DIAGNOSTIC AND THERAPEUTIC CHALLENGES IN THE TREATMENT OF PATIENTS DURING THE COVID-19 EPIDEMIC
Abstract
Introduction: The beginning of December 2019 is considered to be the beginning of infection with the
new coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2 - SARS-CoV-2), in Wuhan, China,
better known among professionals as COVID-19 (Coronavirus Disease 2019 -COVID-19).
Case report: A 42-year-old male was referred for examination due to suspicion of COVID-19. According
to the patient, the symptoms started four days ago with nausea and cough, heavy breathing, and
fever. During the examination, the patient was pale, breathed with difficulty, subfebrile, tachycardic,
normotensive. A severe form of COVID 19 pneumonia was verified by the radiological examination.
Laboratory parameters indicated the infectious syndrome and heart failure. On the first day of
hospitalization, the general condition worsened: with the appearance of arrhythmia, then respiratory
deterioration. The therapeutic support was provided according to the COVID-19 protocol. On the
second day of hospitalization, the patient was intubated, followed by three-day mechanical ventilatory
support, vasopressor stimulation of hemodynamics, double stimulation of diuresis. All steps provided
vital parameter stabilization. Repeated Polymerase Chain Reaction (PCR) testing and bronchoalveolar
lavage (BAL) testing were negative. Repeated chest x-ray indicated the significant regression of findings.
A heart ultrasound was performed, which indicated a significantly reduced function of the left ventricle
in comparison to the previous examination. The patient had previous cardiac co-morbidities and the
cardiac surgeon gave an opinion and confirmed the need for surgical correction of aortic and mitral
valves disease with the previous treatment of the infection. Two months later, reconstructive cardiac
surgery was performed.
Conclusion: By presenting the clinical course of the disease, diagnostic, and therapeutic approach in
a patient with cardiovascular comorbidity, we wanted to point out the difficulties in recognizing the
clinical picture and diagnosing COVID-19.
References
Huang C, Wang Y, Li X, Ren Lili, Zhao J, Hu Y, et al.
Clinical features of patients infected with 2019 novel
coronavirus in Wuhan, China. Lancet 2020; 395:497–
WHO: Coronavirus disease (COVID-19) pandemic.
[Internet] Available at: https://www.who.int/
emergencies/diseases/novel-coronavirus-2019
[Accessed 21st September 2020]
Korona virus COVID-19. [Internet] Available at:
https://covid19.rs/ [Accessed 21st September 2020]
Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical
characteristics of 138 hospitalized patients with
Novel Coronavirus–Infected pneumonia in
Wuhan, China. JAMA 2020;323:1061-9.
Jordan R, Abab P, Cheng K. Covid-19: risk factors for
severe disease and death. BMJ 2020; 368:1-2.
Liang W, Guan W, Chen R, Wang W, Li J, Xu K, et al.
Cancer patients in SARS-CoV-2 infection: a nationwide
analysis in China. Lancet Oncol 2020; 21:335–337.
Livingston E, Bucher K. Coronavirus Disease 2019
(COVID-19) in Italy. JAMA 2020;14;323(14):1335.
Clerkin K, Fried J, Raikhelkar J,Sayer G, Griffin J,
Masoumi A, et al. COVID-19 and Cardiovascular
Disease.Circulation 2020; 141:1648-1655.
Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al.
Association of cardiac injury with mortality in
hospitalized patients with COVID-19 in Wuhan,
China. JAMA Cardiol 2020; 5(7):802-810.
Shi S, Qin M, Cai Y, Liu T, Shen B, Yang B, et al.
Characteristics and clinical significance of myocardial
injury in patients with severe coronavirus disease
Eur Heart J 2020; 41:2070–2079.
Tan C, Huan Y, Shi F, Tan K, Ma Q, Chen Y, et al.
C reactive protein correlates with computed
tomographicfindings and predicts severe COVID-19
early. J Med Virol 2020; 92:856–862.
Stojadinović M, Sekulić D, Vasin D, Mašulović D. COVID
-radiološke metode i karakteristike radiološkog
nalaza. SJAIT 2020; 42:5-16.
Mossa-Basha M, Meltzer CC, Kim CD, Tuite JM, Kolli
P, Tan SB. Essentials for Radiologists on COVID-19:
An Update—Radiology Scientific Expert Panel.
Radiology2020; 296:E106–E112.