Case Presentation:

A 46-year-old female referred to heart failure clinic for further evaluations of her new onset heart failure. In her first visit on January 2021, she complained of a dyspnea of exertion, New York Heart Association functional class of II (NYHA-FC) and fatigue.
Her past medical history was unremarkable in terms of cardiovascular problems before her recent episode of acute heart failure. She had a history of a controlled lichen plan dermatitis (LP) treated by immunosuppressive therapy several years ago. She also had a history of antithyroid peroxidase antibody (TPO) positive hypothyroidism that was managed with levothyroxine.
A month before the first visit in our clinic (on December 2020), she had developed symptoms of COVID-19 such as fever, sore throat and malaise. The real time polymerase chain reaction (RT-PCR) test for the novel corona virus infection was positive but the clinical course of her COVID-19 infection was uneventful without any decrease in arterial O2 saturation or pulmonary involvement and the disease was subsided using the recommended medications for mild COVID-19.
About three weeks later (a week after the remission of the COVID-19 infection), she was admitted due to a severe chest discomfort and shortness of breath. Her electrocardiogram (ECG) was highly suggestive of acute anterior myocardial infarction (ST segment elevation in V2-V6 leads), according to her hospital discharge note. Considering the ECG changes and an elevated cardiac Troponin-I level, she underwent emergent coronary angiography, which revealed normal epicardial coronary arteries. Her echocardiogram reported a normal left ventricular (LV) size, with apical hypokinesia and an ejection fraction (EF) of 35-40%, normal right ventricular (RV) size and function, a mild mitral valve regurgitation (MR), a mild tricuspid valve regurgitation (TR), no pulmonary hypertension and no pericardial effusion.
With an impression of acute myocarditis, she underwent a cardiac magnetic resonance imaging (CMR), and based on the results (Figure 1), she was referred to our heart failure clinic for further evaluations.