Cardiac Tamponade: A Delayed Complication of COVID-19

First Author(s)

• AC

  Amala Chacko, MD

  Resident Physician, Department of Internal Medicine
  Loyola MacNeal Hospital, United States

  Disclosure information not submitted.

Co-Author(s)

• SR

  Shelden Rodrigues, MD

  Resident Physician, Department of Internal Medicine
  Loyola MacNeal Hospital, United States

  Disclosure information not submitted.

Title: Cardiac tamponade, a delayed complication of COVID-19

Case Report Body:

Introduction:
COVID 19 infection can involve multiple systems. Cardiovascular complications of COVID include heart failure, shock, myocardial injury, arrhythmias, and rarely pericardial effusion.

Description: A 72-year-old woman with a history of hypertension, dyslipidemia, and COVID-19 pneumonia ten months back was found to have a mild to moderate pericardial effusion during a routine echocardiogram. Five months later, she presented to the emergency room with sub-sternal chest pain and dyspnea. Point of care troponin was undetectable, and EKG revealed low voltage QRS complexes. An urgent bedside echocardiogram showed an extensive pericardial effusion (maximum depth of 3.79 cm) with evidence of hemodynamic compromise. She underwent urgent pericardiocentesis, removing one liter of sanguineous fluid, which was sent for analysis.
Further laboratory workup was significant for an elevated C- Reactive Protein of 127.4 mg/L, an Erythrocyte Sedimentation Rate of 65 mm/hour, and a negative serology test for anti-nuclear antibodies. Pericardial fluid analysis was significant only for an elevated RBC count, and microbiology tests were negative. In the light of no identifiable etiology, the hemorrhagic pericardial effusion was attributed as a post-COVID-19 sequela.

Discussion: Recent studies show that around 12% of COVID patients sustain cardiac injury. Pericardial effusion (PE) is one of the rarer cardiac manifestations of COVID-19 infection. While the definite mechanism of the pericardial effusion is unclear, it can be explained by the virus's predilection to cause cardio-pulmonary serosal inflammation. The first reported case of COVID-19 associated cardiac tamponade was described in a 47-year-old patient with a previous history of myopericarditis, unlike our patient. Two other cases of cardiac tamponade were reported, but these were in patients who were acutely ill, and pericardiocentesis drained only 250ml and 400ml, respectively. In another case series, two out of three COVID-19 associated with pericarditis were associated with myocarditis, and only one case had isolated pericardial involvement. Pericardial manifestations of COVID-19 are rare. Given its low incidence, it is not easy to establish a clear pattern. More cases need to be studied, and physicians should be aware of delayed pericardial complications.