Case Report: A case of Dilated Cardiomyopathy in COVID-19; A case report

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Though variety of cardiac manifestations have been reported and described in scientific literature, case of dilated cardiomyopathy (DCM) has not been well reported and described. We present a case of DCM post-COVID-19 without any co-morbidities who was admitted several times for cardiac symptoms post-COVID-19. As it was a new finding associated with COVID-19, it has been worth understanding the variations in which cardiac conditions manifest in COVID-19." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/11-567", "name": "Case Report: A case of Dilated Cardiomyopathy in COVID-19; A case..." } } ] } Home Browse Case Report: A case of Dilated Cardiomyopathy in COVID-19; A case... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Dhakal B, Sharma N, Pathak BD et al. Case Report: A case of Dilated Cardiomyopathy in COVID-19; A case report [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :567 ( https://doi.org/10.12688/f1000research.110063.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: A case of Dilated Cardiomyopathy in COVID-19; A case report [version 1; peer review: 1 approved with reservations] Bishal Dhakal https://orcid.org/0000-0001-9432-5233 1 , Neeraj Sharma 1 , Bishnu Deep Pathak https://orcid.org/0000-0002-0811-8316 1 , Nabin Simkhada https://orcid.org/0000-0002-4346-3940 1 , Binod limbu 1 Bishal Dhakal https://orcid.org/0000-0001-9432-5233 1 , Neeraj Sharma 1 , [...] Bishnu Deep Pathak https://orcid.org/0000-0002-0811-8316 1 , Nabin Simkhada https://orcid.org/0000-0002-4346-3940 1 , Binod limbu 1 PUBLISHED 25 May 2022 Author details Author details 1 Internal Medicine, Nepalese Army Institute of Health and Sciences, Kathmandu, 44600, Nepal Bishal Dhakal Roles: Conceptualization, Investigation, Methodology, Resources, Software, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Neeraj Sharma Roles: Investigation, Resources, Supervision Bishnu Deep Pathak Roles: Conceptualization, Resources, Supervision, Writing – Review & Editing Nabin Simkhada Roles: Conceptualization, Investigation, Methodology, Resources, Supervision Binod limbu Roles: Investigation, Methodology, Resources OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Coronavirus (COVID-19) collection. Abstract As of 2022, myocardial injury associated with COVID-19 has been one of the most discussed topics in literature. Though variety of cardiac manifestations have been reported and described in scientific literature, case of dilated cardiomyopathy (DCM) has not been well reported and described. We present a case of DCM post-COVID-19 without any co-morbidities who was admitted several times for cardiac symptoms post-COVID-19. As it was a new finding associated with COVID-19, it has been worth understanding the variations in which cardiac conditions manifest in COVID-19. READ ALL READ LESS Keywords Dilated cardiomyopathy; COVID-19 Corresponding Author(s) Bishal Dhakal ( [email protected] ) Close Corresponding author: Bishal Dhakal Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2022 Dhakal B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Dhakal B, Sharma N, Pathak BD et al. Case Report: A case of Dilated Cardiomyopathy in COVID-19; A case report [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :567 ( https://doi.org/10.12688/f1000research.110063.1 ) First published: 25 May 2022, 11 :567 ( https://doi.org/10.12688/f1000research.110063.1 ) Latest published: 25 May 2022, 11 :567 ( https://doi.org/10.12688/f1000research.110063.1 ) Introduction Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), manifests typically with respiratory symptoms but cardiac signs and symptoms have also been common in the process of disease and post-COVID-19. Although the cardiac cases in COVID-19 have been much less as compared to respiratory cases, a review found cardiac injury to be reported in 19.7% to 29.8% of cases. 1 The involvement of cardiac myocardium in COVID-19 has been due to various mechanisms and up to 20-30% in hospitalized patients as manifested by elevated troponin levels. 2 Although lungs have been the primary target of SARS-CoV-2, cardiovascular involvement has been common in hospitalized patients ranging from mild cardiac injury to complications like acute myocardial infarction, myocarditis, arrhythmias, thrombotic complications and heart failure. 