A 15-year-old girl (with no underlying disease) was admitted with mild dyspnea, abdominal pain, nausea, and fever that had occurred for 2 days before admission. At the time of admission, vital signs were as follows: body temperature = 39.8°C, systolic blood pressure = 90/50 mmHg, heart rate = 120/min, and O2 saturation = 95% without oxygenation. Cold limbs and thready pulse were obvious through physical examination. Moreover, the ECG revealed sinus tachycardia and inverted T wave in lateral limb and precordial leads. Simultaneously, an enlarged liver (146 mm) and elevated levels of liver enzymes (alanine aminotransferase [ALT] = 176 U/L, aspartate aminotransferase [AST] = 120 U/L, alkaline phosphatase [ALP] = 170 U/L, albumin = 4.5 g/dl, total bilirubin = 1 mg/dl, and direct bilirubin = 0.3 mg/dl) were observed that were suggestive of acute hepatitis. The TTE indicated severe ventricular (RV and LV) enlargement and dysfunction (LVEF = 5%–10%), moderate mitral regurgitation, PAP = 35 mmHg, and mild pericardial effusion. The patient had a positive nasal and oropharyngeal PCR test for COVID-19, and the lung CT scan disclosed GGO as well as peripheral consolidations (Figure ). The patient was treated with broad-spectrum antibiotics (meropenem [500 mg q8 h for 5 days] and doxycycline [200 mg/day]), corticosteroids (methylprednisolone 1 mg/kg/day), and remdesivir. Ten days after admission, the patient was discharged from the hospital in a stable condition with normalization of white blood cell (WBC) count and liver enzymes, and the TTE exhibited no change compared to the first examination. However, an LVEF of 20% and a dysfunctional and enlarged RV were observed by follow-up of the patient for 3 months. It is worth mentioning that the patient suffered from dyspnea during ordinary physical activities (functional class II).
A 51-year-old woman was admitted with cardiopulmonary arrest. The ECG showed torsade de pointes (Tdp). So, cardio-version and lidocaine administration were carried out and she was successfully resuscitated after 20 min. Serum electrolytes were normal, and she received no QT-prolonging agents. Lung CT scan exhibited bilateral GGO (Figure ) as well as the patient had a positive nasal and oropharyngeal PCR test for COVID-19. The TTE exhibited an LVEF of 35%, normal LV size, increased LV wall thickness (13 mm), no pericardial effusion, no valvular lesion, and no LV thrombus. The patient received IVIG (1 g/kg), 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. So, her hemodynamic status improved after 12 h. Also, angiography displayed a non-significant (<50%) lesion in the middle part of the left anterior descending artery (Figure ). The TTE (after 10 days) revealed a 50% improvement of LVEF with a slight increase in LV wall thickness (11 mm) and the cTnI value had decreased. The patient was discharged in a satisfying condition after 10 days. Follow-up of the patient over 3 months demonstrated an LVEF of 50%.