Cardiac Damage in an Adolescent Patient with COVID-19: a Case Report
Prihati Pujowaskito (a, b)*, Tamia Setia Tartila (b), Novaro Adeneur Tafriend (b), Fatimah Defina Khamarul Jannah (b), Elsy Mayasari (b)

(a) Department of Internal Medicine, Faculty of Medicine, Jenderal Achmad Yani University
(b) Department of Cardiology, Gatot Soebroto Army Hospital
*pujowaskito[at]yahoo.com


Abstract

COVID-19 has been found to affect the cardiovascular system leading to myocardial damage. As a chronic sequela, this condition may result in cardiomyopathy. We report a case of an adolescent COVID-19 survivor with dilated cardiomyopathy who had no underlying heart disease. A male patient aged 16 was admitted to our outpatient clinic with a primary symptom of exhaustion and had recently recovered from mild to moderate COVID-19 one month prior to the visit. The patient had no previous history of heart disease. Physical examination showed no abnormalities, but the laboratory results revealed substantially elevated NT-proBNP (7705 pg/mL) and D-dimer (1850 ng/mL). ECG showed normal sinus rhythm with poor R wave progression. Bedside echocardiography revealed all chamber dilatation, eccentric left ventricular hypertrophy, global hypokinetic, moderate mitral regurgitation and reduced ejection fraction (22%). We diagnosed the patient with new-onset dilated cardiomyopathy as a COVID-19 sequela, and we began treatment with an angiotensin II receptor blocker (candesartan), a beta-blocker (bisoprolol), diuretics (furosemide and spironolactone), rivaroxaban, and trimetazidine. The recovery was steady at a three-month follow-up visit. The emergence of new-onset cardiomyopathy in this previously healthy young patient raises the possibility of COVID-19 acting as a sole cause of myocardial injury in the absence of underlying heart disease. To avoid further complications, comprehensive evaluation and effective therapy should be implemented during hospitalization and post-discharge period. To offer final proof, additional tests such as cardiac magnetic resonance imaging and endomyocardial biopsies should be performed.

Keywords: Cardiomyopathy, COVID-19, myocardial injury

Topic: COVID-19

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