Heart failure with preserved ejection fraction in coronavirus disease 2019 patients: the promising role of diuretic therapy in critically ill patients

ESC Heart Fail. 2021 Apr;8(2):1610-1614. doi: 10.1002/ehf2.13175. Epub 2021 Jan 14.

Abstract

The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on diastolic function is less known. We describe a 46-year-old man with a history of mild hypertension who presented to the emergency department with fever, cough, and myalgia for 2 days. The patient was tested positive for SARS-CoV-2. He was admitted and started on a combination of antiviral and antimicrobial therapy. He developed respiratory distress 2 days later, and O2 saturation declined. Blood tests showed an increased N-terminal pro-B type natriuretic peptide (NT-proBNP) level, and echocardiography showed normal left ventricular ejection fraction and E/e' ratio of 16. Computed tomography scan showed interstitial pulmonary oedema and prominent peripheral pulmonary vascular markings. Given these findings, heart failure with preserved ejection fraction (HFpEF) was considered. Low-dose diuretic was started, and fluid administration was restricted, resulting in a decrease in NT-proBNP level, clinical and haemodynamic stabilization, and improved oxygenation. This case highlights the occurrence of HFpEF in coronavirus disease 2019.

Keywords: COVID-19; Diastolic heart failure; Diuretic; Heart failure with preserved ejection fraction (HFpEF); N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP); Pandemic; SARS-CoV-2.

Publication types

  • Case Reports

MeSH terms

  • COVID-19 / complications*
  • COVID-19 / diagnosis
  • COVID-19 / therapy
  • Diuretics / therapeutic use*
  • Furosemide / therapeutic use*
  • Heart Failure / diagnosis
  • Heart Failure / therapy*
  • Heart Failure / virology*
  • Humans
  • Male
  • Middle Aged
  • Stroke Volume

Substances

  • Diuretics
  • Furosemide