On October 11, 2022, a 60-year-old middle-aged black African female widow was admitted with history of muscular weakness for two days and lack of appetite, and occasional vomiting for one day. She had a medical and pharmaceutical history. She had a history of taking public transit to another town to visit her father five days before her admission. She had no prior history of infection with COVID-19. Her father has a history of type 2 diabetes mellitus. She has a family medical and pharmaceutical history. She had a history of stage II hypertension and had been taking enalapril 10 mg twice a day and hydrochlorothiazide 25 mg once a day for five years. She had been taking his hypertension medications correctly until her admission.
She arrived at the emergency room after complaining of peeing less than usual, paroxysmal nocturnal dyspnea, a fast heartbeat, swelling in the feet, pink blood-tinged mucus, fever, headache, dehydration, a non-productive cough, and shortness of breath for two days. Her vital signs in the emergency room were 339.2°C body temperature, 85 kg weight, 1.68 m height, 30.1 kg/m2 body mass index, 106 beats per minute peripheral pulse rate, 164/105 mmHg blood pressure, 19 cycles per minute respiration rate, and 89% oxygen saturation in room air.
Her blood chemistry done upon his admission in the emergency department showed blood urea nitrogen of 37 mg/dL, fasting blood glucose of 124 mg/dL, a 2-hour postprandial blood glucose of 163 mg/dL, serum sodium level of 113 mEq/L, serum potassium level of 7.3 mEq/L, Hb 13.4 g/dL, leukocytes 4,290/L, polymorphonuclear leucocytosis with 1760 neutrophils per microliter of blood (normal value: 2,500–7,000 neutrophils per microliter of blood), platelets of 143,200/µL, neutrophils 69%, pH arterial blood of 7.05 (normal value: 7.32–7.43), anion gap level of 18 mEq/L (normal value: 3–10 mEq/L), partial pressure of carbon dioxide of 29 mmHg (normal value: 38–42 mmHg), serum bicarbonate level of 21.0 mEq/L (normal value: 22–29 mEq/L), plasma creatinine of 2.5 mg/dL, serum phosphate level of 2.3 mg/dL (normal value: 2.8–4.5 mg/dL), white blood cell count of 17650 cells/mm3 (normal value: 4500–11000 cells/mm3), serum chlorine level of 90 (normal value: 96–106 mEq/L), an aspartate aminotransferase level of 72 units/L (normal value: 0–35 units/L), an alanine aminotransferase level of 82 units/L (normal value: 0–35 units/L), an erythrocyte sedimentation rate of 13 mm/hour (normal value: 0–20 mm/hr), 46% hematocrit (normal value: 39% − 49%), lymphocytes 16%, and urine volume of 1240 mL per day. At the time of admission, troponin levels were 454 ng/L (within the normal range of 0–45 ng/L), which is a measure of cardiac biomarkers, but there was no expected rise or decline in these levels. Upon arrival, she received four liters of intranasal oxygen per minute through a nasal cannula for three hours before being transported to the critical care unit.
A neurological assessment of her level of awareness resulted in a Glasgow coma grading of 10/15. A chest CT scan revealed bilateral pleural effusion, multifocal, patchy airspace disease, and interstitial and alveolar thickening in the right middle and both inferior lobes. On the chest X-ray, there were bilateral infiltrates. She was found to have a sinus tachycardia on her electrocardiogram (ECG), with a heart rate of 106 beats per minute (normal range: 60–100 beats per minute) and an ST-segment of 0.07 second (the normal range of the ST-segment is ordinarily around 0.08 second). There was no indication of an arrhythmia or a change in the ventricular repolarization of the anterolateral wall, despite the fact that the ECG showed a fast heartbeat. The left ventricular ejection fraction was 43% on the echocardiogram, which was below the normal range of 50 to 75%. It is typical to have cardiac magnetic resonance. A 12-lead EKG revealed sinus rhythm with widely spaced, profoundly negative T-waves and an extended QTc interval of 497 ms (normal value: 360–460 ms). She has no prior history of proven COVID-19 interaction. Routine reverse transcription polymerase chain reaction (COVID-19) testing was performed in the emergency room; she tested positive and was hospitalized in the critical care unit.
She was transported to an intensive care unit after spending thirty hours in the emergency room and being diagnosed with the SARS-CoV-2 virus. She had previously been diagnosed with managed stage II hypertension, new-onset NYHA class III stage B chronic heart failure, and a newly confirmed COVID-19 infection.
When she arrived, she began oxygen saturation with four liters of oxygen administered via nasal cannula as part of a SARS-COV-2 care strategy. She was taking 81 mg of aspirin every day. To treat her proven COVID-19 infection, she was given subcutaneous enoxaparin 80 mg every 12 hours as deep venous thromboembolism. She received atenolol 50 mg orally once a day and enalapril 5 mg orally twice a day for 30 days. Because of a probable lung bacterial superinfection, 500 mg of azithromycin were given orally once a day for five days to reduce her hospital-acquired infectious diseases. She was given acetaminophen (500 mg) as needed to treat the fever caused by the COVID-19 infection.
Outcome and follow-up
She obtained acceptable blood pressure control after nineteen days with antihypertensive medicines and life style modification strategy. After two consecutive negative throat swab tests for COVID-19 infection, she was released from the hospital on October 27, 2022. She was released with her existing hypertension medications plus losartan 20 mg twice a day. She was advised to return to the ambulatory clinic on a monthly basis.