Presentation Title

COVID-19 Pneumonia Complicated With Fulminant Myocarditis and a Left Ventricular Thrombus in an Obese but Otherwise Healthy Young Man

Speaker Credentials

Medical Education

Speaker Credentials

MD

Format

Poster

Start Date

6-11-2020 11:45 AM

End Date

6-11-2020 12:00 PM

Abstract

COVID-19 pneumonia complicated with fulminant myocarditis and a left ventricular thrombus in an obese but otherwise healthy young man Al-Midfai D Younus MD, Alabi O Christopher MD, Turk Jordan MD, Kowalski Amanda DO Introduction It has been established that severe complications of COVID-19 pneumonia can be seen in all age groups but with greater incidence in the elderly population and those with some co-morbid conditions. This article presents a case of fulminant myocarditis with severely reduced ejection fraction and a left ventricular thrombus in an obese but otherwise healthy young man. Case description A 30-year old obese man (BMI 32.4) presented to the ER on account of fatigue, cough, fever and shortness of breath. He had associated orthopnea and on examination bilateral pedal edema and tachycardia. Significant lab findings include; absolute lymphopenia, elevated BNP, D-dimer and liver enzymes. Troponin was minimally elevated and flat. CPK was normal. Chest x-ray (figure 1) revealed diffuse multifocal bilateral airspace disease. COVID-19 PCR came back positive. 2D echo (figure 2) revealed severe diffuse hypokinesis with an ejection fraction of 20% and a 16 mm x 14mm left ventricular thrombus on the apical wall. He was treated with IV loop diuretics, along with beta blockers, ACE inhibitors and aldosterone antagonist. He was also treated with treatment dose anticoagulation, Remdesevir, steroids as well as convalescent plasma. Cardiac catheterization was deferred due to active infection. He was discharged after 14 days still with an ejection fraction of 20% on guideline-directed medical care for CHF and anticoagulation. Discussion Myocarditis has been established as a possible severe sequel of COVID-19 pneumonia. The severity of the cardiac dysfunction associated with acute COVID-19 pneumonia has been unpredictable. It is not yet known, as with most cases of myocarditis, if the cardiac function will recover. The thrombi formation seen in this patient can be attributable to the cardiac hypokinesis and also to the hypercoagulable state seen with COVID-19 cytokine storm. Obesity is the only co-morbid condition seen in this young and healthy patient who had a severe complication from COVID-19 pneumonia. This case further reinforces obesity as a risk factor that can possibly predispose a young and healthy patient to severe complications of COVID-19 pneumonia. It will be imperative to monitor such patients closely with subsequent echocardiograms and cardiac MRI. Figure 1: Plain radiograph revealing diffuse multifocal bilateral airspace disease Figure 2: 2D Echo showing left ventricular thrombus on the apical wall

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Nov 6th, 11:45 AM Nov 6th, 12:00 PM

COVID-19 Pneumonia Complicated With Fulminant Myocarditis and a Left Ventricular Thrombus in an Obese but Otherwise Healthy Young Man

COVID-19 pneumonia complicated with fulminant myocarditis and a left ventricular thrombus in an obese but otherwise healthy young man Al-Midfai D Younus MD, Alabi O Christopher MD, Turk Jordan MD, Kowalski Amanda DO Introduction It has been established that severe complications of COVID-19 pneumonia can be seen in all age groups but with greater incidence in the elderly population and those with some co-morbid conditions. This article presents a case of fulminant myocarditis with severely reduced ejection fraction and a left ventricular thrombus in an obese but otherwise healthy young man. Case description A 30-year old obese man (BMI 32.4) presented to the ER on account of fatigue, cough, fever and shortness of breath. He had associated orthopnea and on examination bilateral pedal edema and tachycardia. Significant lab findings include; absolute lymphopenia, elevated BNP, D-dimer and liver enzymes. Troponin was minimally elevated and flat. CPK was normal. Chest x-ray (figure 1) revealed diffuse multifocal bilateral airspace disease. COVID-19 PCR came back positive. 2D echo (figure 2) revealed severe diffuse hypokinesis with an ejection fraction of 20% and a 16 mm x 14mm left ventricular thrombus on the apical wall. He was treated with IV loop diuretics, along with beta blockers, ACE inhibitors and aldosterone antagonist. He was also treated with treatment dose anticoagulation, Remdesevir, steroids as well as convalescent plasma. Cardiac catheterization was deferred due to active infection. He was discharged after 14 days still with an ejection fraction of 20% on guideline-directed medical care for CHF and anticoagulation. Discussion Myocarditis has been established as a possible severe sequel of COVID-19 pneumonia. The severity of the cardiac dysfunction associated with acute COVID-19 pneumonia has been unpredictable. It is not yet known, as with most cases of myocarditis, if the cardiac function will recover. The thrombi formation seen in this patient can be attributable to the cardiac hypokinesis and also to the hypercoagulable state seen with COVID-19 cytokine storm. Obesity is the only co-morbid condition seen in this young and healthy patient who had a severe complication from COVID-19 pneumonia. This case further reinforces obesity as a risk factor that can possibly predispose a young and healthy patient to severe complications of COVID-19 pneumonia. It will be imperative to monitor such patients closely with subsequent echocardiograms and cardiac MRI. Figure 1: Plain radiograph revealing diffuse multifocal bilateral airspace disease Figure 2: 2D Echo showing left ventricular thrombus on the apical wall