Table 1
Laboratory parameters of the patient throughout hospitalization
| Reference | Arrival | Day 2 - Intubation | D5 | D8 | D9 - VA ECMO | D11 | D12 | D14 -VV ECMO | DECMO 16 - decannulation | Discharge | |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Laboratory Test | |||||||||||
| WBC | 4-103 u/L | 7.8 | 11.2 | 14.9 | 33.3 | 32.2 | 26 | 33 | 10 | ||
| Absolute Lymphocytes | 1-33 u/L | 0.7 | 0.4 | 0.7 | |||||||
| CRP | 0-5 mg/L | 193 | 428 | 23 | 20 | 11 | 8 | 5 | 4 | ||
| Procalcitonin | <0.5 ng/mL | 1.38 | 7.14 | 6.27 | 2.89 | 0.94 | 0.25 | ||||
| Pro-BNP | <125 pg/mL | 430 | 34.198 | 4.403 | 1.132 | ||||||
| Troponin T | 3-10 ng/L | 9 | 146 | 112 | 1.076 | 1.401 | 75 | ||||
| Myoglobin | 25-58 ng/mL | 331 | |||||||||
| Ferritin | 18-340 ug/L | 628 | 928 | 4.689 | 1,633 | 1.959 | 1.339 | 576 | 457 | 303 | |
| LDH | 135-214 U/L | 548 | 835 | 1.239 | 980 | 948 | 1,011 | >1000 | 1249 | ||
| AST/ALT | <33 U/L | 23/12 | 35/15 | 49/27 | 251/114 | 118/95 | 82/97 | 70/74 | 131/90 | 137/138 | 23/32 |
| Triglycerides | < 1.7 mmol/L | 1.4 | 2.7 | 3.1 | 1.8 | 1.1 | 1.4 | 2 | 1.8 | ||
| Blood Gases | |||||||||||
| FiO2 (%) | 50% | 50% | 45% | 50% | 30% | 40% | |||||
| PaO2 (mmHg) | 79 | 77 | 56 | 61 | 90 | 123 | |||||
| PH | 7.35 to 7.45 | 7.37 | 7.56 | 7.47 | 7.36 | 7.43 | 7.42 | ||||
| Lactate | 0.5-2.2 mmol/L | 1.4 | 2.6 | 3.4 | 5.6 | 1.6 | 0.8 |
Fig. 1
A. The Initial Chest X-ray. B. The repeat Chest X-ray
Fig. 2
ECG taken on Day 8 showed T wave inversion in the lateral leads.
Fig. 3
CT chest revealing a pulmonary embolism
Table 2
Reported studies of COVID-19 and Myocarditis
| Author | Country | Age/ Gender | Cardiac Symptoms | ECG | EF (%) | Myocarditis Means of diagnosis | Troponin level | NT-BNP | IL-6 Level | Treatment * | ECMO | Outcome | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Zeng [2] | China | 63/M | Chest tightness | Sinus tachycar dia, no STE | 32% | Clinical echo and | 11.37 g/L | 22,600 | 272.4 | 1,2,6,7( | DayYes 11) | days Died later 33 | |
| Hongde Hu [7] | China | 37/M | Chest dyspnea pain, | STE (III,aVF) | 27% | Clinical echo and | >10,000 ng/L | 21,025 | 1,2 | No | Survived | ||
| Inciardi RM [5] | Italy | 53/W | No symptoms cardiac | Diffuse STE | 35% | Clinical, MRI Echo, | 0.89 ng/mL | 8465 ng/L | No | Survived | |||
| Sala S [6] | Italy | 43/W | Chest dyspnea pain, | Mild STE (V1-2, aVR), cal ST reciprodepres- sion V4-6 | 43 | Clinical, MRI, biopsy Echo, | 135-107-106 ng/L | 7,9 | No | Survived | |||
| Justin Coyle [4] | USA | 57/M | Dyspnea | ST only | 40% | Clinical, MRI Echo, | 7.33 ng/L | 1300 mL P g/ | 1,3,5 | No | Survived | ||
| Angela Irabien- Ortiz [10] | Spain | 59/W | Angina | PR depression, Concave upwards STE | depressed | Clinical, echo | 110 ng/L | 4421 ng/L | 1,6,7 | Yes | Survived | ||
| Dayen [8] | France | (69Italian) /M | No symptoms cardiac | LVH depression and ST | Normal LVH and EF | Clinical, MRI | 9002 ng/L | 1 | No | Survived | |||
| Massi- miliano Gnecchi [9] | Italy | 16/M | Chest pain with radiation to the left arm | Inferolateral STE | 54%, inferolateral hypokinesia | Clinical, Echo, MRI | 14,810 ng/L | Intravenous ibuprofen | No | Survived | |||
| Kesci [11] | Turkey | 2/M | Biopsy | Yes | |||||||||
| Guido Tavazzi [15] | Italy | 69/M | No cardiac symptoms | 25% Global | Biopsy, ECHO, Normal CAG | 4332 ng/L | Yes | Died 12 days later | |||||
| Quentin Fischer [16] | France | 15/M | chest pain | diffuse STE | 50%, Glob- al, Mild effusion | MRI | 13.1 μg/L | 65 ng/L | Beta blocker ACE I | No | Survived | ||
| Current report | Qatar | 49/W | No cardiac symptoms | T inversion on lateral leads | 25%, Global | Clinical, Echo | 1401 ng/L | 34198 pg/ mL | 1,2,3, 7,9 | Yes (day 9) | Survived |
[i] *Treatment Key: 1: Steriod; 2: Immunoglobulin; 3: Tocilizumab; 4: Colchicine; 5: aldose reductase inhibitor (ARI), currently known as AT-001; 6: interferon alfa-2b; 7: lopinavir, ritonavir; 8: Nonstertoidal anti-inflammatory agents; 9: hydroxycholroquie.
Diagnostic modality: biopsy, clinical or MRI. ECMO: Extracorporeal membrane oxygenation. STE: ST segment Elevation. NT-BNP: NT-proB-type Natriuretic Peptide. CAG: Coronary Angiography. ACE-I: Angiotensin-Converting enzyme inhibitors