3 Till date various cases of stress-induced (Takotsubo) cardiomyopathy have been described with a classic case described by a case report where a patient presented with fever for five days and progressive dyspnea on exertion. 4 The cardiac-related conditions like myocarditis, heart failure, thrombotic complications, stress-induced cardiomyopathies associated with COVID-19 have been described in literature. But cases of dilated cardiomyopathy (DCM) in adult have not been described in literature, though a case of DCM has been reported in a child of one year old. 5 We hereby present a case of dilated cardiomyopathy (DCM) in a 35 years male post-COVID-19 without any co-morbidities. Case presentation A 35-year-old Hindu male tested COVID-19 positive (RT-PCR positive) dated six months back presented to our center with cough and shortness of breath. The cough was often associated with hemoptysis and shortness of breath was mostly on lying flat and walking with New York Heart Association (NYHA) grade-II at first. It progressed to NYHA grade III gradually. It was associated with orthopnea and paroxysmal nocturnal dyspnea (PND). It was followed by recurrent hospital admission for the same complaints complemented with dizziness, loss of consciousness and chest pain. For two times he was admitted in high dependency unit and was even treated with nor-adrenaline and dopamine for severe hypotension (SBP/DBP: 80/60). There was not any significant medical, family and psycho-social history related to the case. There were also not relevant past interventions. On general examination, he was conscious and oriented to time, place and person. There was bilateral pitting pedal edema but the jugular venous pressure (JVP) was not raised. As for vital parameters, his blood pressure was more of consistent with SBP/DBP of 90/60 mm of Hg and his saturation was maintained at 90% in room air. On systemic examination, systolic murmur was heard at the apex beat area which was consistent with carotid pulse and was non-radiating in nature. Bilaterally, crepitations were heard in infra-scapular and infra-axillary regions. He was diagnosed as having Covid-19 infection from the real time-polymerase chain reaction (RT-PCR) 6 months back. He was kept on isolation for 14 days and discharged after the RT-PCR test was negative. He started developing shortness of breath after a month of Covid-19 infection. This was followed by recurrent hospital admission and diagnosed was DCM post-Covid-19. The baseline laboratory investigations are shown in Table 1 . Table 1. Baseline laboratory investigations. Laboratory tests Result Unit Reference range Total Leukocytes Count 10.6 10 3 /μL 4-11 Neutrophil 49 % 40-80 Lymphocyte 45 % 20-40 Hemoglobin 12.9 g/dl 13-17 Platelet Count 201 10 3 /μL 150-450 Urea 39 mg/dl 17-43 Creatinine 0.9 mg/dl 0.7-1.3 Sodium 134 mEq/L 135-145 Potassium 4.1 mEq/L 3.5-5.5 Bilirubin Total 0.8 mg/dl 0.1-1.2 Bilirubin Direct 0.3 mg/dl 0.0-0.2 Alkaline Phosphatase (ALP) 48 U/L 53-128 Alanine Transferase (ALT) 34 U/L 0-35 Aspartate Transferase (AST) 32.7 U/L 0-35 Random Blood Glucose 115 mg/dl 70-140 Prothrombin time (PT) 15.2 seconds 11-13.5 CPK NAC 68 U/L 20-200 CPK MB 17.7 U/L < 35 Troponin I Negative The ultrasonography of abdomen and pelvis showed normal scan. The chest x-ray showed cardiomegaly. Similarly, pulmonary function test (PFT) was performed to exclude any respiratory pathology. PFT showed moderate restriction with insignificant post-bronchodilator responsiveness. The 12-lead electrocardiogram showed wide QRS complexes and right bundle branch block (RBBB) pattern. Then, echocardiography was performed to narrow down the diagnosis. The 2D echocardiography findings are given below: • Left atrium (LA): 4.6 cm; Right atrium (RA): 5.9 cm; Left ventricle (LV): 6.7 cm; Right ventricle (RV): 5.9 cm [Dilated all chambers of heart] • Global LV hypokinesia • Severe LV systolic dysfunction [Ejection fraction (EF): 10-15%] • Severe Mitral regurgitation (MR), mild Pulmonary regurgitation (PR) • Severe Tricuspid regurgitation (TR) • Severe Pulmonary artery hypertension (PAH) with elevated Pulmonary artery systolic pressure (ePASP) of 71 mmHg • RV systolic dysfunction [Tricuspid annular plane systolic excursion (TAPSE): 15 mm and RV systolic prime (RVS′)] • LV diastolic dysfunction-grade III The figure for 2D-echocardiography and 12-lead electrocardiogram are shown in Figures 1 and 2 respectively. The high-resolution computed tomography (HRCT) scan of chest showed cardiomegaly with enlarged pulmonary trunk and diffuse ground glass opacity in basal segment of lungs. He was diagnosed as dilated cardiomyopathy (DCM) secondary to covid-19 infection resulting in heart failure with reduced ejection fraction (HFrEF) of 10-15%. He was kept on following medications Table 2 . Figure 1. 