472 Development of a Rural NSW Cardiac Catheter and Coronary Intervention Service Over 14 Years: Impacts on Service and 30 Day AMI Mortality

Abstract

Background: Clinical data on novel coronavirus COVID-19 arising from early cases in Hubei province revealed high incidence of cardiac complications, especially arrhythmias, amongst infected. We present a case series describing the clinical course of three COVID-19 positive patients, which were amongst the first cases of the COVID-19 outbreak in NSW. Case 1: Male in early-80's from nursing home with comorbid ischaemic cardiomyopathy presents with a 3-day history of dyspnoea. Viral swabs confirmed COVID-19. Febrile on presentation with marked elevation in inflammatory markers. 72-hours into admission, patient developed recurrent ventricular tachycardia (VT). Despite maximal supportive and medical therapy, patient deteriorated clinically with increasing VT burden resulting in death. Case 2: Male in mid-50's presents with lethargy, myalgia and a subacute history of low-grade fever. Mild dyspnoea on presentation with subsequent development of profound hypoxia in the ensuing 24-48 hours. Blood tests showed rapid rise in inflammatory markers with renal impairment. Imaging showed widespread interstitial lung changes consistent with acute respiratory distress syndrome. Patient was intubated and bronchial lavage cultures confirmed COVID-19. Patient received anti-viral and corticosteroid therapy with subsequent improvement. Case 3: Female in late-80's from nursing home without significant background history. Reported mild coryzal symptoms but was screened for given close contact with COVID-19 positive patient. Swabs confirmed COVID-19 positivity. 48-hours into admission, patient developed fever which was managed conservatively. Blood tests showed mildly elevated inflammatory markers. She remained otherwise well and was discharged following negative viral testing. Conclusion: COVID-19, recently declared a pandemic, has a highly variable clinical presentation and outcomes.