The patient, a male patient, was 43 years old. Due to "chest pain, shortness of breath for more than 6 hours", he was admitted to our hospital. None of breath 6 hours before admission, Sudden chest pain on the walking hospital, Located behind the sternum, Persistent, pressing samples, The range is about a slap-sized, Blood pressure measurement: 82 / 50mmHg, To the static drip of dopamine, The ECG shows an uplift change in the ST segment, CK-MB 42.31ng/ml, cTnI 16.66ng/ml, Myo < 30.0ng/ml", Consider "acute myocardial infarction", "Polivine 300mg, aspirin 300mg, low molecular weight heparin 4250iu" and referral to our hospital emergency, Emergency coronary angiography was performed through a green channel, Coronary angiography was performed without any abnormality. Novel coronavirus infection for more than 20 days.Smoking for more than 20 years, an average of 20 cigarettes per day, did not quit smoking, no special rest. Physical examination on admission: blood pressure 90 / 53mmHg, pulse 101 times / minute, fingertip blood oxygen about 88–93%. Clear, a little wet rales can be heard in the left floor of the left lung, heart rate 101 times / min, heart rhythm, no third and fourth heart sounds, no pathological noise in the auscultation area of each valve, no pericardial friction sounds, and no abnormal signs. After admission: blood cell analysis: white blood cell count 17.25 (10 ^ 9 / L), Hemoglobin concentration of 124 (g / L); Blood biochemistry: total protein 61.1 (g / L), Creatine kinase 403 (U / L), Total bilirubin 1.6 (u mol/L), C-Reactive protein 7.65 (mg/L), Albumin, 36.6 (g / L), Creatine kinase Isozyme 66 (U / L), Lactate dehydrogenase 282 (U / L), Myoglobin 144.2 (ug / L), Troponin I 18.023 (ug / L), D dimer 1.11 (mg/L), Pro-BNP 4942pg/ml. All the other blood parameters were within the normal range. Chest CT: considering the possibility of interstitial pulmonary edema; admitted cardiac ultrasound: left atrial enlargement, segmental wall motion abnormalities, mitral regurgitation (mild); pericardial effusion (small), reduced left ventricular systolic function (EF: 40%); recommended review after treatment. Combined with the above history, physical examination and examination results, patients with young men, no basic history, will be coronavirus infection more than 20 days, before the onset of fever, symptoms of chest pain, elevated troponin, patients with blood pressure to maintain adrenaline, consider will be coronavirus infectious myocarditis, acute heart failure, cardiogenic shock, with respiratory failure, serious illness.
Into intensive care unit via endotracheal intubation, continuous ventilator assisted ventilation treatment, high-dose vascular active drugs pump to maintain blood pressure and heart rate, blood pressure is still unstable, respiratory failure, oliguria, limbs cold tissue low perfusion performance, consider patient myocardial edema, will be coronavirus infection myocarditis progression, accord with mechanical heart auxiliary indications. Decided to perform extracorporeal membrane lung (ECMO) V-A mode assistance. The arterial cannula (17 Fr) and venous cannula (21 Fr) were placed in the peripheral femoral artery and femoral vein, respectively, allowing drainage from the femoral vein and reflux to the femoral artery. The cardiopulmonary bypass was successfully established, and the patient was successfully connected to the ECMO machine. The ratio of blood flow and gas flow is 1:1, the rotation speed is 3000rpm, and the flow rate is 2.8-3.0 l. During the period of continuous ECMO assistance, Pro-BNP 11267 pg/ml, electrocardiogram indicated high atrioventricular block (see Fig. 2), reexamination of cardiac ultrasound showed no effective contraction, EF: 17%, no open aortic valve, aggravated pulmonary edema, and LV hypertension. In accordance with IABP indications, the IABP pacemaker was combined in a 1:1 ratio. The patient had continuous diuresis, obvious metabolic alkalosis, combined with bedside color ultrasound monitoring: the inferior vena cava was still full, and there were indications for bedside CRRT treatment. In order to optimize capacity and adjust the internal environment, CRRT treatment was received. According to the development of the patient's condition, With empirical anti-bacterial infection treatment with cefuroxime / piperacillin tazobactam / cefoperazone sulbactam / in combination with voriconazole plus compound sulfamethoxazole, Add β blockers according to blood pressure and heart rate, diuretic, Neoretin resistance against heart failure, Spironolactone discharges sodium, preserves potassium、improves cardiac remodeling7、and reduces pulmonary edema8, Blood pressure has leveled off, Regulation of immunity, With vitamin C, coenzyme Q10 / trimetazidine, Patient general condition, oxygenation and liver and kidney function, Cardiac enzymes, troponin became normal, Repeat cardiac color ultrasound: EF53%, Pro-BNP 495pg/ml, Improvement and discharged. After outpatient follow-up, the condition is stable.