2D echocardiography. Legend: Arrows showing dilated ventricles and atrium. Figure 2. 12 lead electrocardiogram (ECG). Legend: White arrow showing wide QRS complex and Black arrows showing right bundle branch block (RBBB) pattern in leads V1 and V6. Table 2. Medications. Dosage form Drug Dose Route Times a day Tablet Digoxin 0.25 mg PO (Per oral) OD (Once a day) Tablet Metoprolol 12.5 mg PO OD Tablet Ramipril 1.25 mg PO OD Tablet Frusemide + Spironolactone 20 mg + 50 mg (1 Tab) PO OD Tablet Thiamine 100 mg PO OD Tablet Torsemide 10 mg PO OD The patient was advised on fluid restriction of less than 1 liter/day and low salt diet. He was then discharged home with plan for follow up in cardiac out-patient department as needed [SOS (Si Opus Sit)]. The patient was stable on discharge. In previous follow-ups his status was assessed by clinical examination, laboratory investigations like N-terminal pro b-type natriuretic peptide (NT-pro-BNP), troponin I, electrocardiogram and 2D echocardiography. The patient was satisfied under medications and was taking regular medications as described above. Discussion COVID-19 associated myocardial injury has well been described in various literatures throughout the world. 2 – 4 The overall pooled prevalence of acute myocardial injury was found to be 29% in hospitalized COVI-19 patients by 19 studies. 6 Various mechanisms have been proposed for myocardial injury. Some of the well described mechanisms are hyperinflammatory reaction, hyperactivation of renin angiotensin aldosterone system pathway and cytokine storm. 3 Similarly, abnormal endothelial function and downregulation of angiotensin-converting enzyme-2 (ACE-2) receptor in cardiac myocytes by SARS-CoV-2 have also predominant role in myocardial injury. 6 A systematic review found SARS-CoV-2 to cause irreversible changes in heart with right heart dilatation due to pulmonary overload as its main features. Similarly, autopsy microscopic findings suggested necrosis, micro thrombosis and lymphocytic infiltration in myocardium. 7 A Systematic review and meta-analysis by Corica et al found prevalence of right ventricular dysfunction (RVD) in COVID-19 patients was almost 1 out of 5 patients. 8 As described by Corica et al , the mortality with COVID-19 and RVD was in excess to that with COVID-19 only. In regards to cardiac biomarkers for myocardial injury in COVID-19, a systematic review and metanalysis by Zhu et al found strong association of creatine kinase (CK), CK-MB, lactate dehydrogenase (LDH), troponin I, NT-pro BNP (brain natriuretic peptide) with severity of COVID-19. 9 COVID-19 associated Takotsubo cardiomyopathy has been reported in literature. A classic case of Takotsubo cardiomyopathy in COVID19 was reported by Gomez et al where a 57 year old presented with 5 days of fever (maximum 39.7°Celcius) and progressive dyspnea on exertion and developed rapid deterioration of cardiorespiratory status during hospitalization. 4 Similar case of stress-induced (TCM) cardiomyopathy was also reported by Tsao et al in a 59 year old woman who also fulfilled the Mayo clinic criteria for TCM cardiomyopathy. 4 , 10 Our case did not fulfil the criteria as both the ventricles were involved in both systole and diastole. Although cases of dilated cardiomyopathy (DCM) in adult have not been reported till date, a case DCM has been reported in one year old healthy boy without any co-morbidities. 5 Among various causes of DCM, viral infection is one of the secondary causes. 11 The viral genomes have been detected in myocardial samples of patients with DCM in spite of undetectable infiltrating inflammatory cells. 12 Due to the activation of persistent immune mechanism after viral infection, it has been presumed to lead to DCM. 13 In regards to our case, he progressed gradually with cardiac symptoms after COVID-19 infection before he was diagnosed as DCM post-COVID-19. Ultimately, he developed heart failure with reduced ejection fraction of 10-15%. He has been repeatedly visiting our center whenever the cardiac symptoms worsen since the diagnosis was made. Conclusions COVID-19 has been a burden due to its global impact on livelihood. Apart from respiratory symptoms and complications, myocardial injury and its consequences should also be equally sought out and thoroughly evaluated in COVID-19 