Ventricular Tachycardia With Epicardial and Pericardial Fibrosis 6 Months After Resolution of Subclinical COVID-19

A Case Report

Jonathan Solaimanzadeh; Aaron Freilich; Michael R Sood


J Med Case Reports. 2021;15(305) 

In This Article


Coronavirus disease 2019 (COVID-19) has been shown to have a wide variety of clinical manifestations. It typically presents with a spectrum of symptoms ranging from no symptoms to an array of mild symptoms such as cough, headache, fever, or anosmia. Less common is a rapid progression of pneumonia, hypoxemia, and acute respiratory distress syndrome and/or death. Recent emerging evidence suggests a significant impact on the cardiovascular system. Proposed mechanisms involve direct viral- or inflammatory-mediated myocardial damage, endothelial dysfunction or plaque instability, arterial or venous thrombosis, and indirect hypoxic cell injury.[1–11] However, the long-term cardiac manifestations remain unclear.

Cardiovascular magnetic resonance imaging (CMR) is an advanced cardiac imaging modality that can directly visualize the cardiovascular system in any dimensional plane. It has excellent spatial and temporal resolution and is used to characterize myocardial tissues. It is considered the gold standard for assessing myocardial function. Clinically, it is utilized to aid in the assessment of various cardiomyopathies, myocarditis, and/or pericardial disease.[12,13] Furthermore, gadolinium-based contrast agents used to demonstrate late gadolinium enhancement (LGE) have been shown to be an important prognosticator in various disease processes.[14–17]

The following is a case report of a mild and self-limited presentation of COVID-19 with the subsequent development of cardiac symptoms months after its clinical resolution and CMR demonstrating epicardial and pericardial fibrosis.