Shiloh
Editor, Senior Moderator
Source: https://jamanetwork.com/journals/ja...ign=ftm_links&utm_content=tfl&utm_term=032720
Brief Report
March 27, 2020
Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)
Riccardo M. Inciardi, MD[SUP]1[/SUP]; Laura Lupi, MD[SUP]1[/SUP]; Gregorio Zaccone, MD[SUP]1[/SUP]; et al Leonardo Italia, MD[SUP]1[/SUP]; Michela Raffo, MD[SUP]1[/SUP]; Daniela Tomasoni, MD[SUP]1[/SUP]; Dario S. Cani, MD[SUP]1[/SUP]; Manuel Cerini, MD[SUP]1[/SUP]; Davide Farina, MD[SUP]2[/SUP]; Emanuele Gavazzi, MD[SUP]2[/SUP]; Roberto Maroldi, MD[SUP]2[/SUP]; Marianna Adamo, MD[SUP]1[/SUP]; Enrico Ammirati, MD, PhD[SUP]3[/SUP]; Gianfranco Sinagra, MD[SUP]4[/SUP]; Carlo M. Lombardi, MD[SUP]1[/SUP]; Marco Metra, MD[SUP]1[/SUP]
Author Affiliations Article Information
JAMA Cardiol. Published online March 27, 2020. doi:10.1001/jamacardio.2020.1096
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Video (0:31) Coronavirus Myocarditis MRI (Short Axis)
Key PointsQuestion What are the cardiac complications associated with the emerging outbreak of coronavirus disease 2019 (COVID-19)?
Findings In this case report, an otherwise healthy 53-year-old patient developed acute myopericarditis with systolic dysfunction confirmed on cardiac magnetic resonance imaging a week after onset of fever and dry cough due to COVID-19. The patient was treated with inotropic support, antiviral drugs, corticosteroids, and chloroquine, with progressive stabilization of the clinical course.
Meaning The emerging outbreak of COVID-19 can be associated with cardiac involvement, even after the resolution of the upper respiratory tract infection.
Abstract
Importance Virus infection has been widely described as one of the most common causes of myocarditis. However, less is known about the cardiac involvement as a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Objective To describe the presentation of acute myocardial inflammation in a patient with coronavirus disease 2019 (COVID-19) who recovered from the influenzalike syndrome and developed fatigue and signs and symptoms of heart failure a week after upper respiratory tract symptoms.
Design, Setting, and Participant This case report describes an otherwise healthy 53-year-old woman who tested positive for COVID-19 and was admitted to the cardiac care unit in March 2020 for acute myopericarditis with systolic dysfunction, confirmed on cardiac magnetic resonance imaging, the week after onset of fever and dry cough due to COVID-19. The patient did not show any respiratory involvement during the clinical course.
Exposure Cardiac involvement with COVID-19.
Main Outcomes and Measures Detection of cardiac involvement with an increase in levels of N-terminal pro–brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T, echocardiography changes, and diffuse biventricular myocardial edema and late gadolinium enhancement on cardiac magnetic resonance imaging.
Results An otherwise healthy 53-year-old white woman presented to the emergency department with severe fatigue. She described fever and dry cough the week before. She was afebrile but hypotensive; electrocardiography showed diffuse ST elevation, and elevated high-sensitivity troponin T and NT-proBNP levels were detected. Findings on chest radiography were normal. There was no evidence of obstructive coronary disease on coronary angiography. Based on the COVID-19 outbreak, a nasopharyngeal swab was performed, with a positive result for SARS-CoV-2 on real-time reverse transcriptase–polymerase chain reaction assay. Cardiac magnetic resonance imaging showed increased wall thickness with diffuse biventricular hypokinesis, especially in the apical segments, and severe left ventricular dysfunction (left ventricular ejection fraction of 35%). Short tau inversion recovery and T2-mapping sequences showed marked biventricular myocardial interstitial edema, and there was also diffuse late gadolinium enhancement involving the entire biventricular wall. There was a circumferential pericardial effusion that was most notable around the right cardiac chambers. These findings were all consistent with acute myopericarditis. She was treated with dobutamine, antiviral drugs (lopinavir/ritonavir), steroids, chloroquine, and medical treatment for heart failure, with progressive clinical and instrumental stabilization.
Conclusions and Relevance This case highlights cardiac involvement as a complication associated with COVID-19, even without symptoms and signs of interstitial pneumonia.
