Cough, dyspnoea, left sho...

A 67-year-old woman with a past medical history significant for non-ischaemic cardiomyopathy in 2018 presented to the emergency department with cough, mild shortness of breath, and left shoulder pain. Physical exam and radiographic imaging of the chest were unremarkable (Figure 1). A nasopharyngeal swab was positive for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) by reverse transcription-polymerase chain reaction. She was discharged home due to mild symptoms. 

One week after her initial presentation, she presented with worsening dyspnoea and orthopnoea. Physical exam was pertinent for a blood pressure of 118/82 mm Hg, heart rate of 122 beats/min, respiratory rate of 24 breaths/min, a temperature of 36.8˚C, normal oxygen saturation on room air, distant heart sounds, and rales at the lung bases bilaterally. A chest X-ray and electrocardiography (ECG) were done.