ABSTRACT
Pericardial disease represents a large diversity of inflammation related injury of the pericardium. Multifactorial causes may contribute to acute and recurrent pericarditis, pericardial effusion without major hemodynamic compromise, cardiac tamponade or constrictive pericarditis. Currently, inflammatory pericardial pathologies are observed in cases of SARS-CoV-2-infection or after vaccination. Beside established anti-inflammatory therapeutic strategies with NSAID, corticosteroids and colchicine, auto-inflammation and inflammasomes seam to offer more specific targets for advanced treatment options.
Subject(s)
COVID-19 , Cardiac Tamponade , Pericardial Effusion , Cardiac Tamponade/diagnosis , Cardiac Tamponade/etiology , Cardiac Tamponade/therapy , Humans , Inflammation/complications , Pericardial Effusion/therapy , SARS-CoV-2Subject(s)
Betacoronavirus , Cardiac Tamponade/virology , Coronavirus Infections/complications , Myocarditis/complications , Pericarditis/complications , Pneumonia, Viral/complications , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Cardiac Tamponade/diagnosis , Cardiac Tamponade/therapy , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Female , Humans , Middle Aged , Pandemics , Pericardiocentesis , Pneumonia, Viral/diagnosis , SARS-CoV-2ABSTRACT
IMPORTANCE: Cardiac tamponade requiring emergent intervention is a possible complication of coronavirus disease 2019 (COVID-19) infection. Favorable clinical outcomes are possible if timely management and drainage are performed unless ventricular failure develops. OBSERVATION: Cardiac tamponade in COVID-19, based on the limited reported cases, seems to be more common among middle-aged men with observed complications in black and ethnic minorities. Prognosis is worse amongst patients with concomitant ventricular failure. DESIGN AND METHODS: This is a case series of three COVID-19 patients complicated by cardiac tamponade, requiring surgical intervention at a single institution in New York. INTERVENTION: Pericardial window, Pericardiocentesis. OUTCOME: One patient had recurrence of cardiac tamponade with hemorrhagic component but fully recovered and was discharged home. Two patients developed cardiac tamponade with concomitant biventricular failure, resulting in death. CONCLUSION AND RELEVANCE: Cardiac tamponade with possible concomitant biventricular failure can develop in COVID-19 patients; incidence seems to be highest at the point of marked inflammatory response. Concomitant ventricular failure seems to be a predictor of poor prognosis.
Subject(s)
COVID-19/complications , Cardiac Tamponade/therapy , Cardiac Tamponade/virology , Drainage , Extracorporeal Membrane Oxygenation , Fatal Outcome , Heart Arrest/etiology , Humans , Male , Middle Aged , Obesity/complications , Pericardial Effusion/therapy , Pericardial Effusion/virology , PericardiocentesisABSTRACT
In the midst of the COVID-19 pandemic, further understanding of its complications points towards dysregulated immune response as a major component. Systemic lupus erythematosus (SLE) is also a disease of immune dysregulation leading to multisystem compromise. We present a case of new-onset SLE concomitantly with COVID-19 and development of antiphospholipid antibodies. An 18-year-old female that presented with hemodynamic collapse and respiratory failure, progressed to cardiac arrest, and had a pericardial tamponade drained. She then progressed to severe acute respiratory distress syndrome, severe ventricular dysfunction, and worsening renal function with proteinuria and hematuria. Further studies showed bilateral pleural effusions, positive antinuclear and antidouble-stranded DNA antibodies, lupus anticoagulant, and anticardiolipin B. C3 and C4 levels were low. SARS-Cov-2 PCR was positive after 2 negative tests. She also developed multiple deep venous thrombosis, in the setting of positive antiphospholipid antibodies and lupus anticoagulant. In terms of pathophysiology, COVID-19 is believed to cause a dysregulated cytokine response which could potentially be exacerbated by the shift in Th1 to Th2 response seen in SLE. Also, it is well documented that viral infections are an environmental factor that contributes to the development of autoimmunity; however, COVID-19 is a new entity, and it is not known if it could trigger autoimmune conditions. Additionally, it is possible that SARS-CoV-2, as it happens with other viruses, might lead to the formation of antiphospholipid antibodies, potentially contributing to the increased rates of thrombosis seen in COVID-19.
Subject(s)
Antiphospholipid Syndrome/immunology , Coronavirus Infections/immunology , Lupus Erythematosus, Systemic/immunology , Pneumonia, Viral/immunology , Adolescent , Anemia/etiology , Antibodies, Anticardiolipin/immunology , Antibodies, Antinuclear/immunology , Antibodies, Monoclonal, Humanized/therapeutic use , Antiphospholipid Syndrome/complications , Antiphospholipid Syndrome/diagnosis , Antiphospholipid Syndrome/therapy , Anuria/etiology , Betacoronavirus , COVID-19 , Cardiac Tamponade/diagnostic imaging , Cardiac Tamponade/etiology , Cardiac Tamponade/therapy , Complement C3/immunology , Complement C4/immunology , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , DNA/immunology , Echocardiography , Fatal Outcome , Female , Heart Arrest/etiology , Hematuria/etiology , Humans , Lupus Coagulation Inhibitor/immunology , Lupus Erythematosus, Systemic/blood , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/diagnosis , Pandemics , Patient Positioning , Pericardiocentesis , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Prone Position , Proteinuria/etiology , Renal Dialysis , Renal Insufficiency/etiology , Renal Insufficiency/therapy , Respiration, Artificial , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , SARS-CoV-2 , Thrombocytopenia/etiology , Venous Thrombosis/etiology , Ventricular Dysfunction, Left/diagnostic imagingSubject(s)
Cardiac Tamponade/etiology , Cardiopulmonary Resuscitation/methods , Coronavirus Infections/complications , Heart Arrest/etiology , Myocarditis/etiology , Pneumonia, Viral/complications , Severe Acute Respiratory Syndrome/complications , Aged , COVID-19 , Cardiac Tamponade/physiopathology , Cardiac Tamponade/therapy , Coronavirus Infections/diagnosis , Disease Progression , Fatal Outcome , Heart Arrest/physiopathology , Heart Arrest/therapy , Humans , Male , Myocarditis/physiopathology , Myocarditis/therapy , Pandemics , Pneumonia, Viral/diagnosis , Respiration, Artificial/methods , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/therapy , SpainABSTRACT
The vast majority of patients in the ongoing coronavirus Disease 2019 (Covid-19) pandemic primarily present with severe respiratory illness. We report a Covid-19 patient who presented with findings of acute coronary syndrome and was found to have purulent fulminant myopericarditis and cardiac tamponade. We compare our case to the previously reported instances of Covid-19-associated myocarditis. Through review of the available literature, we also highlight the potential mechanisms of cardiac injury in Covid-19. We hope to increase awareness amongst clinicians about this unusual presentation of Covid-19.