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Tytuł:
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The semantic of a pandemic: Are cardiovascular patients dying "with" or "from" COVID-19? Reflections from a case report.
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Autorzy:
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Mapelli M; Centro Cardiologico Monzino IRCCS.; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
Mantegazza V; Centro Cardiologico Monzino IRCCS.
Agostoni P; Centro Cardiologico Monzino IRCCS.; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, Milan, Italy.
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Źródło:
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Medicine [Medicine (Baltimore)] 2021 Mar 05; Vol. 100 (9), pp. e25072.
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Typ publikacji:
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Case Reports; Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: Hagerstown, Md : Lippincott Williams & Wilkins
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MeSH Terms:
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COVID-19*/diagnosis
COVID-19*/mortality
COVID-19*/physiopathology
Coronary Artery Disease*/epidemiology
Coronary Artery Disease*/physiopathology
Coronary Artery Disease*/therapy
Hypertension*/epidemiology
Hypertension*/physiopathology
Hypertension*/therapy
Pneumonia, Viral*/blood
Pneumonia, Viral*/diagnostic imaging
Pneumonia, Viral*/physiopathology
Pneumonia, Viral*/therapy
Patient Care Management/*methods
Aged ; Blood Gas Analysis/methods ; COVID-19 Nucleic Acid Testing/methods ; Clinical Deterioration ; Fatal Outcome ; Humans ; Male ; Risk Assessment ; SARS-CoV-2/isolation & purification ; Tomography, X-Ray Computed/methods
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References:
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Eur Respir J. 2020 May 27;55(5):. (PMID: 32312864)
N Engl J Med. 2020 Apr 30;382(18):1708-1720. (PMID: 32109013)
Lancet. 2020 Feb 15;395(10223):497-506. (PMID: 31986264)
N Engl J Med. 2020 Oct 8;383(15):1479-1480. (PMID: 33027574)
Radiology. 2020 Aug;296(2):E115-E117. (PMID: 32073353)
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Entry Date(s):
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Date Created: 20210303 Date Completed: 20210309 Latest Revision: 20240331
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Update Code:
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20240331
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PubMed Central ID:
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PMC7939151
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DOI:
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10.1097/MD.0000000000025072
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PMID:
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33655986
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Rationale: Northern Italy has been particularly hit by the current Covid-19 pandemic. Italian deceased patients have a mean age of 78.5 years and only 1.2% have no comorbidities. These data started a public debate whether patients die "with" or "from" Covid-19. If on one hand the public opinion has been persuaded to believe that Covid-19 infection has poor outcomes just in elderly and/or fragile subjects, on the other hand, hospitals are admitting an increasing number of healthy young patients needing semi-intensive or intensive care units.
Patient Concerns: At the end of March 2020, a 79-year-old patient (M.G.) was admitted to the emergency department of our hospital with a 5 days history of fever, dyspnea, and cough. He was known for hypertension and coronary artery disease with a previous coronary artery stenting. Both the comorbidities were carried out without complications and the patient was previously asymptomatic and in good health. At admission, he was febrile and showed signs of respiratory failure with hypoxia and hypocapnia at blood gas analysis.
Diagnosis: The day after, he was tested for SARS-CoV-2 with a real-time reverse transcriptase-polymerase chain reaction assay of nasopharyngeal swab, which turned positive and a chest CT-Scan was consistent with the diagnosis of interstitial pneumonia.
Interventions: He was treated with i.v. diuretics, paracetamol, prolonged noninvasive ventilation (CPAP), and empiric antibiotic therapy on top of his chronic treatment.
Outcomes: A treatment with heparin and corticosteroids was started; however, he developed irreversible respiratory failure. Invasive ventilation was not considered appropriate due to his comorbidities, low chances of recovery, and intensive care unit overcrowding. The patient died 9 days after admission.
Lessons: Health conditions that are most reported as risk factors are common cardiovascular diseases that can be managed in modern clinical practice. Through a brief illustrative clinical case, we would like to underline how Covid-19 can be per se the cause of death in patients that would otherwise have had an acceptable life expectancy.
Competing Interests: The authors report no conflicts of interest.
(Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)
