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1.
Dtsch Med Wochenschr ; 147(11): 704-710, 2022 Jun.
Article in German | MEDLINE | ID: covidwho-1873574

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-2
3.
Am J Case Rep ; 23: e935839, 2022 Apr 09.
Article in English | MEDLINE | ID: covidwho-1786274

ABSTRACT

BACKGROUND The COVID-19 outbreak emerged in December 2019 in Wuhan, China. COVID-19 is caused by the SARS-CoV-2 coronavirus and mostly affects the respiratory system but can also affect other organs, including the cardiovascular system. Furthermore, the most common cardiac complications include severe left ventricular dysfunction, acute myocardial injury, and arrhythmias. Life-threatening cardiac tamponade and large pericardial effusion are exceedingly rare complications in patients recovered from COVID-19. Previously, this condition was treated with pericardiocentesis, colchicine, and corticosteroids. CASE REPORT We present the case of a 54-year-old man who recovered from a SARS-CoV-2 infection 7 days before presentation and describe a complicated pericardial effusion with life-threatening cardiac tamponade. To the best of our knowledge, this is the first case of pericardial effusion with cardiac tamponade that was successfully treated with single port or uniportal video-assisted thoracoscopic surgery with an excellent outcome. CONCLUSIONS Life-threatening cardiac tamponade with pericardial effusion is an exceedingly rare complication in patients recovered from COVID-19. Generally, patients diagnosed with pericardial effusion undergo a pericardiocentesis procedure. Although there are multiple treatment options for draining pericardial effusion, the recurrence rate with surgical pericardial window formation is the lowest. However, our patient underwent surgery using a uniportal video-assisted thoracoscopic surgery with an excellent outcome.


Subject(s)
COVID-19 , Cardiac Tamponade , Pericardial Effusion , COVID-19/complications , Cardiac Tamponade/etiology , Cardiac Tamponade/surgery , Humans , Male , Middle Aged , Pericardial Effusion/etiology , Pericardial Effusion/surgery , Pericardiocentesis/methods , SARS-CoV-2 , Thoracic Surgery, Video-Assisted
6.
J Emerg Med ; 62(2): 250-253, 2022 02.
Article in English | MEDLINE | ID: covidwho-1611823

ABSTRACT

BACKGROUND: Acute pericarditis is a diffuse inflammation of the pericardial sac with many well-defined etiologies. Acute pericarditis as a vaccine-related adverse event is a rare entity, and the association between pericarditis and the immunogenic response to Coronavirus disease 2019 (COVID-19) vaccines is still being fully characterized. CASE REPORT: A previously healthy 18-year-old man presented with fever, pleuritic chest pain, and shortness of breath 3 weeks after receiving the first dose of a COVID-19 mRNA-based vaccine. The patient was found to have a large pericardial effusion with early tamponade physiology requiring pericardiocentesis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: As COVID-19 vaccination becomes more prevalent globally, physicians should be aware of pericarditis as a rare but potentially serious adverse reaction. Although a direct causal link cannot be demonstrated, we present this case to increase awareness among emergency physicians of pericarditis as a rare, but potentially serious adverse event associated with COVID-19 vaccination.


Subject(s)
COVID-19 , Cardiac Tamponade , Pericarditis , Adolescent , COVID-19 Vaccines , Cardiac Tamponade/etiology , Humans , Male , Pericarditis/complications , SARS-CoV-2 , Vaccination/adverse effects
8.
BMJ Case Rep ; 14(9)2021 Sep 13.
Article in English | MEDLINE | ID: covidwho-1406642

ABSTRACT

COVID-19 has a broad spectrum of cardiac manifestations, and cardiac tamponade leading to cardiogenic shock is a rare presentation. A 30-year-old man with a history of COVID-19-positive, reverse transcription polymerase chain reaction (RT-PCR) done 1 week ago and who was home-quarantined, came to the emergency department with palpitations, breathlessness and orthopnoea. His ECG showed sinus tachycardia with low-voltage complexes, chest X-ray showed cardiomegaly and left pleural effusion and two-dimensional echocardiography showed large pericardial effusion with features suggestive of cardiac tamponade. He was taken up for emergency pericardiocentesis which showed haemorrhagic pericardial fluid. Intercostal drainage insertion was done for left-sided large pleural effusion. After ruling out all the other causes for haemorrhagic pericardial effusion, the patient was started on colchicine, steroids, ibuprofen and antibiotics to which he responded. Both pericardial and pleural effusions resolved completely on follow-up.


