Acute Myopericarditis with Pericardial Effusion and Cardiac Tamponade in a Patient with COVID-19. 

 -  2020 
<br/><br/> BACKGROUND Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness. However, with rising numbers of cases, multiple reports of  cardiovascular manifestations have emerged. We present a case of COVID-19 infection complicated by myopericarditis and tamponade requiring drainage. CASE  REPORT An 82-year-old woman with multiple comorbidities presented with five days of productive cough, fever with chills, and intermittent diarrhea. She  tested positive for COVID-19. Index EKG revealed new diffuse T-wave inversions and a prolonged QT interval (>500 ms). Troponin was mildly elevated without  any anginal symptoms. Hydroxychloroquine and azithromycin were not initiated due to concerns about QT prolongation. The echocardiogram revealed preserved  left ventricular (LV) function, a small global pericardial effusion, and apical hypokinesis. Serial echocardiograms revealed an enlarging circumferential  pericardial effusion with pacemaker wire reported as 'piercing' the right ventricular (RV) apex alongside early diastolic collapse of the right ventricle,  suggesting echocardiographic tamponade. Chest CT revealed extension of the RV pacemaker lead into the pericardial fat. Interestingly, on comparison with a  previous chest CT from 2019, similar lead positions were confirmed. Pericardiocentesis was performed with removal of 400 cc exudate. CONCLUSIONS Acute  myopericarditis and pericardial effusion can occur in COVID-19 infection, even in the absence of severe pulmonary disease. This case highlights the  importance of awareness of rare cardiac manifestations of COVID-19 in the form of acute myopericarditis and cardiac tamponade and their early diagnosis and  management. 
<br/><br/><br/>English 
<br/><br/><label>ISSN: </label>1941-5923 
<br/><br/><label>Standard No.: </label>10.12659/AJCR.925554 [doi] 925554 [pii] 
<br/><br/><label>Subjects--Topical Terms: </label><br/>*Betacoronavirus<br/>*Cardiac Tamponade/et [Etiology]<br/>*Early Diagnosis<br/>*Myocarditis/co [Complications]<br/>*Pericardial Effusion/et [Etiology]<br/>*Pericardiocentesis/mt [Methods]<br/>*Pericarditis/co [Complications]<br/>Aged, 80 and over<br/>Cardiac Tamponade/di [Diagnosis]<br/>Cardiac Tamponade/su [Surgery]<br/>Echocardiography<br/>Female<br/>Humans<br/>Myocarditis/di [Diagnosis]<br/>Pericardial Effusion/di [Diagnosis]<br/>Pericardial Effusion/su [Surgery]<br/>Pericarditis/di [Diagnosis]<br/>Ventricular Function, Left/ph [Physiology]
<br/><br/><label>Subjects--Geographic Terms: </label><br/>MedStar Heart & Vascular Institute at MedStar Franklin Square Medical Institute<br/>MedStar Heart & Vascular Institute at MedStar Union Memorial Hospital<br/>MedStar Medical Group
<br/><br/><label>Index Terms--Occupation: </label><br/>Cardiology<br/>MedStar Health Baltimore Residents
<br/><br/><label>Index Terms--Function: </label><br/>Journal Article