sir,

COVID-19 has a wide range of clinical presentations. The differential diagnosis of obstructive shock in patients with COVID-19 includes acute pulmonary embolism and acute cor pulmonale.

A 39-year-old nonsmoker male with no known comorbidities was tested to be COVID positive by RT-PCR 5 days after a contact history. He had an uneventful course with no hypoxia till day 18, when he developed sudden-onset breathlessness and presented to the emergency department. Electrocardiography showed sinus tachycardia with S1Q3T3 pattern. Point-of-care ultrasound (POCUS) revealed gross dilatation of the right atrium and ventricle with D-shaped left ventricle and bilateral B-profile; deep venous thrombosis screening of bilateral lower limbs revealed no thrombus. Computed tomography pulmonary angiogram revealed no pulmonary embolus. He had refractory hypotension and succumbed to his illness on day 3 of admission.

The various cardiovascular manifestations of COVID-19 can be broadly categorized into asymptomatic heart disease, myocardial injury, heart failure, cardiac arrhythmias, and vascular complications [Figure 1].[1],[2],[3]
Figure 1: Cardiovascular manifestations of COVID-19

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The right ventricle (RV) has been called the forgotten chamber historically. However, the importance of RV is increasingly being recognized. The COVID pandemic has further highlighted the importance of RV. The two major life-threatening causes for acute RV dysfunction in COVID-19 are acute pulmonary embolism and acute cor pulmonale. Acute pulmonary embolism is well-recognized; however, acute cor pulmonale is not well-recognized and is poorly understood. The proposed mechanisms for acute right ventricular dilatation and dysfunction in COVID-19 include hypoxemic vasoconstriction from acute respiratory distress syndrome (ARDS), negative inotropic effects of cytokines, and direct effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the right ventricle, through angiotensin-converting enzyme 2 (ACE2) mediated binding. In a study of 100 hospitalized patients, RV dilatation was the most common echocardiographic abnormality observed in COVID-19, and was the only echocardiographic finding significantly associated with mortality.[4],[5]

The diagnosis of acute cor pulmonale is based on bedside echocardiographic findings in such patients, implying the utility of point-of-care ultrasound (POCUS) performed by emergency physicians. Since the presence of acute cor pulmonale in COVID-19 patients has increased the risk of cardiac arrest and mortality, early recognition and its treatment may result in decreased mortality and improved patient outcomes.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Nishiga M, Wang DW, Han Y, Lewis DB, Wu JC. COVID-19 and cardiovascular disease: From basic mechanisms to clinical perspectives. Nat Rev Cardiol. 2020;17:543–58.  Back to cited text no. 1
    
2.
Shafi AMA, Shaikh SA, Shirke MM, Iddawela S, Harky A. Cardiac manifestations in COVID-19 patients—A systematic review. J Card Surg. 2020;35:1988–2008.  Back to cited text no. 2
    
3.
Creel-Bulos C, Hockstein M, Amin N, Melhem S, Truong A, Sharifpour M. Acute Cor Pulmonale in Critically Ill Patients with Covid-19. N Engl J Med. 2020;382:e70.  Back to cited text no. 3
    
4.
Szekely Y, Lichter Y, Taieb P, Banai A, Hochstadt A, Merdler I, et al. Spectrum of Cardiac Manifestations in COVID-19: A Systematic Echocardiographic Study. Circulation. 2020;142:342–53.  Back to cited text no. 4
    
5.
Argulian E, Sud K, Vogel B, Bohra C, Garg VP, Talebi S, et al. Right Ventricular Dilation in Hospitalized Patients With COVID-19 Infection. JACC Cardiovasc Imaging. 2020;13:2459–61.  Back to cited text no. 5
    

Top
Correspondence Address:
Prof. N Balamurugan
Department of Emergency Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), JIPMER Campus Road, Gorimedu, Dhanvantari Nagar, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jgid.jgid_240_21

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2008 Journal of Global Infectious Diseases | Published by Wolters Kluwer - Medknow
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