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.
An 18-year-old woman (with no underlying disease) was admitted with a sudden loss of consciousness, fever, and headache that had occurred for 2 days before admission. At the time of admission, vital signs were as follows: body temperature = 36.8°C, systolic blood pressure = 80/60 mmHg, heart rate = 110/min, and O2 saturation = 80% without oxygenation. Glasgow Coma Scale (GCS) score was 11. She was intubated and treated with vasopressors. Also, rales were heard on pulmonary auscultation. Initial electrocardiogram (ECG) demonstrated sinus tachycardia (110/min) and low voltage QRS. Transthoracic echocardiography (TTE) indicated a small left ventricle (LV) with an end-diastolic dimension of 42 mm, a left ventricular ejection fraction (LVEF) of 10% with global hypokinesis, a normal right ventricle (RV), and pulmonary arterial pressure (PAP), no pericardial effusion (PE) or thrombosis, and no significant valve lesions or dysfunction. Chest computed tomography (CT) scan revealed diffuse bilateral ground-glass opacities (GGO) and basal consolidations (Figure ). Moreover, the patient had a positive nasal and oropharyngeal polymerase chain reaction (PCR) test for COVID-19. Laboratory findings are summarized in Table . The patient received intravenous immunoglobulin (IVIG; 1 g/kg), broad-spectrum antibiotics (meropenem [500 mg] and doxycycline [200 mg/day]), high-dose corticosteroid (methylprednisolone 1 g/day), and remdesivir for COVID-19. However, she died due to cardiac arrest (less than 24 h after admission).