# Right-to-Left Intra-cardiac Shunt in a COVID-19 Patient Leading to Stroke and Poor Prognosis: A Case Report and Review of the Literature

## TL;DR

A 73-year-old man with severe COVID-19 developed a stroke and poor outcomes due to a previously undiagnosed heart condition called patent foramen ovale.

## Contribution

Highlights a rare case linking a heart defect to severe complications in a COVID-19 patient.

## Key findings

- A patient with severe hypoxemic respiratory failure and MRSA pneumonia had a patent foramen ovale.
- The undiagnosed heart defect likely contributed to stroke and paradoxical embolism.
- Multidisciplinary care is essential in managing complex cases of severe COVID-19.

## Abstract

Coronavirus disease 2019 (COVID-19) often presents with a wide range of complications, including respiratory distress, acute respiratory distress syndrome (ARDS), and hypercoagulable states with resultant cerebrovascular incidents. Intra- and extra-pulmonological shunts can further complicate patient courses, leading to persistent hypoxemia and paradoxical emboli, resulting in potentially life-threatening consequences, necessitating a comprehensive, multidisciplinary approach to patient care. Here we present the case of a 73-year-old male who experienced severe persistent hypoxemic respiratory failure, superimposed methicillin-resistant Staphylococcus aureus (MRSA) pneumonia, and stroke with a previously undiagnosed patent foramen ovale (PFO) contributing to his clinical presentation.