Extended Data Fig. 2

Myocardial injury in a patient treated in the Intensive Care Unit for COVID-19 pneumonitis and respiratory failure. A 58-year-old male healthcare worker was hospitalized with breathlessness, cough and pyrexia. There was no history of chest pain. Admission electrocardiogram (a) showed sinus tachycardia with premature atrial complexes and lateral ST-segment depression, and a peak troponin I concentration of 532 ng/L. The medical history included asthma and hypertension. A PCR test was positive for SARS-CoV-2. Due to respiratory distress and hypoxemia, the patient was intubated and admitted to the intensive care (ICU). A computed tomography (CT) pulmonary angiogram (8) revealed COVID pneumonitis and pulmonary thromboembolism was excluded. The ICU admission lasted one-month and the patient was discharged after a period of 52 days in hospital. The research CT scan revealed resolution of changes in the lung parenchyma (c). Coronary CT angiography revealed atherosclerosis in the left coronary artery (d) and FFRCT (e) excluded obstructive coronary artery disease. Protocol-directed cardio-renal magnetic resonance imaging (MRI) did not reveal features of myocardial inflammation. Specifically, the myocardial T2 (F, 41 ms) and T1 (G, 1218 ms) relaxation times were normal and there was no intra-myocardial late gadolinium enhancement other than at the right ventricular insertion point, which can be a normal finding (H). The adjudicated cardiac diagnosis was acute myocardial injury secondary to hypoxemia, not myocarditis.