To the best of our knowledge, we present here the first confirmed case of COVID-19 in a patient on left ventricular assist device (LVAD) support. Our case patient is a 66-year-old man with a history of end-stage ischemic cardiomyopathy, on HeartMate II (Abbott Laboratories, Abbott Park, IL) LVAD as destination therapy, hypertension, atrial flutter, and ischemic stroke who presented with a 4-day history of fever, cough, and shortness of breath after recent 2-month travel to Egypt. Initial physical examination revealed a body temperature of 100.9°F (38.3°C), normal mean arterial pressure by Doppler, and oxygen saturation of 70% on room air. Arterial blood gas revealed a partial pressure of oxygen in arterial blood of 46 mm Hg despite delivery of 100% fraction of inspired oxygen via nonrebreather ventilation. LVAD parameters were stable on presentation. A chest radiograph showed bilateral pulmonary infiltrates suggestive of multifocal pneumonia (Fig. 1 a). The patient seemed to be in moderate respiratory distress, with tachypnea and accessory muscle use. Owing to concern for developing respiratory muscle fatigue and impending respiratory failure, the decision was made to pursue intubation and mechanical ventilation.
Fig. 1 (a) Chest radiograph showing bilateral patchy opacities suspicious for multifocal pneumonia on hospital day 1. (b) Chest radiograph on hospital day 13.