Development of acute myocarditis as a complication of COVID-19

Abstract

The definite proofs of injury of SARS-CoV-2 infection on cardiovascular system are existing. Heart damage may be as primary without lung injury mentioned in literature «the heart phenotype», as secondary which is developed under lung injury and named «mixed cardio-pulmonary phenotype». The reason of prevalence of one or another phenotype is unknown but with confidence it can be confirmed that myocardial injury worsens the patient’s prognosis. The clinical case concernes the 19-year-old patient after new coronavirus infection COVID-19. The ilness courced in mild form, without lung injury. Myocarditis is clinically fixed after 2 weeks after coronavirus symptoms beginning. In our case repeated сonsistent hypertermia observed since 17 day of disease, the level of C-reactive proteine was elevated. The patient was evaluated after COVID-19. Echocardiography was done, it has been revealed segmentary and global strain decrease. Acute myocarditis was suggested and confirmed by magnetic resonance investigation (MRI) with gadolinium enhancement. Carvedilol 3,125 mg twice daily with dose titration to 25 mg twice, zophinapril 7,5 mg twice a day, spironolacton 25 mg daily, colchicin 0,5 mg twice daily, trimetazidiin 80 mg daily, phisical load restricition, rational nutrition were prescribed to the patient. Repeated MRI demonstrated resolution of acute myocarditis, only elements of light focal unischemic myocardial fibrosis were remained. Conclusion is that in patients with COVID-19 can develop myocarditis. The mechanism of development of this complication is unknown and needs further investigation.