Abstract | November 8, 2021
COVID-19 Related Pericarditis
Learning Objectives
- Patient with covid especially children are being seen with inflammatory condition of the heart which is leading to pericarditis. It's been termed Multisystem inflammatory syndrome in children.
- Multisystem inflammatory syndrome in adults (MIS-A) after recent COVID infection is a Kawasaki like disease found in children. These cases are usually found in young to middle aged people. They can present with various features of cardiovascular disease, acute kidney injury and elevated inflammatory markers. It has been seen that patients with myocardial injury are typically older and have more comorbidities.
- Upon completion of this lecture, learners should be better prepared to think and identify pericarditis in a patient who had covid 19 exposure with subtle signs and symptoms.
Introduction: As we move forward in the current state of the ongoing pandemic, we have started to look at other aspects of COVID-19 which have caused substantial changes to the human anatomy at a molecular level and looking at the clinical symptoms and signs at the hospital level. Although there have been decrease in trends for the number of cases all over the globe, New variants are emerging which could wreck havoc on our bodies that we don’t know of yet. From our current research and data analysis, there have been several cases of Post covid complications, which have emerged. Patients with post covid symptoms and complications have been referred to as “long haulers”. One of the most common one is chronic fatigue. This is could be attributed to the pulmonary functioning post covid which has been seen in multiple literature reviews. In terms of Heart complications, Heart failure with either preserved ejection fraction or reduced ejection fraction were seen. Pericarditis is a rare complication of Covid 19 Sequelae. Although acute pericarditis has been seen in some cases. One review showed a finding of pericardial effusion in 4.8% cases in 83 patients, which had severe covid . However the cases seen in literature review were diagnosed within one week after covid 19 infection and not as a later manifestation after recovery. Our case presents an immunocompetent female coming to the hospital following pleuritic symptoms after recovery from Covid 19 infection.
The case discusses the initial presentation; workup and outpatient follow up following resolution of her symptoms.
Case Discussion: We are presenting the rare case of 83-year-old female with past medical history of hypertension,hyperlipidemia and osteoarthritis who came to the hospital with complaints of fatigue, dyspnea and non-productive cough. Physical examination was within normal limits and inconclusive other than muffled heart sounds.The patient initially went to her primary care physician and got chest x-ray done which showed enlarged cardiac silhouette. The last chest Xray done couple of months before when she had been diagnosed with Covid had shown normal cardiac image. In the ED; Doppler done for her heart showed pericardial effusion. Ct chest (Figure 2) confirmed Pericardial effusion as well. Blood work did not show any significant changes with electrolytes being normal, H&H being stable with no leukocytosis.Management: Cardiology was consulted for pericardial effusion. Echocardiogram (Figure 3) was done which showed 400 to 500 cc of pericardial effusion with normal chamber sizes and filling pressures with 73% ejection fraction Recommendation to CT surgeon was made for pericardial window and they were able to drain 80 cc of fluid. Chest tube output for next 2 days showed drainage of 50 cc following which it was removed. Pericardial fluid analysis showed fibrinous pericarditis. Patient was stabilized and discharged on colchicine for 3 months and advised to follow up in cardiology
clinic.
Management/Follow Up: She followed up in the cardiology clinic with repeat Chest x ray which showed resolution of the pericardial effusion. She was advised to stop taking the colchicine as her symptoms had resolved.
