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?:abstract
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Introduction: The novel coronavirus 2019 (COVID-19) and ensuing pandemic placed significant pressure on the care of critically ill patients We present a case of a patient presenting with acute onset left ventricular systolic failure with acute right ventricular dysfunction and unremitting supraventricular tachycardia Methods: A 69 year-old male presented with severe shortness of breath and fever to the emergency department in March of 2020 to a major city hospital in the midst of the resource-limited height of the COVID-19 pandemic After a thorough history, physical exam, laboratory evaluation, and preliminary point-of-care ultrasonographic examination he was found to be have COVID-19 and mild acute respiratory distress syndrome (ARDS) He was managed initially with non-invasive ventilation, but on hospital day #6, was found to be profoundly hypoxic, confused, and tachycardic On further evaluation, his vital signs demonstrated a fever of 38 2 C, tachycardia at 140 bpm, blood pressure 125/70 and SpO2 92% on 100% FiO2 Bedside transthoracic echocardiography demonstrated globally severely reduced left ventricular systolic function and a dilated right ventricle with severely reduced systolic function An electrocardiogram demonstrated monomorphic supraventricular tachycardia Results: We describe the patient\'s prolonged hospital course extending forty-five days with nearly half requiring critical care The patient eventually improved and was discharged from the hospital Discussion: We discuss the implications of resource-limited pandemic conditions in the care of critically ill patients We incorporate the international experience of developed countries in facing a once-in-a-lifetime global medical emergency In addition, we comment on the proposed ethical considerations when allocating patients to a significantly high level-of-care and the implications of this decision for other patients requiring care
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