CORONAVIRUS-INDUCED MYOCARDITIS REQUIRING BI-VENTRICULAR ASSIST DEVICE

Abstract

SESSION TITLE: Medical Students/Residents' COVID-19 SESSION TYPE: Med Student/Res Case Report PRESENTED ON: October 18-21, 2020 INTRODUCTION: Myocarditis describes an inflammatory disorder of the myocardium. Typical presentation occurs with new-onset heart failure and can occur secondary to infection, autoimmune, drug reaction, or other etiology. Literature review describes only two previous cases of coronavirus induced myocarditis in humans. CASE PRESENTATION: A 72-year-old male presented with chest pressure, progressive dyspnea, and cough over one week. Labs demonstrated no leukocytosis but an elevated troponin of 313ng/L, BNP of 696pg/m, and an RNA PCR was positive for Coronavirus-COVID19. CT-scan of the chest revealed bilateral ground-glass opacities with bilateral pleural effusion. Due to acute hypoxic respiratory failure, the patient was intubated and subsequently developed wide-complex tachycardia and was cardioverted to sinus rhythm. The patient was found to be in cardiogenic-shock and placed on vasopressors. Solumedrol and hydroxychloroquine were initiated for five days. The patient was also given tocilizumab and IVIG for 2 days. Echocardiogram revealed biventricular cardiomyopathy, severely depressed LV systolic function, and an ejection fraction of <10%. Cardiac catheterization revealed no significant signs of epicardial CAD. Given the acute nature of his heart failure, an LVAD and RVAD were placed for hemodynamic support. The patient developed hemolysis secondary to these devices and they were removed in the following days. The non-ischemic cardiomyopathy resolved as repeat echocardiography revealed an ejection fraction of 55% and the patient was successfully extubated. The patient was discharged to subacute rehabilitation on hospital day-18. DISCUSSION: We present an exceptional case of viral myocarditis caused by Coronavirus-COVID19. Previously, limited cases have claimed Coronavirus as the culprit of myocarditis; the novel middle east respiratory syndrome Coronavirus seemed to be the only documented subtype causing severe myocarditis leading to viral dilated cardiomyopathy. CONCLUSIONS: Documenting this case is important to raise awareness of the potential life-threatening COVID19 as a cause of acute congestive heart failure and allow for possible diagnosis and prompt treatment of the future of cases especially since coronavirus seems to carry a high mortality rate in patients with cardiac risk factors. Reference #1: Postgrad Med J. 2001 Jan; 77(903): 4–10. doi: 10.1136/pmj.77.903.4 Reference #2: Postgrad Med J. 2006 Feb; 82(964): 140–144. doi: 10.1136/pgmj.2005.037515 Reference #3: European Heart Journal, ehaa190, https://doi.org/10.1093/eurheartj/ehaa190 Published: 16 March 2020 DISCLOSURES: No relevant relationships by Marianna Avagyan, source=Web Response No relevant relationships by Gurinder Pal Gakhal, source=Web Response no disclosure on file for Samer Kazziha; No relevant relationships by Connor Kerndt, source=Web Response No relevant relationships by Hayk Papukhyan, source=Web Response