Fulminant myocarditis is an uncommon but life-threatening cardiovascular complication that may follow infection with SARS-CoV-2. It can present with abrupt onset of heart failure, cardiogenic shock, and life-threatening arrhythmias even in patients without prior cardiac disease. This case report describes a previously healthy 35-year-old woman who developed fulminant myocarditis after coronavirus disease 2019 (COVID-19), illustrating the hyperacute course and diagnostic and therapeutic challenges in the acute setting.
A 35-year-old woman with no reported chronic medical conditions presented to the emergency department on the fourth day of acute constitutional symptoms related to COVID-19. Her presenting complaints were progressive dyspnea and severe chest pain. On arrival she was in cardiogenic shock. She had previously completed a 2-dose primary series of the Sinovac COVID-19 vaccine.
Initial evaluation demonstrated pronounced elevation of cardiac biomarkers and electrocardiographic abnormalities consistent with an acute cardiac process. Given the clinical picture of chest pain and biomarker elevation, an acute coronary event was considered and rapidly investigated.
Urgent coronary angiography was performed and promptly excluded acute coronary occlusion as the cause of the patient’s presentation. Transthoracic echocardiography was obtained and—together with the hyperacute clinical deterioration—supported a diagnosis of probable fulminant myocarditis associated with the patient’s SARS-CoV-2 infection.
The combination of markedly elevated cardiac biomarkers, electrocardiographic changes, echocardiographic abnormalities, and exclusion of obstructive coronary disease framed the working diagnosis of myocarditis in the context of recent COVID-19.
The patient experienced a brief, transient hemodynamic improvement after initiation of inotropic support. Seventeen hours after admission she developed rapid electrical instability characterized by polymorphic ventricular tachycardia with a sine-wave–like QRS morphology. This arrhythmia progressed to refractory ventricular fibrillation and cardiac arrest, from which she did not recover.
Echocardiographic findings and the overall hyperacute course were consistent with a diagnosis of probable fulminant COVID-19–associated myocarditis. The case concluded in a fatal outcome despite initial resuscitative and supportive efforts.
Taken together, the clinical timeline—onset on day 4 of acute symptoms, severe chest pain, cardiogenic shock, markedly elevated cardiac biomarkers, electrocardiographic abnormalities, supportive echocardiographic findings, and exclusion of acute coronary occlusion—are consistent with probable fulminant myocarditis related to SARS-CoV-2 infection in this patient.
The report does not provide histologic confirmation or detailed laboratory values beyond the description of pronounced biomarker elevation, so the diagnosis remains clinical and probable based on the available data.
This case highlights several important clinical points:
Fulminant myocarditis, although rare, can occur after COVID-19 and may present with rapid hemodynamic collapse and malignant ventricular arrhythmias in previously healthy adults.
Early recognition is critical. Prompt assessment with cardiac biomarkers, electrocardiography, and echocardiography can help identify patients at risk and exclude alternative causes such as obstructive coronary disease.
Rapid diagnostic exclusion of acute coronary occlusion (for example, with coronary angiography when indicated) is an important step to guide therapy.
Even with initial transient hemodynamic response to inotropic support, fulminant myocarditis may evolve quickly to refractory ventricular arrhythmias and death, underscoring the need for early escalation of supportive measures and consideration of advanced circulatory support where available.
The report emphasizes vigilance for severe cardiovascular complications in patients with COVID-19 and the importance of early aggressive supportive care to inform acute clinical decision-making.
Fulminant myocarditis is a rare but devastating complication of COVID-19. In this reported case of a 35-year-old woman, the illness progressed from initial presentation to refractory ventricular arrhythmia and death within a short timeframe despite initial supportive therapy. Clinicians should maintain a high index of suspicion for myocarditis in COVID-19 patients with chest pain, elevated cardiac biomarkers, and echocardiographic dysfunction, and act promptly to evaluate and escalate care.