Internal Medicine and Subspecialties
2 cases of COVID 19 at our critical access hospital. Our first. First patient 71 yo male with “ farmers lung” interstitial lung disease on chronic prednisone and home nocturnal O2 at 5 liters with BiPap. Second patient fit 79 yo female “ pre diabetic on no home meds. Both with pneumonia. Both on maximum non invasive ventilatory support and meds including hydroxychloroquine/ Azithromycin/ VitC / zinc etc. Both with rising ProBNP responding to diuretics. Both DNRs. Observation : both patients exhibit pulse/ temperature deficit ie relative bradycardia. With temps of 103 pulse in the 70s. With any stimulation or agitation O2 sats plummets with no rise in pulse. I suspect viral cardiomyopathy but also pulse/ temp deficit seems to be a factor in reduced cardiac output. I have seen this in patients with typhoid fever ( in Haiti) but reported in Legionella and Psittacosis. Presumed to be related to cytokine related inflammation of the SA node cells. Has anyone else made this observation?