Background
Although the most known feature of SARS-CoV-2 associated infection is a mild to severe pneumonia, increasing evidence suggests the existence of an infection-associated risk of both arterial and venous thromboembolism (VTE), but the exact magnitude of this phenomenon is still unknown.
Given that, it is important for the Emergency Physician to remember that a SARS-CoV-2 associated respiratory failure can be caused not only by the pulmonary parenchymal inflammation that characterizes the pneumonia, but also by an associated pulmonary thromboembolism.
Case report
A healthy 73-years old woman admitted to the ED for dyspnea, fever and thoracic pain. Cardiac ultrasound, electrocardiogram and clinical findings suggested a diagnosis of cardiogenic obstructive shock due to acute pulmonary embolism, successfully treated with thrombolysis. A CT angiography confirmed the pulmonary embolism (EP) diagnosis and showed bilateral pneumonia, caused by SARS-CoV-2 infection.
Conclusion
Considering the high prevalence of thromboembolic events in COVID-19 patients it is mandatory for the emergency physician to systematically evaluate signs of pulmonary thromboembolism, in order to perform the most patient-tailored therapy as soon as possible.
Hemodynamic monitoring of unstable patients is an everyday issue for Emergency Physicians (EP). Considering the difficulty, in Emergency Department (ED) settings, to assess invasively Stroke Volume (SV), Cardiac Output (CO) and Peripheral Vascular Resistance (PVR), EP should be familiar with non-invasive, easy and reproducible methods that can estimate these parameters. The use of Left Ventricular Outflow Tract aortic Velocity Time Integral (LVOT-VTI) with echocardiography, as estimate of SV, integrated with inferior vena cava collapse index and clinical examination could give the opportunity to non-invasively understand at which point of an ideal cardiac output/central venous pressure relation (according to the Frank Starling law) the patient is situated. In this case report we describe a septic patient accessing the ED with both respiratory and cardiac failure, and we show that the use of aortic LVOT-VTI is an easy and reproducible approach to understand cardiac hemodynamic in scenarios involving multiple pathologic mechanisms.
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