Case Report: COVID-19 in the Setting of HCOM

Importance: Viral infections have been discussed as one of the most common causes of myocarditis but a rare encounter of a patient suffering with a condition of Hypertrophic Cardiomyopathy (HCOM) incidentally discovered with COVID-19, has been presented in this case report with lesser known facts about the involvement of cardiomyopathies (CMPs) as a further complication or an alleviating factor against severe COVID-19 Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection. Objective: To describe the presentation of corona virus disease (COVID-19) in a patient with incidental HCOM, who experienced influenza like syndrome at first and then developed fatigue and signs of severe upper respiratory tract symptoms along with dizziness and chest tightness. Design, Setting, and Participant: This case report describes a 39-year-old man who tested positive for COVID-19 by rapid antigen testing and was admitted to the respiratory care unit in April 2021 with typical imaging features of COVID-19 for acute respiratory depression syndrome, confirmed on HRCT thorax scanning, 8-10 days after a rapid onset of fever, severe headache, myalgia and dry coughing due toa viral COVID-19 infection. Exposure: COVID-19 aggression with stable yet severe cardiac involvement. Main Outcomes and Measures: Monitoring COVID-19 pulmonary effects along the detection of cardiac involvement with normal ECG but increased changes in systolic ejection fraction levels on echocardiography and gradual recovery and resolution by treatment shown through repeat HRCTthoraximaging and echocardiography. Results: An otherwise healthy 39-year-old man presented to the emergency department with fatigue, fever, myalgia, dry cough and signs of severe respiratory depression. He described weakness, recurrent fever, severe headache, body ache, loss of appetite and constant dry coughing that got worse in 8-10 days. His vitals at admission were documented to be febrile with a feeling of anxiety and suffocation, low in oxygen saturation but with normal blood pressure and based on the second wave of the COVID-19 outbreak, a nasopharyngeal swab was performed with a rapid COVID-19 antigen test resulting positive. Typical findings for COVID-19 infection were apparent on HRCT chest imaging. After the patient?s inability of laying in the prone position as a practice to improve oxygen status along with dizziness and chest tightness, a thorough history inclined the consulting physician towards an associated cardiogenic cause. Bedside ECG revealed no serious abnormalities but on echocardiography, left ventricular wall thickness abnormality was evident. The findings were all consistent with HCOM and the patient was placed on 24 hour Holter monitoring which recorded no arrhythmias. He was treated with medications for COVID-19 and its pulmonary and hematological complications till the end of the course of the disease and finally managed with beta-blockers for HCOM. Conclusions and Relevance: This case highlights a progression of cardiac involvement as a complication associated with severe symptoms and signs of COVID-19 sequelae.