(Figure 1C and 1D and Movies II and III in the Data Supplement). Because of progressive cardiogenic shock (invasive blood pressure, 60/40 mm Hg), vasopressors and intra-aortic balloon pump were initiated for hemodynamic support (Figure 1E). The patient was transferred to the intensive care unit. Chest radiography showed pulmonary congestion without signs of interstitial pneumonia (Figure 1F).

A nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 infection by reverse-transcriptase polymerase chain reaction assays, and antiretroviral therapy (darunavir/cobicistat) was started in the intensive care unit. Blood tests for concomitant bacterial or viral infections were negative. Despite hemodynamic support, she remained hypotensive (72/34 mm Hg) with a cardiac index of 1.1 L· min− 1· m− 2 and oliguria (20 mL/h). Blood lactate increased, requiring escalating doses of inotropes, intubation, and mechanical ventilation. A repeat ECG showed diffuse ST-segment elevation, whereas an echocardiogram confirmed severe left ventricular