Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19).
By R. Inciardi, L. Lupi, G. Zaccone, Leonardo Italia, M. Raffo, D. Tomasoni, D. Cani, M. Cerini, D. Farina, E. Gavazzi and 6 more. JAMA cardiology, 2020
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Importance Virus infection has been widely described as one of the most common causes of myocarditis. However, less is known about the cardiac involvement as a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Objective To describe the presentation of acute myocardial inflammation in a patient with coronavirus disease 2019 (COVID-19) who recovered from the influenzalike syndrome and developed fatigue and signs and symptoms of heart failure a week after upper respiratory tract symptoms. Design, Setting, and Participant This case report describes an otherwise healthy 53-year-old woman who tested positive for COVID-19 and was admitted to the cardiac care unit in March 2020 for acute myopericarditis with systolic dysfunction, confirmed on cardiac magnetic resonance imaging, the week after onset of fever and dry cough due to COVID-19. The patient did not show any respiratory involvement during the clinical course. Exposure Cardiac involvement with COVID-19. Main Outcomes and Measures Detection of cardiac involvement with an increase in levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T, echocardiography changes, and diffuse biventricular myocardial edema and late gadolinium enhancement on cardiac magnetic resonance imaging. Results An otherwise healthy 53-year-old white woman presented to the emergency department with severe fatigue. She described fever and dry cough the week before. She was afebrile but hypotensive; electrocardiography showed diffuse ST elevation, and elevated high-sensitivity troponin T and NT-proBNP levels were detected. Findings on chest radiography were normal. There was no evidence of obstructive coronary disease on coronary angiography. Based on the COVID-19 outbreak, a nasopharyngeal swab was performed, with a positive result for SARS-CoV-2 on real-time reverse transcriptase-polymerase chain reaction assay. Cardiac magnetic resonance imaging showed increased wall thickness with diffuse biventricular hypokinesis, especially in the apical segments, and severe left ventricular dysfunction (left ventricular ejection fraction of 35%). Short tau inversion recovery and T2-mapping sequences showed marked biventricular myocardial interstitial edema, and there was also diffuse late gadolinium enhancement involving the entire biventricular wall. There was a circumferential pericardial effusion that was most notable around the right cardiac chambers. These findings were all consistent with acute myopericarditis. She was treated with dobutamine, antiviral drugs (lopinavir/ritonavir), steroids, chloroquine, and medical treatment for heart failure, with progressive clinical and instrumental stabilization. Conclusions and Relevance This case highlights cardiac involvement as a complication associated with COVID-19, even without symptoms and signs of interstitial pneumonia.
Subfields: Cardiology and Cardiovascular Medicine, Surgery
View Paper: https://www.semanticscholar.org/paper/30296bf659a439a64e7ed67a21448cae476277de
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In Cardiology and Cardiovascular Medicine
Citations in the corpus
- Artificial Intelligence and COVID-19: Deep Learning Approaches for Diagnosis and Treatment (2020, methodology): “Reference [64] has studied clinical and biological data of five COVID-19 patients.”
- Blockchain-Federated-Learning and Deep Learning Models for COVID-19 Detection Using CT Imaging (2020, background): “Due to the small number of data patients [61] the data analytic is difficult.”
- Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARS-CoV-2 pandemi (2021, neutral): “described in the adult population from the start of the pandemic (6,7).”
- Recognizing COVID-19–related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management (2020, neutral): “Presumably, in a more hemodynamically stable case, medical treatment consisting of inotropes or vasopressors was sufficient to mitigate the ventricular systolic dysfunction.(4,13,48) In some cases, immunomodulatory treatments were given.”
- The Role of Imaging in the Detection and Management of COVID-19: A Review (2020, background): “Similarly, cardiac MRI also showed cardiac involvements in patients with COVID-19, such as acute myopericarditis with systolic dysfunction [57].”