Stone heart: a case of endo-myocardial calcification with severely reduced left ventricular global strain in post-acute coronavirus syndrome in a quadragenarian

ABSTRACT

Background: Cardiac calcification is a broad entity encompassing calcific deposits in the valves, coronary arteries, aortic root, myocardium, endocardium, or pericardium. It is reported in approximately 19 percent of post myocardial infarction (MI) patients. (1) Coronary artery disease is by far the commonest cause of endo-myocardial calcification, other causes include endomyocardial fibrosis, myocarditis, metastatic calcification in chronic kidney disease patients. Post - acute coronavirus (COVID) syndrome is defined as the persistence of symptoms even beyond 4 weeks of onset of acute symptoms. (2) A recent study has shown that, beyond the first 30 days after infection, individuals with COVID are at increased risk of incident cardiovascular disease including cerebrovascular disorders, dysrhythmias, ischemic and non-ischemic heart disease, pericarditis, myocarditis, heart failure and thromboembolic disease. (3) This study cited the risk and additional burden of ischemic heart disease outcome as an hazard ratio of 1.66 (95% confidence interval of 1.52 - 1.80) and 7.28 (95% confidence interval 5.8 - 8.88) per 1000 population respectively. (3) We present an interesting case of a forty-three-year-old man with endo-myocardial calcification with ischemic cardiomyopathy (ICMP) and severely reduced left ventricular (LV) global longitudinal strain (GLS) in post COVID syndrome. Case report A forty - three-year-old man presented to us with gradually worsening dyspnea on exertion - New York Heart Association (NYHA) grade II at present - and pedal edema since the past 6 months. He had a history of COVID infection prior to that for which he received institutional care and was discharged uneventfully - not requiring any intensive care stay during the hospitalization. On presentation now a 12-lead electrocardiogram was done which revealed left bundle branch pattern. He underwent - an echocardiogram which showed a reduced ejection fraction of 38 % along with regional wall motion abnormality in anterior, apical and lateral wall;a computed tomogram of thorax which did not reveal any lung disease but endo - myocardial calcification. (Fig 3) He further underwent myocardial strain imaging using echocardiography, which revealed a severely reduced LV GLS. (Fig 4) Routine blood investigations including inflammatory markers and Troponin levels were within normal limit, brain natriuretic peptide (BNP) levels were found to be very high. The patient underwent coronary angiogram which revealed significant disease in distal left main coronary artery and ostio-proximal left anterior descending and left circumflex artery. After detailed heart team discussion along with patient relatives the patient was advised coronary artery bypass grafting. The patient took discharge and went to a different hospital to undergo the same. Conclusion(s) Acute Coronavirus infection has already been wreaking havoc all around the globe since the past 3 years. We have now showcased a unique and devastating consequence of the post COVID state in a relatively young man. [Formula presented] [Formula presented] Copyright © 2022