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%.
A 28-year-old man was admitted with chest pain, fever, and dry cough that had arisen for 3 days before admission. Vital signs were as follows: body temperature = 36.8°C, systolic blood pressure = 100/60 mmHg, heart rate = 92/min, and O2 saturation = 92% without oxygenation. The ECG illustrated sinus rhythm with ST-segment elevation and Q waves in precordial leads. Also, angiography showed normal coronary arteries. Echocardiography revealed LVEF = 30%–35%, hypokinesis in the anterior wall, normal LV size as well as normal RV size and function. Lung CT scan showed a bilateral GGO pattern (Figure ) as well as the patient had a positive nasal and oropharyngeal PCR test for COVID-19. The patient received broad-spectrum antibiotics (meropenem [500 mg q8 h for 5 days] and doxycycline [200 mg/day]), corticosteroid (methylprednisolone 1 mg/kg/day), and remdesivir for COVID-19 for 7 days. It is worth mentioning that LVEF improved to 45%–50% after treatment. He recovered within 3 days and was discharged in a satisfying condition. Follow-up of the patient for 3 months revealed LVEF of 45%–50% and a normal cardiac function.