Cardiomyopathy in pregnancy with COVID-19: An enigma

Abstract

Background: The coronavirus disease-2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global public health emergency. Physiological and mechanical changes in pregnancy increase susceptibility to infections in general, particularly when the cardiorespiratory system is affected, and encourage rapid progression to respiratory and heart failure in the gravida. Case description: We present a case report of 30-year-old primigravidae with 36.5 weeks by date and 37 week by scan with diagnosed preeclampsia 2 weeks back on medication with 11 × 10.4 × 10.9 cm single intramural anterior wall fibroid with breech presentation. COVID nasopharyngeal sample reported as SARS-CoV-2 real-time PCR positive. The patient was started on medication defining the Stage 1 Group A Asymptomatic Category. Chest X-ray showed mild bilateral pulmonary infiltrates. On Day 6 of admission, the patient went in labor, and hence was taken for emergency LSCS in view of primigravidae with breech with preeclampsia with fibroid with PROM under spinal anesthesia with all precautions. Intraoperatively, the LSCS was uneventful. Postoperatively 6 hours postpartum, the patient developed sudden onset breathlessness NYHA Grade 4, with saturation of 56%, and patient was intubated and shifted to ICU. Chest X-ray revealed viral pneumonia, and further 2D ECHO was suggestive of cardiomyopathy. Conclusion: We suggest an echocardiogram in pregnant women with coronavirus disease 2019 pneumonia, in particular those necessitating oxygen or those who are critically ill. Clinical significance: Viral myocarditis and cardiomyopathy have been reported in nonpregnant COVID-19 patients. Information on COVID-19 in pregnancy is currently limited. No specific literature is available of viral cardiomyopathy reported in pregnant women with COVID-19 infection.