Severe COVID-19 pneumonia associated with transient complete heart block
and myocarditis: A case report
Abstract
A 70-year-old male presented with complaints of fever for 10 days;
associated with dry cough for one week, gradually progressive shortness
of breath for five days, and non-radiating chest pain for three days.
Chest examination revealed bilateral basal crepitation, and cardiac
examination showed muffled first heart sound with soft systolic murmur
at apex. All severity markers of COVID-19 were elevated. Twelve lead
electrocardiography (ECG) showed complete heart block. Troponin-I test
was negative. High resolution computed tomography (HRCT) thorax showed
extensive bilateral multifocal patchy and confluent areas of
ground-glass opacities distributed along with peripheral subpleural and
peribronchovascular regions with interlobular septal thickening
suggestive of viral pneumonia .He was started on high flow oxygen,
parenteral corticosteroids, and anticoagulants with antibiotics
coverage. Injection Isoprenaline infusion was started for heart block,
but the patient developed atrial flutter-fibrillation with premature
ventricular complexes. The patient clinically improved and was
discharged on the 11th day of admission. On follow up after 2 weeks,
repeat ECG showed atrial fibrillation, and 2D Echocardiography revealed
global hypokinesia, severe mitral regurgitation with left ventricular
systolic dysfunction (ejection fraction of 28%), and dilated left
ventricle and atrium. He was planned for coronary angiography after one
month. High clinical suspicion, early diagnosis, and prompt treatment
with corticosteroids can yield a favorable outcome. Follow up is
necessary to rule out long term complications like viral cardiomyopathy.