COVID-19 infection and hypertensive heart disease in the elderly (Clinical case study)

Abstract

Among the risk factors for severe course and poor outcome of coronavirus infection, hypertensive heart disease and old age are noteworthy, which is determined by the high prevalence of hypertension (30-45% in the adult population), its leading position among the causes of mortality (cause of death of 10.4 million people per year), the participation of components of the renin-angiotensin-aldosterone system in facilitating the entry of the COVID-19 virus into the body, and the high mortality rate from COVID-19 in the elderly (95% of those who died from COVID-19 in Europe were >60 years old). The analysis of the course of the new coronavirus infection was carried out in an elderly (95 years old) patient who had hypertensive heart disease as a comorbidity. The disease began acutely. COVID-19 was diagnosed on the very first day, immediately after the onset of clinical symptoms (fever, muscle and joint pain), a rapid COVID-19 test was positive, symptomatic treatment and monitoring were carried out by the family doctor. The condition worsened in dynamics, new symptoms appeared, in the form of dry cough and shortness of breath, due to which the patient was hospitalized on the fourth day of the disease. Covid-19 infection was confirmed in the clinic, complex treatment was carried out in accordance with the guideline and protocol, due to oxygenation-desaturation, against the background of which oxygenation indicators were improving. Despite the complex treatment, on the tenth day from the onset of the disease, the condition worsened due to the development of complications of Covid-19 infection (pneumonia, acute respiratory failure). Treatment continued in the general intensive care unit. Against the background of the treatment (oxygenation, breathing exercises, antibiotic therapy (Cefamed, Dominal, Steptenbakt), infusion, inhalation bronchodilators and glucocorticosteroids, sedatives, hormone therapy with dexamethasone, anticoagulants, gastroprotectors, control and correction of volemia, glycemia, electrolyte balance), the condition improved. Hemodynamic-oxygenation parameters stabilized. Disease management and rehabilitation continued at home and he recovered within 6 months. Therefore, it can be noted that despite the aggravated premorbid background, which to some extent determines the severe course of the disease and the development of complications, timely diagnosis of COVID-19 infection, positive oxygenation indicators, adequate treatment and monitoring contribute to the development of a favorable outcome of the disease. Timely and continuous rehabilitation accelerates the recovery process.