Key result
POCUS detects new-onset HFrEF in a patient with SARS-CoV-2, guiding treatment and LVEF recovery to 60%.
Why the study?
SARS-CoV-2 infection is associated with myocardial inflammation, new onset cardiomyopathy, and arrhythmias, prompting report of POCUS utilization to manage concurrent new onset atrial tachycardia and HFrEF.
Case Report (n=1)
No
Bedside POCUS can rapidly identify new-onset HFrEF in patients with tachyarrhythmias, preventing the potentially harmful use of AV nodal blocking agents in decompensated heart failure.
Supports bedside POCUS for detecting reversible HFrEF in tachyarrhythmia; hypothesis-generating and requires prospective validation before broader adoption.
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.
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Sivasubramanian et al. (2023) conducted a case report in SARS-CoV-2 infection with new-onset tachyarrhythmia and cardiomyopathy (n=1). Point-of-care ultrasound (POCUS) guided management was evaluated on Clinical improvement and LVEF recovery. Bedside point-of-care ultrasound identified new-onset heart failure with reduced ejection fraction in a patient with SARS-CoV-2 and atrial tachycardia, leading to tailored treatment and recovery of ejection fraction to 60% at 4 months.
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