Case Presentation:
A 46-year-old female referred to heart failure clinic for further
evaluations of her new onset heart failure. In her first visit on
January 2021, she complained of a dyspnea of exertion, New York Heart
Association functional class of II (NYHA-FC) and fatigue.
Her past medical history was unremarkable in terms of cardiovascular
problems before her recent episode of acute heart failure. She had a
history of a controlled lichen plan dermatitis (LP) treated by
immunosuppressive therapy several years ago. She also had a history of
antithyroid peroxidase antibody (TPO) positive hypothyroidism that was
managed with levothyroxine.
A month before the first visit in our clinic (on December 2020), she had
developed symptoms of COVID-19 such as fever, sore throat and malaise.
The real time polymerase chain reaction (RT-PCR) test for the novel
corona virus infection was positive but the clinical course of her
COVID-19 infection was uneventful without any decrease in arterial O2
saturation or pulmonary involvement and the disease was subsided using
the recommended medications for mild COVID-19.
About three weeks later (a week after the remission of the COVID-19
infection), she was admitted due to a severe chest discomfort and
shortness of breath. Her electrocardiogram (ECG) was highly suggestive
of acute anterior myocardial infarction (ST segment elevation in V2-V6
leads), according to her hospital discharge note. Considering the ECG
changes and an elevated cardiac Troponin-I level, she underwent emergent
coronary angiography, which revealed normal epicardial coronary
arteries. Her echocardiogram reported a normal left ventricular (LV)
size, with apical hypokinesia and an ejection fraction (EF) of 35-40%,
normal right ventricular (RV) size and function, a mild mitral valve
regurgitation (MR), a mild tricuspid valve regurgitation (TR), no
pulmonary hypertension and no pericardial effusion.
With an impression of acute myocarditis, she underwent a cardiac
magnetic resonance imaging (CMR), and based on the results (Figure 1),
she was referred to our heart failure clinic for further evaluations.