COVID-19 pericarditis mimicking an acute myocardial infarction: a case report and review of literature

Abstract

The novel coronavirus disease (Covid-19) continues to spread all over the world with acute respiratory distress syndrome and multiorgan failure being a significant cause of morbidity and mortality. The involvement of the cardiovascular system is associated with increased mortality and there have been various manifestations reported in the literature. We present a case of a patient requiring intensive care unit (ICU) admission for acute respiratory distress syndrome from Covid-19 who developed ST elevations in inferior leads in electrocardiogram (ECG) and elevated troponins. The changes resolved in serial ECG accompanied by normalization of blood troponin levels. His subsequent echocardiogram did not reveal any abnormalities in wall motion or heart function leading to a diagnosis of focal pericarditis mimicking an acute myocardial infarction. We also present a review of literature on various cardiac manifestations reported so far in cases of Covid-19.

Para-cardiac Inflammatory Mass Compressing the Heart

“…Post-COVID-19 cardiac complications include myocarditis (42.1%), pericardial effusion (15.8%), acute MI (15.8%), cardiac arrhythmias (10.5%), RV mural thrombus with pulmonary embolism (5.3%), acute HF with cardiogenic shock (5.3%), cardiac tamponade, Takotsubo cardiomyopathy, pericarditis, and myopericarditis. 1 In addition, the majority of symptoms of post-COVID-19 cardiac complications include shortness of breath (52.6%), chest pain (36.8%), fever (26.3%), cough (26.3%), fatigue (10.5%), abnormal troponin levels (68.4%), abnormal B-type natriuretic peptide (BNP) levels (42.1%), and ST-segment elevation (52.6%). 1 Different factors are involved in myocardial injury and the development of cardiovascular complications of COVID-19 and include an increased hypercoagulable status, systemic inflammatory response to a viral infection which may lead to increased metabolic activity, angiotensin-converting enzyme 2 (ACE2) expression on cardiac cells (which act as a receptor for the SARS-CoV2 virus leading to the invasion of the cardiac cells by the virus), and direct viral injury of cardiac cells.…”

“…1 In addition, the majority of symptoms of post-COVID-19 cardiac complications include shortness of breath (52.6%), chest pain (36.8%), fever (26.3%), cough (26.3%), fatigue (10.5%), abnormal troponin levels (68.4%), abnormal B-type natriuretic peptide (BNP) levels (42.1%), and ST-segment elevation (52.6%). 1 Different factors are involved in myocardial injury and the development of cardiovascular complications of COVID-19 and include an increased hypercoagulable status, systemic inflammatory response to a viral infection which may lead to increased metabolic activity, angiotensin-converting enzyme 2 (ACE2) expression on cardiac cells (which act as a receptor for the SARS-CoV2 virus leading to the invasion of the cardiac cells by the virus), and direct viral injury of cardiac cells. 1 On the other hand, around 90% of primary cardiac tumors are benign including myxoma (50%), fibroelastoma (26%), fibroma (6%), lipoma (4%), inflammatory myofibroblastic tumors (IMTs) (< than 5%), and other benign tumors.…”

“…1 Different factors are involved in myocardial injury and the development of cardiovascular complications of COVID-19 and include an increased hypercoagulable status, systemic inflammatory response to a viral infection which may lead to increased metabolic activity, angiotensin-converting enzyme 2 (ACE2) expression on cardiac cells (which act as a receptor for the SARS-CoV2 virus leading to the invasion of the cardiac cells by the virus), and direct viral injury of cardiac cells. 1 On the other hand, around 90% of primary cardiac tumors are benign including myxoma (50%), fibroelastoma (26%), fibroma (6%), lipoma (4%), inflammatory myofibroblastic tumors (IMTs) (< than 5%), and other benign tumors. 2 Primary pericardial masses are also usually benign and constitute about 6% to 10% of primary cardiac tumors.…”

“…The most common clinical manifestations of SARS-CoV-2 infection are respiratory symptoms; however, this infection may also involve other organs such as the heart and kidneys. 1 Some of the most common cardiac complications following coronavirus disease 2019 (COVID-19) include myocarditis, pericardial effusion and tamponade, myocardial infarction (MI), arrhythmias, acute heart failure (HF) with cardiogenic shock, and pericarditis. Most of these patients have shortness of breath and chest pain.…”

“…Most of these patients have shortness of breath and chest pain. 1 On the other hand, primary cardiac tumors are very rare and have an incidence of 0.001%-0.03% on autopsy findings and about 90% of them are benign. 2 In addition, 6 to 10% of primary cardiac tumors are primary pericardial masses which are also usually benign.…”