NPPB and acute respiratory distress syndrome: 57 y old male presented with symptoms of COVID 19 pneumonia and subsequently developed ARDS. Troponin and BNP were elevated with no ST changes. Echocardiogram showed diffuse hypokinesis and reduced ejection fraction. Cardiac MRI showed diffuse edema. The patient was treated with hydroxychloroquine, azithromycin, ceftriaxone, methylprednisolone and tocilizumab.