ABSTRACT
Introduction: The SARS-CoV2 pandemic has changed the health system. The lockdown have significantly reduced potentially high threatening diseases in Emergency Departments. Aim: Of: Study: To analyze the consulting activity of the cardiological first aid (FAc) in the COVID-19 era;assess characteristics and clinical management of COVID-19 era patients compared to that of a standard period. Materials and Methods: From 11 March to 11 April 2020, consecutive patients of FAc were analyzed and compared with those of the same period of standard activity. RESULTS: From 11 March to 11 April 2020 (lockdown period), 224 cardiologist consulting's carried out;in a standard period 400 patients were examined. In lockdown period, 32 patients were hospitalized in Cardiology department compared to 90patients in the standard period. Table 1 lists the indication for cardiological consulting's in COVID-era compared to standard period. Conclusions: On the hand the lockdown has improved the appropriateness of access to Emergency Departments, on the other hand has reduced the number of diagnoses and the early treatment of many potentially high threatening diseases. Many patients did not request access to the emergency room and, therefore, were not identified, hospitalized and treated. In the coming period, cardiologists will find themselves having to manage patients with left ventricular dysfunction, with an unfavorable prognosis, for which a greater number of hospitalizations, more aggressive treatment and a closer follow-up will be necessary.
ABSTRACT
Male 19 years old, in the absence of risk factors presents in the emergency room for retrosternal pain, headache and photophobia. In the two days prior to admission fever and diarrhea. Negative for Sars-Cov-2 infection. On auscultation no pericardial rubbing.ECG showed RS, HR 95 bpm, negative T wave in DIII. The echocardiogram was normal. Serial determinations of high sensitivity troponin (TnHS) were positive and increasing (1st TnHS: 2780, 2nd 3435 ng/L;cut off: 2.3-19.8 ng/L). In the first days of hospitalization, the apyretic patient presented frequent episodes of chest pain that were accentuated with inspiration and with the supine position, in the absence of other diagnostic criteria of pericarditis. Therefore therapy with paracetamol was initially set, subsequently associated with anti-inflammatory therapy with ibuprofen and beta-blocker. The episodes of chest pain progressively disappeared, associated with negativization of TnHS in 4th day of hospitalization. The same day fever appeared, reaching up to 39 °C, worsening asthenia, abdominal pain localized to the upper quadrants and pharyngodynia associated with pharyngeal plaques. COVID-19 swab was repeated and throat swab, coprocultures and urinary antigens were collected for the detection of Legionella and Pnemococcus. All of these tests were negative. Finally, viral serology was collected which showed a possible acute viral infection by EBV with positive IgM anti-VCA (96.7 U/ml) and Ig anti-EA (83 U/ ml), then confirmed by the molecular identification of EBV-DNA (copies of DNEPA 7559). Abdomen ultrasound instead showed splenomegaly (14x 6.5 cm) with homogeneous echostructure.On the 5th day, new alterations in repolarization appeared on the ECG trace with negativization of the T wave also in aVF and hypokinesia of the SIV posterior to the basal segment appeared on the echocardiogram, not previously known, even in the presence of normal biventricular systolic function. On day 6 the patient underwent cardiac MRI which confirmed the diagnosis of acute myocarditis showing inflammatory edema in T2-weighted sequences of the posterior mid-basal segments and late enhancement in T1-weighted sequences with subepicardial distribution of the posterior middle segments. Finally, low dose angiotensin-converting enzyme inhibitors was introduced in therapy and in the 10th day, apiretic and in the absence of abdominal and thoracic symptoms, the patient was discharged.