Acute pericarditis and severe acute respiratory syndrome coronavirus 2: Case report

Blagojevic, Nikola; Bosnjakovic, Dragana; Vukomanovic, Vladan; Arsenovic, S. M.; Suzić-Lazić, Jelena; Tadić, Marijana

doi:10.1016/j.ijid.2020.09.1440

Cited by 16 publications

(35 citation statements)

References 14 publications

(30 reference statements)

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“…In the past months, few papers described cases of pericardial involvement in COVID-19 patients, either in association with myocarditis or as isolated manifestation [ 8 , 43 – 46 ].…”

Section: Pericarditismentioning

confidence: 99%

Role of advanced imaging in COVID-19 cardiovascular complications

et al. 2021

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Clinical manifestations of COVID-19 patients are dominated by respiratory symptoms, but cardiac complications are commonly observed and associated with increased morbidity and mortality. Underlying pathological mechanisms of cardiac injury are still not entirely elucidated, likely depending on a combination of direct viral damage with an uncontrolled immune activation. Cardiac involvement in these patients ranges from a subtle myocardial injury to cardiogenic shock. Advanced cardiac imaging plays a key role in discriminating the broad spectrum of differential diagnoses. Present article aims to review the value of advanced multimodality imaging in patients with suspected SARS-CoV-2-related cardiovascular involvement and its essential role in risk stratification and tailored treatment strategies. Based on our experience, we also sought to suggest possible diagnostic algorithms for the rationale utilization of advanced imaging tools, such as cardiac CT and CMR, avoiding unnecessary examinations and diagnostic delays.

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“…In the past months, few papers described cases of pericardial involvement in COVID-19 patients, either in association with myocarditis or as isolated manifestation [ 8 , 43 – 46 ].…”

Section: Pericarditismentioning

confidence: 99%

Role of advanced imaging in COVID-19 cardiovascular complications

et al. 2021

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“…Interestingly, 45.6% of the patients had a mild pericardial effusion. Pericardial effusion incidence has not been thoroughly evaluated in Covid-19 [34,35]. In addition, troponin levels were elevated on ICU admission, a nding that has been linked to myocardial involvement in Covid-19 [3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

Secondary bacterial infections trigger New Onset Atrial Fibrillation in ICU Covid-19 ARDS patients

Zakynthinos¹,

Tsolaki²,

Karavidas³

et al. 2021

Preprint

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Background Cardiac arrhythmias, mainly atrial fibrillation (AF), is frequently reported in COVID-19 patients, yet causality has not been explored. Intensive Care Unit patients frequently present AF during critical illness. Sepsis is one of the main contributors of AF occurrence in ICU patients. The aim of the study was to explore if Covid-19 myocardial involvement is the only contributor for New Onset Atrial Fibrillation (NOAF) in intubated ICU patients. Methods Consecutive intubated, Covid-19ARDS patients, were prospectively studied for factors triggering NOAF. Demographics, data on Covid-19 infection duration, severity of illness and ARDS are reported. Echocardiographic findings, troponin levels and secondary infection (sepsis/septic shock) data were collected on the day of AF and compared to the preceding days’ and/or ICU admission data. Comparison was also performed between NOAF and control group (no AF) on admission. Results Among 105 patients screened, 79 were eligible; nineteen presented NOAF (24%). Baseline characteristics did not differ between the NOAF and control groups. Troponin levels were mildly elevated upon ICU admission in both groups. NOAF occurred on the 18 ± 4.8 days from Covid-19 symptoms’ onset, and the 8.5 ± 2.1 ICU day. Seventeen patients in the NOAF group (89.5%) presented a septic secondary infection vs 25 (41.6%) in the control group (p < 0.001). In sixteen NOAF patients (84.2%), AF occurred concurrently with a secondary septic episode. Noradrenaline, lactate levels and inflammation biomarkers presented a gradual increase in the days preceding the AF day (all p < 0.05). Troponin increased compared to admission (p = 0.017). AF did not resolve or re-occurred if sepsis persisted. Upon ICU admission left ventricular ejection fraction was rather normal, yet, global longitudinal strain was equally impaired (< 16.5%) in 63% vs 78% in the NOAF and control groups, respectively. The right ventricle was mildly dilated, and 36 (45.6%) patients had pericardial effusion. Echocardiographic findings did not change on NOAF occurrence. Conclusion Secondary infections seem to be major contributors for NOAF in Covid-19 patients, probably playing the role of the “second hit” in an affected myocardium from Covid-19.

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“…Post-mortem studies have identified pericarditis in about 20% of the COVID-19 cases [ 50 , 51 ] and several case reports reported acute pericarditis in patients with SARS-CoV-2 infection with typical ECG signs (diffuse ST elevation and PR depression) [52] , [53] , [54] , [55] , [56] .…”

Section: “Typical” Ecg Features Of Covid-19 Complicationsmentioning

confidence: 99%