COVID-19 Myopericarditis With Cardiac Tamponade in the Absence of Respiratory Symptoms

A Case Report

Lauren Cairns; Yazeed Abed El Khaleq; Will Storrar; Michaela Scheuermann-Freestone

Disclosures

J Med Case Reports. 2021;15(31) 

In This Article

Discussion

Fever and dry cough were the first reported common symptoms in COVID-19 positive patients.[1] Studies have demonstrated the following cardiac complications to be associated with COVID-19: myocardial infarction, microembolic complications, myocardial injury, arrythmia, heart failure, coronary vasospasm, non-ischemic cardiomyopathy, stress cardiomyopathy, pericarditis and myocarditis.[2,3] There is little known about myocarditis as a COVID-19 complication. Viral infections including influenza, are the most common infectious cause of myocarditis.[4] Cardiac tamponade has rarely been reported as a COVID-19 complication.

There are multiple case reports illustrating myopericarditis in COVID-19 patients in conjunction or after the onset of respiratory symptoms. Two of the cases report no previous medical history.[3,4] Past medical history in the other cases include non-ischemic cardiomyopathy[5] and previous myopericarditis.[6] It seems plausible that previous cardiovascular co-morbidity could increase risk of COVID-19 myopericarditis, although further studies would be required.[7,8]

Size of pericardial effusion reported ranges from 1.1 to 2 cm, smaller compared to the pericardial effusion in our case (3–4 cm). Three case reports diagnosed cardiac tamponade with TTE requiring pericardiocentesis. These cases recorded pericardial fluid drained as 300 ml serous fluid,[3] 540 ml serous fluid[6] and 800 ml of exudative bloody fluid.[5] Where possible the PCR of the fluid was tested and found to be COVID-19 negative, supporting the findings in our case.[3,5,6] Takotsubo cardiomyopathy was identified post pericardiocentesis in the third case.[5]

Troponin was raised in all expect one case report. As troponin can be raised with pneumonia, myocardial damage can be differentiated with TTE or cardiac MRI if necessary.[2] ECG findings were recorded as ST elevation or nonspecific ST changes.[2,5,6]

Similar to our case, two patients were prescribed heart failure medication such as Furosemide.[2,5] Although, antibiotics were not documented to have been given in the other reported cases. The main therapies to treat myopericarditis include non-steroidal anti-inflammatories and glucocorticoids.[3] Four cases mentioned which medications were used. Three received glucocorticoids, two were prescribed colchicine in addition. Three also received trial COVID therapies including hydroxychloroquine and antiretrovirals, however these therapies have not been validated. Moreover, no medications have currently been recommended to treat COVID-19 myopericarditis.[2–5]

Although there is no clear mechanism for the pathogenesis of cardiac involvement, various methods have been proposed.[4,5] SARS-CoV2 could reflect the dissemination process of the virus through blood or lymphatics of the respiratory tract.[5] Conversely, an inflammatory response, similar to other viruses, could be triggered resulting in pericarditis and pericardial effusion.[4]

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