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Title: Cardiopulmonary exercise test in the detection of unexplained post-COVID-19 dyspnea: A case report
Authors: Djokovic, Danijela
Nikolic M.
Muric, Nemanja
Nedeljković I.
Simovic, Stefan
Novkovic, Ljiljana
Cupurdija V.
Savovic Z.
Vučković-Filipović J.
Susa R.
Cekerevac, Ivan
Issue Date: 2021
Abstract: There is emerging evidence of prolonged recovery in survivors of coronavirus disease 2019 (COVID-19), even in those with mild COVID-19. In this paper, we report a case of a 39-year-old male with excessive body weight and a history of borderline values of arterial hypertension without therapy, who was mainly complaining of progressive dyspnea after being diagnosed with mild COVID-19. According to the recent guidelines on the holistic assessment and management of patients who had COVID-19, all preferred diagnostic procedures, including multidetector computed tomography (CT), CT pulmonary angiogram, and echocardiography, should be conducted. However, in our patient, no underlying cardiopulmonary disorder has been established. Therefore, considering all additional symptoms our patient had beyond dyspnea, our initial differential diagnosis included anxiety-related dysfunctional breathing. However, psychiatric evaluation revealed that our patient had only a mild anxiety level, which was unlikely to provoke somatic complaints. We decided to perform further investiga-tions considering that cardiopulmonary exercise test (CPET) represents a reliable diagnostic tool for patients with unexplained dyspnea. Finally, the CPET elucidated the diastolic dysfunction of the left ventricle, which was the most probable cause of progressive dyspnea in our patient. We suggested that, based on uncontrolled cardiovascular risk factors our patient had, COVID-19 triggered a subclinical form of heart failure (HF) with preserved ejection fraction (HFpEF) to become clinically manifest. Recently, the new onset, exacerbation, or transition from subclinical to clinical HFpEF has been associated with COVID-19. Therefore, in addition to the present literature, our case should warn physicians on HFpEF among survivors of COVID-19.
Type: article
DOI: 10.1536/ihj.21-069
ISSN: 1349-2365
SCOPUS: 2-s2.0-85116369233
Appears in Collections:Faculty of Medical Sciences, Kragujevac

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