Cardiovascular Journal of Africa: Vol 32 No 6 (NOVEMBER/DECEMBER 2021)

CARDIOVASCULAR JOURNAL OF AFRICA • Volume 32, No 6, November/December 2021 AFRICA 299 D-dimer. 32 A case of probable pulmonary embolism was seen in a patient in this preliminary report. In addition to SARS- Cov-2 infection, the patient was also at risk of pregnancy- associated venous thromboembolism. Delivery by caesarean section increased her risk for pulmonary embolism. There is a paucity of reports relating to the multi-systemic impact of COVID-19 in Africa. A Dar es Salaam case series reported association with stroke in three cases. 33 Among the first 32 COVID-19 patients admitted in Nigeria, 9% had breathlessness. 34 There is no information provided on the evaluation of the breathlessness beyond SARS-Cov-2 infection. In a report of 10 patients with severe COVID-19, admitted in an intensive care unit in Tunisia, four had neurological complications. 35 There are also no details provided on cardiovascular evaluation of the patients. Conclusion The commonest manifestation of COVID-19 disease in this preliminary report was heart failure. COVID-19 is a multi- systemic disease with cardiac manifestation being one of its commonest complications. The choice of out-of-hospital isolation-centre treatment, which is adopted in Nigeria, is not an ideal setting for the management of a multi-systemic disease that requires a multidisciplinary approach in its management. This unfortunately also impacted negatively on this study, as well as local understanding of the disease condition. In view of the protracted nature of the pandemic, a change of policy will be necessary. References 1. Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al . A pneu- monia outbreak associated with a new coronavirus of probable bat origin. Nature 2020; 579 : 270–273. 2. Roujian L, Xiang Z, Juan L, Peihua N, Bo Y, Honglong W, et al . 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