CHRONIC CARDIOVASCULAR SEQUELAE OF SEVERE ACUTE RESPIRATORY SYNDROME CORONA VIRUS 2 (SARS-COV-2) INFECTION - A NEW DIFFERENTIAL FOR CARDIOMYOPATHY

Background

Multiple cardiovascular complications have been reported with Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), including acute coronary syndrome, myocarditis, heart failure, and thromboembolic disease. Long-term effects of these acute cardiovascular complications are uncertain.

Case

46-year-old female presented to the cardiology clinic with a two-week history of recurrent chest pain and dyspnea. She presented to the emergency room with similar complaints on multiple occasions during this time, but was discharged after her symptoms were attributed to anxiety. Her past medical history was significant for supraventricular tachycardia treated with ablation 3 years previously, without known recurrence. On physical examination, she had regular rhythm, normal heart sounds, and no murmur, but JVP was mildly elevated with some pretibial edema. Her electrocardiogram showed normal sinus rhythm and her laboratory tests showed normal troponin and elevated NT-proBNP to 600pg/ml (normal < 100pg/ml). An echocardiogram revealed a left ventricular ejection fraction (LVEF) of 45-50% with inferior akinesis, which was new compared to a prior echocardiogram. With patient's persistent symptoms and abnormal echocardiogram, a cardiac catheterization was performed. Coronary angiography showed non-obstructive disease. She was started on furosemide for clinical fluid overload and rosuvastatin for prevention of progression of coronary disease.

Decision-making

On further questioning, patient stated that she did not initially disclose she had SARS-CoV-2 about a month before her symptoms started. A cardiac MRI was then performed, which showed a normal LVEF with epicardial enhancement in the basal to mid-inferior and lateral walls suggesting myocarditis, likely secondary to her prior SARS-CoV-2 infection.

Conclusion

The knowledge and implications of cardiovascular complications after recovery from SARS-CoV-2 continue to be recognized. In patients presenting with no clear etiology of cardiomyopathy, the differential diagnosis should include this sequela of SARS-CoV-2 infection, especially if the patient had an asymptomatic SARS-CoV-2 infection.