Cardiac Tamponade in a Patient With Myocardial Infarction and COVID-19

García‐Cruz, Edgar; Manzur‐Sandoval, Daniel; Lazcano-Díaz, Emmanuel Adrián; Soria-Castro, Elizabeth; Jiménez-Becerra, Silvia

doi:10.1016/j.jaccas.2020.07.042

Cited by 11 publications

(24 citation statements)

References 2 publications

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“…The presence of COVID-19 in pericardial fluid has been recently reported [26]. Also, viral particles in pericardial effusion were seen on electron microscopy [27]. From our standpoint, this is a sufficient reason to include early echocardiography into the standard work-up of symptomatic COVID-19 patients.…”

Section: Discussionmentioning

confidence: 55%

Clinical variants of myocardial involvement in COVID-19-positive patients: a cumulative experience of 2020

et al. 2021

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Myocardial injury, diagnosed by troponin elevation, is common in COVID-19 patients, but cardiac involvement with clinical manifestations occurs less frequently. We analyzed the literature on COVID-19 (2020) and systematically reviewed the cases where individual patient data were presented. We searched PubMed and Google Scholar for "COVID," "COVID-19," and "coronavirus" in combination with "myocarditis," "heart failure," "takotsubo," "cardiomyopathy," and "cardiogenic shock." We identified 90 cases of COVID-19 with myocardial involvement, mean age 52.9 ± 18.3 years, 54.5% males. Of them, 55 survived (61.1%), 20 died (22.2%), and in 15 (16.7%) the outcome was unknown at the time of publication. Among patients with known outcome, mortality was 26%. The nadir LVEF was 31.7 ± 13.1% and recovered to 50.1 ± 16.0%. Pericardial effusion was a common finding, reported in 21 (23.3%) of patients, including moderate size effusion in 8.9% and large in 7.8%. The effusion caused tamponade in 11 (12.2%) of patients. Out of 83 patients who experienced a decrease in LVEF, 30 could be classified as takotsubo syndrome. The takotsubo patients were older than those with myocarditis, and with relatively high proportion of males. About one third of the cases was complicated by cardiogenic shock. Myocardial involvement in COVID-19 patients most often presents as a new, rapid decrease in LVEF, although normal LVEF or takotsubo-like wall motion pattern does not rule out myocarditis. Moderate and large pericardial effusion is common, and cardiac tamponade occurs in 12.2% of patients. Cardiogenic shock develops in one third of the patients. Mortality appears to be high at 26%.

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Section: Discussionmentioning

confidence: 55%

Clinical variants of myocardial involvement in COVID-19-positive patients: a cumulative experience of 2020

et al. 2021

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“…Also in Foster et al study of a 44-year-old woman reveal a positive COVID-19 test three weeks before her large hemorrhagic pericardial effusion (with a two-week isolation period)(13). Cruz et al reported another hemorrhagic pericardial effusion and cardiac tamponade on the ninth day of the illness 14 . In addition to the above, Purohit et al presented an 82-year-old woman with five days of productive cough, fever with chills, and intermittent diarrhea.…”

Section: Review Of Literaturementioning

confidence: 98%

Coronavirus Disease 2019 (COVID-19) and Severe Pericardial Effusion: From Pathogenesis to Management: A Case Report Based Systematic Review

Kermani-Alghoraishi

Pouramini

Kafi

et al. 2022

Current Problems in Cardiology

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The Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) created a global pandemic that continues to this day. In addition to pulmonary symptoms, the virus can have destructive effects on other organs, especially the heart. For example, large pericardial effusion has been observed as a critical and life-threatening finding in Coronavirus disease of 2019 (COVID-19) patients. In this case report based systematic review, we review the reports of moderate to severe pericardial effusion associated with tamponade physiology. Direct cardiomyocyte and pericardium invasion, inflammation and cytokine storms and oxidative stress due to acute respiratory distress syndrome (ARDS), are the pathogenesis of this phenomenon. The results showed that the manifestations of this finding are variable. Pericardial effusion can be seen as a delayed complication, accompanied by myocarditis or pericarditis, isolated, or with ARDS. In most patients, emergency percutaneous pericardiocentesis was performed, and fluid analysis was often exudative in three pattern of hemorrhagic, serous, and serosanguinous. Medical treatment and follow-up are recommended, especially in cases of pericarditis.

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“…COVID-19 testing on the pericardial fluid is neither available widely nor validated. However, COVID-19 has been demonstrated in the pericardial fluid using reverse transcriptase-polymerase chain reaction and electron microscopy [ 14 , 15 ]. Since management would not change depending on this, it is reasonable to avoid these investigations, which are often laborious and expensive.…”

Section: Discussionmentioning

confidence: 99%

Challenges in Managing Pericardial Disease Related to Post Viral Syndrome After COVID-19 Infection

Sollie¹,

Vallepu²,

Jagadeesan³

et al. 2021

Cureus

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Although primarily a respiratory illness, coronavirus disease 2019 (COVID-19) has been associated with cardiac involvement with reported cases of myocardial ischemia, arrhythmia, myocarditis, pericarditis, and pericardial effusion leading to cardiac tamponade. Most cases of pericardial disease in this setting have been during the acute infection. Here, we present a patient who developed pericarditis leading to cardiac tamponade after the resolution of the acute COVID-19 infection. Her course of illness was further complicated by poor response to initial medical therapy with non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine which could possibly be related to early exposure to steroids. It is often difficult to establish an underlying etiology for acute pericarditis. Similarly, in our case, although there is no definitive test to prove the causal relationship, this effusion is highly suspicious of being secondary to post viral sequelae after COVID-19 infection when considering the clinical course. It is important to consider pericardial disease as a late complication of COVID-19 even after apparent resolution of the acute infection and be mindful of the therapeutic challenges that we might face while managing such patients.

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Cardiac Tamponade in a Patient With Myocardial Infarction and COVID-19

Cited by 11 publications

References 2 publications

Clinical variants of myocardial involvement in COVID-19-positive patients: a cumulative experience of 2020

Clinical variants of myocardial involvement in COVID-19-positive patients: a cumulative experience of 2020

Coronavirus Disease 2019 (COVID-19) and Severe Pericardial Effusion: From Pathogenesis to Management: A Case Report Based Systematic Review

Challenges in Managing Pericardial Disease Related to Post Viral Syndrome After COVID-19 Infection

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