RESUMO
BACKGROUND: Coronavirus disease 2019 (COVID-19) is a syndrome that has been associated with multiple cardiac complications including myopericarditis. The pathophysiology and treatment for myopericarditis in the setting of COVID-19 infection is still under investigation. CASE SUMMARY: We present a case of a 60-year-old male admitted for dyspnoea due to COVID-19. He developed new ST-segment elevation, elevated cardiac enzymes, severe left ventricular dysfunction, and high inflammatory markers in the setting of haemodynamic and respiratory collapse from the viral illness. He was diagnosed with COVID-19-induced myopericarditis. He showed rapid clinical improvement with a rapid wean off pressure support, resolution of electrocardiogram (ECG) findings, and recovery of left ventricular systolic function following treatment with intravenous immunoglobulin (IVIG) and methylprednisolone. DISCUSSION: COVID-19's complex and devastating complications continue to create new challenges for clinicians. Cardiac complications, specifically, have been shown to be a signal for worse prognosis in these patients. IVIG and steroids can inhibit the inflammatory cascade and decrease myocardial injury, with implications in treatment of severe myopericarditis.
RESUMO
Coronary artery fistulae are rare anomalies in which a communication is present between a coronary artery and either a cardiac chamber or another vascular structure, such as the pulmonary artery or coronary sinus. Most fistulae are congenital in origin, but they can also occur as a result of chest trauma or endocardial biopsy. The presence of a fistula is a rare occurrence in itself, but the different origins and drainage sites of fistulae are what make them even more rare. We report the case of a 74-year-old woman with a history of progressive congestive heart failure who was found to have a large left main coronary fistula draining into a persistent left superior vena cava to a markedly dilated and aneurysmal coronary sinus.
