A Systematic Review of COVID-19 and Pericarditis

Abstract

Coronavirus disease 2019 , caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China in December 2019. Since then, the disease has spread globally, leading to the ongoing pandemic. It can cause severe respiratory illness; however, many cases of pericarditis have also been reported. This systematic review aims to recognize the clinical features of pericarditis and myopericarditis in COVID-19 patients.Google Scholar, Medline/PubMed, CINAHL, Cochrane Central, and Web of Science databases were searched for studies reporting "Coronavirus" or "COVID" and "Peri-myocarditis," "heart," or "retrospective." Case reports and retrospective studies published from May 2020 to February 2021 were reviewed.In total, 33 studies on pericarditis, myopericarditis, and pericardial infusion were included in this review. COVID-19 pericarditis affected adult patients at any age. The incidence is more common in males, with a male-to-female ratio of 2:1. Chest pain (60%), fever (51%), and shortness of breath (51%) were the most reported symptoms, followed by cough (39%), fatigue (15%), myalgia (12%), and diarrhea (12%). Laboratory tests revealed leukocytosis with neutrophil predominance, elevated D-dimer, erythrocyte rate, and Creactive protein. Cardiac markers including troponin-1, troponin-T, and brain natriuretic peptide were elevated in most cases. Radiographic imaging of the chest were mostly normal, and only 31% of chest X-rays showed cardiomegaly and or bilateral infiltration. Electrocardiography (ECG) demonstrated normal sinus rhythm with around 59% ST elevation and rarely PR depression or T wave inversion, while the predominant echocardiographic feature was pericardial effusion. Management with colchicine was favored in most cases, followed by non-steroidal anti-inflammatory drugs (NSAIDs), and interventional therapy was only needed when patient developed cardiac tamponade. The majority of the reviewed studies reported either recovery or no continued clinical deterioration.The prevalence of COVID-19-related cardiac diseases is high, and pericarditis is a known extrapulmonary manifestation. However, pericardial effusion and cardiac tamponade are less prevalent and may require urgent intervention to prevent mortality. Pericarditis should be considered in patients with chest pain, ST elevation on ECG, a normal coronary angiogram, and COVID-19. We emphasize the importance of clinical examination, ECG, and echocardiogram for decision-making, and NSAIDs, colchicine, and corticosteroids are considered to be safe in the treatment of pericarditis/myopericarditis associated with COVID-19.

Peri-Myocarditis as a Dire Consequence of Coronavirus Disease: A Clinical Challenge

“…While the exact incidence of COVID-19-related myocarditis is unknown, studies suggest that approximately 7% of COVID-19-associated deaths are linked to this condition [ 1 ]. Additionally, a systematic review by Kariyanna T et al found that COVID-19 pericarditis is more common in males, with a male-to-female ratio of two to one [ 4 ]. Myocarditis is typically caused by viral infections, such as adenovirus, enterovirus, and parvovirus [ 1 ].…”

Left ventricular thrombus formation in a COVID‐19 patient with a complex course of pericarditis and myocardial infarction

“…Fatigue (15%), cough (39%), and diarrhea (12%) were the next most prevalent symptoms. 15 Cardiovascular manifestations and complications following clinical recovery from SARS-CoV2 infection are unclear, and few studies have examined longterm COVID-19 patients in detail in an effort to determine the degree to which cardiovascular disturbance contributed to the development of post-recovery symptoms. 16 Our case demonstrated thrombotic complications such as coronary thrombosis.…”

“…The most common symptoms reported were fever (51%), shortness of breath (51%), chest discomfort (60%), and myalgia (12%). Fatigue (15%), cough (39%), and diarrhea (12%) were the next most prevalent symptoms 15 . Cardiovascular manifestations and complications following clinical recovery from SARS‐CoV2 infection are unclear, and few studies have examined long‐term COVID‐19 patients in detail in an effort to determine the degree to which cardiovascular disturbance contributed to the development of post‐recovery symptoms 16 …”

New-onset acute psychosis as a manifestation of lupus cerebritis following concomitant COVID-19 infection and vaccination: a rare case report

“…She also had an acute stroke. Both pericarditis and stroke can either be due to the COVID-19 [ 14 , 15 ], or to SLE [ 16 , 17 ]. We could find only one case report of lupus cerebritis occurring three weeks after COVID-19 infection in a 29-year-old female with a past medical history of SLE, and which manifested as slow speech, psychomotor agitation, and intermittent choreiform movements in the upper part of the body [ 18 ].…”