Patient 1
On March 2020 a 61 years old patient was admitted to our Department because of acute right heart failure, 2-month after LVAD implantation for primary dilated cardiomyopathy. He was also affected by obesity with body mass index of 36 kg/mq, type 2 diabetes, Chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), atrial flutter, moderate to severe mitral regurgitation. A Cardiac Resynchronization Therapy Defibrillator (CRT-D) had been implanted six years before.
Clinical examination at admission revealed peripheral edema, severe dyspnea and increased weight
(>10 kg compared to previous discharge). He was apyretic, hemodynamically stable with an oxygen saturation of 98%. Patient’s chest X-ray is shown figure 1, with evidence of left pleural effusion. Transthoracic echocardiogram concluded for right ventricular dysfunction and pulmonary hypertension. The LVAD was functioning well. Infusion of dobutamine, levosimendan and furosemide was immediately started.
The day after the admission, a nasopharyngeal swab was positive for SARS-CoV-2. Thus he was transferred to a dedicated COVID-19 ward.
During the following days his hemodynamic condition gradually improved, with a weight loss of 10 kg. Dobutamine was progressively reduced and discontinued. We report a unique episode of fever during the second day after admission, which was treated with paracetamol. The patient did not develop pneumoniae and, after 8 days, since clinical conditions, blood and radiological tests improved, he was discharged.
At clinical follow up two and half months later he was hemodynamically stable, without signs of right heart failure. At follow-up the swab test for SARS-CoV-2 was negative.