Management of COVID-19 myopericarditis with reversal of cardiac dysfunction after blunting of cytokine storm: a case report

Figure 1. Chest radiograph with bilateral pulmonary infiltrates.

Figure 2. (A) ECG on day 1 shows diffuse ST elevation and PR depression in precordial and limb leads, reciprocal ST depression, and PR elevation in aVR. (B) Day 6 shows incomplete right bundle branch block and horizontal ST depression in precordial and limb leads. (C) Day 13 shows sinus tachycardia without ST or T wave abnormalities.

Figure 3. (A) TTE in parasternal long-axis view at end systole, demonstrating severe LV systolic dysfunction. (B) Subcostal view with small pericardial effusion. (C) Repeat echocardiogram on day 6 in three-chamber view at end systole, demonstrating normal LV function. (D) Resolution of pericardial effusion on hospital day 6. (E) TTE at day 35, showing continued normal systolic function in the parasternal long-axis view at end systole. (F) No further pericardial effusion on subcostal view.

Figure 4. Graphs of laboratory values following steroid and IVIG treatment. Decreasing cardiac biomarker trends through Day 5: (A) high-sensitivity troponin; (B) CK-MB. Decreasing inflammatory markers through Day 9: (C) ferritin; (D) C-reactive protein; (E) procalcitonin; (F) D-dimer. Initial worsening then improvement through Day 9 of (G) hepatic function; (H) renal function.