Abstract | December 19, 2022

Acute COVID-Pericarditis: A Rare, But Life-Threatening Condition

Presenting Author: Amy Weinberg, BS, Medical Student, 4th Year, Department of Medicine, Division of Cardiology, McGovern Medical School at UT Health Houston, Houston, Texas

Coauthors: Amy Weinberg, BS, Internal Medicine, MS4, McGovern Medical School at UT Health Houston, Houston, TX; Amit Koduri, MD, Cardiology, Fellow, McGovern Medical School at UT Health Houston, Houston, TX.

Learning Objectives

  1. Recognize the signs, symptoms, and laboratory findings associated with COVID Pericarditis
  2. Escalate management appropriately for COVID patients who develop pericarditis

Intro: In this case, we present the diagnostic dilemma in recognizing acute COVID-pericarditis from the span of cardiovascular complications associated with SARS-COV2 infection, and the escalation of care required to address its increased risk of morbidity and mortality.

 

Case: A 53-year-old woman with co-morbidities of heart failure with preserved ejection fraction, stroke, chronic obstructive pulmonary disease, and chronic kidney disease was recovering after receiving inpatient antibiotic treatment for severe sepsis due to a urinary tract infection, when she unexpectedly clinically worsened. She had fever, cough, and a positive COVID PCR test. After 7 days of supportive care, her vitals suddenly worsened to a temperature of 102.7°F, an irregular heart rate of 106 beats per minute, a blood pressure of 84/63 mmHg, a respiratory rate of 20 breaths per minute, and a pulse oxygenation of 93%. On physical exam, she was in respiratory distress, using accessory muscles to breathe; diffuse pulmonary wheezing was audible on auscultation. Labs were notable for a creatinine of 3.4 and negative serial troponins. An electrocardiogram displayed atrial fibrillation with rapid ventricular response and diffuse ST elevation with PR depression. A transthoracic echocardiogram revealed a moderate circumferential pericardial effusion with septal bounce, early diastolic ventricular indentation, and respirophasic changes in mitral and tricuspid inflows.

 

Diagnosis: Acute pericarditis due to COVID, complicated by pre-cardiac tamponade

 

Management: First, we initiated aspirin and colchicine for the management of pericarditis. We added remdesivir and dexamethasone for increased COVID severity. We also started metoprolol tartrate and amiodarone for atrial fibrillation with apixaban for stroke prophylaxis. Finally, we initiated transfer of the patient to a facility with the means to perform a pericardial window if symptoms of tamponade emerged. Two days later, a surveillance echocardiogram showed similar findings: small-moderate circumferential pericardial effusion measuring 0.7-0.9cm with septal bounce and minimal early diastolic ventricular collapse. With medical management, the patient’s blood pressure and heart rate stabilized. Ten days later, a follow-up echocardiogram showed absence of both early diastolic collapse and respirophasic changes.

 

References:

  1. Buckley BJR, Harrison SL, Fazio-Eynullayeva E, Underhill P, Lane DA, Lip GYH. Prevalence and clinical outcomes of myocarditis and pericarditis in 718,364 COVID-19 patients. Eur J Clin Invest. 2021;51:e13679.
  2. Diaz-Arocutipa C, Saucedo-Chinchay J, Imazio M. Pericarditis in Patients with COVID-19: a systematic review. J. Cardiovasc. Med. 2021:22(9):693-700.
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