TEN DAYS OF CHEST PAIN: A UNIQUE PRESENTATION OF COVID-19 AT A COMMUNITY HOSPITAL

Abstract

SESSION TITLE: Medical Student/Resident Chest Infections Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: There has been a global impact by the virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the relevant disease called coronavirus disease 2019 (COVID-19) that has affected thousands of lives.(1),(2) This case report highlights the uncommon presentation of a patient who tested positive for COVID-19. Around this time, our hospital's incidence of SARS-CoV-2 was 1 positive test result through our drive-through process.(3) CASE PRESENTATION: We present a case of a 49 year old male with no known medical history, other than obesity, who was found to have hypertension and diabetes based on a hemoglobin A1c drawn while hospitalized. The patient presented with worsening left sided chest pain at rest of about 10 days duration, slight bilateral frontal headache relieved by Tylenol, and occasional wheezing relieved by an inhaler. He denied dyspnea, cough, fevers, chills, recent travels or sick contacts. On physical examination, patient's lungs were clear with no wheezing appreciated. The EKG showed no acute findings, however, he did have positive high sensitivity troponins. His Nt-proBNP was mildly elevated at 494. During his hospitalization, he developed a fever of 100.4 Fahrenheit and several tests, including COVID-19, were sent. Influenza A&B and RSV were negative. He had a leukocyte count of 7,220, 18.7% lymphocytes, troponins of 25, 22, and 25, LDH of 252, CK of 649, and a ferritin level of 435. After there was resolution of symptoms, he was discharged home with instructions on isolation, proper hygiene, and to return if he developed any worsening or new symptoms, such as, chest pain, shortness of breath or unrelenting fevers. He was discharged with a prescription for aspirin 81 mg and was instructed to follow up with his outpatient primary medical team and cardiology team. Eventually, his COVID-19 test results returned positive. After discharge, he received daily follow-up calls from our medical team and COVID-19 isolation at home instructions were reinforced in our calls. DISCUSSION: There have been reports of varying cardiac presentations, such as, those "with cardiac predominant symptoms” and "those who seem to have secondary myocardial injury with globally elevated inflammatory biomarkers".(2) The nuance here was a fairly typical low-risk chest pain patient with uncontrolled hypertension, obesity, normal EKG, admitted for indeterminate high sensitivity troponins, who then spiked a fever raising our suspicion in the midst of the evolving COVID-19 outbreak. CONCLUSIONS: While it is crucial to maintain the common presentations of this disease, such as its affect on the respiratory, hepatic, neurological, and enteric systems presenting as fever, fatigue, dry cough, myalgia and shortness of breath as part of the triage criteria, we also believe it to be equally as important to keep in mind the uncommon presentations such as headache, sputum production, and chest pain.(2) Reference #1: 1. He F, Deng Y, Li W. Coronavirus disease 2019: What we know?. Journal of Medical Virology. Wiley Online Library. 2020. Reference #2: 2. Clerkin KJ, et.al. Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease. CIRCULATIONAHA. 2020. Reference #3: 3. NSMC QI department. 2020 DISCLOSURES: no disclosure on file for Allisa ALpert; No relevant relationships by Anneris Estevez, source=Web Response My spouse/partner as a Employee relationship with Agamatrix, Inc. Please note: >$100000 Added 04/07/2020 by Patrick Lee, source=Web Response, value=Salary