An 82-year-old man had coronary artery disease, systolic heart failure with reduced ejection fraction, measles, hypertension, and hyperlipidemia in his medical history.
Aspirin 81 mg twice a day, clopidogrel 75 mg twice a day, isosorbide mononitrate 30 mg twice a day, atorvastatin 40 mg twice a day, lisinopril 10 mg twice a day, metoprolol succinate 25 mg twice a day, furosemide 40 mg twice a day, and other supplements were among his regular drugs.
Owing to his polio history, the patient was confined to a wheelchair. He denied using cigarettes or any other recreational drugs.
Presenting Symptoms
Due to increasing weakness (especially in his legs) and cough, he presented to the emergency department via emergency medical service (EMS). He had tested positive for COVID-19 10 days ago and had begun to experience symptoms a week prior. His primary care physician had recommended hydroxychloroquine and azithromycin before his admission. His situation worsened, and EMS was summoned.
Examinations
With a respiratory rate of 32 breaths per minute, the patient was found to be hypoxic. He couldn't form complete sentences and had to be fitted with a high-flow nasal cannula. To maintain a saturation of 94 percent, he required 10 L of supplemental oxygen. With a blood pressure of 94/54 mmHg and a heart rate of 106 beats per minute, the patient was hypotensive and tachycardic.
On auscultation of the lungs, there were diffuse crackles and wheezing on both sides. A chest CT revealed diffuse ground-glass infiltrates and pleural effusions, all of which were consistent with COVID-19, namely; D-dimer >4.00 g/mL, 3600 pg/mL brain natriuretic peptide (BNP), white cell count 14, total bilirubin 1.1 mg/dL, and an AST/ALT of 1526/1075.
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