SUDDEN CARDIAC DEATH AND THE PECULIAR COVID-19 CASE

Abstract

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: The COVID-19 pandemic has left the medical community floundering for answers as patients present with a variety of symptoms, at different stages of the infection. As the outbreak spread, the public was made aware of the range of symptoms associated with SARS-COV-2. Respiratory symptoms of dry cough and shortness of breath, Gastrointestinal symptoms such as nausea, vomiting, and even more vague signs such as Anosmia have been observed. Our case further highlights the devastating outcomes and the multi systemic involvement, the difficulty of false-negative testing on these patients, the associated hyper-coagulability causing multi-organ dysfunction. CASE PRESENTATION: Healthy 32-year-old gentleman presented with nausea, non-bloody emesis, epigastric pain, and poor oral intake of 6 days duration. Patient also reported shortness of breath and cough productive of yellow sputum for the past 2 day. He denied any sick contacts and initial real-time PCR COVID testing in ED was negative. On admission, patient was comfortable on room air, with tachycardia. lab findings significant for elevated lactate, Procalcitonin, and LFTs. CT abdomen w/o contrast revealed bilateral pleural effusions and ground glass opacities. Upon transfer to medical floors, rapid response was called for hypotension. Initially, patient was alert, oriented, and in no acute distress. Shortly thereafter, he began to gasp for air and complain of chest pain. pulse-oximetry decreased to 75% and patient became unresponsive, without a pulse. Cardiopulmonary resuscitation was initiated promptly per ACLS protocol. reversible causes including tension pneumothorax, cardiac tamponade, and electrolyte/metabolic disturbances were ruled out. The course of illness and clinical features were highly suggestive of acute massive pulmonary embolism, and intravenous TPA was administered. Thrombectomy was considered, however it was determined that it would not change the outcome. After 64 minutes of resuscitation and 21 doses of epinephrine, the efforts came to a halt and patient was pronounced dead. A repeat swab for COVID-19 was taken and later reported as positive. DISCUSSION: This puzzling case displays a rapid deterioration of a COVID-19 related complication. The infection creates a diagnostic dilemma due to the myriad of associated symptoms and multi-system involvement as well as the False-negative testing which may alter the course of management and admission criteria. Hypercoagulability triad is seen with lack of mobility, systemic inflammatory response, and endothelial invasion by SARS-CoV-2 causing endothelial damage. This phenomena may be the underlying cause of the systemic involvement. CONCLUSIONS: Although COVID-19 infection is widely viewed as a respiratory infection, it's crucial to recognize the multi-systemic involvement and array of symptoms. Reliable testing may possibly alter medical management, improve outcome, and reduce exposure. Reference #1: Magro C. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Translational research : the journal of laboratory and clinical medicine. 04/2020. Doi 10.1016/j.trsl.2020.04.007. Reference #2: Panigada M. Hypercoagulability of COVID-19 patients in intensive care unit. A report of thromboelastography findings and other parameters of hemostasis. Journal of thrombosis and haemostasis. 04/2020. doi: 10.1111/jth.14850. DISCLOSURES: No relevant relationships by Padmini Giri, source=Web Response No relevant relationships by Verisha Khanam, source=Web Response No relevant relationships by Sarwan Kumar, source=Web Response No relevant relationships by DANYAL TAHERI ABKOUH, source=Web Response No relevant relationships by Jurgena Tusha, source=Web Response