ABC | Volume 114, Nº5, May 2020

Case Report Huyut Covid-19 and cardiomyopathy Arq Bras Cardiol. 2020; 114(5):843-845 1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020 Feb 20;382(8):727-33. 2. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020 Feb 24. doi: 10.1001/jama.2020.2648. [Epub ahead of print] 3. Ai T, Yang Z, HouH, ZhanC, ChenC, LvW, et al. Correlation of Chest CT and RT-PCR Testing inCoronavirus Disease 2019 (COVID-19) inChina: AReport of 1014 Cases. Radiology. 2020 Feb 26:200642. [Epub ahead of print] 4. Fang Y, Zhang H, Xie J, LinM, Ying L, Pang P, et al. Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR. Radiology. 2020 Feb 19:200432. doi: 10.1148/radiol.2020200432. [Epub ahead of print] 5. Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019‑nCoV): a study of 63 patients inWuhan, China. Eur Radiol. 2020 Feb 13. doi: 10.1007/s00330-020-06731-x. [Epub ahead of print] 6. Acquatella H, Asch FM, Barbosa MM, Barros M, Bern C, Cavalcante JL, et al. Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease: A Report from the American Society of Echocardiography in Collaboration With the InterAmerican Association of Echocardiography (ECOSIAC) and the Cardiovascular Imaging Department of the Brazilian SocietyofCardiology(DIC-SBC).JAmSocEchocardiogr.2018Jan;31(1):3-25. 7. Ukimura A, Satomi H, Ooi Y, Kanzaki Y. Myocarditis Associated with Influenza A H1N1pdm2009. Influenza Res Treat. 2012;2012:351979. 8. Mamas MA, Fraser D, Neyses L. Cardiovascular manifestations associated with influenza virus infection. Int j Cardiol. 2008;130(3):304–9. 9. Miura M, Asaumi Y, Wada Y, Ogata K, Sato T, Sugawara T, et al. A case of influenza subtype A virus-induced fulminant myocarditis: an experience of percutaneous cardio-pulmonary support (PCPS) treatment and immunohistochemical analysis. Tohoku J Exp Med. 2001;195(1):11–9. 10. Bowles NE, Ni J, Kearney DL, Pauschinger M, Schultheiss HP, McCarthy R, et al. Detection of viruses inmyocardial tissues by polymerase chain reaction: evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol. 2003;42(3):466–72. References This is an open-access article distributed under the terms of the Creative Commons Attribution License effects, and endogenous and exogenous catecholamines, which play important role in sepsis, may also trigger the cardio-depressant effect in COVID-19. Also, we considered that the cardiomyopathy might be reversible by clearing cytokines from the circulation during recovery. Previous studies have also demonstrated that inhibiting trypsin‑mediated viral replication and downregulation of matrix metalloproteinases and cytokines, significantly improved the cardiac functions of mice infected with influenza A virus. 7-9 According to these findings, we have to promptly identify critically-ill patients and treat them as soon as possible, to avoid fatal complications. We need to use all kinds of diagnostic tools and treatment options during the follow-up. Especially, TTE may be the cheapest and the easiest way to follow-up these patients. However, there is still no specific drug for the treatment of COVID-19 patients. Based on the experience of the treatment of SARS and MERS, some drugs such as hydroxychloroquine, azithromycin, oseltamivir, lopinavir-ritonavir, remdesivir, and favipiravir might have positive effects on COVID-19 patients. 1 In conclusion, our patient did not experience myocarditis, because there was no troponin-I increase, but we believe she might experience cardiomyopathy due to the over-release of cytokines. In our case, cardiomyopathy and COVID-19 were treated with hydroxychloroquine, methylprednisolone, azithromycin, and finally with favipiravir. However, the curative effects of these medications have not yet been proven, and still need further researches. Author contributions Conception and design of the research, Acquisition of data, Analysis and interpretation of the data, Statistical analysis, Obtaining financing, Writing of the manuscript and Critical revision of the manuscript for intellectual content: Huyut MA Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 845