715 - COVID-19-induced Cardiogenic Shock in a Setting of Chronic Postpartum Cardiomyopathy Necessitating Cardiac Transplantation and Inpatient Rehabilitation

Thursday, February 22, 2024

5:00 PM – 6:30 PM EDT

Presenting Author(s)

JF

Jeremy K. Fagan, PhD

Medical Student
Tulane University SOM
New Orleans, Louisiana, United States

Co-Author(s)

OJ

Oranicha Jumreornvong, MD

Resident Physician
Icahn School of Medicine at Mount Sinai
New York, New York, United States
NP

Nishil Patel, DO

Resident Physician
Ichan School of Medicine at Mount Sinai/Department of Rehabilitation and Human Performance
New York, New York, United States

Corresponding Author(s)

VH

Vincent Huang, MD

Associate Professor
Mount Sinai Hospital
New York City, New York, United States

Case Diagnosis: Debility, Covid-19 induced Cardiogenic Shock, Chronic Postpartum Cardiomyopathy, Cardiac Transplantation

Case Description: A 57-year-old woman with a 19-year history of postpartum nonischemic cardiomyopathy with heart failure with reduced ejection fraction (HFrEF) and an Automatic Implantable Cardioverter Defibrillator presented to the ED with generalized weakness, gastrointestinal distress, and SOB. She was diagnosed as COVID-19 positive in the context of cardiogenic shock and was subsequently transferred to Mount Sinai Hospital. Due to her deteriorating condition, the patient was placed on VA-ECMO and upgraded to status 1 for cardiac transplantation. The patient underwent orthotopic heart transplantation (OHT). Her post-operative recovery was complicated by headaches and reduced coordination, strength, and sensation in the right upper extremity, specifically in the right hand. Following her surgery, a decline in activities of daily living (ADLs) and musculoskeletal strength in the RUE was observed, leading to the diagnosis of debility.

Discussions: This case holds particular significance due to the patient’s extensive medical history, including manageable postpartum nonischemic cardiomyopathy that culminated in cardiogenic shock following COVID-19 infection, necessitating a heart transplant. Cardiac rehabilitation in the context of those who are transplant recipients focuses on not only optimizing cardiac conditioning while restoring and improving function but also identifying and addressing cardiovascular risk factors. The intricate medical needs associated with managing debility in a post-cardiac transplant patient require thorough communication among various medical disciplines, all working toward the common goal of improving the patient's quality of life and restoring her baseline ability of ADLs.

Conclusions: The rehabilitation requirements of organ transplantation recipients in the era of COVID-19 are intricate but can be effectively managed through comprehensive and robust inpatient rehabilitation programs. These programs should involve active collaboration between transplant surgery, infectious disease specialists, and the inpatient rehabilitation team to ensure the best possible outcomes for patients in their recovery journey.