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Unexpected finding of myocardial depression in 2 healthy young patients with COVID-19 pneumonia: possible support for COVID-19-related myocarditis.

ABSTRACT: COVID-19 is proving to be a devastating pandemic with both tragic economic and health consequences worldwide. Point-of-care ultrasound (POCUS) of the lungs has been thrust into the forefront of resources that could be used in the management of COVID-19 acute care patients. However, relatively little attention has been paid to POCUS utility in assessing the heart in COVID-19 patients. Anecdotal reports suggest encounters of likely COVID-19 induced pericardial effusions and myocardial electrical dysfunction. This article presents 2 cases of generally healthy patients who were noted to have classic COVID-19 bilateral pneumonia findings on lung ultrasound and incidentally discovered to have unsuspected left ventricular dysfunction likely resulting from myocarditis. POCUS videos are presented as illustrations of this potentially overlooked complication.

SUBMITTER: Blaivas M

PROVIDER: S-EPMC7323425 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

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Unexpected finding of myocardial depression in 2 healthy young patients with COVID-19 pneumonia: possible support for COVID-19-related myocarditis.

Blaivas Michael M

Journal of the American College of Emergency Physicians open 20200613 4

COVID-19 is proving to be a devastating pandemic with both tragic economic and health consequences worldwide. Point-of-care ultrasound (POCUS) of the lungs has been thrust into the forefront of resources that could be used in the management of COVID-19 acute care patients. However, relatively little attention has been paid to POCUS utility in assessing the heart in COVID-19 patients. Anecdotal reports suggest encounters of likely COVID-19 induced pericardial effusions and myocardial electrical d ...[more]

PMID: 32838381

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Project description:Background: Despite the ongoing global pandemic, the impact of COVID-19 on cardiac structure and function is still not completely understood. Myocarditis is a rare but potentially serious complication of other viral infections with variable recovery, and is, in some cases, associated with long-term cardiac remodeling and functional impairment. Aim: To assess myocardial injury in patients who recently recovered from an acute SARS-CoV-2 infection with advanced cardiac magnetic resonance imaging (CMR) and endomyocardial biopsy (EMB). Methods: In total, 32 patients with persistent cardiac symptoms after a COVID-19 infection, 22 patients with acute classic myocarditis not related to COVID-19, and 16 healthy volunteers were included in this study and underwent a comprehensive baseline CMR scan. Of these, 10 patients post COVID-19 and 13 with non-COVID-19 myocarditis underwent a follow-up scan. In 10 of the post-COVID-19 and 15 of the non-COVID-19 patients with myocarditis endomyocardial biopsy (EMB) with histological, immunohistological, and molecular analysis was performed. Results: In total, 10 (31%) patients with COVID-19 showed evidence of myocardial injury, eight (25%) presented with myocardial oedema, eight (25%) exhibited global or regional systolic left ventricular (LV) dysfunction, and nine (28%) exhibited impaired right ventricular (RV) function. However, only three (9%) of COVID-19 patients fulfilled updated CMR-Lake Louise criteria (LLC) for acute myocarditis. Regarding EMB, none of the COVID-19 patients but 87% of the non-COVID-19 patients with myocarditis presented histological findings in keeping with acute or chronic inflammation. COVID-19 patients with severe disease on the WHO scale presented with reduced biventricular longitudinal function, increased RV mass, and longer native T1 times compared with those with only mild or moderate disease. Conclusions: In our cohort, CMR and EMB findings revealed that SARS-CoV-2 infection was associated with relatively mild but variable cardiac involvement. More symptomatic COVID-19 patients and those with higher clinical care demands were more likely to exhibit chronic inflammation and impaired cardiac function compared to patients with milder forms of the disease.

Dataset Information

Unexpected finding of myocardial depression in 2 healthy young patients with COVID-19 pneumonia: possible support for COVID-19-related myocarditis.

Publications

Unexpected finding of myocardial depression in 2 healthy young patients with COVID-19 pneumonia: possible support for COVID-19-related myocarditis.

Similar Datasets

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