COVID-19-What do we miss?

Nevena Ivanova

Keywords: COVID-19, GP, cardiovascular

COVID‐19 (SARS‐CoV‐2 virus) is a novel coronavirus which emerged in Wuhan, China in December 2019 and became pandemic in March 2020. COVID-19 symptoms are nonspecific and their severity can vary. Most common symptoms are fever, dry cough and tiredness. COVID‐19 mainly affects the respiratory tract from mild symptoms to bilateral pneumonia and acute respiratory distress syndrome. Due to a global inflammatory response and endothelial damage, COVID‐19 may predispose to cardiovascular disorders. GPs are first line doctors, so it is of great importance to diagnose including complications and make a proper decision about the treatment

Research questions:
Recognition of cardiac coronavirus complications in general practice

Study of several cases with cardiac coronavirus complications in outpatient cardiology clinic. Patients were diagnosed positive for COVID-19 and treated by GP according to established protocol.

Along with the most common symptoms, all of the patients complained anxiety, emotional instability and depressive thoughts. On 8-9th day of disease’s onset occurred chest discomfort, heaviness, daggers, palpitations and arrhythmias. Those were interpreted by GP as panic attacks and psycho-emotional disorders and treated with sedatives. Because of no effect on the cardiac symptoms even acceleration and worsening, patients sought for consultation with cardiologist on 30-40th day. In cardiology clinic an ECG and echocardiography were performed which findings revealed pericarditis with pericardial effusion. A proper treatment was prescribed and parents were followed with regular checkups for 1 month by cardiologist.

COVID-19 is a multisystem disease which leads to various symptoms and could affect cardiovascular system. GP being a front line doctor and gate keeper should be familiar with possible cardiac coronavirus complications, suspect and recognize their development. It would reflect to an early diagnose and treatment so to avoid further severe complications. More case reports, discussion and collaboration between GPs and cardiologists are needed for better results

Points for discussion: