Obstructive hypertrophic cardiomyopathy in association with chronic exudative pericarditis and COVID-19
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 1st 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
Funding. The study had no sponsor support.
Conflict of interests. The authors declare no conflict of interests.
For citation: Blagova O.V., Sedov A.V., Savina P.O.,
Senchikhin P.V., Pavlenko E.V., Sedov V.P., Volovchenko A.N., Parfenov D.A.,
Cherniavskii S.V., Tsyganov A.V., Korzh D.A., Martyanova Yu.B., Dzemeshkevich
S.L., Sarkisova N.D. Obstructive hypertrophic cardiomyopathy in association
with chronic exudative pericarditis and COVID-19. Clinical and Experimental
Surgery. Petrovsky Journal. 2020; 8 (3): 95-109. DOI: https://doi.org/10.33029/2308-1198-2020-8-3-95-109 (in Russian)
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