patients. It is necessary to keep in mind that COVID-19 can present with wide variances of cardiac symptoms and complications as described above. Among them DCM also stands as a consequence in COVID-19 as evidenced in this case. Therefore, a thorough cardiac evaluation which include cardiac biomarkers, ultrasonogram of abdomen and pelvis, echocardiography and electrocardiogram should be performed in COVID-19 patients. It helps us to guide our management strategies and prevent further cardiac complications in COVID-19 patients. The patient was treated on hospital basis with both pharmacological and dietary interventions. According to the patient, he felt relieved after the therapeutic interventions. He was performing daily activities without any hindrance. Similarly, with the intervention his sleep activity was sound and good. He was feeling more comfortable with the treatment and was convinced for the regular follow up. Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. Data availability All data underlying the results are available as part of the article and no additional source data are required. Consent Written informed consent for publication of their clinical details and/or clinical images was obtained from the patient/parent/guardian/relative of the patient. References 1. Singh R, Kashyap R, Hutton A, et al. : A Review of Cardiac Complications in Coronavirus Disease 2019. Cureus. 2020; 12 (5): e8034–e8012. PubMed Abstract | Publisher Full Text 2. Mitrani RD, Dabas N, Goldberger JJ: COVID-19 cardiac injury: Implications for long-term surveillance and outcomes in survivors. Hear Rhythm. 2020; 17 (11): 1984–1990. PubMed Abstract | Publisher Full Text 3. Cajanding RJM: Comprehensive Review of Cardiovascular Involvement in COVID-19. AACN Adv. Crit. Care. 2021; 32 (2): 169–187. PubMed Abstract | Publisher Full Text 4. Gomez JMD, Nair G, Nanavaty P, et al. : COVID-19-associated takotsubo cardiomyopathy. BMJ Case Rep. 2020; 13 (12): e236811–e236815. PubMed Abstract | Publisher Full Text 5. Kishore R, Choudekar A, Xess AB, et al. : Dilated Cardiomyopathy in a Child with COVID-19. Indian J. Pediatr. 2021; 88 (3): 278–279. PubMed Abstract | Publisher Full Text 6. Mizera L, Borst O: COVID-19 and the Incidence of Acute Myocardial Injury. Hamostaseologie. 2021; 41 (5): 356–364. Publisher Full Text 7. Maiese A, Frati P, Del Duca F, et al. : Myocardial pathology in covid-19-associated cardiac injury: A systematic review. Diagnostics. 2021; 11 (9): 1–14. PubMed Abstract | Publisher Full Text 8. Corica B, Marra AM, Basili S, et al. : Prevalence of right ventricular dysfunction and impact on all-cause death in hospitalized patients with COVID-19: a systematic review and meta-analysis. Sci. Rep. 2021; 11 (1):1–9. Article number: 17774. Publisher Full Text PubMed Abstract | 9. Zhu Z, Wang M, Lin W, et al. : Cardiac biomarkers, cardiac injury, and comorbidities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. Immunity Inflamm. Dis. 2021; 9 (4): 1071–1100. PubMed Abstract | Publisher Full Text 10. Tsao CW, Strom JB, Chang JD, et al. : COVID-19-Associated Stress (Takotsubo) Cardiomyopathy. Circ. Cardiovasc. Imaging. 2020; 13 (7): e011222–e011224. PubMed Abstract | Publisher Full Text 11. Jefferies JL, Towbin JA: Dilated cardiomyopathy. Lancet. 2010; 375 (9716): 752–762. Publisher Full Text 12. Kühl U, Pauschinger M, Noutsias M, et al. : High prevalence of viral genomes and multiple viral infections in the myocardium of adults with “idiopathic” left ventricular dysfunction. Circulation. 2005; 111 (7): 887–893. PubMed Abstract | Publisher Full Text 13. Komiyama M, Hasegawa K, Matsumori A: Dilated cardiomyopathy risk in patients with Coronavirus disease 2019: How to identify and characterise it early? Eur. Cardiol. Rev. 2020; 15 : e49–e10. PubMed Abstract | Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 25 May 2022 ADD YOUR COMMENT Comment Author details Author details 1 Internal Medicine, Nepalese Army Institute of Health and Sciences, Kathmandu, 44600, Nepal Bishal Dhakal Roles: Conceptualization, Investigation, Methodology, Resources, Software, Supervision, Writing – Original Draft Preparation, Writing – Review & Editing Neeraj Sharma Roles: Investigation, Resources, Supervision Bishnu Deep Pathak Roles: Conceptualization, Resources, Supervision, Writing – Review & Editing Nabin Simkhada Roles: Conceptualization, Investigation, Methodology, Resources, Supervision Binod limbu Roles: Investigation, Methodology, Resources Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 25 May 2022, 11:567 https://doi.org/10.12688/f1000research.110063.1 Copyright © 2022 Dhakal B et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Dhakal B, Sharma N, Pathak BD et al. Case Report: A case of Dilated Cardiomyopathy in COVID-19; A case report [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :567 ( https://doi.org/10.12688/f1000research.110063.