SARS-CoV-2 Infection in the Heart Transplant Recipient.

Review of the literature and reported case series has not reported an increased risk of SARS-CoV-2 infection in heart transplant recipients. However, this population is at increased risk of a more severe infection with increased mortality because of age and the presence of multiple comorbid conditions There is no significant difference in presenting symptoms in transplant recipients as compared to nontransplant patients, although diarrhea has been reported to be more frequent in transplant patients, a common side effect of immunosuppressive medications. Standard preventive measures have been shown to be equally protective in heart transplant recipients. Risk factors for severe disease and mortality are similar in both transplant recipients and nontransplant patients and include older age and the presence of comorbidities hypertension being the most common. The SARS-CoV-2 infection did not increase the risk of transplant allograft rejection. Currently, there are no specific treatment recommendations for SARS-CoV-2 infection in transplant recipients. However, the International Society of Heart and Lung and Transplant has issued guidance on how to modulate immunosuppressive therapy during SARS-CoV-2 infection.

Myocarditis and Pericarditis in Patients with COVID-19.

COVID-19 has been associated with a variety of cardiac manifestations. Myocarditis and pericarditis have been reported as one of the many cardiac manifestations in association with COVID-19. We describe below three cases of myocarditis, pericarditis with associated pericardial effusion and myopericarditis, respectively, in the setting of COVID-19. Although these entities may occur in isolation, they often occur in association to varying degrees. It could either be the initial diagnosis at the time of presentation or it could occur later in the course of COVID-19 infection. Pericarditis may occasionally be associated with significant pericardial effusion and tamponade requiring therapeutic pericardiocentesis. The assessment of pericardial effusion has been found to be exudative and is usually negative for SARS-CoV-2. Treatment of pericarditis with nonsteroidal anti-inflammatory drugs, colchicine, and corticosteroids has proven to be safe in COVID-19. Myocarditis may present with severe left ventricular systolic dysfunction and cardiogenic shock requiring inotropes and mechanical circulatory support.