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 39-year-old woman was admitted with chest pain, orthopnea, and cough that had arisen for 1 week before admission. Also, she had a history of asthma. Vital signs were as follows: body temperature = 37.2°C, systolic blood pressure = 100/60 mmHg, heart rate = 125/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 the lung CT scan showed GGO in both lungs (Figure ). Echocardiography represented an LVEF of 30%–35%, normal LV size, mild RV enlargement (restrictive diastolic pattern), moderate tricuspid and mitral regurgitation, and mild pericardial effusion. Cardiac magnetic resonance (CMR or cardiac MRI) imaging showed myocardial edema and hyperemia suggestive of active myocarditis. Also, coronary CT angiography was normal. Subepicardial and subendocardial fibrosis in the middle part of the inferoseptal wall was also present. Her vital signs and oxygen saturation (98% on room air) improved after dexamethasone administration for 3 days. Echocardiography revealed an LVEF of 45% and a hypermobile thrombus in the LV (1.5 × 1.5 cm; Figure ). Although the cardiac surgeon suggested surgical removal of the thrombus, the patient refused the surgery. So, the patient was subjected to anticoagulation therapy (heparin 24,000 U/24 h). After 3 days, the thrombus had disappeared on the echocardiography, and there were no clues of embolism. The patient was discharged in a satisfying condition on β-blocker, angiotensin-converting enzyme (ACE) inhibitor, spironolactone, and warfarin. Follow-up of the patient for 3 months showed an LVEF of 45%–50%.