Abstract

Introduction

The outbreak of COVID-19, caused by the novel coronavirus SARS-CoV-2, has affected a huge number of patients worldwide. The clinical presentation spectrum is wide, from asymptomatic patients to critically ill cases. Most pulmonary infections are mild, but severe and critical cases have been described, especially in the elderly, developing with dyspnea, hypoxia, major lung involvement in imaging, respiratory failure, shock and multiple organ failure.⁽¹⁾ However, extra pulmonary manifestations of the disease are also increasingly being reported.^(2-6)

Extrapulmonary features are mainly due to the cytokine storm, whereby pro- inflammatory cytokines and chemokines such as tumour necrosis factor- α, IL-1β and IL-6 are overproduced by the immune system, resulting in multiorgan damage.

Cases of heart involvement by the coronavirus 2019 disease (COVID-19), developing with acute myocarditis have also been described, mainly in severe cases.^(7,8) Chest CT, however, is limited in terms of heart assessment.⁽⁹⁾ Thus, these patients with clinically suspected COVID-19 myocarditis have been assessed by other imaging methods, such as echocardiography and cardiac magnetic resonance imaging (CMR).⁽¹⁰⁾

We describe a case of patient of myocarditis with heart failure due to COVID 19.

Case Report

28 year old female came to the hospital with complaints of multiple episodes of loose stool and vomiting since 1 day. Patient had 10-15 episodes of watery loose stools and 4-5 episodes of vomiting. She also gave history of fever since 1 day, maximum Up to 100’F associated with chills and rigours. No previous history of any co morbidities or any cardiac or respiratory illness. She was referred from an outside facility where she had constant hypotension despite fluids and inotropic support.

On arrival, in emergency department, she was afebrile, her pulse was 125/min, tachypnea present (RR-30), BP -90/60 mm Hg on vasopressor support, SPO2 – 94% on 2L O2.

She was conscious, oriented. Pallor was present. No cyanosis, clubbing or oedema was present. On Auscultation bilateral mild crepitations were present.

She was primarily managed in emergency department and then shifted to ICU.