After a few days of fever then uncontrolled vomiting, Ramya Yeleti visited the emergency room. She felt dizzy and thought she was dehydrated. But the doctors wanted her to undergo an EKG because they worried about her heart. The fourth year medical student was confused.
“I turned to my dad and was like, ‘What is going on?’ He was like, ‘I don’t know,’” the medical school student at Marian College of Osteopathic Medicine in Indianapolis, recalled to TODAY. “Everyone was so nice to me and that put me more on edge. Nurses are super nice to the young patients who are critical … My brain wasn’t really functioning well.”
Doctors worried because she had ventricular tachycardia, an abnormal heart rhythm when the heart beats too fast and out of sync.
“There is no reason for a 25-year-old to have this,” she said. “Then I passed out.”
Yeleti had myocarditis — heart muscle inflammation that causes irregular heart beats, heart failure and sudden death — and her heart was struggling to work. Doctors put her on ECMO, a machine that circulates blood for her. Still they worried. Sometimes ECMO patients need heart transplants.
But then something unexpected happened: Yeleti recovered in only two days.
“Her heart had come back to almost normal. That is very, very, very rare,” Dr. Roopa Rao, a cardiologist who specializes in transplants and heart failure at Indiana University Health, told TODAY. “Within 48 hours, this is something I haven’t heard of or read. It was a miraculous recovery.”
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COVID-19 twice?
In April, Yeleti’s father, a cardiologist, contracted COVID-19 at work. He tried isolating from his family as he recovered, though with five adults in the house it was tough. A few weeks later, Yeleti’s mother had COVID-19 and went to the intensive care unit for treatment. Then her sister lost her sense of smell and taste and assumed she, too, had COVID-19. When Yeleti started showing symptoms, she didn’t worry too much.
“We figured if we got it, it was no big deal,” she said. “People who are 25 are not really showing negative effects at the time like older adults.”
Yeleti’s case of coronavirus also seemed mild, but she experienced more fatigue and she took about three weeks to recover.
“We all finished recovering by like May. It was pretty chill,” she said. “Me and my sister got the antibody test done and we were both positive for antibodies.”
Throughout the rest of May and June she stayed at home until her medical school rotations started in July. Toward the end of the month, she had a fever and felt exhausted again. She called out of work two days to recover. Because she had a fever, her school required a negative COVID-19 test to return. She received one and tested negative.
“Since I already had COVID I really didn’t think I had COVID again. There was no way I was reinfected. It was like a one in a billion chance,” Yeleti said. “I thought it was some nasty flu bug.”
But then one Saturday she started feeling chest pains. She asked her dad to listen to her heart and he thought it sounded normal. Then she started vomiting and prescription medications that stop vomiting didn’t even work on her. After a full night of throwing up, she went to the emergency room where they noticed her heart beat was erratic and that her heart was inflamed. She was shocked to learn she tested positive for COVID-19.
“It was not clear if the positive COVID testing was reminiscent of the first infection in April, which is a stretch, but we didn’t know, or a reinfection,” Rao, one of her doctors, said. “Sometimes patients can remain positive. We have to assume she is reinfected with COVID and treat her.”
Amazing recovery
Soon after arriving in the emergency room, Yeleti lost consciousness.
“I don’t remember anything until that next Saturday,” she said. “When I woke up, my condition was stable but to me it was bad. I was very, very weak. I didn’t have my voice and I was just in a lot of pain and I was in a foreign hospital room without my parents. I was all alone.”
She learned that they inserted a heart catheter to try to pump blood. When that didn’t work well enough, they put her on ECMO.
“ECMO is a pretty big deal,” she said. “A lot of patients often don’t get off ECMO.”
While she was intubated because she struggled to breathe, there appeared to be little to no damage to her lungs.
“Nothing had happened to my lungs. All this happened to my heart,” she said. “They found a valve problem, my valve had like detached and was kind of flapping in the wind. It wasn’t pumping well and it required an open-heart surgery.”
They also discovered she had another virus. Viruses can cause myocarditis and the doctors suspect that the coronavirus was behind her heart damage.
“We assume that it was all COVID. COVID attacks the heart. It can cause myocarditis but COVID causing this amount of inflammation is really, really unusual,” Rao explained.
While Rao admits there’s still much to learn to understand why someone like Yeleti would experience such serious heart damage from COVID-19, she says experts suspect that in some young healthy patients, the immune system overreacts when trying to protect the body.
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“This hyperactivity causes the damage to the heart muscle,” Rao said.
While Yeleti began rotations again and feels mostly well, she still gets a little tired and has some inflammation still. Doctors do not expect her to have long-term heart problems. Two weeks after she left the hospital she approached Rao with a unique request.
“I get an email saying, ‘I want to work with you and I want to write my case report.’ I almost fell off my chair. I wanted to make sure this is what she wants,” Rao said. “She amazed me. That’s the thing I like about her: She has such a positive attitude.”
Yeleti, who recently applied to psychiatry residencies, says the process of writing up her unusual medical case helps her mentally grapple with her experience. And, she hopes others learn from her.
“There are a lot of other people with COVID who have gotten this sick. I really don’t want them to feel like they are alone,” she said. “For people recovering, it sucks, I get it, but they are not alone in their struggle.”
For those who haven’t gotten COVID-19, she has another message.
“Wear your mask. I’m not saying this in an angry way, just in a sad way. There are people who are suffering, please if you can wear a mask,” she said.