Covid-19 Induced Biventricular Takotsubo Cardiomyopathy

Background Takotsubo Cardiomyopathy (TTS) is a syndrome of transient LV dysfunction. Myocardial injury (MCI) has been reported in acute COVID-19 (C19) infections, however, the exact pathophysiology is unclear. Association of rising cardiac biomarkers with inflammatory markers suggests systemic inflammatory response in C19 infection in causing MCI. Case A 52-year-old AA male with history of HTN presents with complaint of worsening shortness of breath and atypical chest pain. Diagnosed with C19 and intubated due to respiratory failure. Chest pain workup included TTE which showed biventricular (BV) systolic dysfunction with apical ballooning and LVEF 25-30%. Left heart catheterization showed non-obstructing coronary disease. Repeat TTE 2 weeks later showed normal BV systolic function with LVEF greater than 55%. Decision-making BV TTS is associated with more hemodynamic instability than is isolated LV TTS. Mayo Clinic diagnostic criteria for TTS requires absence of obstructive CAD or plaque rupture. Rapid recovery of BV function is consistent with TTS with transient BV dysfunction. LV TTS is common in COVID-19 infections, but BV TTS is a less common complication of COVID. Conclusion Due to the propensity of C19 to cause hemodynamic instability it is important to not relate to a patient's instability to C19 alone. It is important to consider TTE in patients with C19, as the patient may be experiencing TTS. [Formula presented]Copyright © 2023 American College of Cardiology Foundation

UNICUSPID AORTIC VALVE CONCOMITANT WITH INFECTIVE ENDOCARDITIS AND SEVERE AORTIC REGURGITATION IN A PATIENT WITH COVID-19

Background Unicuspid aortic valve (UAV) is a rare congenital heart disease. We report a case of a young male who presented with COVID-19 and found to have UAV concomitant with infective endocarditis (IE) and severe aortic regurgitation (AR). Case 28-year-old male with history of polysubstance abuse presented with worsening generalized weakness, fever, cough, and respiratory distress. COVID-19 PCR was positive. He developed acute hypoxic respiratory failure requiring mechanical ventilation. Hospital course was complicated by septic shock requiring multiple pressors, MRSA pneumonia, serratia marcescens bacteremia, PEA arrest due to hypoxia, acute kidney injury requiring hemodialysis, and acute liver failure. Decision-making TTE revealed low normal LVEF, moderate-severe AR, and prolapsing aortic valve leaflet. TEE revealed UAV with vegetation on AV leaflet and severe AR. Cardiothoracic surgery recommended aortic valve replacement after medical optimization. Prognosis of patients with UAV complicated by IE and severe AR and sepsis with multi organ failure is very poor. In our case, his condition was further complicated by COVID-19. Our case possessed unique challenges in management of this rare disease during COVID-19 pandemic. Unfortunately, our patient eventually succumbed due to complications from multi organ failure. Conclusion We discussed a case of a patient with COVID-19 with multi organ failure who is found to have UAV concomitant with IE and severe AR. [Formula presented]