YOUNG MALE WITH COVID-19 PRESENTING IN CARDIOGENIC SHOCK

Abstract

TYPE: Late Breaking Case Report TOPIC: Cardiovascular Disease INTRODUCTION: Although COVID-19 usually presents with pulmonary disease, suspicion for other etiologies of respiratory distress must be present. CASE PRESENTATION: A 25-year-old patient presented with general malaise, fevers, chill, and shortness of breath on exertion. He was treated with Dexamethasone and Tocilizumab. The patient had rapid deterioration with respiratory distress. On physical exam, the patient was clinically in heart failure with low blood pressure. Further evaluation revealed elevated troponin, 15% ejection fraction with global hypokinesis, and nonischemic cardiomyopathy. DISCUSSION: Several cardiac manifestations of COVID-19 have been reported, including myocarditis, arrhythmias, acute coronary syndrome. However, its incidence remains unknown. The pathophysiology based on its late presentation suggests an exacerbated host immune response. Diagnosis is similar to other causes, based mainly on clinical history, physical exam laboratory findings, noninvasive imaging studies, and if needed, endomyocardial biopsy. There is no research investigating the treatment of COVID-19 in patients whose only presentation is myocarditis. Management depends on the severity of heart injury in conjunction with COVID-19 treatment. Core measures for heart failure management with beta-blocker, and ACE/ARB as main drugs. Mineralocorticoids, diuretics, digoxin and sacubritil/valsartan, SGLT-2 as needed. Inotropic medications and mechanical circulatory support as needed. Early recognition and management are crucial due to the high risk of in-hospital mortality. CONCLUSIONS: Few cases of COVID-19 myocarditis have been reported since the beginning of the pandemic. This case remarks the importance of early recognition of the different presentations of COVID-19 due to the high risk of in-hospital mortality. DISCLOSURE: Nothing to declare. KEYWORD: myocarditis