Incidental RV dysfunction and pulmonary hypertension in a patient with Covid-19
This protocol is extracted from research article:
Pulmonary thrombosis in Covid-19: before, during and after hospital admission
J Thromb Thrombolysis, Jan 1, 2021; DOI: 10.1007/s11239-020-02370-7

Of note, RV dysfunction and pre-capillary pulmonary hypertension was also observed as incidental finding in a Covid-19 patient. A 53-year-old woman, SARS-CoV-2 positive, was admitted and treated with high flow oxygen and oxygen requirements improved the following week. On day seven, she complained of non-pleuritic chest pain and increased breathlessness. Electrocardiogram showed new widespread T wave inversion and Troponin-T rose from 16 to 38 ng/l. CTPA was performed and showed no evidence of PE, but widespread consolidation in all lobes, and RV dilatation (RV/LV ratio 1.2/1). A diagnosis of non-ST segment elevation myocardial infarction was made. Coronary angiogram demonstrated a 70% proximal left anterior descending artery stenosis, treated with a percutaneous coronary intervention.

In view of her RV dilation, right heart catheterisation was performed. Pulmonary artery systolic/diastolic pulmonary pressures were 55/25 mmHg respectively, mean pulmonary arterial pressure was 36 mmHg, with a pulmonary capillary wedge pressure of 11 mmHg, a cardiac index of 1.6 L/min/m2, and a pulmonary vascular resistance of 10 Wood Units.

In this case, extensive lung disease, causing microvascular thrombosis or hypoxaemia, leading to pulmonary hypertension and secondary right heart strain, is the most likely explanation for the observed RV dilatation.

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