Cardiac involvement in cancer patients under chemotherapy and diagnosed with COVID-19: case report and literature review

Abstract

Many cases of severe cardiac complications due to Coronavirus disease 2019 (COVID-19) were reported. Cancer and chemotherapy appear to be risk and prognostic factors for COVID-19. A 49-year-old Female, with a history of breast cancer treated by tumorectomy and anthracycline-based chemotherapy was admitted with acute respiratory distress syndrome (ARDS) confirmed as COVID-19. She also had elevated troponin I level (up to 43 g/L), and diffuse myocardial hypokinesia along with severe left ventricle dysfunction on echocardiography. Initial treatment included hydroxychloroquine, azithromycin, corticosteroids and mechanical ventilation. The evolution was marked by QT interval prolongation (QTc=523 ms) and occurrence of cardiogenic shock. The patient died of hemodynamic instability reluctant to resuscitation measures at the 2 nd day of hospitalization. COVID-19 patients may develop severe cardiac complications such as myocarditis and heart failure. Receiving chemotherapy especially anthracyclines may be a precipitating and prognostic factor of cardiac manifestations in COVID-19 cancer patients.

Myocarditis in Cancer Patients: A Review of an Emerging Problem in Cardio-Oncology

“…In some scenarios, the causative agent of myocarditis is difficult to determine, as patients are being treated with multiple drugs or have a history of recent COVID-19 infection, COVID-19 vaccination, or infection with other viruses commonly associated with myocarditis. 42,43…”