Miscellaneous - Cases
Lilia M. Sierra-Galan, MD, FSCMR
Cardiologist
American British Cowdray Medical Center, Mexico City, Mexico
Mexico City, Mexico City, Mexico
María Fernanda Trejo Millan, MD
Cardiology Fellow
American British Cowdray Medical Center
Ciudad de México, Distrito Federal, Mexico
A 28-year-old man presented with a 2-week history of palpitations that made sleep difficult and got worst with supine, recent onset blood hypertension, paresthesia of the extremities, headache, blurred vision, mild chest pain, intense palpitation at the supine position, and after meals, with occasional dyspnea, reduced exertional capacity, panic attacks, anxiety. 2 years before he had asymptomatic SARS-CoV2 infection. Physical examination showed a wide splitting of S2, no systolic or diastolic murmurs, no S3, no S4, no pericardial rub, and no limb edema.
Diagnostic Techniques and Their Most Important Findings:
An electrocardiogram revealed a recent onset complete right bundle branch block. Routine laboratory tests were normal, including high-sensitive troponin, high-sensitive CRP, and NT-pro-BNP. A cardiac MRI showed heart chambers of normal size. Normal global and regional systolic left ventricular function (LVEF 65%) and mildly decreased right ventricular global systolic function (LVEF 49%) with regional wall motion abnormalities, no significant myocardial edema or inflammation observed, and with normal native T1, T2 values, and ECV. Myocardial fibrosis with a non-coronary pattern was observed right ventricle, mild pericardial effusion with LGE of the pericardium consistent with pericardial inflammation, and pleural LGE suggestive of pleural inflammation. As a finding, an aberrant origin of the right subclavian artery from the aortic arch posterior to the trachea and anterior to the esophagus.
Learning Points from this Case:
Although SARS-CoV-2 causes myocarditis and pericarditis, it usually affects the left ventricle. Still, there is little evidence of right ventricular involvement. To the best of our knowledge, there are no reports of isolated right ventricular involvement with the development of complete right bundle branch block and right ventricular dysfunction with clinical presentation of right-sided heart failure.