25-year-old had life-threatening heart infection
Marian University’s Ramya Yeleti was sick with COVID-19 in April. The virus infected her heart, requiring open-heart surgery a month later.
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The last thing that Ramya Yeleti remembers thinking before she passed out in the emergency room that August day was that she might never wake up again.
The 25-year-old medical student knew something was very wrong with her heart, a suspicion the doctors’ reaction confirmed. Once they took her vitals, they ordered an EKG, whisked her back to a trauma room, and placed shock pads on her chest. They also gave her some medicine to try to bring her heart back into a normal rhythm.
“The doctors were obviously freaking out. Something is really, really wrong,” Yeleti recalled thinking. “Then I passed out. I remember just thinking I hope my family will be OK. … I did think I might die.”
Ramya Yeleti of Carmel looks toward her surgery scar. (Photo: Grace Hollars/IndyStar)
Six days later Yeleti woke up in IU Health Methodist Hospital and slowly started to learn what she had been through over the past week: days on a heart-lung life support machine, having her name added to the heart transplant list, open heart surgery, and a recovery that doctors found nothing short of miraculous.
And, her doctors believe, the whole saga started months earlier when the Carmel resident fell ill with the coronavirus.
Doctors will never know exactly what role, if any, the coronavirus played in Yeleti’s near-death experience. However, they suspect that the virus weakened her immune system, setting her up for disaster when another virus struck some months later and leading to a heart condition known as myocarditis that can be life-threatening.
“This is a very rare event, but it is happening,” said Dr. Cole Beeler, medical director of infection prevention at Indiana University Health University Hospital, who did not treat Yeleti himself. ”We see this with other viral infections, too, where the initial viral infection sets off an issue with the immune system that leads to an attack of various organs. … With COVID, we’re still learning a lot about it. It may be that we even discover a broader set of immune processes and diseases that develop after the infection.”
Is she infected now with the coronavirus?
Some viruses like Coxsackie or influenza in very rare cases have been known to cause damage to the heart similar to what Yeleti sustained. Now, the SARS-Co-V-2 virus also has been shown to cause myocarditis in young adults.
In Yeleti’s case, doctors do not know whether Yeleti was actively infected with the coronavirus. Signals were mixed. During her hospital stay, she tested positive for the coronavirus as well as a different virus. But she also had antibodies to the coronavirus, suggesting she had been infected in the past. The positive coronavirus result may have been a red herring, detecting dead strands of the virus in her system rather than an active infection, doctors say.
Still, just to be sure, Yeleti received both remdesivir and convalescent plasma while in the hospital in case the coronavirus had contributed to her condition, said her cardiologist, Dr. Roopa Rao, a heart failure transplant cardiologist with IU Health.
“We treated her like she had COVID infection,” Rao said. “We were not clear whether we were dealing with a dead virus or an active infection.”
Four months earlier, Yeleti knew she had a coronavirus infection. Her father, a physician, fell ill around March and quarantined himself, but everyone else in the family — Yeleti, her twin sister and her mother — also developed the virus. Yeleti had a fever and cough, lost her sense of taste and smell and felt awful for about two weeks. Her sister had a milder case, but their mother spent time in the intensive cure unit before recovering. By May all felt better.
So three months later when Yeleti developed nausea and a fever and started vomiting, she was reasonably sure it was not the coronavirus. Still, she went for a rapid test the last Thursday of July, which came back negative. That Friday and Saturday she thought she felt better, but laterSaturday she started vomiting uncontrollably.
Her chest hurt, so she asked her father to listen to her heart. He heard nothing unusual, and so she figured the pain might just be a sore esophagus from the vomiting. Her father gave her medicine to stop the vomiting, but when he saw that did not help, he started to wonder if she had appendicitis.
‘As a young patient, I wasn’t expecting that’
Off they went to the Community North emergency room. Once the doctors took Yeleti’s vital signs, they realized something was wrong. Very wrong. Usually when someone has a fever, Yeleti says, it raises their vital signs. Hers were dangerously low.
They sent her to a trauma room, where they hooked her up to an EKG machine.
“As a young patient, I wasn’t expecting that,” she said. “It normally doesn’t happen to young patients, not for people who were young and just chilling.”
