COVID-19 CARDIAC TAMPONADE WITH CARDIOGENIC SHOCK IN A PREVIOUSLY VACCINATED YOUNG ADULT: A CASE REPORT

ABSTRACT

SESSION TITLE Cardiovascular Complications in Patients with COVID-19 SESSION TYPE Rapid Fire Case Reports PRESENTED ON 10/19/2022 1245 pm - 145 pm INTRODUCTION: Previous case reports have shown a number of cardiac complications associated with, and attributed to COVID-19 infection including acute myocardial injury and infarction, dysrhythmias, acute heart failure, pericarditis, and venous thromboembolic events, among others. Up until this point, these cases have all been documented in unvaccinated individuals 1. CASE PRESENTATION Here we report a unique case of a 40-year-old previously vaccinated woman who presented with generalized weakness, chest pain, dyspnea, and vomiting. She was found to be septic and positive for COVID-19. Transthoracic echocardiogram showed a small pericardial effusion on admission and the patient was diagnosed with acute myopericarditis secondary to COVID-19. Within the first 24 hours following admission, the patient's condition rapidly deteriorated and she developed worsening pericardial effusion, with subsequent cardiac tamponade, and cardiogenic shock. Following attempted pericardiocentesis and surgical drainage, cardiac function did not improve and she expired soon after. DISCUSSION: Despite most of the clinical attention being focused on the effects of SARS-CoV-2 on the respiratory system and the pneumonia it causes, there have been more reported complications involving other organ systems, particularly the heart and kidneys. Studies have shown three main categories of cardiac involvement and complications related to COVID-19 myocardial injury, acute heart failure, and arrhythmia. Focusing on myocardial injuries, there have been some reports attempting to elucidate the frequency of myo- and pericarditis as complications of COVID-19. Yet still to this date, little is known about pericarditis as a COVID-19 complication. Of the case reports published thus far regarding COVID-19 pericarditis, the majority of them do not exhibit cardiac tamponade. In one systematic review published in September, 2021, a total of 33 studies including 32 case reports and one case series were included and pericardial effusion and cardiac tamponade were reported in 76% and 35% of the cases, respectively 2. To our knowledge, our case is the first of its kind, illustrating cardiac tamponade in a fully vaccinated individual. Although, there have been no clear mechanisms explaining the pathogenesis of cardiac involvement in patients suffering from COVID-19, multiple possibilities have been hypothesized. Similar to other cardiotoxic viruses, an inflammatory response is likely triggered resulting in pericarditis and pericardial effusion 3. When left unabated, cardiac tamponade can occur. CONCLUSIONS: Our case documents a reminder of the critical nature of SARS-CoV-2, even in vaccinated patients. To our knowledge, this is the first reported case of cardiac tamponade in a previously vaccinated individual. This case highlights the importance of quick diagnosis and treatment in patients suffering from potential lethal complications of COVID-19. Reference #1 Long B, Brady WJ, Koyfman A, Gottlieb M. Cardiovascular complications in COVID-19. Am J Emerg Med. 2020;38(7)1504-1507 Reference #2 Diaz-Arocutipa C, Saucedo-Chinchay J, Imazio M. Pericarditis in patients with COVID-19 a systematic review. J Cardiovasc Med (Hagerstown). 2021 Sep 1;22(9)693-700 Reference #3 Inciardi RM, Lupi L, Zaccone G, et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7)819–24 DISCLOSURES no disclosure on file for Thomas Bumbalo;no disclosure on file for Thaddeus Golden;No relevant relationships by Omar Kandah