A Case of Pure Pericarditis Associated With COVID-19: Application of Classical Clinical Evaluation for Differential Diagnosis

Abstract

Pericarditis of varying severity is being recognized as a rare complication of the COVID-19 infection. We present a patient with an electrocardiogram (EKG) and physical exam findings that initially seemed to most likely be pericarditis related to the COVID-19 infection. The differential diagnosis was a bit difficult because it included ST-segment elevation myocardial infarction (STEMI) due to some EKG changes and early repolarization changes that were rather robust. Treatment options for STEMI could cause severe harm if the process turned out to be pericarditis. Treatment options for pericarditis could cause severe harm if the process turned out to be STEMI. And treatment options for early repolarization might be no treatment at all, which could cause harm if the process turned out to be STEMI or pericarditis. In this case, a correct diagnosis was very important to ensure a good clinical outcome. We would like to share our thought processes in the management of this case.

Association of New-Onset Atrial Fibrillation With All-Cause Mortality in COVID-19 Patients

“…Overall, the mechanisms related to the development of arrhythmias in SARS-CoV-2 infected patients are not fully elucidated; however, the potential pathophysiological mechanisms underlying arrhythmias encompass (1) direct injury to cardiomyocytes disrupting both the integrity of the plasma membrane and the normal electrical conduction pathways [14]; (2) potential infection of the pericardium, instigating significant edema [15]; (3) ischemia from microvascular disease due to possible infection of the pericytes [16,17]; (4) the induction of re-entrant arrhythmias attributable to myocardial fibrosis [18]; (5) the influence of proinflammatory cytokines, rendering a predisposition to arrhythmogenicity [19]. Scenarios 1, 2, and 3 may manifest acutely, while scenarios 4 and 5 typically occur in a chronic or post-inflammatory myocarditis context.…”