Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac.
Clinic for Psychiatry, Clinical Center Kragujevac.
Int Heart J. 2021 Sep 30;62(5):1164-1170. doi: 10.1536/ihj.21-069. Epub 2021 Sep 17.
There is emerging evidence of prolonged recovery in survivors of coronavirus disease 2019 (COVID-19), even in those with mild COVID-19. In this paper, we report a case of a 39-year-old male with excessive body weight and a history of borderline values of arterial hypertension without therapy, who was mainly complaining of progressive dyspnea after being diagnosed with mild COVID-19. According to the recent guidelines on the holistic assessment and management of patients who had COVID-19, all preferred diagnostic procedures, including multidetector computed tomography (CT), CT pulmonary angiogram, and echocardiography, should be conducted. However, in our patient, no underlying cardiopulmonary disorder has been established. Therefore, considering all additional symptoms our patient had beyond dyspnea, our initial differential diagnosis included anxiety-related dysfunctional breathing. However, psychiatric evaluation revealed that our patient had only a mild anxiety level, which was unlikely to provoke somatic complaints. We decided to perform further investigations considering that cardiopulmonary exercise test (CPET) represents a reliable diagnostic tool for patients with unexplained dyspnea. Finally, the CPET elucidated the diastolic dysfunction of the left ventricle, which was the most probable cause of progressive dyspnea in our patient. We suggested that, based on uncontrolled cardiovascular risk factors our patient had, COVID-19 triggered a subclinical form of heart failure (HF) with preserved ejection fraction (HFpEF) to become clinically manifest. Recently, the new onset, exacerbation, or transition from subclinical to clinical HFpEF has been associated with COVID-19. Therefore, in addition to the present literature, our case should warn physicians on HFpEF among survivors of COVID-19.
越来越多的证据表明，即使是 COVID-19 轻症患者，其康复时间也会延长。在本文中，我们报告了一例 39 岁男性病例，他体重超重，且有临界值的动脉高血压病史但未进行治疗，主要诉在被诊断为 COVID-19 轻症后出现进行性呼吸困难。根据最近关于 COVID-19 患者全面评估和管理的指南，应进行所有首选的诊断程序，包括多排螺旋 CT（CT）、CT 肺动脉造影和超声心动图。然而，在我们的患者中，没有确定心肺疾病。因此，考虑到除呼吸困难外，我们的患者还有所有其他症状，我们的初始鉴别诊断包括与焦虑相关的功能性呼吸困难。然而，精神科评估显示，我们的患者仅有轻度焦虑水平，不太可能引起躯体投诉。我们决定进行进一步的检查，因为心肺运动试验（CPET）是不明原因呼吸困难患者的可靠诊断工具。最后，CPET 显示出左心室舒张功能障碍，这是我们患者进行性呼吸困难的最可能原因。我们建议，基于患者未得到控制的心血管危险因素，COVID-19 引发了一种无症状的心力衰竭（HF）伴射血分数保留（HFpEF），并表现为临床症状。最近，新发、恶化或从无症状 HFpEF 向临床 HFpEF 的转变与 COVID-19 有关。因此，除了目前的文献外，我们的病例还应该提醒医生注意 COVID-19 幸存者中的 HFpEF。
