Acute Myopericarditis in the Post COVID-19 Recovery Phase

Abstract

The COVID-19 viral infection, caused by the novel coronavirus severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is a currently ongoing global pandemic that, as of mid-October, 2020, has resulted in more than 38.7 million confirmed cases globally and has caused more than 1.1 million fatalities. COVID-19 infection is associated with severe life threatening respiratory and cardiac complications such as acute respiratory distress syndrome (ARDS), pneumonia, shock, cardiac arrhythmias, myocardial infarction and heart failure, particularly in the acute infectious stage. Acute myopericarditis is another reported cardiac complication of COVID-19. Case reports have been limited in reporting the effects of COVID-19 in the post-symptomatic period. In this article, we present a case of acute myopericarditis resulting 6 to 8 weeks after testing positive for COVID-19. Here we will breakdown the initial emergency department (ED) presentation, with particular attention to the electrocardiogram (ECG) findings of acute myopericarditis. This case, to the our best knowledge and after an extensive literature review, depicts the first case of myopericarditis in the post COVID-19 infection recovery phase.

Cardiac sequelae after coronavirus disease 2019 recovery: a systematic review

“…Through screening of titles and abstracts, we excluded 2670 records, leaving 197 to be assessed as full text. Of these, we finally included in this review 35 studies ( 5 , 8 , 11 , 12 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ), of which 3 were pre-prints ( 5 , 23 , 50 ), three were presented as research letters ( 21 , 43 , 51 ) and three were presented as research communications ( 22 , 31 , 44 ). The reasons for excluding 162 articles are listed in the PRISMA flow chart (see Figure 1 ) ( 52 ).…”

“…Of the 35 studies included in this review, 15 were prospective cohort ( 8 , 12 , 22 , 29 , 30 , 31 , 34 , 35 , 40 , 41 , 42 , 44 , 45 , 47 , 50 ), 7 were case reports ( 21 , 25 , 28 , 36 , 37 , 39 , 48 ), 5 had a cross-sectional design ( 5 , 20 , 24 , 26 , 38 ), 4 were case series ( 23 , 32 , 43 , 46 ), 3 were retrospective cohort ( 11 , 27 , 49 ), and 1 was ambidirectional cohort study ( 33 ).…”

“…22 articles (63%) included patients previously hospitalized for COVID-19 (N=51117, 97.2%) ( 11 , 21 , 24 , 25 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 48 , 49 ), 8 studies a mixed population of discharged patients and outpatients (N= 1330, 2.5%) ( 5 , 8 , 12 , 22 , 26 , 29 , 47 , 50 ) among which one included healthcare workers ( 5 ), 5 included only outpatients (N=122; 0.3%) ( 20 , 23 , 27 , 28 , 30 ), among which 4 included solely athletes ( 20 , 23 , 27 , 30 ).…”

“…Using the WHO scale for COVID-19 severity ( 15 ), we divided the latter population into severity categories and then combined them with other studies with pre-specified groups. Studies included participants with a majority of asymptomatic-mild (13/35 studies; N=1359 participants) ( 5 , 12 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 28 , 29 , 30 , 50 ), moderate-critical (21/35 studies; N=51234 participants) ( 8 , 11 , 25 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 ) and one remaining study (N=16 participants) with no clear demarcation ( 46 ).Most studies were from Europe (n=19/35; 54.3%), followed by Asia (10/35; 28.6%), North America (5/35; 14.3%), and Africa (1/35; 2.9%).…”

Sudden Cardiac Arrest at the Triage of Emergency Medicine Department in a Patient With COVID-19

“…In this case, we illustrate one of the manifestations of COVID-19 infection in the cardiovascular system; the patient rapidly developed VF arrest upon presentation. The clinical presentation, laboratory results, and post-arrest ECG are consistent with myopericarditis [ 15 ]. Echocardiogram and cardiovascular magnetic resonance (CMR) are mandatory to assess myocardial involvement.…”