• Muhammad Adil Soofi King Fahad Medical City, Riyadh-Saudi Arabia
  • Muhammad Azam Shah King Fahad Medical City, Riyadh-Saudi Arabia
  • Olaa Hassan Mhish King Fahad Medical City, Riyadh-Saudi Arabia
  • Faisal AlSamadi King Fahad Medical City, Riyadh-Saudi Arabia



Covid-19, Pregnancy, Acute heart failure, Case report


The COVID-19 infection has spread rampantly, attaining pandemic status within three months of its first appearance. It has been classically associated with respiratory signs and symptoms. However, unusual presentations have also been reported in multiple literatures. We are reporting a case of acute heart failure in a pregnant patient diagnosed with Covid-19 infection. Her hospital course has been complicated by pneumonia and venous thrombosis during the postpartum period. Her laboratory investigations showed evidence of myocardial injury, acute heart failure, and COVID-19 infection in second PCR sample taken during postpartum period. Echocardiography exhibited features of severe left ventricle systolic dysfunction. She had successful delivery through caesarean-section, nevertheless, her postpartum period was complicated by pneumonia and right femoral venous thrombosis. CT scan of the chest and pulmonary arteries revealed infiltrations in the left lower lobe and right middle lobe, suggestive of consolidation, with no evidence of pulmonary embolism. Cardiac MRI displayed severe global LV and RV systolic dysfunction, but no evidence of myocardial infarction, myocardial infiltration, or abnormal myocardial delayed enhancement. Her condition improved and she was discharged on heart failure medications. During follow-up at the heart failure clinic, her symptoms continued to ameliorate, except the LV and RV systolic dysfunction which persisted. Multiple unusual presentations of Covid-19 infection have been reported in various literatures and screening of the COVID-19 infection should be practiced on regular basis especially among high-risk patients. Prompt identification of COVID-19 infection will lead to proper isolation and mitigation of infection spread among hospitalized patients and health care workers. Covid-19 PCR should be repeated in cases having clinical indication and negative first sample. A proper history and cardiac MRI can differentiate between different aetiologies of heart failure during pregnancy and peripartum COVID-19 infection. Adequate anticoagulation should be considered in COVID-19 patients due to the high risk of thromboembolism. Among patients with COVID-19 infection, CT chest helps demonstrate the extent of pulmonary involvement.

Author Biographies

Muhammad Azam Shah, King Fahad Medical City, Riyadh-Saudi Arabia

consultant cardiologist king salman heart center

Olaa Hassan Mhish, King Fahad Medical City, Riyadh-Saudi Arabia

Physician Al Faisal University

Faisal AlSamadi, King Fahad Medical City, Riyadh-Saudi Arabia

Consultant cardiologist King Salman Heart Center


Yu N, Wei L, Kang Q, Xiong Z, Wang S, Lin X, et al. Clinical features and obstetric and neonatal outcomes of pregnant patients with COVID-19 in Wuhan, China: a retrospective, single-center, descriptive study. Lancet Infect Dis 2020;20(5):559–64.

WHO. Rolling updates on coronavirus disease (COVID-19). 2020.

Luo Y, Yin K. Management of pregnant women infected with COVID-19. Lancet Infect Dis 2020;20(5):513–4.

Lam CM, Wong SF, Leung TN, Chow KM, Yu WC, Wong TY, et al. A case-controlled study comparing clinical course and outcomes of pregnant and non-pregnant women with the severe acute respiratory syndrome. BJOG 2004;111(8):771–4.

Yudin MH, Steele DM, Sgro MD, Read SE, Kopplin P, Gough KA. Severe acute respiratory syndrome in pregnancy. Obstet Gynecol 2005;105(1):124–7.

Arevalo-Rodriguez I, Buitrago-Garcia D, Simancas-Racines D, Zambrano-Achig P, Campo RD, Ciapponi A, et al. False-negative results of initial RT-PCR assays for COVID-19: a systematic review. PLoS One 2020;15(12):e0242958.

Watson J, Whiting PF, Brush JE. Interpreting a COVID-19 test result. BMJ 2020;369:m1808.

Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of cardiac Injury with mortality in hospitalized patients with COVID-19 in Wuhan, China. JAMA Cardiol 2020;5(7):802–10.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054–62.

Siddiqi HK, Mehra MR. COVID-19 Illness in Native and Immunosuppressed States: A Clinical-Therapeutic Staging Proposal. J Heart Lung Transplant 2020;39(5):405–7.

Liang YD, Xu YW, Li WH, Wan K, Sun JY, Lin JY, et al. Left ventricular function recovery in peripartum cardiomyopathy: a cardiovascular magnetic resonance study by myocardial T1 and T2 mapping. J Cardiovasc Magn Reson 2020;22(1):2.

McCrohon JA, Moon JCC, Prasad SK, McKenna WJ, Lorenz CH, Coats AJS, et al. Differentiation of Heart Failure Related to Dilated Cardiomyopathy and Coronary Artery Disease Using Gadolinium-Enhanced Cardiovascular Magnetic Resonance. Circulation 2003;108(1):54–9.

Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered from Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020;5(11):1265–73.

Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020;135(23):2033–40.

Hope MD, Raptis CA, Shah A, Hammer MM, Henry TS. A role for CT in COVID-19? What data really tell us so far. Lancet 2020;395(10231):1189–90.