Young patients with ongoing pulmonary symptoms may benefit from earlier cardiac evaluation
Asthma or pneumonia are often to blame when young people experience pulmonary symptoms like shortness of breath. That was the case for one patient who became ill just as health systems across the country began battling COVID-19.
Divya Gupta, MD, Emory Healthcare heart failure and transplantation cardiologist, says that recurrent, unresolved pulmonary symptoms could signal a more serious condition and recommends thoroughly evaluating the heart.
The following case highlights how one young patient’s pulmonary symptoms were initially discounted, and how subsequent cardiac testing at Emory led to a heart failure diagnosis and life-saving transplant.
The case also demonstrates how Emory’s ongoing relationship with the Centers for Disease Control and Prevention (CDC) enabled the health care organization to stay on the forefront of the latest recommendations and guidelines in slowing the spread of COVID-19, while continuing to make heart transplant a priority and safely providing care throughout the system.
Case Background
In early 2020, an otherwise healthy 35-year-old man began experiencing ongoing shortness of breath, lower extremity edema and unprovoked deep vein thrombosis (DVT). The patient visited an Atlanta-area community hospital where he was diagnosed with pneumonia and discharged home.
Symptoms persisted for the patient, a high school athletic coach and long-distance runner. In March 2020, he was evaluated at an Emory Healthcare emergency room and was diagnosed with cardiogenic shock.
Emory physicians admitted the patient, began treatment with inotropes and performed a complete cardiac evaluation, which included cardiac catheterization. In April 2020, the patient was listed for a heart transplant. He underwent heart transplant surgery on May 29, 2020, and was discharged from the hospital on June 8, 2020.
Cardiac Evaluation
The patient’s initial cardiac evaluation at Emory uncovered significantly deteriorated cardiac function indicative of heart failure. Though he had no known family history of heart failure, the patient’s test results revealed:
- Ejection fraction: 15%
- Left ventricular end-diastolic diameter (LVEDD): 7 centimeters
- Cardiac index: 1.6 L/min/m2
“These numbers demonstrate that the patient was experiencing heart failure for quite some time before exhibiting symptoms,” states Dr. Gupta. “This is common in young, healthy patients as their bodies are able to compensate for the heart failure for quite some time, until they can’t.”
The patient’s age and fitness level also likely led to his initial misdiagnosis of pneumonia.
“When a seemingly healthy patient presents with shortness of breath or other possible cardiac symptoms, providers often first think pulmonary. However, if symptoms continue to return, it then becomes critical to evaluate the heart.”
In this case, thorough testing likely saved the patient’s life.
Pre-surgery, Surgery and Recovery
The patient was listed for transplant in April 2020 and remained stable for several weeks. He then began to decompensate and required an axillary intra-aortic balloon pump to maintain hemodynamics.
While the patient waited for his heart to become available, the Emory Heart & Lung Transplant team continued to evaluate, implement and assess COVID-19 systems and procedures put in place to ensure heart transplants could safely continue.
“Our institute prioritizes heart transplant,” explains Dr. Gupta. “We know that this is an important endeavor that saves our patients’ lives.”
Emory Healthcare was able to ensure the transplantation team and its patients had access to resources for surgery, including:
- ECMO
- PPE
- Covid testing (for surgical cases)
- ICU beds
- Pre-op beds
- Operating room space
An organ became available in late May and the patient was successfully transplanted on May 29, 2020. On June 8, 2020, the patient was discharged from the hospital. Two weeks post discharge, the patient walked 20 miles.
“He came in for a follow-up appointment and told us that he was feeling so good during a walk that he didn’t even realize he had already gone 10 miles,” shares Dr. Gupta. “Of course, he then realized he had to turn around and walk the 10 miles back home, which he was able to safely do.”
Nearly one-year post transplant, the patient is back to coaching full-time and running every day. Because the cause of his heart failure is not known, the patient will receive recommended genetic testing and counseling to better understand his condition.
Dr. Gupta expects the patient’s age and good health will contribute to longer-than-expected viability of his transplanted organ. The patient is also a good candidate for future retransplantation surgery, if needed.
Emory is a national leader in heart transplantation surgery and performed the first heart transplant in Georgia. In early 2021, Emory became one of the first of five hospitals in the nation to perform heart transplantation from a donor who experienced circulatory death. Offering donation after circulatory death (DCD) expands access to available donor organs and has the potential to reduce wait times for patients in need of a life-saving heart transplant.
Processes, procedures and prioritization allow Emory to perform more transplant surgeries during global pandemic
In early spring 2020, elective procedures and even life-saving surgeries were canceled around the country as health care organizations shifted resources to care for the influx of COVID-19 patients and slow the spread of the virus.
At Emory — while steps were being taken to keep patients, healthcare providers and the community healthy — leaders in the heart transplant program also realized the vital importance their services brought to individuals suffering from heart failure.
While many institutions performed fewer transplantation surgeries and bridge procedures, Emory experienced an increase in the number of heart failure-related surgeries, performing 48 heart transplants in 2020 (an increase of 33% from 2019) and implanting 72 LVADs.
“Emory Healthcare is known for its heart failure and transplantation program,” explains Dr. Gupta. “We have been able to continue to provide much-needed services to our patients for several reasons: From an increase in organ availability as other programs around the country were pausing transplantation surgeries to our reputation for being able to safely take on high-risk patients.”
To make a referral or consult with one of our Emory Advanced Heart Failure Center specialists, call our physician referral line at 404-778-5050.
Emory Healthcare is committed to the continued health and safety of all patients. During this time, we are taking all necessary precautions to screen for coronavirus (COVID-19) and to prevent its potential spread. We continue to monitor the evolving COVID-19 pandemic and are working with experts throughout Emory Healthcare to keep your patients safe. For the most up-to-date information for our referring partners, click here.
