Post COVID Myocarditis

One early morning a 66 years old gentleman was brought to the emergency with complains of severe breathlessness. His breathing distress emerged suddenly and oxygen level fell to 70% at home. He had suffered from pneumothorax (air between the outer layers of lung) before a week and a tube in left side of his chest was there. His cardiogram taken on admission was abnormal. Heart specialist was called and he suggested angiography as his blood markers for heart attack were high. His angiography did not show any block in heart. But now we noticed a new symptom. Up on making him semi recumbent (45 degree reclining) his blood pressure fell to 70/40 mmHg. He complained of light headedness and giddiness. After several minutes of acquiring recumbent position again, his BP would come back to 90/50 mmHg. However later on his BP remained low even on lying down. He had urinary tract infection too. Further evaluation of heart by echocardiography suggested left ventricular ejection fraction of 30% only. His BP by now was significantly low and needed moderate to high doses of BP raising medicine. He had brief episodes of giddiness and breathing difficulty. His condition remained very critical and he needed continuous oxygen inhalation. He had POST COVID MYOCARDIRIS along with infection and circulatory shock. His heart rhythm was irregular. He was treated with the special medicines for his postural hypotension. His condition remained critical for another 20 days. After 20 days of intensive treatment for blood pressure fluctuations, his condition stabilized. Second echocardiography showed significant improvement of pumping ability of his heart (left ventricular ejection fraction of 50%). His left lung achieved full expansion and the tube inserted in his chest was removed by now. His postural BP fall was minimal and he needed minimal doses of oral medicines. He was able to walk with support. He was shifted to ward with supplemental oxygen that was stopped after three days of ward stay. He did reasonably well in ward and after twenty five days of hospital stay he was discharged.

Air in left side of chest

Immediately after chest tube

Significant expansion of lung