Management of COVID-19 in a durable left ventricular assist device recipient: A continuity of care perspective.
Sai Krishna C Korada, James A Mann, Ayesha K Hasan and 4 others
PMID 32861886WHAT IT FOUND
A durable LVAD recipient with mild COVID-19 developed subacute thyroiditis four weeks after discharge.
Remote monitoring of pulmonary artery pressures and LVAD parameters helped distinguish this post-viral complication from heart failure exacerbation or reinfection, guiding readmission and treatment.
Key findings
01The patient developed subacute thyroiditis as a post-viral complication, diagnosed after remote monitoring showed elevated pulmonary artery pressures despite negative SARS-CoV-2 tests.
02Drug interaction between lopinavir-ritonavir and warfarin likely caused the elevated INR observed during the initial admission.
03Remote interrogation of LVAD parameters and pulmonary artery pressure data allowed accurate assessment of volume status and helped identify the need for readmission.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a single case report and cannot establish causality or generalizable treatment protocols. The patient had multiple comorbidities (diabetes, CKD, obesity) which may have influenced the clinical course and complications. The utility of remote monitoring is described retrospectively; prospective validation in larger cohorts is needed. The authors note that the protective or predisposing effect of LVAD support on inflammatory states is unknown.
Declared interests
Dr. Mokadam is a consultant for Abbott, Medtronic, SynCardia, and Carmat. The other authors have no conflicts of interest to disclose.
The easy way to misread this
Do not assume that elevated pulmonary artery pressures in a post-COVID LVAD patient indicate heart failure exacerbation or reinfection. In this case, negative viral tests and specific thyroid labs revealed subacute thyroiditis, a post-viral complication requiring different management.