VCOM Carolinas Research Day 2023
Clinical Case-Based Reports
The Development of Pulmonary Hypertension after COVID-19 Infection in a Patient with Chronic Restrictive and Obstructive Lung Disease Christina Duechle, OMS-II, Dakota Becker- Greene, OMS-II, Lindsay Tjittas- Saleski, DO, MBA VCOM- Carolinas, Dept of Clinical Research., Spartanburg, SC. Abstract Results Conclusions
Abstract # CBR-8
COVID-19 infection, a serious medical condition that can lead to extensive pulmonary interstitial and alveolar inflammatory infiltrates. In patients without previous cardiac conditions, COVID-19 infection led to an increased risk of developing PAH, regardless of infection severity. Severe scoliosis has numerous adverse effects on the cardiorespiratory system. Previous studies have shown that scoliosis compromises chest-wall movement and is a causative factor in restrictive ventilatory disorders by reducing forced vital capacity (FVC). Patients with severe scoliosis who develop COVID-19 infection are at an increased risk of pulmonary arterial hypertension, acute myocardial injury, and acute respiratory distress syndrome. Additionally, COVID-19 has been documented to cause acute asthma exacerbations that contribute to COVID-19 morbidity via limiting airflow worsening the hypoxemia from diffuse alveolar damage caused by a COVID-19 infection. With the patient presenting with all of these as risk factors for PAH development, the progression to severe disease seems less surprising, but it raises the question if more could have been done preemptively to prevent this progression.
The long-term effects of COVID-19 infection remain relatively unknown but have been demonstrated to have an affect on restrictive and obstructive lung disease. The patient presented to the Emergency Department with an NSTEMI and a past medical history of chronic asthma, severe scoliosis, and past COVID-19 infection. They was ultimately diagnosed with severe pulmonary arterial hypertension.
Table 1 . EKG taken during initial Emergency Department Visit, 3/26/2022
Table 2 . Notable Initial Labs Taken on 04/22/2022 at 19:01
• 51-year-old female with established severe scoliosis and chronic asthma status post COVID-19 infection 2 years prior • Recent hospitalization a month prior for hypoxia and volume overload • Presented to the emergency department for exertional substernal chest tightness with radiation to her back for 2-3 days, O2 saturation >90% on 2L nasal cannula • A diagnosis of Non-ST-Elevation myocardial infarction was made due to EKG findings of tachycardia, anterior and inferior T wave inversions, elevated troponin, and elevated BNP • Upon admission, a CTA of the chest was ordered and demonstrated mild cardiomegaly with no pleural effusion and no focal areas of consolidation. • A right and left heart catheterization showed normal left ventricular function, but severe pulmonary artery hypertension. • After admission, the patient was initiated on a heparin drip and given aspirin for chest pain • Repeat cardiac catheterization was performed on day three of admission and showed severe PAH with signs of diastolic heart failure. • Aggressive diuresis was performed, with moderate improvement. • The patient was stable on discharge and prescribed empagliflozin and torsemide for diastolic heart failure, aspirin, and a statin for non-obstructive cardiovascular disease.
Table 3 . Cardiac Catheterization, 4/25/2022 (day 3 of admission)
Edward Via College of Osteopathic Medicine- Carolinas Campus St. Luke’s Medical Center – Columbus, NC
2 0 2 3 R e s e a r c h R e c o g n i t i o n D a y
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