ABSTRACT
Background: Malaria is extremely rare in the United States. Physicians should not only be familiar with signs and symptoms, but also be aware of the available resources at their respective institutions to be able to effectively treat it. Presentation: 52-year-old female presented with worsening generalized fatigue. Vitals were stable. Labs were significant for anemia and thrombocytopenia. Peripheral smear showed ring formed parasitic trophozoites consistent with Plasmodium falciparum. Due to unavailability of antimalarial agents at our hospital, the patient was transferred to a tertiary care center. Patient was started on IV artesunate therapy. Repeat smear after 3 days showed <1% parasitemia after 3 days and the patient was discharged with artemether/lumefantrine for 3 additional days, resulting in full recovery. Conclusion: This case gives a unique insight into the challenges that hospitals in non-endemic regions may have to face, in terms of diagnosing malaria and having access to antimalarial agents.
ABSTRACT
Introduction: SARS-CoV-2 infection is associated with myocardial inflammation, new onset cardiomyopathy, and arrhythmias. Here, we describe the utilization of POCUS and management of concurrent new onset atrial tachycardia and heart failure with reduced ejection fraction (HfrEF) in a patient with SARS-CoV-2 infection. Presentation: An 80-year-old female with multiple medical problems presented with sudden onset of shortness of breath and cough. She tested positive for SARS-CoV-2. Initially, she was hypoxic on room air and her heart rhythm was sinus tachycardia. CT angiogram of the chest showed consolidation, pleural effusion, and absence of pulmonary embolism. Because of persistent tachycardia, repeat EKGs and POCUS were performed. Subsequent EKGs showed intermittent atrial tachycardia and sinus tachycardia. Initially, home beta blockers were continued on admission, and additional dosages were considered for rate control, but Cardiac POCUS revealed HfrEF and was subsequently confirmed by comprehensive cardiac echocardiogram, consistent with SARS-CoV-2 infection-related cardiomyopathy. Beta blockers were discontinued, and treatment with amiodarone and furosemide showed improvement in symptoms. The patient was discharged with oral amiodarone and supplemental oxygen. Additionally, once the patient's hemodynamics improved, oral carvedilol was also started as part of GDMT for HfrEF. Follow-up echocardiogram 4 months later showed recovery of systolic EF to 60%. Conclusion: It is essential to consider new onset HFrEF in the evaluation and management of new onset tachyarrhythmias since IV fluids and AV nodal blocking agents can be harmful in decompensated HFrEF. With the advent of POCUS, HFrEF can be quickly identified, and therapy can be tailored to that diagnosis.
