Abstract 16344: Pericardial Complications in Patients With COVID-19: A Systematic Review of Published Cases

Introduction: COVID-19 has been linked to cardiac damage and life-threatening pericardial complication on which data are trivial which incited us to perform this review of published case reports. Methods: PubMed/Medline, Web of Science and SCOPUS were searched until June 2020 for case reports on COVID-19-associated pericarditis, cardiac tamponade or pericardial effusion. Results: We identified 8 articles reporting 11 COVID-19 positive cases [mean age: 51.4±14.3 (34-78 yrs) 5 male/6 female)] with pericardial complications. All (100%) cases were COVID-19 positive at the presentation with ~80% having dyspnea, chest pain and cough. Time interval from first symptom to pericardial effusion was 7±8 (1-26) days. Five patients reported heart failure with reduced EF on echocardiography with mean LVEF 36.25%±8.54%. All patients showed nearly normal Troponin-I without angiographically significant stenosis except one. Out of 8 cases on echocardiography 4 cases reported with diffuse hypokinesia, 2 reported inferior and inferolateral walls hypokinesia and 2 reported signs of pericardial tamponade. Out of 11 patients, cardiovascular risk factors in the form of diabetes or hypertension or obesity were present in 5 patients. Cardiovascular comorbidities such as heart failure with low ejection fraction, non-ischemic cardiomyopathy and prior myocarditis were present in 3 patients. ST-segment elevation in 3, sinus tachycardia in 2, T wave inversion in 1 case were noted. Four patients developed cardiac tamponade, 1 developed takotsubo syndrome and 3 patients died. Conclusions: COVID-19 patients had signs of a high burden of cardiac injury. Pericardial complications (pericardial effusion and cardiac tamponade) remain infrequent complications which may require prompt care to avoid mortality.

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Pericardial effusion and cardiac tamponade requiring pericardial window in an otherwise healthy 30-year-old patient with COVID-19: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02467-w ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Christina Walker ◽

Vincent Peyko ◽

Charles Farrell ◽

Jeanine Awad-Spirtos ◽

Matthew Adamo ◽

...

Keyword(s):

Case Report ◽

Pericardial Effusion ◽

Cardiac Tamponade ◽

Case Reports ◽

Healthy Woman ◽

Signs And Symptoms ◽

Rare Presentation ◽

Pericardial Window ◽

Acute Pericarditis ◽

Novel Coronavirus

Abstract Background This case report demonstrates pericardial effusion, acute pericarditis, and cardiac tamponade in an otherwise healthy woman who had a positive test result for coronavirus disease 2019. Few case reports have been documented on patients with this presentation, and it is important to share novel presentations of the disease as they are discovered. Case presentation A Caucasian patient with coronavirus disease 2019 returned to the emergency department of our hospital 2 days after her initial visit with worsening chest pain and shortness of breath. Imaging revealed new pericardial effusion since the previous visit. The patient became hypotensive, was taken for pericardial window for cardiac tamponade with a drain placed, and was treated for acute pericarditis. Conclusion Much is still unknown about the implications of coronavirus disease 2019. With the novel coronavirus disease 2019 pandemic, research is still in process, and we are slowly learning about new signs and symptoms of the disease. This case report documents a lesser-known presentation of a patient with coronavirus disease 2019 and will help to further understanding of a rare presentation.

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Age independently predicts hemodynamic, but not arrhythmic STEMI-related complications. Data from a cohort study on 848 STEMI patients

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.065 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

RC Serban ◽

L Hadadi ◽

I Sus ◽

EK Lakatos ◽

Z Demjen ◽

...

Keyword(s):

