Myocardial localization of coronavirus in COVID-19 cardiogenic shock

Eur J Heart Fail. 2020 May;22(5):911-915. doi: 10.1002/ejhf.1828. Epub 2020 Apr 11.

Abstract

We describe the first case of acute cardiac injury directly linked to myocardial localization of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a 69-year-old patient with flu-like symptoms rapidly degenerating into respiratory distress, hypotension, and cardiogenic shock. The patient was successfully treated with venous-arterial extracorporeal membrane oxygenation (ECMO) and mechanical ventilation. Cardiac function fully recovered in 5 days and ECMO was removed. Endomyocardial biopsy demonstrated low-grade myocardial inflammation and viral particles in the myocardium suggesting either a viraemic phase or, alternatively, infected macrophage migration from the lung.

Keywords: Cardiac injury; Cardiogenic shock; Coronavirus; Extracorporeal membrane oxygenation; Myocardial inflammation; SARS-CoV-2.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Betacoronavirus / isolation & purification*
  • Biopsy
  • Coronavirus Infections / complications*
  • Coronavirus Infections / therapy
  • Coronavirus Infections / virology
  • Extracorporeal Membrane Oxygenation
  • Heart / virology*
  • Heart Failure / pathology
  • Heart Failure / therapy
  • Heart Failure / virology
  • Humans
  • Male
  • Myocarditis / pathology
  • Myocarditis / virology*
  • Myocardium / pathology
  • Pandemics
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / therapy
  • Pneumonia, Viral / virology
  • Respiration, Artificial
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / pathology
  • Shock, Cardiogenic / therapy*
  • Shock, Cardiogenic / virology*

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2