Case report, case study

DELAYED MANIFESTATION OF POST-COVID MYOCARDITIS

IVA POPOV orcid.org/0000-0001-9225-5411 ; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Institute of Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Serbia *
MILA KOVAČEVIĆ ; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Institute of Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Serbia
BRANISLAV CRNOMARKOVIĆ ; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Institute of Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Serbia
MILENKO ČANKOVIĆ ; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Institute of Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Serbia
MILANA JARAKOVIĆ ; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Institute of Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Serbia
STEVAN KEČA ; Institute of Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Serbia
SONJA DIMIĆ ; Institute of Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Serbia
SRĐAN MALETIN ; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Institute of Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Serbia
MILENA SPIROVSKI ; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Oncology Institute of Vojvodina, Sremska Kamenica, Serbia
MAJA STEFANOVIĆ ; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Institute of Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Serbia
MILOVAN PETROVIĆ ; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Institute of Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Serbia
ALEKSANDRA MILOVANČEVA ; University of Novi Sad, Faculty of Medicine, Novi Sad, Serbia; Institute of Cardiovascular Diseases of Vojvodina, Cardiology Clinic, Sremska Kamenica, Serbia

* Corresponding author.

Abstract

: Myocardial involvement of coronavirus disease 2019 (COVID-19) varies and is considered to be more serious in patients with severe COVID-19 clinical presentation. Although myocarditis is usually recognized in the setting of acute SARS-CoV-2 infection, delayed manifestations are recognized as well. Case report. A 51-year-old male patient was admitted due to the clinical signs of congestive heart failure, two months after moderate clinical expression of COVID-19 pneumonia, treated as an outpatient. Transthoracic echocardiography (TTE) revealed dilated cardiomyopathy with the presence of diffuse left ventricular (LV) hypokinesia, severely reduced ejection fraction (EF 18%) and diastolic dysfunction with increased left atrial filling pressure. Baseline laboratory tests revealed elevated hs-troponin I, NT-proBN. Diagnostic workout excluded coronary artery disease. Cardiac magnetic resonance imaging strongly pointed in the direction of unrecognized post-COVID myocarditis. The patient was treated according to current guidelines for heart failure with reduced EF. Eight months after discharge, the patient had no limitations of physical activity and TTE showed significant improvement in the systolic function of the left ventricle, EF was 47%, with normal LV filling pressure. Conclusion: Myocarditis is not an infrequent manifestation of COVID-19 infection, especially in hospitalized patients with severe clinical presentation, and commonly manifests within the first week after initial symptoms. Our case report represents an example that also patients with mild form of COVID-19 treated as outpatients can have delayed onset of heart failure as a consequence of COVID-19-induced myocarditis. Therefore, COVID-19 patients deserve a comprehensive approach with systematic clinical and echocardiographic follow-up in order to establish a timely diagnosis, provide appropriate treatment, and prevent serious complications.

Keywords

COVID-19; myocarditis; dilated cardiomyopathy; magnetic resonance imaging

Hrčak ID:

310552

URI

https://hrcak.srce.hr/310552

Publication date:

22.11.2023.

Article data in other languages: croatian

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