Pericardial Diseases in COVID19: a Contemporary Review

Abstract

Purpose of Review Coronavirus disease 2019 (COVID19) involves the heart, including pericardium. This article reviews the possible pathophysiological mechanisms in pericardial involvement in COVID19 and pericardial manifestations of COVID19. It also summarizes the patients with pericarditis secondary to COVID19 and outlines the contemporary treatment strategies in this patient population. Recent Findings A high degree of suspicion is required to identify the pericardial involvement in COVID19 patients. It is proposed that an underlying hyperinflammatory reaction in COVID19 leads to pericardial inflammation. Acute pericarditis with or without myocardial involvement is diagnosed on clinical presentation, serum inflammatory markers, electrocardiogram, and echocardiogram. Multimodality imaging may also have an additional diagnostic value. Patients are usually managed medically, but some patients develop a life-threatening pericardial tamponade necessitating pericardial drainage. Summary Pericardial involvement is an important clinical manifestation of COVID19 requiring a proper workup. Timely diagnosis and a specific management plan based on the presentation and concomitant organ involvement usually lead to a complete recovery.

Electrocardiographic features of patients with COVID-19: One year of unexpected manifestations

“…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] .…”

“…To date, the exact pathophysiological mechanism of pericardial involvement is not fully understood. As proposed mechanisms, systemic inflammatory reaction (with cytokine storm), and endothelial damage induced by COVID-19 may lead to pericardial involvement [52] . Furthermore, COVID-19 induced pericarditis might reflect the expression of ACE2 receptors in epicardial adipocites (mediating the cell entry of SARS-CoV-2) [ 17 , [61] , [62] , [63] , [64] , [65] ], and possibly triggering local inflammation [ 63 , [65] , [66] , [67] , [68] , [69] , [70] ].…”

Echocardiography in COVID-19 Pandemic

“…Some case reports reported acute pericarditis during SARS-COV2 infection 54 . This type of cardiac involvement is often seen in patients with troponin elevation in the context of myocardial damage and less frequently as a primary presentation of COVID-19 infection which occurred most in younger patients 55 , 56 .…”

“…In conclusion, in COVID-19 patients with high suspicion of IE or significant VHD, explorative TTE and if inconclusive a subsequent TOE is mandatory for the diagnosis with all the precautions aimed at avoiding the spread of the infectious disease. Some case reports reported acute pericarditis during SARS-COV2 infection 54 . This type of cardiac involvement is often seen in patients with troponin elevation in the context of myocardial damage and less frequently as a primary presentation of COVID-19 infection which occurred most in younger patients 55,56 .…”

Pericardial Cytokine “Storm” in a COVID-19 Patient: the Confirmation of a Hypothesis

“…SARS-CoV-2 cardiac involvement has been frequently reported, with acute myocardial infarction and pericarditis the most frequently described diseases [10][11][12]. Also, rare cases of cardiac tamponade have been quoted as a suspected isolated manifestation of COVID-19 infection [13]. However, no strong demonstration has been produced so far.…”