ABSTRACT
Case presentation A 36-year-old with recent vaginal delivery cocaine abuse, and COVID-19 infection was admitted for new acute systolic heart failure. Etiology of heart failure was suspected as peripartum cardiomyopathy, cocaine-induced, or COVID myocarditis. EKG had no ischemic changes and echocardiography revealed an ejection fraction (EF) of 10-15% with severe global hypokinesis. Additional diagnostics showed a BNP of 3600 and a stable high-sensitivity troponin with a negative delta of 60-65. No arrhythmia on telemetry noted as well. Cardiac MRI was suggestive of myocarditis and no evidence of ischemia on stress MRI (figure 1). The patient received diuresis until euvolemia and tolerated lisinopril and carvedilol. With a diagnosis of clinically suspected non-fulminant COVID myocarditis, she was discharged on a tapered oral dexamethasone for two weeks. On a follow-up telemedicine encounter, the patient denied any chest pain, shortness of breath, and was otherwise asymptomatic Discussion Currently, there remain no guidelines of treatment for COVID-19 myocarditis. Many published management strategies are focused on use of IV corticosteroids and other immunosuppression for cases of fulminant myocarditis. However there is limited data on outpatient management of nonfulminant myocarditis associated with COVID-19. In our case report, we demonstarte successfully managing a patient with non-fulimant myocarditis in the setting of severely reduced EF with an outpatient steroid regimen. Of note, her systolic dysfunction was not exclusively from myocarditis as the patient also had a history of cocaine abuse and possible peripartum cardiomyopathy. At the time of hospital discharge, she was clinically stable, euvolemic, tolerated guideline-directed medical therapy, and her troponins suggested no on-going myocardial injury.