Acute heart damage and COVID-19: a case study

ABSTRACT

Background: COVID-19 disease is characterized by respiratory symptoms, but acute cardiovascular complications are reported in severe infections that adversely affect prognosis. Clinical Case A patient is hospitalized for fever, chest pain, and dyspnoea. Clinical examination pulmonary and peripheral congestion, low blood pressure values, oxygen saturation in ambient air 91%. Increased myocardiocytolysis and inflammatory indices. Nasopharyngeal swab positive for COVID-19. Chest CT scan interstitial pneumonia. ECG sinus tachycardia, changes in ventricular repolarization. Echocardiogram left ventricle dilated, hypertrophic and with severe global systolic dysfunction. Therapy furosemide, high flow oxygen alternating CPAP, antiretrovirals, antibiotics, low molecular weight heparin, beta blocker. Cardiac MRI focal edema of the anterior wall. Coronary angiography moderate coronary artery disease. Control chest CT scan resolution of pulmonary interstitial disease. Cardiac MRI after 2 months improvement of the overall systolic function of the left ventricle. Conclusions: An entity defined as “acute myocardial damage” characterized by an increase in troponin with ECG and/or echocardiographic changes, is reported in COVID patients. These forms are not related to coronary artery disease but are the consequence of the septic state and the excessive activation of the infectious- inflammatory systems and can manifest themselves with myocarditis/stress myocardiopathy causing heart failure and left ventricular systolic dysfunction.