Introduction: Infectious endocarditis (IE) is a potentially life-threatening condition that requires urgent diagnosis and treatment (1). Heart valve endocarditis associated with COVID infection presents a challenge, not only for physicians but for nurses as well. Considering the situation and implementation of new epidemiological measures, challenging nursing care in changed and difficult working conditions presented an important factor in the treatment of the patient. In this paper we will present a case of 36-year-old patient who was hospitalized in December 2020 in University Hospital Dubrava for infectious endocarditis complicated by COVID-19.
Case report: Patient was initially hospitalized in October 2020 at the University Hospital for Infectious Diseases for pneumococcal pneumonia and meningitis. Mechanical ventilation begins due to the development of respiratory insufficiency. Vancomycin antibiotic therapy consequently results in acute renal injury. Renal function recovers after a short period of hemodialysis. During the stay, cardiorespiratory arrest developed and resuscitation was successfully performed. Transthoracic echocardiography finds a perivalvular abscess of the aortic valve without a visible vegetation. After a month of hospitalization, there is a further deterioration of the clinical condition. Testing for coronavirus (SARS-CoV-2) was performed and a positive finding was confirmed, with the development of bilateral COVID-19 pneumonia with respiratory failure requiring oxygen therapy and further mechanical ventilation. Due to the need for further diagnosis, transesophageal ultrasound of the heart, which could be performed only by trained staff, and implementation of measures to prevent the spread of the virus, the patient was transferred to University Hospital Dubrava which became the central COVID hospital for the Republic of Croatia. Transesophageal ultrasound, in compliance with all safety measures, found an aortic root abscess with pseudoaneurysm with large mobile vegetation on the aortic valve and massive aortic regurgitation, which confirmed the diagnosis of infectious endocarditis. Massive bilateral pleural effusion with signs of acute respiratory distress syndrome (ARDS) was verified. Emergency cardiac surgery was indicated for treatment of aortic valve endocarditis. A biological aortic valve was successfully implanted, the aortic root abscess was repaired and the remaining defect was closed with a pericardial patch. Postoperative recovery proceeded without complications. Control echocardiography records normal hemodynamic parameters over the aortic valve. With adequate nursing care and intensive physical therapy, the patient successfully recovered and was discharged home on the twelfth postoperative day.
Conclusion: A positive finding for coronavirus led to a prolongation of the diagnosis and treatment of infective endocarditis. Despite all treatment measures taken, COVID infection accelerated the progression of IE symptoms leading to cardiac arrest. The patient’s condition required urgent cardiac surgery which could be performed only by trained medical staff (physicians, nurses, perfusionists, technicians) and with adherence to epidemiological measures in pre-planned COVID hospitals that could meet the demanding conditions.