Although COVID-19 was primarily considered a respiratory illness, rapidly accumulating data suggest that COVID-19 is associated with a high incidence of venous thromboembolic complications. The primary objective of this review article was to reveal whether we need to increase awareness of pulmonary embolism in the period following the COVID-19 infection given that the epidemiologic facts are still poor. A literature search and a critical review of the collected studies were conducted. An electronic search of PubMed, Science Direct Scopus, Google Scholar, and Excerpta Medica Database (EMBASE) from June 2020 until June 2022. The long-term health consequences of COVID-19 remain largely unclear. This review highlights the importance of awareness of the potentially increased incidence of venous thromboembolism in post-COVID-19 patients, even those with mild or asymptomatic disease. Further research is required to establish appropriate clinical management guidelines for the prevention of thromboembolic complications in the post-COVID-19 period.
Keywords Pulmonary embolism • Post-COVID-19 • Thromboembolic eventsThis article is part of the Topical Collection on Covid-19
Background
Over the past two years, Coronavirus Disease (COVID-19) and associated complications, including hypercoagulopathy, is a routine in our hospitals. We already know, that hospitalized critical ill patients with COVID-19 pneumonia, have an increased risk for Pulmonary Embolism (PE). However, only limited data refer to the potential risk in post-COVID-19 patients, and fewer, in patients who had mild disease. We define as mild COVID -19, cases that either didn't need hospitalization or they were hospitalized without respiratory complications. The incidence of PE in post-COVID-19 patients who had only mild symptoms remains unknown.
Material and methods
We are presenting a case series of five patients with mild COVID-19 infection, from our hospital, who presented with PE during the post COVID-19 infectious period. All of the patients presented mild symptoms during the infectious period. One among them needed a short duration of hospitalization for the COVID-19 infection and another one needed hospitalization due to an established stroke.
Results and conclusions
Our cases advocate that even mild COVID-19 could be considered a potential risk factor for PE, after the infectious period. According to our case series, the mean susceptible period in which post-COVID-19 patients may present PE is 21,6 days. However, the time frame in which these patients are more vulnerable to developing PE is not yet known. Nevertheless, the fact that PE occurs even in past mild disease, reinforces the idea that COVID-19 is an independent and cumulative risk factor predisposing to PE.
Dysphagia is a common clinical symptom in older people that can be attributed to a wide range of diseases, extending from neoplasm to gastroesophageal reflux diseases such as stroke or achalasia. We are presenting a case of a 78-year-old male with a history of heart failure with preserved ejection fraction and progressive dysphagia, due to a rare case, namely, dysphagia megalatriensis. Even though left ventricular ejection fraction was preserved, the patient improved, when we provided him with optimal medical heart failure with reduced ejection fraction treatment. In our case report, we intend to highlight the benefits of optimized medical therapy in a patient with heart failure with preserved ejection fraction, due to mitral valve regurgitation leading to a hugely dilated left atrium.
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