COVID-19 Associated Fulminant Myocarditis: A Multidisciplinary Approach to Treatment Utilizing Advanced Mechanical Circulatory Support and Anti-Viral Medical Therapies

Abstract

A 58-year-old man presented with fever, chills, nausea, vomiting, and diarrhea. A presumptive diagnosis of viral gastroenteritis was made and fluid resuscitation was undertaken. An initial nasopharyngeal COVID-19 swab was negative. CT scan of the chest and abdomen showed no acute pathology. The EKG, however, showed ST-segment elevation anterolaterally and an echocardiogram demonstrated severe LV dysfunction. His condition deteriorated requiring intubation. Cardiac catheterization showed normal coronary arteries and elevated right-sided filling pressures. Biventricular VADS were placed percutaneously (BiPella®). His condition failed to improve and support was escalated to VA-ECMO. The patient was transferred to a quaternary care center whereupon a repeat COVID-19 test was positive. Inflammatory biomarkers were markedly elevated. The diagnosis of COVID-19 associated fulminant myocarditis was made. The patient received IV steroids, broad-spectrum antibiotics, and enrolled in a Phase 1 convalescent plasma trial. In addition, CRRT was initiated for renal failure. His condition rapidly improved and mechanical circulatory support was discontinued. He was discharged and maintained on hemodialysis until his kidney function normalized several months later. His Ejection Fraction at the time of discharge was 65%.