Obstructive hypertrophic cardiomyopathy in association with chronic exudative pericarditis and COVID-19

• Olga V. Blagova
• Sedov A.V.
• Savina P.O.
• Senchikhin P.V.
• Pavlenko E.V.
• Vsevolod P. Sedov
• Volovchenko A.N.
• Parfenov D.A.
• Cherniavskii S.V.
• Tsyganov A.V.
• Korzh D.A.
• Martyanova Yu.B.
• Sergey L. Dzemeshkevich
• Natalia D. Sarkisova

Abstract

The problem of comorbidity in elderly cardiac patients includes combinations of not only widespread but also rarer diseases that significantly aggravate each other and require all modern treatment options.

Clinical case. We present a description of 2-year catamnesis of a 70-year old female patient suffering from obesity, hypertension, insulin-dependend diabetes, hyperuricemia with urolithiasis, systemic atherosclerosis, degenerative mitral and aortal stenosis, atrial fibrillation with cardiac pacemaker implantation, chronic heart failure, cerebral ischemia, chronic kidney disease, who was diagnosed obstructive hypertrophic cardiomyopathy at the age of 58 and pericardial effusion at the age of 69. The patient was first admitted to the clinic in April 2018 with pulmonary edema. Due to the marked obstruction at the level of the middle third of the left ventricle, alcohol ablation of the 1^st septal branch was performed in June. The gradient decreased from 78 to 15-30 mm Hg, but this did not lead to a marked decrease in dyspnea. At the same time the volume of pericardial effusion increased from 300 ml to 1 liter. In the first study of the item, PCR for the mycobacterium tuberculosis was positive, T-SPOT test was also positive. Repeated prescribing different tuberostatics were accompanied by mental retardation, an episode of sustained ventricular tachycardia. In July 2019, the ICD was implanted. The numerous appropriate shocks were detected, up to the electrical storm followed by a disseminated pulmonary lesion with respiratory failure in late 2019 (pulmonary embolism? tuberculosis? non-specific viral-bacterial pneumonia?). Due to the accumulation of serous hemorrhagic exudate in the pericardium (up to 2 liters maximum), three more punctures were performed. Repeated tests for tuberculosis were negative. In March 2020, 600 mg of triamcynolone was injected intrapericardially. In May 2020, she died from COVID-19 with bilateral pneumonia. The direct cause of death was cerebral infarction. No tumors or active pulmonary tuberculosis were detected in autopsy and no PCR was performed.

Conclusion. In spite of obviously severe combination of hypertrophic cardiomyopathy and pericarditis with polyorgan pathology, application of the whole arsenal of medication and interventional treatment allows prolonging life of patients and improving its quality. However, the risk of an unfavourable course of new coronavirus infection in such patients is extremely high.

Keywords:exudative pericarditis, obstructive hypertrophic cardiomyopathy, alcohol septal ablation, tuberculosis, ventricular tachycardia, cardioverter-defibrillator, COVID-19

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