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

Sollie, Zachary W.; Vallepu, Shirisha R; Jagadeesan, Cindrel Tharumia; White, L.; Nagalapuram, Vishnu

doi:10.7759/cureus.13461

Cited by 8 publications

(16 citation statements)

References 20 publications

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“…Amongst these cases, most of them were reported in positive COVID-19 patients and usually presented as a late finding [ 17 ]. However, PE as a post-COVID-19 complication has been observed only a few times in the literature [ 18 , 19 ]. Tachycardia, tachypnea, raised jugular venous pressure, muffled heart sound, pulsus paradoxus, and hypotension are important indicators of PE upon clinical examination [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

Post COVID-19 hemorrhagic pericardial effusion; A case report with literature review

Amin¹,

Kakamad

Hamasaeed

et al. 2022

Annals of Medicine &Amp; Surgery

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Introduction Pericardial effusion (PE) related to COVID-19 has rarely been observed, with most reported cases being non-hemorrhagic. This study aims to present a rare case of post-COVID-19 hemorrhagic PE. Case report A 44-year-old male presented with shortness of breath upon exertion, palpitation, and left-sided chest tightness. He was a recently recovered from COVID-19. He was conscious, oriented, tachypneic, and tachycardic. Chest examination revealed a mixture of fine and coarse crackles along with muffled heart sounds. He had elevated D-dimer, C-reactive protein, prothrombin time, and aPTT. Computed tomography pulmonary angiogram showed acute pulmonary thromboembolism involving the posterior segmental lobar branch of the left lower lobe with concomitant pulmonary infarction. Echocardiography showed severe PE without diastolic collapse. Pericardial drainage was performed and by the 2nd day, there was no more effusion. On the 7th day, the patient developed severe complications which led to cardiac arrest. Discussion PE is the buildup of fluid in the pericardium. It has been rarely observed in relation to COVID-19, both during and after the viral infection. If PE is suspected, Echocardiography can be used to confirm its diagnosis. There is no standard management for these cases and only non-hemorrhagic patients with mild to moderate effusion can be treated using conservative measures. Conclusion Hemorrhagic PE can be a rare but possible post-COVID-19 sequel, and Echo can be used to confirm its diagnosis. Drainage is necessary to resolve the effusion.

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Section: Discussionmentioning

confidence: 99%

Post COVID-19 hemorrhagic pericardial effusion; A case report with literature review

Amin¹,

Kakamad

Hamasaeed

et al. 2022

Annals of Medicine &Amp; Surgery

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“…Inflammatory markers, D-Dimer 31 , and brain natriuretic peptide 26 have increased in most cases, especially in cases of severe pulmonary involvement. Troponin as a non-specific biomarker can be negative 12 , 20 , 26 , 27 , 28 , 29 , 31 , slightly elevated 8 , 13 , 15 , 24 , or high. In cases with high troponin levels, suspicion of concomitant myocarditis increases 18 .…”

Section: Review Of Literaturementioning

confidence: 99%

“…However, chest x-ray findings are not sensitive and specific enough. Clues to pericardial effusion in ECG are sinus tachycardia (especially without fever), low QRS voltage, and electrical alternant 12 . PR depression with concave diffuse ST elevation and non-specific ST-T changes like invert T wave are signs of pericarditis and myocarditis, respectively.…”

Section: Review Of Literaturementioning

confidence: 99%

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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“…To date, cardiac injury (troponin I elevation, ECG and echocardiography abnormalities) has been observed in ∼7.2% of patients with severe and critical COVID-19 infection (27)(28)(29)(30)(31)(32)(33), while pericardial effusion was found in 4.8% of patients, which suggests that acute pericarditis could be an underdiagnosed pathology, and therefore, not properly managed and treated (5,34,35).…”

Section: Discussionmentioning

confidence: 99%

“…In the case of coronavirus disease 2019 (COVID-19) in patients with pericarditis, although there is no definitive test to prove the causal relationship, this complication could be secondary to viral biological effects of COVID-19 infection (4,5). It is significant to reflect that pericardial disease could be a late complication of COVID-19, and to have therapeutic solutions available when facing such events (4,5). The major protein involved with SARS-Cov2 pathogenesis is the spike protein, which causes an imbalance of the Renin-Angiotensin-Aldosterone System (RAAS) (6)(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

A Case of Acute Pericarditis After COVID-19 Vaccination

et al. 2021

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A two-dose regimen of Pfizer–BioNTech COVID-19 vaccination confers 95% protection against COronaVIrus Disease 19 (COVID-19) and the safety profile is adequate. To the submission date, there were no reports in literature of acute pericarditis after BNT162b2 vaccination. However, pericarditis has been reported as a rare event associated with COVID-19 infection, which could be due to the pro-inflammatory effects of the spike protein. Recent evidence of post-vaccine myocarditis has been published. Herein we describe the case of a middle-aged healthy women who developed symptoms and signs of acute pericarditis 7–10 days after the second dose of Pfizer–BioNTech COVID-19 vaccination. Although a direct effect cannot be stated, it is important to report a potential adverse vaccine reaction effect that could be associated with the expression of SARS-CoV-2 spike protein induced from the mRNA of the vaccine.

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

Cited by 8 publications

References 20 publications

Post COVID-19 hemorrhagic pericardial effusion; A case report with literature review

Post COVID-19 hemorrhagic pericardial effusion; A case report with literature review

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

A Case of Acute Pericarditis After COVID-19 Vaccination

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