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Medical Mystery in the Age of Heart Crisis COVID for Medical Students

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Medical student Ramya Yeleti after her incredible recovery.

Editor’s Note: Find the latest COVID-19 news and guidance from Medscape Coronavirus Resource Center..

Within minutes of arriving at Community North Hospital in Indianapolis, Ramya Yeleti’s vital signs plummeted. Her pulse was 45 beats per minute and the ejection fraction remained close to 10%. “I was convinced that I could close my eyes and never open them again, but I only had a few seconds to handle it,” she recalled. After that, everything turned black. Lamia lost consciousness when the shock pad was placed and a herd of clinicians prepared to insert an impeller heart pump into her aorta through a catheter.

A third-year medical student and aspiring psychiatrist had a face-to-face neurological rotation when he began experiencing fever and uncontrolled vomiting in July. Her first thought was that she must have had the flu from her patient.

After all, Ramya, along with his father Ram Yeleti, MD, mother Indira, and twin sister Divya, all weathered COVID-19 the previous month and later tested positive for SARS-CoV-2 antibodies. The only family that escaped was her younger brother Rohis.

Indira was severely ill and required two days of ICU care, but did not require a ventilator. Others experienced almost mild symptoms. Ramya, who was studying for a third-year board exam after the classes at the College of Osteopathic Medicine in Indiana Police were virtualized in March, was left with prolonged fatigue. However, my cough and muscle aches were alleviated, and my sense of taste and smell was restored. When she started the rotation, she thought her life was back to normal.

I thought there was definitely a possibility that I would close my eyes and never open them again.

Lamiya influenza Symptoms did not improve. The college-mandated rapid COVID test returned negative, but another two days of vomiting began to worry both her and her father, a cardiologist and attending physician at the Indianapolis Community Health Network. After feeling chest pain, Lamia asked her father to listen to her heart.Everything sounded normal and Ram was prescribed Ondansetron Because of her nausea.

However, the antiemetics did not work and I was convinced that by the next morning both my father and daughter had to go to the emergency department.

“I wanted to reaffirm if I was missing something about her dehydration,” Ram said. Medscape Medical News.. “Several things can cause prolonged nausea, such as: hepatitis, appendicitis, Or another infection. I feel terribly guilty because she didn’t realize she had heart disease. “

Worst surprising turn

The subtle symptoms of Lamia quickly gave way to the dramatic heart crisis that occurred shortly after arriving at Community North. “Girlfriend EKG It looked absolutely scary, like the 75-year-old who had a heart attack, “Mr. Lamb said.

As a cardiologist, he finds out that his daughter’s situation is dire when he hears a doctor screaming that the impeller isn’t working and needs extracorporeal membrane oxygenation (ECMO). Was there.

“At that point, I didn’t expect her to survive,” her father recalled. “We had 10 doctors in the room who worked on her for 5 hours to stabilize her.”

“Obviously, it was especially traumatic because I knew exactly what was going on,” he added. “Nothing can be sugar-coated.”

After being connected to the cardiopulmonary device, Lamia was transferred to the IU Health Methodist Hospital, also in Indianapolis, where she was tested for COVID-19 again. Unlike the rapid test performed just a few days ago, the PCR assay returned positive.

I knew she had acute myocarditis, but the coronavirus never exceeded my heart.

“I knew she was acute MyocarditisBut the coronavirus never crossed my heart, “Lamb said.

“We were also tackling this challenge when we were dealing with her mind. She was back positive for COVID-19 again,” said Dr. Lupa Lao, MD. .. heart failure IU Health Transplant Cardiologist who treated Ramya.

“I didn’t know if I was dealing with an active infection or a dead virus,” Lao said from a previous infection. “So treat her as if she had active COVID-19. We started and administered remdesivir, convalescent plasma, and steroids. This was our protocol. “

A biopsy of Ramya’s heart tissue, along with a blood test, showed a past parvovirus infection. Lamia’s previous coronavirus infection may have made her more susceptible to heart damage from the new parvovirus infection, Lao said. Either or both of the viruses may have been the cause of the disaster.

