ABSTRACT
Background The COVID-19 pandemic was primarily considered a respiratory malady in the early phases of the outbreak. However, as more patients suffer from this illness, a myriad of symptoms emerge in organ systems separate from the lungs. Among those patients with cardiac involvement, myocarditis, pericarditis, myocardial infarction, and arrhythmia were among the most common manifestations. Pericarditis with pericardial effusion requiring medical or interventional treatments has been previously reported in the acute setting. Notably, chronic pericarditis with pericardial thickening resulting in constriction requiring sternotomy and pericardiectomy has not been published to date.Case Presentation A patient with COVID-19-associated constrictive pericarditis three years after viral infection requiring pericardiectomy was reported. The COVID-19 infection originally manifested as anosmia and ageusia. Subsequently, the patient developed dyspnea, fatigue, right-sided chest pressure, bilateral leg edema, and abdominal fullness. Following recurrent right pleural effusions and a negative autoimmune work-up, the patient was referred for cardiothoracic surgery for pericardiectomy when radiographic imaging and hemodynamic assessment were consistent with constrictive pericarditis. Upon median sternotomy, the patient’s pericardium was measured to be 8 mm thick. Descriptions of the clinical, diagnostic, and therapeutic features are provided. Within the first week after the operation, the patient’s dyspnea resolved; one month later, leg edema and abdominal bloating were relieved.Conclusions Although an association between COVID-19 and cardiac complications has been established, this case adds another element of virus severity and chronic manifestations. The need for sternotomy and pericardiectomy to treat COVID-19-related constrictive pericarditis is believed to be the first reported diagnosis.
Subject(s)
Myocardial Infarction , Pleural Effusion , Pericarditis , Dyspnea , Arrhythmias, Cardiac , COVID-19 , Olfaction Disorders , Myocarditis , Pericarditis, Constrictive , Heart Diseases , Fatigue , Respiratory Insufficiency , EdemaABSTRACT
COVID-19 has been reported to affect a variety of organs. We report a case of constrictive pericarditis in a patient who had contracted the SARS-CoV-2 virus. Other possible causes such as tuberculosis and metabolic causes were considered, but excluded by special investigations.
Subject(s)
COVID-19/complications , Pericarditis, Constrictive/diagnosis , Adult , COVID-19/diagnosis , Female , Humans , Pericarditis, Constrictive/virologyABSTRACT
Coronavirus disease 2019 (COVID-19) and vaccination against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are associated with cardiovascular complications. Here, we report a case of right-sided heart failure caused by constrictive pericarditis that developed after the administration of messenger ribonucleic acid (mRNA) vaccine against SARS-CoV-2. A 70-year-old woman presented with body weight gain, peripheral edema, and dyspnea on effort, which developed over a period of 1 week after the second dose of vaccine. The jugular venous pressure was high with a prominent y descent (Friedreich's sign) and paradoxical increase on inspiration (Kussmaul's sign). The results of IgM and IgG testing specific to SARS-CoV-2 spike and nucleocapsid proteins indicated the presence of mRNA vaccine-induced antibody and were not suggestive of COVID-19 infection. Echocardiography showed pericardial thickening and septal bounce of the interventricular septum. Computed tomography (CT) also showed pericardial thickening compared with the results of the previous CT scan performed 4 months earlier. A diagnosis of right-sided heart failure due to constrictive pericarditis was confirmed on the basis of pressure analysis during cardiac catheterization.
Subject(s)
COVID-19 , Pericarditis, Constrictive , Aged , COVID-19 Vaccines/adverse effects , Female , Humans , Pericarditis, Constrictive/complications , Pericarditis, Constrictive/etiology , SARS-CoV-2 , Vaccination/adverse effects , Vaccines, Synthetic , mRNA VaccinesABSTRACT
We report the case of a previously healthy young woman, who developed a severe form of COVID-19 with massive pneumonia and acute pericarditis in whom constrictive physiology developed rapidly. To our knowledge, this represents the second reported case of SARS-CoV-2 constrictive pericarditis, a rare, but severe cardiac complication.
Subject(s)
COVID-19 , Pericardial Effusion , Pericarditis, Constrictive , Pericarditis , Female , Humans , Pericardial Effusion/diagnostic imaging , Pericardial Effusion/etiology , Pericarditis/complications , Pericarditis/diagnostic imaging , Pericarditis, Constrictive/complications , Pericarditis, Constrictive/diagnostic imaging , SARS-CoV-2ABSTRACT
This report documents a rare case of COVID-19-associated constrictive pericarditis (CP) in the setting of a recent COVID-19 infection. A 55-year-old man with a history of hypertension and gout presented with acute hypoxic respiratory failure and was diagnosed with COVID-19 pneumonia with progression to acute respiratory distress syndrome. His hospital course was complicated by a large pericardial effusion; an emergent bedside transthoracic echocardiography was concerning for cardiac tamponade, so pericardiocentesis was performed. A workup with cardiac magnetic resonance imaging showed changes consistent with a diagnosis of CP. Viral and idiopathic aetiologies are the most common cause of CP in the developed world, with COVID-19 now a proposed predisposing viral illness. The virus induces systemic inflammation and pericardial changes that can lead to CP physiology. Imaging modalities including echocardiogram and cardiac magnetic resonance play an integral role in confirming the diagnosis.
Subject(s)
COVID-19 , Cardiac Tamponade , Pericardial Effusion , Pericarditis, Constrictive , Pericarditis , Cardiac Tamponade/diagnostic imaging , Cardiac Tamponade/etiology , Humans , Male , Middle Aged , Pericardial Effusion/surgery , Pericardiocentesis , Pericarditis, Constrictive/diagnostic imaging , Pericarditis, Constrictive/etiology , SARS-CoV-2ABSTRACT
BACKGROUND: Since December 2019, there has been an increasing number of patients infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) around the world. As of March 2020, the World Health Organization declared a global pandemic. CASE PRESENTATION: To our best knowledge, this is the first report of a patient with SARS-CoV-2 infection presenting with constrictive pericarditis, possibly from the COVID infection. She was presented after a week of fever, persistent dry cough, and diarrhea. She received a single dose of hydroxychloroquine 400 mg, Oseltamivir 75 mg every 12 hours, lopinavir/ritonavir (Kaletra) 400/100 mg every 12 hours, and levofloxacin 750 mg daily. After 24 hours, she was immediately transferred to the Intensive Care Unit (ICU) because of dyspnea and progressive respiratory failure with a drop of the O2 saturation to 70%. CONCLUSION: After a week of progress, her respiratory condition deteriorated again. She was re-admitted to the ICU and she expired. She died due to constrictive pericarditis, most probably caused by SARS-CoV-2.