Acute Viral Pericarditis Complicated by Cardiac Tamponade as a Result of COVID-19

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) and coronavirus disease 2019 (COVID-19) predominantly cause respiratory symptoms but cardiovascular complications from COVID-19 have been documented in the literature. Acute pericarditis has been known to be caused by COVID-19 but severe cardiac complications, such as cardiac tamponade, have rarely been reported. Early diagnosis and treatment with pericardiocentesis are imperative, as this can improve patient outcomes. A 56-year-old female presented with chest pain and recurrent episodes of presyncope. The patient tested positive for SARS-Cov-2 through a polymerase chain reaction (PCR) test. The patient was hypotensive on arrival and the initial workup with electrocardiogram was significant for sinus tachycardia with low voltage QRS complexes in the precordial and limb leads. A transthoracic echocardiogram was also done and showed a large circumferential pericardial effusion with chamber collapse of the right atrium and right ventricle during diastole indicative of tamponade physiology. The patient's clinical course was complicated by pulseless electrical activity cardiac arrest during which a pericardiocentesis was done. One hundred (100) mL of serous pericardial fluid was drained and a return of spontaneous circulation was obtained after roughly 10 minutes of cardiopulmonary resuscitation. Further infectious and noninfectious workups, including malignant and rheumatologic etiologies for acute pericarditis, were negative. The patient was subsequently treated with high-dose non-steroidal anti-inflammatory drugs (NSAIDs) and colchicine for viral pericarditis. The patient's clinical course improved, and the patient was subsequently discharged after a prolonged hospital course to a subacute rehabilitation facility to undergo physical therapy.

Keywords: cardiac arrest; cardiogenic shock; covid-19; pericardial effusion. cardiac tamponade; sars-cov-2.

Figure 1. A 12-lead electrocardiogram showing sinus tachycardia with low voltage QRS complexes in both precordial and limb leads with electrical alternans

Figure 2. Echocardiogram subcostal view showing large pericardial effusion (arrow) with evidence of tamponade physiology

Figure 3. Echocardiogram Doppler view showing a variation of transvalvular flow velocity across the mitral valve

The peak flow velocity during expiration is 0.9 m/s (red arrow) and 0.63 m/s during inspiration (blue arrow), which is a 30% decrease, a finding characteristic in cardiac tamponade.