Brief Report
March 27, 2020
Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)
Riccardo M. Inciardi, MD[SUP]1[/SUP]; Laura Lupi, MD[SUP]1[/SUP]; Gregorio Zaccone, MD[SUP]1[/SUP]; et al Leonardo Italia, MD[SUP]1[/SUP]; Michela Raffo, MD[SUP]1[/SUP]; Daniela Tomasoni, MD[SUP]1[/SUP]; Dario S. Cani, MD[SUP]1[/SUP]; Manuel Cerini, MD[SUP]1[/SUP]; Davide Farina, MD[SUP]2[/SUP]; Emanuele Gavazzi, MD[SUP]2[/SUP]; Roberto Maroldi, MD[SUP]2[/SUP]; Marianna Adamo, MD[SUP]1[/SUP]; Enrico Ammirati, MD, PhD[SUP]3[/SUP]; Gianfranco Sinagra, MD[SUP]4[/SUP]; Carlo M. Lombardi, MD[SUP]1[/SUP]; Marco Metra, MD[SUP]1[/SUP]
Author Affiliations Article Information
JAMA Cardiol. Published online March 27, 2020. doi:10.1001/jamacardio.2020.1096
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- Editorial
Association of Coronavirus Disease 2019 (COVID-19) With Myocardial Injury and Mortality
Robert O. Bonow, MD, MS; Gregg C. Fonarow, MD; Patrick T. O’Gara, MD; Clyde W. Yancy, MD, MSc
- Original Investigation
Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China
Shaobo Shi, MD; Mu Qin, MD; Bo Shen, MD; Yuli Cai, MD; Tao Liu, MD; Fan Yang, MD; Wei Gong, MMSC; Xu Liu, MD, PhD; Jinjun Liang, MD, PhD; Qinyan Zhao, MD, PhD; He Huang, MD, PhD; Bo Yang, MD, PhD; Congxin Huang, MD, PhD - Viewpoint
Acute Respiratory Infection and the Most Common Noncommunicable Epidemic—COVID-19 and Cardiovascular Diseases
Chengzhi Yang, MD, PhD; Zening Jin, MD, PhD - Original Investigation
Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)
Tao Guo, MD; Yongzhen Fan, MD; Ming Chen, MD; Xiaoyan Wu, MD; Lin Zhang, MD; Tao He, MD; Hairong Wang, MD; Jing Wan, MD; Xinghuan Wang, MD; Zhibing Lu, MD - Review
Potential Effects of Coronaviruses on the Cardiovascular System
Mohammad Madjid, MD, MS; Payam Safavi-Naeini, MD; Scott D. Solomon, MD; Orly Vardeny, PharmD
Video (0:31) Coronavirus Myocarditis MRI (Short Axis)
Key PointsQuestion What are the cardiac complications associated with the emerging outbreak of coronavirus disease 2019 (COVID-19)?
Findings In this case report, an otherwise healthy 53-year-old patient developed acute myopericarditis with systolic dysfunction confirmed on cardiac magnetic resonance imaging a week after onset of fever and dry cough due to COVID-19. The patient was treated with inotropic support, antiviral drugs, corticosteroids, and chloroquine, with progressive stabilization of the clinical course.
Meaning The emerging outbreak of COVID-19 can be associated with cardiac involvement, even after the resolution of the upper respiratory tract infection.
Abstract
Importance Virus infection has been widely described as one of the most common causes of myocarditis. However, less is known about the cardiac involvement as a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Objective To describe the presentation of acute myocardial inflammation in a patient with coronavirus disease 2019 (COVID-19) who recovered from the influenzalike syndrome and developed fatigue and signs and symptoms of heart failure a week after upper respiratory tract symptoms.
Design, Setting, and Participant This case report describes an otherwise healthy 53-year-old woman who tested positive for COVID-19 and was admitted to the cardiac care unit in March 2020 for acute myopericarditis with systolic dysfunction, confirmed on cardiac magnetic resonance imaging, the week after onset of fever and dry cough due to COVID-19. The patient did not show any respiratory involvement during the clinical course.
Exposure Cardiac involvement with COVID-19.
Main Outcomes and Measures Detection of cardiac involvement with an increase in levels of N-terminal pro–brain natriuretic peptide (NT-proBNP) and high-sensitivity troponin T, echocardiography changes, and diffuse biventricular myocardial edema and late gadolinium enhancement on cardiac magnetic resonance imaging.
Results An otherwise healthy 53-year-old white woman presented to the emergency department with severe fatigue. She described fever and dry cough the week before. She was afebrile but hypotensive; electrocardiography showed diffuse ST elevation, and elevated high-sensitivity troponin T and NT-proBNP levels were detected. Findings on chest radiography were normal. There was no evidence of obstructive coronary disease on coronary angiography. Based on the COVID-19 outbreak, a nasopharyngeal swab was performed, with a positive result for SARS-CoV-2 on real-time reverse transcriptase–polymerase chain reaction assay. Cardiac magnetic resonance imaging showed increased wall thickness with diffuse biventricular hypokinesis, especially in the apical segments, and severe left ventricular dysfunction (left ventricular ejection fraction of 35%). Short tau inversion recovery and T2-mapping sequences showed marked biventricular myocardial interstitial edema, and there was also diffuse late gadolinium enhancement involving the entire biventricular wall. There was a circumferential pericardial effusion that was most notable around the right cardiac chambers. These findings were all consistent with acute myopericarditis. She was treated with dobutamine, antiviral drugs (lopinavir/ritonavir), steroids, chloroquine, and medical treatment for heart failure, with progressive clinical and instrumental stabilization.
Conclusions and Relevance This case highlights cardiac involvement as a complication associated with COVID-19, even without symptoms and signs of interstitial pneumonia.