Diagnostic dilemma: COVID-19 related cardiomyopathy or peripartum cardiomyopathy?

Elsevier, Journal of Cardiology Cases, Volume 24, November 2021
Akintayo A.A., Addo B., Soleye S.O., Patel D., Ahmad A., Tongia S.
Peripartum cardiomyopathy is a relatively rare condition, that usually presents with features of heart failure in the peripartum period. The ongoing pandemic caused by coronavirus disease 2019 (COVID-19) has been reported to be associated with myocarditis, with progression to dilated cardiomyopathy and heart failure. Dilated cardiomyopathy in a peripartum patient with COVID-19 infection may present a diagnostic dilemma. We report a case of dilated cardiomyopathy in a peripartum patient with COVID-19 infection. She presented with shortness of breath in the peripartum period. Chest X-ray showed a grossly enlarged heart with bilateral pulmonary infiltrates consistent with congestive heart failure or viral pneumonia. Echocardiography revealed dilated chambers with 22% left ventricular ejection fraction (LVEF) and global hypokinesis. Despite completing 5 days of remdesivir and dexamethasone, she had worsening dyspnea on postpartum day 10, a repeat echocardiogram showed further reduction in LVEF to 10-15% and was discharged with a life-vest after acute management. She had multiple hospital admissions for decompensated heart failure. Myocardial core biopsy showed marked acute inflammation and necrosis. She had an intra-aortic balloon pump, left ventricular and right ventricular assist devices placed on account of persistent hemodynamic instability, and is now scheduled to have a cardiac transplant.



Abdominal Distension; Abnormal Respiratory Sound; Acute Heart Failure; Acute Kidney Failure; Adult; African American; Alanine Aminotransferase; Alanine Aminotransferase Blood Level; Alcohol; Arterial Gas; Article; Aspartate Aminotransferase; Aspartate Aminotransferase Blood Level; Blood Pressure; Body Temperature; Brain Natriuretic Peptide; Breathing Rate; C Reactive Protein; COVID-19; COVID-19 Testing; Cardiologist; Cardiomyopathy; Cardiorenal Syndrome; Cardiovascular Magnetic Resonance; Case Report; Clinical Article; Computed Tomographic Angiography; Congestive Cardiomyopathy; Congestive Heart Failure; Consultation; Coronavirus Disease 2019; D Dimer; Dexamethasone; Digoxin; Dyspnea; Echocardiography; Enoxaparin; Exertional Dyspnea; Female; Ferritin; Ferritin Blood Level; Fibrinogen; Fibrinogen Blood Level; Foot Edema; Furosemide; Ground Glass Opacity; Heart Atrium Enlargement; Heart Failure; Heart Left Ventricle Ejection Fraction; Heart Muscle Biopsy; Heart Rate; Heart Right Atrium; Heart Transplantation; Hemodynamics; Hemoptysis; Hepatomegaly; Hospital Admission; Hospital Discharge; Hospital Readmission; Human; Hypokinesia; Incidental Finding; Interleukin 6; Kidney Function; Laboratory Test; Lactate Dehydrogenase; Lactate Dehydrogenase A; Lactate Dehydrogenase Blood Level; Leg Swelling; Lung Auscultation; Lung Edema; Lung Embolism; Lung Infiltrate; Medical History; Metoprolol; Myocarditis; Never Smoker; Nonischemic Cardiomyopathy; Obesity; Oxygen Saturation; Pericardial Effusion; Perinatal Period; Peripartum Cardiomyopathy; Peripheral Edema; Physical Examination; Procalcitonin; Pulse Rate; Recreational Drug; Remdesivir; Respiratory Distress; Sinus Tachycardia; Tachycardia; Thorax Pain; Thorax Radiography; Troponin; Vaginal Delivery; Venous Thromboembolism; Virus Pneumonia; Global