Cardiac damage in an adolescent patient with COVID-19: a case report

Abstract

COVID-19 has been found to affect the cardiovascular system leading to myocardial damage. A study of 41 patients in Wuhan, China, found that 12% of COVID-19 patients experienced virus-related acute cardiac damage.Subsequent bigger Chinese studies also found acute cardiac damage in 7.2% to 27.8% of hospitalized patients. As a chronicsequela, this condition may result in cardiomyopathy. We report acase of an adolescent COVID-19 survivor with dilated cardiomyopathy with no underlying heart disease. A male patient aged 16 years old was admitted to our outpatient clinic with the primary symptom of exhaustion and had recovered frommild to moderate COVID-19 one month prior to the visit. No previous history of heart disease was documented. Physical examination showed no abnormalities. Laboratory results revealed substantially elevated NT-proBNP (7705 pg/mL) and D-dimer (1850 ng/mL). ECG presented normal sinus rhythm with poorR wave progression. Echocardiography revealed all chamber dilatation, eccentric left ventricular hypertrophy, globalhypokinetic, moderate mitral regurgitation, and reduced ejection fraction (22%). We diagnosed the patient with new-onset dilated cardiomyopathy and began treatment with candesartan, bisoprolol, furosemide, spironolactone, rivaroxaban, and trimetazidine. The recovery was steady at three-month follow-up visit. The emergence of new-onset cardiomyopathy in this previously healthy adolescent raisesthepossibility of COVID-19 acting asthe sole cause of myocardial injuryin the absence of underlying heart disease. To avoid further complications, comprehensive evaluation and effective therapy should be implemented during hospitalization and post-discharge. Additional tests such as cardiac magnetic resonance imaging and endomyocardial biopsies shouldbe performed to support final proof.