A 32-year-old man was admitted with syncope after an episode of chest pain accompanied by fever and myalgia that had occurred for 4 days before admission. At the time of admission, the GCS score equaled 13, and he was confused. Also, he complained about dyspnea and dry cough. Vital signs were as follows: body temperature = 36.8°C, systolic blood pressure = 85/60 mmHg, heart rate = 120/min, and O2 saturation = 80% without oxygenation. The ECG showed sinus tachycardia, low-voltage limb leads, inverted T waves in two limb leads (L1 and aVL), and ST-segment depression in three pericardial leads (V1–V3). The TTE revealed LVEF = 25%, an enlarged end-diastolic diameter of the left ventricle, normal RV size (mild dysfunction), and normal valvular and pericardial function. Moreover, echocardiography demonstrated increased wall thickness. The patient had a positive nasal and oropharyngeal PCR test for COVID-19 as well as the lung CT scan showed diffuse bilateral GGO suggestive of COVID-19.\nThe patient received corticosteroids (methylprednisolone 1 mg/kg/day), broad-spectrum antibiotics (meropenem [500 mg q8 h for 5 days] and doxycycline [200 mg/day]), and remdesivir for COVID-19. The patient was discharged after 2 weeks with an ejection fraction of 45%. Follow-up of the patient for 3 months revealed an LVEF of 45% and normal RV function.
A 22-year-old man (with no history of underlying disease) was admitted with dry cough and dyspnea that had developed for 5 days before admission. Vital signs were as follows: body temperature = 36.8°C, systolic blood pressure = 70/50 mmHg, heart rate = 120/min, and O2 saturation = 90% without oxygenation. The ECG showed sinus tachycardia. The patient had a positive nasal and oropharyngeal PCR test for COVID-19, and pulmonary edema was observed by CT scan (Figure ). Echocardiography showed LVEF of 30%–35%, left ventricular end-diastolic diameter of 5 cm, moderate RV enlargement and dysfunction, dilated inferior vena cava, and mild left-sided pleural effusion. The patient received broad-spectrum antibiotics (meropenem [500 mg q8 h for 5 days] and doxycycline [200 mg/day]), high-dose corticosteroid (methylprednisolone 1 g/day), and remdesivir for COVID-19. The patient was discharged after 7 days with stable hemodynamics. Follow-up of the patient for 3 months showed an LVEF of 45% and a normal cTnI value.