Subject(s)
COVID-19 , Cardiac Tamponade , Pleural Effusion , Adult , Cardiac Tamponade/diagnostic imaging , Cardiac Tamponade/etiology , Cardiac Tamponade/surgery , Humans , Male , Pericardiocentesis , Pericardium , Pleural Effusion/diagnostic imaging , Pleural Effusion/etiology , SARS-CoV-2
9.
Curr Cardiol Rep ; 23(7): 90, 2021 06 03.
Article in English | MEDLINE | ID: covidwho-1252215

ABSTRACT

PURPOSE OF REVIEW: Coronavirus disease 2019 (COVID19) involves the heart, including pericardium. This article reviews the possible pathophysiological mechanisms in pericardial involvement in COVID19 and pericardial manifestations of COVID19. It also summarizes the patients with pericarditis secondary to COVID19 and outlines the contemporary treatment strategies in this patient population. RECENT FINDINGS: A high degree of suspicion is required to identify the pericardial involvement in COVID19 patients. It is proposed that an underlying hyperinflammatory reaction in COVID19 leads to pericardial inflammation. Acute pericarditis with or without myocardial involvement is diagnosed on clinical presentation, serum inflammatory markers, electrocardiogram, and echocardiogram. Multimodality imaging may also have an additional diagnostic value. Patients are usually managed medically, but some patients develop a life-threatening pericardial tamponade necessitating pericardial drainage. Pericardial involvement is an important clinical manifestation of COVID19 requiring a proper workup. Timely diagnosis and a specific management plan based on the presentation and concomitant organ involvement usually lead to a complete recovery.


Subject(s)
COVID-19 , Cardiac Tamponade , Pericardial Effusion , Pericarditis , Cardiac Tamponade/diagnostic imaging , Cardiac Tamponade/etiology , Humans , Pericarditis/diagnostic imaging , Pericarditis/therapy , Pericardium/diagnostic imaging , SARS-CoV-2
10.
BMJ Case Rep ; 14(5)2021 May 11.
Article in English | MEDLINE | ID: covidwho-1223563

ABSTRACT

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-2
12.
Air Med J ; 40(3): 179-181, 2021.
Article in English | MEDLINE | ID: covidwho-1108010

ABSTRACT

A 42-year-old man with coronavirus disease 2019 pneumonia was admitted to a small town hospital that did not have intensive care unit (ICU)-level resources available. Twelve hours later, the patient suddenly became agitated, and an extensive anterolateral ST-elevation myocardial infarction was detected by 12-lead electrocardiography and supported by a rise in serum cardiac enzymes. Low blood oxygen saturation (59%) and cardiac ejection fraction (ejection fraction = 20%) reflected criticality that could potentially require a catheterization laboratory, coronary artery bypass graft surgery, and ICU-level resources. After the coordination of physicians with the nearest equipped hospital and air medical crew, a Mil Mi-17 medical helicopter unit was dispatched. About 20 minutes before reaching the destination hospital, his clinical condition declined; his heart was 50 beats/min, his blood pressure was 75/40 mm Hg, and he had jugular vein distention. Muffled heart sounds, decreased electrocardiographic voltage, and the accumulation of pericardial effusion on a bedside ultrasound indicated cardiac tamponade. The air medical crew resuscitated the patient through the interventions of intubation, mechanical ventilation, administration of intravenous fluids, and initiation of an epinephrine infusion. Ultrasound-guided pericardiocentesis was performed in the helicopter, which kept him alive until pericardotomy could be performed at the destination hospital. Unfortunately, after pericardiotomy and coronary artery bypass graft surgery, the patient died 7 days later in the ICU due to severe cardiopulmonary failure.


