ABC | Volume 114, Nº5, May 2020

Case Report Coronavirus and the Heart | A Case Report on the Evolution of COVID-19 Associated with Cardiological Evolution Arthur Rente 1, 2 Delcio Uezato Junior, 2 Karina Margareth Kunyoshi Uezato 2 Hospital Municipal de Emergências Albert Sabin – Emergência, 1 São Caetano, SP – Brazil Beneficência Portuguesa de São Caetano do Sul – Cardiologia, 2 São Caetano, SP – Brazil Introduction Beginning on December 31, 2019, in China, the coronavirus (Sars-Cov-2) 1 has been the target of studies in the most diverse medical fields, with cardiology as one of the major pillars of evolution. Chronic diseases such as hypertension, diabetes mellitus and coronary artery disease dramatically increase the negative outcome of infected patients. According to data from the American College of Cardiology (ACC), in this profile of the general population, hospitalization levels resulting from COVID-19 hit 50% 2 Due to infectious abnormalities resulting from infection, chronic comorbidities that until then were stabilized may tend to decompensate due to changes in O 2 supply and demand, among other factors of physiological responses to septic conditions. 3 It is known that, previously, other pandemics of viral etiology, such as SARS and MERS, involved acute myocarditis with a tragic outcome from the cardiological point of view, and COVID-19 may be a source of acute myocarditis. 4 According to data from the Brazilian Society of Cardiology (SBC), in March 2020, cardiovascular impairment related to the novel coronavirus has the following outcomes: arrhythmias (16%), myocardial ischemia (10%), myocarditis (7.2%) and shock (1–2%). 5 Objective Case report of a patient with diabetes mellitus who contracted the novel coronavirus in community, evolved with cardiac disorders and died. Methods The information included in this clinical case description derived from reviews of medical records, interviews with the medical team, diagnostic imaging tests and literature reviews. Case Report R.S.C., 33 years old, sought the emergency service at a municipal emergency hospital in São Caetano do Sul, state of São Paulo, on March 12, 2020, with unverified fever, body pain and wet cough for 3 days. The patient was evaluated by the emergency duty manager, where he was physically examined but presented no abnormalities, was medicated, presented symptoms, showed improvement and was discharged. On March 14, 2020, the patient returned to the emergency room reporting dry cough, dyspnea and fever (39 degrees — measured in the early morning). Denied congestion or rhinorrhea. Chest radiography (Figure 1) was performed and the medical prescription was amoxicillin + clavulanate 875/125 mg every 12 hours. The patient was later discharged. On March 16, 2020, the patient returned with worsened sensation of dyspnea, no improvement of adynamia and increased dry cough; the fever had ceased, but the patient presented severe sweating. On physical examination, the patient progressed with decreased bilateral breath sounds. A new chest X-ray was performed (Figure 2), which presented intense worsening , radiopacity bilaterally pronounced in lung fields, with supplementation of O 2 by a nasal catheter, with slight improvement. The emergency room team requested a place in the ward to clarify diagnosis and treatment. On March 16, 2020, the patient was received at the emergency hospital ward and history-taking was performed (as described below). Mailing Address: Arthur Rente • Hospital Municipal de Emergências Albert Sabin – Emergência - Rua Aurélia, 101. Postal Code 09551340, São Caetano, SP – Brazil E-mail: arthurfelipe3@gmail.com Manuscript received March 29, 2020, revised manuscript April 03, 2020, accepted April 08, 2020 Keywords Cardiovascular Diseases; Coronavirus; COVID 19; Myocarditis/complications; Respiratory Insufficiency. DOI: https://doi.org/10.36660/abc.20200263 Figure 1 – Chest radiography at first visit. 839