Severe COVID-19 pneumonia associated with transient complete heart block and myocarditis: A case report

Abstract

A 70-year-old male presented with complaints of fever for 10 days; associated with dry cough for one week, gradually progressive shortness of breath for five days, and non-radiating chest pain for three days. Chest examination revealed bilateral basal crepitation, and cardiac examination showed muffled first heart sound with soft systolic murmur at apex. All severity markers of COVID-19 were elevated. Twelve lead electrocardiography (ECG) showed complete heart block. Troponin-I test was negative. High resolution computed tomography (HRCT) thorax showed extensive bilateral multifocal patchy and confluent areas of ground-glass opacities distributed along with peripheral subpleural and peribronchovascular regions with interlobular septal thickening suggestive of viral pneumonia .He was started on high flow oxygen, parenteral corticosteroids, and anticoagulants with antibiotics coverage. Injection Isoprenaline infusion was started for heart block, but the patient developed atrial flutter-fibrillation with premature ventricular complexes. The patient clinically improved and was discharged on the 11th day of admission. On follow up after 2 weeks, repeat ECG showed atrial fibrillation, and 2D Echocardiography revealed global hypokinesia, severe mitral regurgitation with left ventricular systolic dysfunction (ejection fraction of 28%), and dilated left ventricle and atrium. He was planned for coronary angiography after one month. High clinical suspicion, early diagnosis, and prompt treatment with corticosteroids can yield a favorable outcome. Follow up is necessary to rule out long term complications like viral cardiomyopathy.