Dr Arun Kochar discusses a case in this article, where a patient with a history of COVID-19 was presented with McConnell's sign. Here he describes how the diagnosis was done that led to the patient's recovery.

Case study

A young male of 39 years presented in ER with a history of diagnosed COVID-19 infection and cardiogenic shock.

Findings:

1. He had a history suggestive of COVID-19 infection about a week back.
2. His ECG revealed NSR with non-specific ST changes.
3. He was in hypotension and needed multiple drugs for inotropic support.
4. His D-Dimer and NT pro BNP values were grossly elevated.
5. His troponins were mildly elevated.
6. His echocardiography revealed evidence of dilated RA and RV with McConnell's sign.

Next steps:

This sign is a distinct echocardiographic feature of acute massive pulmonary embolism. The decision for thrombolysis was made on echocardiography alone. However, for records CT pulmonary angiography was performed, which revealed evidence of massive pulmonary embolism. 

He underwent urgent thrombolysis, following which gradual recovery in blood gas, blood pressure and hemodynamics were noted. The next day, he was off inotropic support and subsequently made an uneventful recovery.

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.
The author, Dr. Arun Kochar is a Senior Interventional Cardiologist practising in Mohali.