Abstract Body

Background and purpose

Worldwide, Auricular Fibrillation (AF) is the most common sustained cardiac arrhythmia in adults, and it can present with similar symptoms as COVID-19, as dyspnea and fatigue.

Case Report

M., female, 81 y/o, requests an urgent appointment with her GP with complaints of dyspnea, fatigue and bilateral leg swelling for the last 2 weeks. She denies syncope, chest pain, dizziness, headache, fever, cough, myalgia, anosmia or dysgeusia. She lives alone and has had no contact with any other person on the last 3 weeks.

Past medical history: Congestive Heart Failure, Essential Arterial Hypertension, Dyslipidemia, Obesity (BMI 34 kg/m²), Depressive Disorder, Hypothyroidism, Bilateral total hip replacement.

Medications: Amlodipine/Olmesartan 5/20mg, Furosemide 40mg id, Bisoprolol 2.5mg id, Simvastatin 20mg id, Amitriptyline 25mg id, Levothyroxine 0.075mg id, Clebopride 0.5mg id. She denies smoking.

Clinical findings: awake, responsive, tachypneic, SpO2 94%, HR 109bpm, BP 94/72mmHg; irregular pulse; irregular rhythm on auscultation, no other heart murmurs; no abnormal lung sounds; bilateral and symmetric leg edema with positive Godet sign. No other abnormal findings on physical examination.

ECG: Atrial Fibrillation with Rapid Ventricular Response, HR 153bpm.

The patient was referred to the Emergency Department with the activation of the Pre-Hospital Medical Emergency Services. She was immediately admitted with the diagnosis of Decompensated Congestive Heart Failure and de novo Atrial Fibrillation.

Discussion

As we sail through this pandemic, we need to keep in mind that there are urgent diagnosis with respiratory symptoms other than COVID19. Excluding epidemiologic context of COVID19 infection is essential to not delay urgent care to these patients.