COVID-19 AND CARDIOVASCULAR COMPLICATIONS. AN INAUSPICIOUS COMBINATION

Abstract

Objective: The case report presents patient with COVID-19 history. Although the course of COVID-19 in most people is mild, most cases, including severe ones, mainly involve the respiratory system. In less common cases, association of SARS-CoV-2 infection with other systems, including cardiac, has been reported. Pericarditis is often associated with viral infection, mostly with Coxsackie B virus but it has been also reported as one of the rare cardiovascular manifestations of SARS-CoV-2 infection. Design and method: Case report of patient with COVID-19 and multiple comorbidities, including secondary hypertension and kidney transplantation. Observation of the symptoms suggested myocardial involvement in the course of SARS-CoV-2 infection and demanded further specialist treatment. Results: A 67-year-old female patient with secondary to chronic kidney disease hypertension, after kidney transplantation, with diabetes type 2 and many other comorbidities was admitted to the Department of Internal Medicine and Hypertension due to worsening of kidney function and COVID-19 infection, in a general bad condition with the shortness of breath and reduced exercise tolerance and low SatO2 - 79%. Chest angio-CT showed COVID-19 pneumonia and pericardial effusion. Echocardiography revealed severe left ventricular systolic failure with left ventricular ejection fraction 20%. Laboratory results showed a high level of inflammatory markers, creatinine and NT-pro-NBP as well as cardiac enzymes activation. The typical treatment was implemented. On the third day of hospitalization, a rapid attack of atrial fibrillation occurred. Attempted pharmacological cardioversion was unsuccessful. Due to respiratory failure, electrical cardioversion was rejected. Continuous intravenous infusion of amiodarone was introduced. The patient's condition deteriorated significantly. Myocardial involvement in the course of COVID-19 infection was suspected. The patient, in a serious general condition, was transferred to the Department of Cardiology and then to ICU where patient died. Conclusions: SARS-CoV-2 is mainly associated with the respiratory tract, but it also has multiple adverse effects on the cardiovascular system. Patients with many comorbidities, especially after organ transplantation on immunosuppression, are more likely to develop severe courses of the disease. This case highlights that although pericarditis is a rare cardiac complication of COVID-19, we should stay alerted about it.