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Early reports — case reports and case series — are now being published about cardiac involvement in COVID-19. In a case report from Italy, physicians describe a 53-year-old previously healthy woman who came to the emergency department with severe fatigue.
In the preceding week, she had a fever and dry cough. On examination, she had a blood pressure of 90/50, a heart rate of 100, and oxygen saturation of 98% on room air. The COVID-19 test was positive, but the patient was afebrile, and her chest x-ray was clear. She had elevations in troponin T, creatine kinase-MB, and N-terminal pro–brain natriuretic peptide. The echocardiogram showed regional wall motion abnormalities, and the electrocardiogram revealed low voltage in the limb leads and diffuse ST-segment elevation. Coronary angiography did not show obstructive coronary disease. On cardiac MRI, short tau inversion recovery and T2-mapping sequences indicated marked biventricular interstitial edema. There was late gadolinium enhancement consistent with acute myocarditis. A circumferential pericardial effusion was also found. With supportive therapy, the patient improved.
Inciardi RM et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19). JAMA Cardiol 2020 Mar 27; [e-pub]. (https://doi.org/10.1001/jamacardio.2020.1096)
Comment
We do not usually cover a case report, but in these times, there is value in understanding the range of ways that COVID-19 can affect the heart. This patient without a history of cardiovascular disease was diagnosed with acute myopericarditis about a week after the initial symptoms. We need to be vigilant with these patients — and realize that cardiac complications might present after a week, not at the initial presentation.