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- Title
Severe hypoxemia in a patient with right ventricular myocardial infarction and SARS-CoV-2 infection.
- Authors
Albuquerque, Francisco; Lopes, Pedro M.; Brízido, Catarina; Strong, Christopher; Andrade, Maria João; de Araújo Gonçalves, Pedro; Tralhão, António
- Abstract
<bold>Background: </bold>Refractory hypoxemia after right ventricular myocardial infarction and concomitant SARS-CoV-2 infection represents an uncommon, yet particularly challenging clinical scenario. We report a challenging diagnostic case of refractory hypoxemia due to right-to-left shunt highlighting contemporary challenges and pitfalls in acute cardiovascular care associated with the current COVID-19 pandemic.<bold>Case Presentation: </bold>A 52-year-old patient admitted for inferior acute myocardial infarction developed rapidly worsening hypoxemia shortly after primary percutaneous coronary intervention. RT-PCR screening for SARS-CoV-2 was positive, even though the patient had no prior symptoms. A computed tomography pulmonary angiogram excluded pulmonary embolism and showed only mild interstitial pulmonary involvement of the virus. Transthoracic echocardiogram showed severe right ventricular dysfunction and significant right-to-left shunt at the atrial level after agitated saline injection. Progressive improvement of right ventricular function allowed weaning from supplementary oxygen support. Patient was latter discharged with marked symptomatic improvement.<bold>Conclusion: </bold>Refractory hypoxemia after RV myocardial infarction should be carefully addressed, even in the setting of other more common and tempting diagnoses. After exclusion of usual etiologies, right-to-left shunting at the atrial level should always be suspected, as this may avoid unnecessary and sometimes harmful interventions.
- Publication
BMC Cardiovascular Disorders, 2022, Vol 22, Issue 1, p1
- ISSN
1471-2261
- Publication type
Article
- DOI
10.1186/s12872-022-02765-9