Heart Disease, Old age and Critical COVID 19 With Readmission

A sixty years old gentleman was brought to me with complains of breathlessness and low oxygen levels of 85%. He was admitted at other hospital for the treatment of COVID 19. Two days before he was discharged from that hospital after five days of treatment. He had history of heart disease and had undergone a procedure for the same. He responded to initial treatment but after a day of stabilization his condition deteriorated and I shifted him to ICU. His oxygen was falling rapidly and he was complaining of increasing uneasiness in breathing in spite of high flow of oxygen. I initiated support of noninvasive ventilation but oxygen level remained at 93%. He had spikes of fever and he became very sick. His oxygenation was becoming increasingly difficult and his heart rate and blood pressure were fluctuating. With ten days of rigorous monitoring and management, he showed improvement in his oxygen levels and blood pressure. He could be weaned from ventilator after almost twelve days. Another few days went uneventful but while he was stabilizing from this life threatening episode, on one morning he felt breathless again and his heart rate increased to 132 beats per minute. Now his breathing was deteriorating and oxygen was falling again. Increasing oxygen provision was not making any impact and he was again supported with BIPAP. His blood pressure decreased and he threw a new spike of fever. By then he was in ICU since twenty days. His lungs were significantly damaged and he was physically weak. There was a possibility of secondary infection in blood or lungs. At this stage secondary infections may prove fatal. Broad spectrum antibiotics to cover multi drug resistant organisms were considered. After almost five days of intensive treatment he showed improvement. I could wean him from ventilator. Now he was able to breath with moderate oxygen supply. He had no fever spikes. However his heart was beating fast. His 2D ECHO revealed mild reduction in pumping but nothing significant. He improved further and transferred to ward after few days. He kept improving in room and after forty days of hospital stay he was discharged. He is now recovering at home.

1_CT scan showing extensive disease

2_CT scan showing extensive disease

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