Atrial Fibrillation in a Young Patient With Ards: The Hidden Role of Suspected Cardiomyopathies

Abstract

Background: Pneumonia is an infection often complicated by cardiovascular events, including atrial fibrillation (AF), favoured by hypoxia or underlying cardiomyopathy.

Case Report: A 31-year-old man presented to the emergency department for dyspnoea and fever. His medical and pharmacological history was silent. On admission: SpO₂ 89%, FR 70 acts/min, buzzing and hissing bilaterally. Chest CT showed areas of consolidation in the lung lobes. Haemogas analysis showed severe hypoxaemic respiratory failure (P/F < 200), requiring non-invasive ventilation. The nasopharyngeal swab was positive for Influenza B, configuring a clinical picture of ARDS. Despite respiratory improvement, AF occurred, treated with transesophageal echocardiogram, electrical cardioversion and anticoagulation. The echocardiogram suggested a suspected cardiac amyloidosis, to be investigated with an MRI. One week after discharge, the patient presented again for AF recurrence and was admitted to cardiology.