新型冠状病毒肺炎合并心肌损伤1例

A Case of COVID-19 with Myocardial Injury

目的探讨新型冠状病毒肺炎(COVID-19)合并心肌损伤的临床诊治和发病机制。方法回顾分析1例COVID-19合并心肌损伤患者的临床资料。患者,女,45岁,经临床症状、CT表现、流行病学史、IgM和IgG阳性确诊为普通型COVID-19。否认心脏及呼吸系统疾病等病史。居家隔离22 d后出现突发高热(39.5℃),伴气促4 d住院治疗。入院第3天症状加重,极度呼吸困难,改为面罩高流量吸氧,并加强补液支持对症治疗;心肌酶提示肌钙、脑钠肽(BNP)明显升高,急诊床旁心脏彩超:左室后壁呈逆向运动,左室壁活动弥漫性减弱。考虑急性左心功能衰竭,紧急予呋塞米静注利尿、左西孟旦、激素冲击疗法(80 mg·d-1,连用3 d)等治疗。结果患者胸闷气促明显好转、体温恢复正常,可平卧,无明显胸闷气促,复查心肌酶、BNP等均恢复正常。住院27 d,达出院标准,转至隔离点观察。结论COVID-19患者多因累及肺脏导致呼吸窘迫,但急性心功能不全也可引发急性呼吸窘迫,其机制可能是因免疫反应失调,细胞因子风暴导致心肌功能受损。临床在关注患者肺脏损伤的同时,要考虑其他脏器受损的可能;完善心肌酶、BNP、心脏彩超等检查有助其鉴别诊断。

Objective To explore the clinical diagnosis,treatment and pathogenesis of COVID-19 complicated by myocardial injury.Methods Clinical data of a case of COVID-19 complicated by myocardial injury were analyzed retrospectively.The 45-year-old woman was diagnosed as having the common COVID-19 by clinical symptoms,CT findings,epidemiology,and positive IgM and IgG antibody detection.She denied any history of heart disease or respiratory disease.The patient was hospitalized after 22 days of isolation at home due to sudden high fever(39.5 ℃) with shortness of breath for 4 days.On the third day after admission,the patient was given high flow oxygen inhalation and strengthened fluid supplement because of worse symptoms and extremely severe dyspnea.However,serum levels of troponin I and brain natriuretic peptide(BNP) significantly increased,and transthoracic echocardiography showed reverse motion of the posterior wall of left ventricle and diffusely weakened activity of left ventricular wall.These findings suggested acute left heart failure.Therefore,furosemide,levosimendan and hormone percussion therapy(80 mg·d-1for successive 3 days) were urgently given in the patients.Results Chest tightness and breath shortness were obviously relieved and body temperature,myocardial enzymes and BNP returned to normal after treatment.After 27 days of hospital stay,the patient met the discharge standard and was converted to isolation for observation.Conclusion The COVID-19 can lead to respiratory distress due to lung involvement.However,acute heart failure can also cause respiratory distress,which may be involved in immune dysregulation and cytokine storm-caused cardiac impairment.In addition to lung injury,we should also consider the possibility of damage to other organs in COVID-19 patients.Furthermore,the improvement in myocardial enzyme and BNP determination and echocardiography is helpful for the differential diagnosis of COVID-19.