Subject(s)
Air Ambulances , COVID-19/complications , COVID-19/mortality , Cardiac Tamponade/mortality , Cardiac Tamponade/surgery , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/surgery , Adult , Cardiac Tamponade/etiology , Coronary Artery Bypass/methods , Fatal Outcome , Humans , Intubation, Intratracheal/methods , Male , Pericardiectomy/methods , SARS-CoV-2 , ST Elevation Myocardial Infarction/etiology , Transportation of Patients
13.
Ann Thorac Surg ; 112(4): e265-e266, 2021 10.
Article in English | MEDLINE | ID: covidwho-1056318

ABSTRACT

Tension pneumomediastinum is a rare but life-threatening cause of tamponade. Mechanical ventilation is a described source of tension pneumomediastinum. Here, we present a case of a 72-year-old man who developed cardiovascular collapse from tension pneumomediastinum in the setting of coronavirus disease 2019-related acute respiratory distress syndrome. We successfully performed bedside mediastinotomy and mediastinal tube placement under local anesthetic to alleviate his hemodynamic instability. Bedside mediastinotomy can be used to relieve tension pneumomediastinum in this setting.


Subject(s)
COVID-19/complications , Cardiac Tamponade/etiology , Mediastinal Emphysema/surgery , Mediastinum/surgery , SARS-CoV-2 , Aged , Humans , Male , Mediastinal Emphysema/complications , Mediastinal Emphysema/diagnostic imaging
14.
Acta Biomed ; 91(4): e2020146, 2020 11 10.
Article in English | MEDLINE | ID: covidwho-1055389

ABSTRACT

BACKGROUND: Coronavirus disease 2019(COVID-19) is an acute respiratory illness, caused by Severe Acute Respiratory Syndrome Coronavirus2 (SARS-COV2) which quickly grew to a pandemic in late 2019 and led to substantial public health problems. Among the extrapulmonary manifestations reported, cardiovascular implications are remarkable as they can be potentially lethal. There have been rare reports of pericardial involvement, despite the pronounced cardiovascular complications including acute myocardial injury, myocarditis, arrhythmia, cardiogenic shock and venous thromboembolism. Herein, we reported a young man with cardiac tamponade as the presenting feature of COVID-19.  Case summary: An otherwise healthy 28-year-old man, was admitted with pleuritic chest pain and shortness of breath and was diagnosed with COVID-19 associated cardiac tamponade. Emergency pericardiocentesis yielded large amount of hemorrhagic pericardial effusion which resulted in symptom relief. He was successfully treated with pericardiocentesis followed by anti-viral and anti-inflammatory medications and remained asymptomatic in 1-month follow-up. CONCLUSION: We highlight this case to mention that "hemorrhagic" cardiac tamponade can be a life-threatening complication of COVID-19, which can be treated if diagnosed early. Therefore, clinicians should be fully aware of this cardiac complication to consider in deteriorating COVID-19 patients.


Subject(s)
COVID-19/complications , Cardiac Tamponade/etiology , Hemorrhage/etiology , Pericardial Effusion/etiology , Adult , Hemorrhage/complications , Humans , Male , Pericardial Effusion/complications
15.
J Med Case Rep ; 15(1): 31, 2021 Jan 25.
Article in English | MEDLINE | ID: covidwho-1045596