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 25 May 2022 Views 0 Cite How to cite this report: Shrestha DB. Reviewer Report For: Case Report: A case of Dilated Cardiomyopathy in COVID-19; A case report [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :567 ( https://doi.org/10.5256/f1000research.121635.r141143 ) The direct URL for this report is: https://f1000research.com/articles/11-567/v1#referee-response-141143 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 31 May 2024 Dhan Bahadur Shrestha , Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, USA Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.121635.r141143 Summary Authors reported an interesting case of DCM, however, needs some editing in writing and technicalities, those can be sorted out in proofreading. Minor comments: Abbreviation in first use must ... Continue reading READ ALL Summary Authors reported an interesting case of DCM, however, needs some editing in writing and technicalities, those can be sorted out in proofreading. Minor comments: Abbreviation in first use must be used with full form (eg. COVID-19 in abstract section, and other in the body), and don't need to provide abbreviation with full form in later use eg. RT-PCR. Case presentation: "There was not any significant medical, family and psycho-social history related to the case. " better rephrase it like "There was no other medical, family, and psycho-social history related to the case." Case presentation: In the fourth paragraph, please maintain a uniform abbreviation here and in other places as well " Covid-19 ", follow the general rule of scientific writing, check standard guidelines, need to spell out numbers less than 10, eg 6. proper way of writing studies with"et al" in discussion Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Internal medicine, general cardiology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Shrestha DB. Reviewer Report For: Case Report: A case of Dilated Cardiomyopathy in COVID-19; A case report [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :567 ( https://doi.org/10.5256/f1000research.121635.r141143 ) The direct URL for this report is: https://f1000research.com/articles/11-567/v1#referee-response-141143 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 25 May 2022 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 Version 1 25 May 22 read Dhan Bahadur Shrestha , Mount Sinai Hospital, Chicago, USA Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Shrestha D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 31 May 2024 | for Version 1 Dhan Bahadur Shrestha , Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, USA 0 Views copyright © 2024 Shrestha D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Summary Authors reported an interesting case of DCM, however, needs some editing in writing and technicalities, those can be sorted out in proofreading. Minor comments: Abbreviation in first use must be used with full form (eg. COVID-19 in abstract section, and other in the body), and don't need to provide abbreviation with full form in later use eg. RT-PCR. Case presentation: "There was not any significant medical, family and psycho-social history related to the case. " better rephrase it like "There was no other medical, family, and psycho-social history related to the case." Case presentation: In the fourth paragraph, please maintain a uniform abbreviation here and in other places as well " Covid-19 ", follow the general rule of scientific writing, check standard guidelines, need to spell out numbers less than 10, eg 6. proper way of writing studies with"et al" in discussion Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Internal medicine, general cardiology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Shrestha DB. Peer Review Report For: Case Report: A case of Dilated Cardiomyopathy in COVID-19; A case report [version 1; peer review: 1 approved with reservations] . F1000Research 2022, 11 :567 ( https://doi.org/10.5256/f1000research.121635.r141143) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. 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