Okor Ivana, Sleem Amber, Zhang Alice, Kadakia Rikin, Bob-Manuel Tamunoinemi, Krim Selim R
Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA.
The University of Queensland Faculty of Medicine, Ochsner Clinical School, New Orleans, LA.
Ochsner J. 2021 Summer;21(2):181-186. doi: 10.31486/toj.20.0090.
The incidence of myocarditis in patients with coronavirus disease 2019 (COVID-19) remains unknown; however, increasing evidence links COVID-19 to cardiovascular complications such as arrhythmias, heart failure, cardiogenic shock, fulminant myocarditis, and cardiac death. We present a case of suspected COVID-19-induced myopericarditis and discuss the diagnostic implications, pathophysiology, and management. A 72-year-old female was admitted to the hospital with acute on chronic respiratory failure in the setting of COVID-19. The next day, she developed pressure-like retrosternal chest pain. Laboratory findings revealed elevated cardiac enzymes and inflammatory markers consistent with myocardial injury. Electrocardiogram revealed diffuse ST segment elevations without reciprocal changes, concerning for myopericarditis. Transthoracic echocardiography showed new findings of severely reduced left ventricular (LV) systolic function, with an estimated ejection fraction (EF) of 20%. Her hospital course was further complicated by cardiogenic shock that required treatment in the intensive care unit with vasopressors and inotropes. During the next few days, she had almost full recovery of her LV function, with EF improving to 50%. However, her clinical status deteriorated, likely the result of a bowel obstruction. She was transitioned to comfort care at the request of her family, and she died shortly after. This case highlights diagnostic and therapeutic challenges that physicians may encounter when managing acute cardiac injury in the setting of COVID-19. The multiple mechanisms of COVID-19-related myocardial injury may influence the approach to diagnosis and treatment.
2019冠状病毒病（COVID-19）患者中心肌炎的发病率尚不清楚；然而，越来越多的证据将COVID-19与心律失常、心力衰竭、心源性休克、暴发性心肌炎和心源性死亡等心血管并发症联系起来。我们报告一例疑似COVID-19诱发的心肌心包炎病例，并讨论其诊断意义、病理生理学和管理。一名72岁女性因COVID-19导致的慢性呼吸衰竭急性加重入住医院。第二天，她出现了胸骨后压榨样胸痛。实验室检查结果显示心肌酶和炎症标志物升高，与心肌损伤一致。心电图显示弥漫性ST段抬高，无对应性改变，提示心肌心包炎。经胸超声心动图显示左心室（LV）收缩功能严重降低的新发现，估计射血分数（EF）为20%。她的住院过程因心源性休克而进一步复杂化，需要在重症监护病房使用血管升压药和正性肌力药物进行治疗。在接下来的几天里，她的左心室功能几乎完全恢复，射血分数提高到50%。然而，她的临床状况恶化，可能是肠梗阻的结果。应其家人的要求，她转为舒适护理，并在不久后去世。 该病例突出了医生在管理COVID-19背景下的急性心脏损伤时可能遇到的诊断和治疗挑战。COVID-19相关心肌损伤的多种机制可能会影响诊断和治疗方法。
