Critical Management of Haemodynamically Unstable Acute Pulmonary Embolism in COVID-19
Thrombotic events occur in up to one-third of patients with COVID-19, predominantly manifesting as pulmonary emboli (PE), which are associated with higher morbidity and mortality. Acute PE should therefore be one of the main differential diagnoses of COVID-19 patients who develop hemodynamic instab...
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| Format: | Article |
| Language: | English |
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Interna Publishing
2025-01-01
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| Series: | Acta Medica Indonesiana |
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| Online Access: | http://www.actamedindones.org/index.php/ijim/article/view/2414 |
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| author | Eka Adip Pradipta Vienna Rossimarina Indira Kemalasari Siska Suridanda Danny |
| author_facet | Eka Adip Pradipta Vienna Rossimarina Indira Kemalasari Siska Suridanda Danny |
| author_sort | Eka Adip Pradipta |
| collection | DOAJ |
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Thrombotic events occur in up to one-third of patients with COVID-19, predominantly manifesting as pulmonary emboli (PE), which are associated with higher morbidity and mortality. Acute PE should therefore be one of the main differential diagnoses of COVID-19 patients who develop hemodynamic instability. Early systemic thrombolysis remains the first line of treatment for hemodynamically unstable PE in those infected with COVID-19, particularly considering the risks of infection to other personnel during catheter-directed thrombolysis procedures. This report aims to describe a typical case of hemodynamically unstable acute PE with COVID-19 management in our center. A 66-year-old male presented to ER with shortness of breath and desaturation was suspected of having COVID-19. Despite unremarkable physical examination, he was later confirmed to be COVID-19 positive. While in the isolation ward, he experienced a cardiac arrest. 12-lead ECG showed sign of right ventricular strain and subsequently bedside echocardiography showed a fresh thrombus in the right atria with signs of acute right ventricular dysfunction. The diagnosis of acute PE with hemodynamic instability was made, and systemic thrombolysis was immediately initiated. Despite the bleeding complication, his symptoms and hemodynamic improved and he was discharged safely with oral anticoagulant. Our case demonstrates how early recognition and prompt treatment of acute PE especially in COVID-19 patients with hemodynamic instability, can be life saving. Recognizing the subtle signs of acute PE during emergency improves patients outcome considerably.
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| format | Article |
| id | doaj-art-d1658fe3b0f2409a94df7734efe0be9c |
| institution | Kabale University |
| issn | 0125-9326 2338-2732 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Interna Publishing |
| record_format | Article |
| series | Acta Medica Indonesiana |
| spelling | doaj-art-d1658fe3b0f2409a94df7734efe0be9c2025-08-20T03:50:00ZengInterna PublishingActa Medica Indonesiana0125-93262338-27322025-01-01564Critical Management of Haemodynamically Unstable Acute Pulmonary Embolism in COVID-19Eka Adip Pradipta0Vienna Rossimarina1Indira Kemalasari2Siska Suridanda Danny3Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, IndonesiaDepartment of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, IndonesiaDepartment of Internal Medicine, Harapan Kita National Cardiovascular Center, Jakarta, IndonesiaDepartment of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia - Harapan Kita National Cardiovascular Center, Jakarta, Indonesia Thrombotic events occur in up to one-third of patients with COVID-19, predominantly manifesting as pulmonary emboli (PE), which are associated with higher morbidity and mortality. Acute PE should therefore be one of the main differential diagnoses of COVID-19 patients who develop hemodynamic instability. Early systemic thrombolysis remains the first line of treatment for hemodynamically unstable PE in those infected with COVID-19, particularly considering the risks of infection to other personnel during catheter-directed thrombolysis procedures. This report aims to describe a typical case of hemodynamically unstable acute PE with COVID-19 management in our center. A 66-year-old male presented to ER with shortness of breath and desaturation was suspected of having COVID-19. Despite unremarkable physical examination, he was later confirmed to be COVID-19 positive. While in the isolation ward, he experienced a cardiac arrest. 12-lead ECG showed sign of right ventricular strain and subsequently bedside echocardiography showed a fresh thrombus in the right atria with signs of acute right ventricular dysfunction. The diagnosis of acute PE with hemodynamic instability was made, and systemic thrombolysis was immediately initiated. Despite the bleeding complication, his symptoms and hemodynamic improved and he was discharged safely with oral anticoagulant. Our case demonstrates how early recognition and prompt treatment of acute PE especially in COVID-19 patients with hemodynamic instability, can be life saving. Recognizing the subtle signs of acute PE during emergency improves patients outcome considerably. http://www.actamedindones.org/index.php/ijim/article/view/2414hemodynamic instabilitypulmonary embolismcoronavirus disease 2019 |
| spellingShingle | Eka Adip Pradipta Vienna Rossimarina Indira Kemalasari Siska Suridanda Danny Critical Management of Haemodynamically Unstable Acute Pulmonary Embolism in COVID-19 Acta Medica Indonesiana hemodynamic instability pulmonary embolism coronavirus disease 2019 |
| title | Critical Management of Haemodynamically Unstable Acute Pulmonary Embolism in COVID-19 |
| title_full | Critical Management of Haemodynamically Unstable Acute Pulmonary Embolism in COVID-19 |
| title_fullStr | Critical Management of Haemodynamically Unstable Acute Pulmonary Embolism in COVID-19 |
| title_full_unstemmed | Critical Management of Haemodynamically Unstable Acute Pulmonary Embolism in COVID-19 |
| title_short | Critical Management of Haemodynamically Unstable Acute Pulmonary Embolism in COVID-19 |
| title_sort | critical management of haemodynamically unstable acute pulmonary embolism in covid 19 |
| topic | hemodynamic instability pulmonary embolism coronavirus disease 2019 |
| url | http://www.actamedindones.org/index.php/ijim/article/view/2414 |
| work_keys_str_mv | AT ekaadippradipta criticalmanagementofhaemodynamicallyunstableacutepulmonaryembolismincovid19 AT viennarossimarina criticalmanagementofhaemodynamicallyunstableacutepulmonaryembolismincovid19 AT indirakemalasari criticalmanagementofhaemodynamicallyunstableacutepulmonaryembolismincovid19 AT siskasuridandadanny criticalmanagementofhaemodynamicallyunstableacutepulmonaryembolismincovid19 |