Case 24-2020: A 44-Year-Old Woman with Chest Pain, Dyspnea, and Shock

A 44-year-old woman with mild COVID-19 symptoms developed acute chest pain, dyspnea, and refractory cardiogenic shock 8 days after symptom onset. Initial evaluation revealed severe biventricular dysfunction, elevated troponin levels, and minimal pulmonary involvement, consistent with acute inflammatory cardiomyopathy secondary to SARS-CoV-2 infection. Despite vasopressor and inotropic support, she required venoarterial extracorporeal membrane oxygenation (ECMO) and subsequent biventricular mechanical support (LVAD/RVAD) due to persistent shock. The case highlights the unique cardiovascular complications of COVID-19, including fulminant myocardial dysfunction without prominent respiratory disease. The patient’s condition improved with mechanical support and intravenous immune globulin, culminating in recovery of ventricular function. This report underscores the importance of early multidisciplinary intervention for COVID-19-associated cardiogenic shock and the potential role of inflammatory mechanisms in myocardial injury.

A 44-year-old woman with mild COVID-19 symptoms developed acute chest pain, dyspnea, and refractory cardiogenic shock 8 days after symptom onset. Initial evaluation revealed severe biventricular dysfunction, elevated troponin levels, and minimal pulmonary involvement, consistent with acute inflammatory cardiomyopathy secondary to SARS-CoV-2 infection. Despite vasopressor and inotropic support, she required venoarterial extracorporeal membrane oxygenation (ECMO) and subsequent biventricular mechanical support (LVAD/RVAD) due to persistent shock. The case highlights the unique cardiovascular complications of COVID-19, including fulminant myocardial dysfunction without prominent respiratory disease. The patient’s condition improved with mechanical support and intravenous immune globulin, culminating in recovery of ventricular function. This report underscores the importance of early multidisciplinary intervention for COVID-19-associated cardiogenic shock and the potential role of inflammatory mechanisms in myocardial injury.