PMC9912035_01
Initial electrocardiogram showed ST-segment elevation in the lateral limb
leads (I and aVL). Note the reciprocal ST-segment depression change in
inferior leads.
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Her electrocardiogram showed ST-segment elevation in the anterolateral leads with reciprocal ST-depression changes in the inferior leads. (Figure 1) then she was referred to our tertiary heart center for further evaluation.
Second electrocardiogram showed prominent ST-elevation in anterior leads and
new right bundle branch block (RBBB).
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ST-segment elevation in anterolateral leads and new right bundle branch block (RBBB). (Figure 2) Second echocardiography was performed; Her LVEF dropped to 15% with global hypokinesia, especially in the anterior circulation, and significant LV enlargement. (Table 3) She was suspected of missed or new myocardial infarction complicated with cardiogenic shock, so she was transferred to the Cath-lab and underwent her second CAG. Similar to her previous coronary angiogram, there were no signs of obstruction or stenosis, and also there was no angiographic evidence of SCAD. (Figure 3) According to the CDC definition of probable acute myocarditis, she was clinically diagnosed with possible acute myocarditis and was scheduled to receive IVIG, colchicine, and corticosteroid.
Initial (left) and second (right) coronary angiography revealed no sign of
stenosis or obstruction.
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There was no evidence of coronary artery obstruction or stenosis in her angiogram (Figure 3). ST-segment elevation in anterolateral leads and new right bundle branch block (RBBB). (Figure 2) Second echocardiography was performed; Her LVEF dropped to 15% with global hypokinesia, especially in the anterior circulation, and significant LV enlargement. (Table 3) She was suspected of missed or new myocardial infarction complicated with cardiogenic shock, so she was transferred to the Cath-lab and underwent her second CAG. Similar to her previous coronary angiogram, there were no signs of obstruction or stenosis, and also there was no angiographic evidence of SCAD. (Figure 3) According to the CDC definition of probable acute myocarditis, she was clinically diagnosed with possible acute myocarditis and was scheduled to receive IVIG, colchicine, and corticosteroid.
Spiral chest CT scan revealed bilateral pleural effusion, significant
cardiomegaly, and interlobular septal thickening, which indicates
cardiogenic pulmonary edema. The presence of peripheral/hilar ground glass
opacity and reversed halo sign indicates COVID-19 lung involvement.
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The spiral chest CT scan revealed bilateral pleural effusion, pericardial congestion, significant cardiomegaly, and peripheral/hilar ground glass opacity, indicating possible COVID-19 lung involvement (Figure 4); therefore pulmonology consultation was requested, and then she was started on antiviral agent remdesivir and was continued to receive corticosteroid.
Late gadolinium enhancement distribution of patient's left ventricle based on
AHA 17 segment model for myocardial segmentation.
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Cardiac magnetic resonance imaging showed subepicardial scar on anterior and
lateral wall of the left ventricle. (Arrow).
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