SHM Converge Scientific Abstract ePoster Gallery-A Case of Sars-Cov-2 Induced Cardiomyopathy in the Setting of Multisystem Inflammatory Syndrome

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A healthy 32-year-old man with recent COVID-19 infection presented with fever, myalgia, vomiting, and diarrhea. Initial evaluation showed mild enteritis on CT abdomen/pelvis and no pneumonia on chest X-ray. He received 3.7 liters of IV isotonic fluids in the ED and was discharged, but returned the next day with persistent gastrointestinal symptoms and worsening weakness. On admission, he was tachycardic and hypotensive with marked inflammatory and organ injury markers, including leukocytosis with bandemia, very high CRP and ferritin, elevated D-dimer, lactate, creatinine, and severe transaminitis.<br /><br />Within hours, he developed progressive dyspnea, hypoxemia, and bilateral basal crackles. Chest CT showed bilateral pleural effusions without pulmonary embolism or consolidation. Cardiac testing revealed a troponin of 4.76 ng/mL, BNP of 6404 pg/mL, and echocardiography demonstrated a reduced left ventricular ejection fraction of 30–35% with global hypokinesia, consistent with acute cardiomyopathy.<br /><br />The patient was treated by stopping IV fluids and starting IV furosemide, dexamethasone, and therapeutic enoxaparin. His oxygen requirement improved rapidly. An extensive workup for other causes of cardiomyopathy, including viral and autoimmune testing, was negative. SARS-CoV-2 IgG was positive, supporting COVID-related multisystem inflammatory syndrome (MIS) with myocardial involvement.<br /><br />He was hospitalized for 7 days and discharged on a life vest, lisinopril, metoprolol, and furosemide. Follow-up echocardiography at 3 months showed complete recovery of ventricular function with normal ejection fraction and no hypokinesis.<br /><br />This case highlights that SARS-CoV-2 can cause cardiomyopathy even without respiratory pneumonia, especially in young adults with MIS. Clinicians should maintain a high index of suspicion and use caution with aggressive IV fluid resuscitation in such patients.

Asset Subtitle

Cristine K. Arcilla

Meta Tag

Author List Amy Pulikeyil, Cristine K. Arcilla, Natalia Plotskaya

Category Clinical Vignettes

Concept Multisystem Inflammatory Syndrome

Concept Myocardial Injury

Concept Cardiomyopathy

Concept SARS-CoV-2

Concept Troponin

Distinguished Non-Finalist

Presenter Organization Capital Health Regional Medical Center

Presenting Author Cristine K. Arcilla

Track Adult

Keywords

COVID-19

multisystem inflammatory syndrome

cardiomyopathy

myocardial involvement

troponin elevation

heart failure

pleural effusion

transaminitis

echocardiography

young adult

Multisystem Inflammatory Syndrome

Myocardial Injury

Cardiomyopathy

SARS-CoV-2

Troponin