TY  - CHAP
M1  - Book, Section
TI  - COVID-19 and Valvular Heart Disease
A1  - Shrivastav, Rishi
A1  - Singh, Amandeep
A2  - Saad, Muhammad
A2  - Vittorio, Timothy J.
PY  - 2022
T2  - COVID-19 and the Heart: A Case-Based Pocket Guide
AB  - A  78-year-old  female  patient  with  history  of  type  2  diabetes  mellitus,  hypertension,  and  moderate  aortic  stenosis  (AS)  on  a  transthoracic  echocardiogram  (TTE)  done  1  year  ago  is  brought  to  a  New  York  City  hospital  with  fever,  fatigue,  cough,  and  worsening  dyspnea  in  April  2020.  On  arrival  the  patient  was  found  to  be  tachypneic,  hypoxic,  and  tachycardic.  Physical  examination  showed  an  elderly  female  responding  to  verbal  stimuli  but  in  distress  with  increased  work  of  breathing.  Respiratory  exam  revealed  intercostal  retractions  and  diffusely  coarse  breath  sounds  along  with  crackles  in  both  lung  fields.  Auscultatory  findings  consisted  of  tachycardia,  with  a  late  peaking  systolic  murmur  that  would  radiate  to  bilateral  carotid  arteries.  Abdomen  was  soft  and  nontender,  but  extremities  revealed  1+  pitting  edema  with  cold  extremities.  The  decision  was  made  to  intubate  the  patient  and  start  her  on  mechanical  ventilation.  Investigation  pursued  thereafter  showed  leukocytosis  of  21,000  with  predominant  neutrophilia  and  lymphopenia.  Metabolic  panel  revealed  elevated  blood,  urea,  nitrogen  (BUN)  and  creatinine  to  40  and  2.0,  respectively,  with  unknown  prior  baseline.  The  CO2  was  at  18,  but  the  electrolytes  were  normal.  A  portable  chest  X-ray  showed  diffuse  bilateral  interstitial  opacities  with  small  bilateral  pleural  effusions  concerning  for  bilateral  pneumonia  and  congestive  heart  failure.  Electrocardiogram  (ECG)  showed  sinus  tachycardia  with  voltage  criteria  of  left  ventricular  hypertrophy.  Patient  was  transferred  to  the  intensive  care  unit  (ICU)  where  she  was  put  in  airborne  precautions  for  concerns  of  COVID-19  disease.  Severe  acute  respiratory  syndrome  coronavirus  2  (SARS-CoV-2)  nasopharyngeal  swab  done  earlier  came  back  positive.  While  in  the  ICU  the  patient  was  found  to  be  hypotensive  and  started  on  norepinephrine  with  escalating  doses.  A  bedside  TTE  showed  a  hyperdynamic  left  ventricle  (LV)  with  turbulent  flow  across  the  aortic  valve.  Further  measurements  revealed  a  mean  gradient  of  50  mmHg,  peak  velocity  of  4.6  m/sec,  aortic  valve  area  of  0.90  cm2,  and  Doppler  velocity  index  (DVI)  of  0.20  consistent  with  severe  AS.  She  rapidly  deteriorated  and  eventually  passed  away  within  48  hours  of  her  initially  presentation.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/19
UR  - accessmedicine.mhmedical.com/content.aspx?aid=1183948469
ER  -