Reversible mixed cardiomyopathy in a patient recovered from severe COVID-19: a case report

Abstract

We present reversible cardiomyopathy in a patient recovered from severe COVID-19. In addition to heart failure, the patient had thrombosis of abdominal aorta, lower extremity arteries and kidney infarction. At admission, the left ventricular ejection fraction (LVEF) was 18%. Primary diagnosis was SARSCoV2-induced myocarditis. However, cardiac MRI with delayed gadolinium enhancement revealed no fibrosis or active myocarditis. Troponin was normal. Atrial fibrillation persisted. Arrhythmia was first verified a week before COVID-19. Previously effective treatment failed to support adequate heart rate after COVID-19. Angiography revealed subtotal stenosis of the left anterior descending artery. After strict rate control and percutaneous coronary intervention, the patient was discharged on optimal medical therapy. Six months later, LVEF was 45%. Pulmonary vein isolation and cardioversion were performed. One week later, LVEF was 60%. In our opinion, this was a mixed cardiomyopathy with predominant role of AF and myocardial ischemia. Probably, COVID-19 modulated natural course of cardiovascular pathology. We also discuss potential contribution of COVID-19 to the course of cardiovascular pathology in long-term period of disease. © 2023, Media Sphera Publishing Group. All rights reserved.