Surviving the Death Roll; Unveiling the Undiagnosed: Case of Hispanic Man with Covid-19 Pneumonia

Khorsandi Michael, M. Nirmala, Ebrahimihoor Elnaz, Muganlinskaya Nargiz
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Abstract

Brugada syndrome (BrS) is an inherited electrophysiological abnormality which typically manifests in patients with diverse ethnicities as ventricular arrhythmias or sudden cardiac death. The onset is frequently unmasked by various precipitating factors including but not limited to febrile diseases. Severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2) infection and associated COVID-19 illness continues to evolve. We are reporting a severe case of Covid-19 infection unveiling the undiagnosed Brugada syndrome, and the complicated course requiring mechanical ventilation and rounds of Cardiopulmonary resuscitation. A 57-years-old Hispanic man with no known prior cardiac history presented to the emergency department with fever and altered mental status. Initial investigations revealed mild leukocytosis, and positive SARS-CoV-2 PCR. The patient was transferred to intensive care unit (ICU) due to hemodynamic instability and electrolyte derangements. On day 2 of ICU stay, patient became febrile, hypotensive, tachycardic, and his hypoxemia worsened with increased supplemental oxygen requirement. His electrocardiogram (ECG) was consistent with atrial fibrillation and covedtyped Brugada pattern. At the early hours of the subsequent day, patient developed first episode of asystolic cardiac arrest requiring cardiopulmonary resuscitations (CPR) and intubation leading to return of spontaneous circulation (ROSC) after 10 mins. Only 3 days after the initial cardiac arrest episode, patient suffered from another episode of asystolic cardiac arrest requiring CPR leading to return of normal sinus rhythm and ROSC. Patient had a successful recovery from COVID-19 pneumonia with no additional cardiac events during his hospitalization, and was subsequently extubated and discharged from hospital with close follow up monitoring. Reported cases of Brugada syndrome in Hispanic population are scarce. Covid-19 positive patients have a guarded prognosis when they require intubation with mechanical ventilation with no chances of survival when they suffer cardiac arrest requiring cardiopulmonary resuscitation. This stimulated us to report a case of Brugada syndrome presented in Hispanic man who recovered a deadly course of Covid-19 infection despite requiring intubation and complicated course by two rounds of cardiopulmonary resuscitation (CPR).
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从死亡名单中幸存;揭开未确诊的面纱:西班牙裔男子Covid-19肺炎病例
Brugada综合征(BrS)是一种遗传性电生理异常,通常在不同种族的患者中表现为室性心律失常或心脏性猝死。发病常被各种促发因素所掩盖,包括但不限于发热性疾病。严重急性呼吸综合征(SARS)冠状病毒2型(SARS- cov -2)感染和相关的COVID-19疾病继续发展。我们报告了一例严重的Covid-19感染病例,揭示了未确诊的布鲁加达综合征,以及需要机械通气和心肺复苏的复杂过程。57岁西班牙裔男性,既往无心脏病史,以发热和精神状态改变就诊于急诊科。初步调查显示轻度白细胞增多,SARS-CoV-2 PCR阳性。由于血流动力学不稳定和电解质紊乱,患者被转移到重症监护病房(ICU)。入住ICU第2天,患者出现发热、低血压、心动过速,低氧血症加重,补充需氧量增加。他的心电图(ECG)符合心房颤动和codtype Brugada型。次日凌晨,患者出现第一次心脏停搏,需要心肺复苏术(CPR)和插管,10分钟后恢复自然循环(ROSC)。初次心脏骤停后仅3天,患者再次出现心脏骤停,需要心肺复苏术,导致窦性心律和ROSC恢复正常。患者成功从COVID-19肺炎中恢复,住院期间无其他心脏事件,随后拔管出院,并进行了密切随访监测。西班牙裔人群中Brugada综合征的报道病例很少。Covid-19阳性患者在需要插管机械通气时预后有保障,在心脏骤停需要心肺复苏时没有生存机会。这促使我们报告了一例Brugada综合征,该病例发生在西班牙裔男性中,尽管需要插管,但仍恢复了致命的Covid-19感染过程,并通过两轮心肺复苏(CPR)进行了复杂的过程。
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