The EKG machine revealed that Yeleti’s heart was barely working. One measure of heart health looks at what’s known as the ejection fraction, how much blood the heart can pump out of the main chamber with each heartbeat. Healthy hearts have an ejection fraction in the 55% to 65% range, Rao said. Yeleti’s measured just below 10%.
Yeleti was not conscious for anything. Shortly after she was placed on the EKG machine, she passed out. She would not wake up until the following weekend.
She later learned that the Community North doctors stabilized her and had her transferred to Methodist’s heart transplant team. They feared her heart might soon give out completely, leaving no other option.
“If this heart didn’t recover, then there was nothing else for her. Transplant would have been the only strategy,” Rao said. “That’s why she came to us.”
As Yeleti’s name was added to the heart transplant list, her body was hooked up to an extracorporeal membrane oxygenation machine, known more casually as ECMO. This machine, similar to a heart-lung bypass device, stepped in to do the work of her heart and lungs, providing oxygen to the other organs and allowing her heart to rest, Rao said.
Meanwhile, the doctors started treatment for the coronavirus after Yeleti tested positive.
‘Her case is pretty rare’
Despite conventional wisdom that infection provides immunity, reinfections have been known to happen, though this is rare, Beeler said. In such cases, including some patients that IU Health has seen, these individuals have a negative test and then after at least three months later test positive again with a new onset of symptoms.
Rao remains doubtful that was the case with Yeleti. Rather, she says that Yeleti, already weakened by coronavirus, contracted a different virus, a parvovirus.
“This is all speculation, that she had infection with COVID and then had this parvovirus, then that led to this type of serial reaction,” Rao said. “That’s one theory. … Her case is pretty rare. We know that COVID can affect the heart, but COVID affecting the heart to this point, requiring ECMO, that is very, very few cases.”
Yeleti’s case was about to get even weirder.
Usually a person remains on ECMO for about a week and in some cases several weeks. But about 48 hours after she first went on the machine, Yeleti’s heart came back to almost normal.
Rao was so surprised by her patient’s progress that she reached out to a colleague in the field, a leader in ECMO treatment. He, too, had never heard of such a rapid recovery.
“This is the amazing part of her journey,” Rao said. “This kind of myocarditis, that is rare to the point of requiring ECMO, it is very, very few cases. And for her to make a recovery like this is even rarer.”
But full recovery remained elusive. Although doctors took her off the ECMO machine, once they did so, they found out that one of her heart valves had become damaged. Four days after she first got to the hospital, she underwent open heart surgery to fix it. Two days later Yeleti slowly awakened.
Because she had tested positive for COVID-19 repeatedly in recent days, her family was not allowed to visit. Without her glasses, she could barely see or make sense of her surroundings. She felt the intubation in her throat and thought she was being gagged. After all she had been through, her arms were so weak she couldn’t lift them.
The nurse would come in and tell her where she was, and Yeleti would drift back off to sleep and awaken once more only to forget what the nurse had told her.
Normally known for her loud voice, Yeleti could barely eke out one word at a time.
“For me to have no voice, it was so weird,” she said. “Literally I couldn’t talk at all, just breaths of air. I had no voice at all.”
An experience to share
Yeleti, though, was committed to doing what it would take to get her out of the hospital and back with her family. Twelve days after she entered the hospital, she was discharged. She credits her youth with her rapid recovery. She remains fatigued but is working hard at rebuilding the muscle mass she lost.
Her heart is still inflamed, which is typical after cases of myocarditis, said Rao, who credits her whole team with helping Yeleti to recover. For her to heal completely may take six months or longer.
Before this all happened, Yeleti had planned a career in psychiatry. As she recovered, Rao asked her whether the experience had changed her mind.
Not at all, said Yeleti, who has always felt a calling to be a psychiatrist.
“My heart is not to be trusted,” she said. “When I woke up, the only thing that was working is my mind. I’ll let everyone else go into all of the body specialties.”
Still, Yeleti who is in her last year of medical school at the Marian College of Osteopathic Medicine, plans to devote a month to working on a research paper with Rao. Her topic? Her own medical case.
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