Acute myocarditis with ventricular noncompaction in a COVID-19 patient

M Bonnet, F Craighero, B Harbaoui - Heart Failure, 2020 - jacc.org
M Bonnet, F Craighero, B Harbaoui
Heart Failure, 2020jacc.org
As highlighted by Nianguo Dong (1), coronavirus disease-2019 (COVID-19) can cause
myocardial injury. Putative mechanisms are acute coronary syndrome, demand ischemia,
microvascular ischemic injury, cytokine dysregulation, or myocarditis (2). However,
myocardial injury does not always correlate exclusively with COVID-19, and it may also
reveal incidental cardiomyopathy. Thus, physicians must stay alert, and careful causative
assessment is required in these patients. As contagious risk and patient instability may …
As highlighted by Nianguo Dong (1), coronavirus disease-2019 (COVID-19) can cause myocardial injury. Putative mechanisms are acute coronary syndrome, demand ischemia, microvascular ischemic injury, cytokine dysregulation, or myocarditis (2). However, myocardial injury does not always correlate exclusively with COVID-19, and it may also reveal incidental cardiomyopathy. Thus, physicians must stay alert, and careful causative assessment is required in these patients. As contagious risk and patient instability may preclude initial work-up, reassessing the patient after the acute phase is of utmost importance. To illustrate, we report the case of an acute myocarditis with an underlying isolated ventricular noncompaction (IVNC) in a COVID-19 patient with heart failure.
A 27-year-old male without medical history was admitted for respiratory distress, and COVID-19 was diagnosed. High-sensitivity troponin I and N-terminal pro–B-type natriuretic peptide concentrations were elevated (100 ng/l and 9,300 pg/ml, respectively) suggesting myocardial involvement. In addition, echocardiography revealed an enlarged left ventricle with impaired left ventricle ejection fraction (LVEF) of 20%. The patient improved on a regimen of highdose diuretic agents and noninvasive ventilation. He was discharged 9 days later with prescriptions for bisoprolol, furosemide, and spironolactone. One
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