Successful treatment of acute heart failure in COVID-19-induced cytokine storm with tocilizumab: a case report

Figures

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  Figure 1. Non-contrast chest computed tomography scan demonstrating bilateral ground-glass opacities.

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  Figure 2. Electrocardiogram before and after new-onset acute decompensated heart failure. (A) Electrocardiogram before development of acute decompensated heart failure showing sinus rhythm with premature supraventricular complexes. (B) Electrocardiogram during cardiogenic shock showing sinus tachycardia with T-wave inversion in V1–V3 and a shift in the QRS axis compared with the earlier study.

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  Figure 3. Transthoracic echocardiography two-dimensional images during acute biventricular heart failure and 2 days after treatment with tocilizumab, dobutamine, norepinephrine, vasopressin, and inhaled epoprostenol. (A) Transthoracic echocardiography apical four-chamber view: severe global right ventricular and left ventricular hypokinesis with paradoxical septal motion and left ventricular ejection fraction of 25%. (B) Transthoracic echocardiography parasternal long-axis view 2 days after tocilizumab administration: complete recovery of left ventricular systolic function with ejection fraction of 64%, grade 2 diastolic dysfunction, and small circumferential pericardial effusion. (C) Transthoracic echocardiography apical four-chamber view 2 days after tocilizumab administration: mild right ventricular systolic dysfunction, much improved from the prior study.

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  Figure 4. Inflammatory markers at baseline and after administration of tocilizumab for COVID-19-induced cytokine storm.

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