Fulminant Myocarditis in Covid 19 - Case report

• Published in: Macedonian pharmaceutical bulletin Vol. 67; no. 1; pp. 91 - 95
• Main Authors: Grueva Nastevska, Elena, Kotlar, Irina, Kandic, Elma, Gruev, Vladislav, Chelikikj, Ana, Lazarova, Emilija, Mitevska, Irena, Busljetic, Oliver
• Format: Journal Article
• Language: English
• Published: 2021
• ISSN: 1409-8695; 1857-8969
• DOI: 10.33320/10.33320/maced.pharm.bull.2021.67.01.009

Fulminant myocarditis (FM) is a syndrome characterized by sudden and severe diffuse cardiac inflammation often leading to death resulting from cardiogenic shock, ventricular arrhythmias, or multi-organ system failure. Clinical presentations vary widely, but the main characteristic is a rapidly progressive clinical course with the need of hemodynamic support. We present a clinical case of a patient with COVID-19 admitted to our cardiac intensive care unit with severely reduced left ventricular ejection fraction and worsening clinical course ending in cardiogenic shock in a very short time. The only available imaging technique in these fast-deteriorating patients is the bedside echocardiography, helping to provide accurate assessment and adequate treatment as soon as possible. Even though the current recommendations imply the use of cardiac magnetic resonance (CMR) and endomyocardial biopsy (EMB) as a diagnostic tool for myocarditis, their application in the COVID-19 pandemic is limited. The use of inotropes and mechanical support is the recommended and the final challenge as a bridge to recovery or bridge to transplant. In the settings where CMR and EMB are not feasible from an infection control standpoint, the diagnose should rely on the integration of clinical, laboratory (cardiac biomarkers), electrocardiographic (ST-segment changes), and echocardiographic -wall motion abnormalities, ejection fraction, and pericardial effusion- data. Keywords: myocarditis; COVID-19; cardiogenic shock; echocardiography; endomyocardial biopsy