open access

Ahead of Print
Case report
Published online: 2021-05-25
Submitted: 2021-04-14
Accepted: 2021-05-20
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Unusual echocardiographic evidence of hypercoagulation in usual left atrium appendage as the first and only sign of COVID-19

M. Świątczak, R. Nowak, A. Faran, E. Wabich, G. Raczak, M. Klimkiewicz, L. Daniłowicz-Szymanowicz
DOI: 10.5603/FM.a2021.0059
·
Pubmed: 34060640

open access

Ahead of Print
CASE REPORTS
Published online: 2021-05-25
Submitted: 2021-04-14
Accepted: 2021-05-20

Abstract

Coronavirus disease (COVID-19) is a condition caused by a novel virus, SARS-CoV-2. The disease's course ranges from entirely asymptomatic to severely ill patients. Hypercoagulation is often a complication of this disease, worsening the prognosis, which is extremely important in patients at higher risk of thromboembolic events, such as atrial fibrillation (AF), where thrombus formation in the left atrial appendage (LAA) is frequent. LAA could be of various sizes, volumes, and shapes, distinguish several morphologies, from which the WindSock LAA is the most frequent. In contrast, thromboembolic complications occur most frequently in patients with AF and the Cactus LAA. We present a clinical case of a 70-year-old woman with an initial negative RT-PCR test for SARS-CoV-2, suspicion of device-related infection after dual pacemaker implantation, AF, and LAA without thrombus in the initial transoesophageal echocardiography (TEE). Despite apixaban treatment, spontaneous restoration of sinus rhythm, and WindSock LAA morphology, the sludge in LAA was diagnosed in control TEE. The patient did not present any typical clinical COVID-19 symptoms but re-checked the RT-PCR test for SARS-CoV-2 infection was positive. The described case presents echocardiographic evidence of hypercoagulation as the first and only feature of SARS-CoV-2 condition besides the usual morphological presentation of the WindSock LAA.

Abstract

Coronavirus disease (COVID-19) is a condition caused by a novel virus, SARS-CoV-2. The disease's course ranges from entirely asymptomatic to severely ill patients. Hypercoagulation is often a complication of this disease, worsening the prognosis, which is extremely important in patients at higher risk of thromboembolic events, such as atrial fibrillation (AF), where thrombus formation in the left atrial appendage (LAA) is frequent. LAA could be of various sizes, volumes, and shapes, distinguish several morphologies, from which the WindSock LAA is the most frequent. In contrast, thromboembolic complications occur most frequently in patients with AF and the Cactus LAA. We present a clinical case of a 70-year-old woman with an initial negative RT-PCR test for SARS-CoV-2, suspicion of device-related infection after dual pacemaker implantation, AF, and LAA without thrombus in the initial transoesophageal echocardiography (TEE). Despite apixaban treatment, spontaneous restoration of sinus rhythm, and WindSock LAA morphology, the sludge in LAA was diagnosed in control TEE. The patient did not present any typical clinical COVID-19 symptoms but re-checked the RT-PCR test for SARS-CoV-2 infection was positive. The described case presents echocardiographic evidence of hypercoagulation as the first and only feature of SARS-CoV-2 condition besides the usual morphological presentation of the WindSock LAA.

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Keywords

COVID-19, SARS-CoV-2, coronavirus, atrial fibrillation, left atrial appendage

About this article
Title

Unusual echocardiographic evidence of hypercoagulation in usual left atrium appendage as the first and only sign of COVID-19

Journal

Folia Morphologica

Issue

Ahead of Print

Article type

Case report

Published online

2021-05-25

DOI

10.5603/FM.a2021.0059

Pubmed

34060640

Keywords

COVID-19
SARS-CoV-2
coronavirus
atrial fibrillation
left atrial appendage

Authors

M. Świątczak
R. Nowak
A. Faran
E. Wabich
G. Raczak
M. Klimkiewicz
L. Daniłowicz-Szymanowicz

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