ABSTRACT

BACKGROUND: Previous reports have shown various cardiac complications to be associated with COVID-19 including: myocardial infarction, microembolic complications, myocardial injury, arrythmia, heart failure, coronary vasospasm, non-ischemic cardiomyopathy, stress (Takotsubo) cardiomyopathy, pericarditis and myocarditis. These COVID-19 cardiac complications were associated with respiratory symptoms. However, our case illustrates that COVID-19 myopericarditis with cardiac tamponade can present without respiratory symptoms. CASE PRESENTATION: A 58-year-old Caucasian British woman was admitted with fever, diarrhoea and vomiting. She developed cardiogenic shock and Transthoracic echocardiogram (TTE) found a pericardial effusion with evidence of cardiac tamponade. A nasopharyngeal swab showed a COVID-19 positive result, despite no respiratory symptoms on presentation. A pericardial drain was inserted and vasopressor support required on intensive treatment unit (ITU). The drain was removed as she improved, an antibiotic course was given and she was discharged on day 12. CONCLUSIONS: Our case demonstrates that patients without respiratory symptoms could have COVID-19 and develop cardiac complications. These findings can aid timely diagnosis of potentially life-threatening COVID-19 myopericarditis with cardiac tamponade.


Subject(s)
COVID-19/complications , Cardiac Tamponade/etiology , Myocarditis/etiology , Pericarditis/etiology , Female , Humans , Middle Aged
17.
World J Pediatr Congenit Heart Surg ; 11(6): 802-804, 2020 11.
Article in English | MEDLINE | ID: covidwho-760520

ABSTRACT

We describe a seven-year-old female with acute pericarditis presenting with pericardial tamponade, who screened positive for coronavirus disease 2019 (COVID-19 [SARS-CoV-2]) in the setting of cough, chest pain, and orthopnea. She required emergent pericardiocentesis. Due to continued chest pain and orthopnea, rising inflammatory markers, and worsening pericardial inflammation, she underwent surgical pericardial decortication and pericardiectomy. Her symptoms and pericardial effusion resolved, and she was discharged to home 3 days later on ibuprofen and colchicine with instruction to quarantine at home for 14 days from the date of her positive testing for COVID-19.


Subject(s)
COVID-19/complications , Cardiac Tamponade/etiology , Pericarditis/etiology , SARS-CoV-2/isolation & purification , COVID-19 Testing , Cardiac Tamponade/diagnosis , Chest Pain/etiology , Child , Electrocardiography , Female , Heart/diagnostic imaging , Humans , Pandemics , Pericardial Effusion/diagnostic imaging , Pericardial Effusion/etiology , Pericardiectomy , Pericardiocentesis , Pericarditis/diagnostic imaging , Pericarditis/surgery , Radiography, Thoracic
18.
Clin Rheumatol ; 39(9): 2811-2815, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-679749

ABSTRACT

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 imaging
20.
Paediatr Int Child Health ; 40(4): 261-267, 2020 11.
Article in English | MEDLINE | ID: covidwho-646316

ABSTRACT

Inflammatory myofibroblastic tumour usually has a benign course and is very rarely associated with the heart. It can have life-threatening consequences, depending on its position or the presence of aggressive and metastatic complications. A 3-month-old boy presented with pericardial tamponade and was diagnosed with intrapericardial inflammatory myofibroblastic tumour associated with Coronavirus OC43. A large tumour attached to the left ventricle was completely removed by surgical resection and he made a full recovery. ABBREVIATIONS: ALK: anaplastic lymphoma kinase; CMV: cytomegalovirus; CRP: C-reactive protein; EB: Epstein-Barr virus; ESR: erythrocyte sedimentation rate; IM: inflammatory myofibroblastic tumour; NSAI: non-steroidal anti-inflammatory drugs; PTFE: polytetrafluoroethylene; SMA: smooth muscle actin.


Subject(s)
Cardiac Tamponade/etiology , Coronavirus Infections/complications , Coronavirus OC43, Human , Heart Neoplasms/pathology , Neoplasms, Muscle Tissue/complications , Coronavirus Infections/pathology , Heart Neoplasms/surgery , Humans , Infant , Inflammation , Male , Myofibroblasts/pathology , Neoplasms, Muscle Tissue/pathology , Neoplasms, Muscle Tissue/surgery , Pericardial Effusion/etiology
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