A 34-year-old woman was admitted with complaint of losing consciousness and she had also been suffering from fever and headache for six consecutive days. Vital signs were as follows: body temperature = 36.7°C, systolic blood pressure = 80/60 mmHg, heart rate = 114/min, and O2 saturation = 82% without oxygenation. Also, the GCS score equaled 8. The ECG monitoring revealed ventricular tachycardia (Figure ); so, the direct current (DC) shock was administered and the patient was intubated. Echocardiography showed normal LV and RV size, moderate tricuspid and mitral regurgitation, systolic pulmonary artery pressure of 30 mmHg, and LVEF of 30%. The chest CT scan illustrated bilateral GGO and basal consolidations (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]), high-dose corticosteroid (methylprednisolone 1 g/day), and remdesivir for COVID-19. The patient was discharged after 3 weeks with LVEF of 40%–45% and normal cardiac biomarkers. Follow-up of the patient for 3 months showed an LVEF of 45%–50%.
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).