Unprecedented during the Lamia heart crisis in early August, evolving evidence has made her more likely to be alone. A handful The number of people around the world who are re-infected with SARS-CoV-2. COVID-related cases are also appearing Myocarditis Other extreme heart complications, especially in young people.

“At that time, it wasn’t clear if people could get another infection so quickly,” Lao said. Medscape Medical News.. “She could be one of these rare individuals who have COVID-19 twice. I hope someday we will have some clarity.”

“I would like to support coinfection, perhaps as a trigger for her illness,” she said. “It may take some time, but like any other illness, COVID doesn’t seem to disappear magically. I hope we can get some answers in the future.”

Another wrinkle



Ramya Yeleti receiving care at the IU Health Methodist Hospital in Indianapolis.

The next 48 hours brought amazing news: Ramya’s cardiac function recovered almost normally and her ejection fraction increased to about 45%. No heart transplant is needed, but Lao was ready to follow through if ECMO only maintained Lamia’s prognosis rather than improving it.

“Lamiya was so ill that if she didn’t recover, the only option was a heart transplant,” Lao said. “But we wanted to do everything to keep that heart.”

After steroid and COVID treatment, Lamia’s heart began to return. “It didn’t make sense to me,” Lao said. “I don’t know what helped. If she hadn’t had ECMO, her heart probably wouldn’t have recovered, so she needs to support these patients and give them time to recover. I think there is. ECMO ”

They would have to stop her and restart, and I was worried that it wouldn’t.

Despite the good news, Ramya’s survival was still in balance. When she was amputated from ECMO, clinicians discovered that the impeller device caused rare complications and damaged the mitral valve. The valve could be surgically repaired, but both Lao and Lamb were very anxious about the prospect of cardiopulmonary bypass during open heart surgery.

“They will need to stop and restart her heart, and I was worried that it wouldn’t restart,” Ram explained. “I didn’t like the idea of ​​open heart surgery, but my biggest fear was that she couldn’t survive it because of a really fresh and sick heart.”

In fact, the fear of cardiologists has become a reality. It took an hour to restore Lamiya’s heart at the end of the surgery. But just as the surgeon was desperately preparing to reconnect Lamiya to the ECMO, “her heart has recovered again,” Lao reported.

“There is something in life that I will never forget,” she said. “I can’t explain how everyone in the operating room took care of her and how she felt. I told Lamiya,” You’re a fighter. ” “

New strength

Six days have passed before Lamia woke up and learned of the amazing sequence of events that saved her. She knew “something was really wrong” because of an incision in the middle of the chest, but when she learned that she was attending an ECMO, the heart transplant list was so close to her death. Went home.

“Most people don’t get off ECMO. They die at ECMO,” she said. “And it’s very likely that you’ll die on the heart transplant list. That’s my story, and it was very strange that it suddenly came to me when I was doing the rotation a week and a half ago.”



Jeretti family. From left to right: Ramya, her brother Rohith, mother Indira, father Ram, twin sister Divya.

Physical therapy, which has continued for the past three months, has transformed Lamia from a state of severe physical weakness to a relatively strong place. Now a fourth-year medical student turns 26 in November and is anxious to resume face-to-face rotation. Her downtime was partially met by working with Lao on myocarditis research and her own case study for journal publication.

However, the trauma from her experience hurt her in a way she knew she would become stronger personally and professionally in the coming years.

“It’s still very difficult. I’m still recovering,” she admitted. “I explained it to the therapist as an invisible wound in my brain.”

“When I left the hospital, I still had ECMO wounds and deep wounds on my legs, which affected the speed and length I could walk,” she said. .. “I felt the same thing happening to my brain. It’s a big cut that no one can see.”

Her intention to specialize in psychiatry is even more pressing now that Lamiya recognizes the effects of trauma on mental health.

“It was terrible for my body to fail me, but I was able to handle it,” she said. “Lost part of my heart would have been worse. I want to take care of it in my patients.”

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