Heart Failure ◽

Coronary Intervention ◽

Hospital Death ◽

High Risk Population ◽

Time Interval ◽

Killip Class ◽

St Segment Elevation ◽

Catheterization Laboratory ◽

Cardiac Stimulation ◽

Cardiac Catheterization Laboratory

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Romanian Ministry of Education and Research, CNCS-UEFISCDI BACKGROUND Age is one of the most relevant prognostic factors in patients presenting with ST-segment elevation myocardial infarction (STEMI). However, it remains unknown whether this impaired prognosis is due to the occurrence of hemodynamic and/or arrhythmic STEMI-related complications. Understanding the mechanisms involved in STEMI-related complications with advancing age could significantly improve outcomes in this high-risk population. PURPOSE We aimed to investigate the contribution of advanced age to the occurrence of hemodynamic and arrhythmic complications in STEMI patients. METHODS A total of 848 consecutive patients treated by primary percutaneous coronary intervention for STEMI were evaluated. Heart failure, cardiogenic shock, asystole, inotropic and diuretic use, and kidney dysfunction were used as in-hospital markers of hemodynamic complications. Ventricular fibrillation, conduction disorders, cardiac stimulation, and antiarrhythmic drugs use were used as markers of arrhythmic complications. The relationship between age and the occurrence of hemodynamic and arrhythmic complications was evaluated. The contribution of age to in-hospital death was also assessed. RESULTS In-hospital death occurred in 50 (5.8%) patients; patients who deceased were significantly older than their non-deceased counterparts (70.9 ± 10.9 vs. 61.2 ± 11.8 years; p< 0.0001). There was no association between age and the occurrence of any of the evaluated arrhythmic complications (all p >0.05). However, patients who presented hemodynamic complications were significantly older than those who did not (all p< 0.05). Age >60 years was a significant predictor of hemodynamic complications (p< 0.0001) with 61.7% sensitivity and 60.4% specificity. The association between age and hemodynamic complications remained significant after correction for additional risk factors (i.e., hypertension, diabetes mellitus, pre-existing heart failure, Killip class on admission, symptom onset-to-cardiac catheterization laboratory time interval). CONCLUSIONS In the present study, age was identified as an independent predictor of STEMI-related hemodynamic, but not arrhythmic complications. These data indicate that whereas age does not seem to affect the occurrence of STEMI-related rhythm disorders, patients above the age of 60 should particularly benefit from closer follow-up and more intensive strategies to prevent life-threating hemodynamic complications.

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COVID-19 and Cardiomyopathy: A Systematic Review

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.695206 ◽

2021 ◽

Vol 8 ◽

Author(s):

Fatemeh Omidi ◽

Bahareh Hajikhani ◽

Seyyedeh Neda Kazemi ◽

Ardeshir Tajbakhsh ◽

Sajedeh Riazi ◽

...

Keyword(s):

Heart Failure ◽

Web Of Science ◽

Cardiac Injury ◽

Left Ventricular ◽

Cardiac Complications ◽

Limited Data ◽

Cardiac Damage ◽

Laboratory Findings ◽

Lv Dysfunction ◽

D Dimer

Background: Cardiomyopathies (CMPs) due to myocytes involvement are among the leading causes of sudden adolescent death and heart failure. During the COVID-19 pandemic, there are limited data available on cardiac complications in patients with COVID-19, leading to severe outcomes.Methods: We conducted a systematic search in Pubmed/Medline, Web of Science, and Embase databases up to August 2020, for all relevant studies about COVID-19 and CMPs.Results: A total of 29 articles with a total number of 1460 patients were included. Hypertension, diabetes, obesity, hyperlipidemia, and ischemic heart disease were the most reported comorbidities among patients with COVID-19 and cardiomyopathy. In the laboratory findings, 21.47% of patients had increased levels of troponin. Raised D-dimer levels were also reported in all of the patients. Echocardiographic results revealed mild, moderate, and severe Left Ventricular (LV) dysfunction present in 17.13, 11.87, and 10% of patients, respectively.Conclusions: Cardiac injury and CMPs were common conditions in patients with COVID-19. Therefore, it is suggested that cardiac damage be considered in managing patients with COVID-19.

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Case Report: Unusual Peritoneopericardial Diaphragmatic Hernia in an 8-Month-Old German Shepherd Dog, Associated With a Pericardial Pseudocyst and Coexisting Severe Pericardial Effusion Resulting in Right-Sided Heart Failure

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.673543 ◽

2021 ◽

Vol 8 ◽

Author(s):

Imke Hennink ◽

Pia Düver ◽

Ulrich Rytz ◽

Felix Meneses ◽

Melania Moioli ◽

...

Keyword(s):

Heart Failure ◽

Case Report ◽

Pericardial Effusion ◽

Cardiac Tamponade ◽

Umbilical Cord ◽

Umbilical Hernia ◽

Surgical Repair ◽

German Shepherd ◽

German Shepherd Dog ◽

Peritoneopericardial Diaphragmatic Hernia

Objective: This study aims to describe an unusual peritoneopericardial diaphragmatic hernia (PPDH) in an 8-month-old German shepherd dog, associated with a pericardial pseudocyst and coexisting severe pericardial effusion resulting in right-sided heart failure.Case Summary: An 8-month-old, male, intact, German shepherd dog, was referred for ascites. Echocardiography revealed a severe pericardial effusion with a cyst-like structure within the pericardium and consequently decompensated right-sided heart failure. The ascites was secondary to right-sided heart failure (cardiac tamponade). Computed tomography (CT) of the thorax and abdomen was performed and showed PPDH with severe pericardial effusion and presence of a pericardial cyst-like structure; xyphoid cleft and Y-shaped seventh sternebra; and mild thickening along the cranioventral abdominal wall consistent with scar tissue from the previous umbilical hernia surgical repair. During surgery, the PPDH was corrected, and it was revealed that the remnant of the umbilical cord passed through it, into the pericardium. The cyst-like structure was successfully resected and sent for pathology. Histopathology showed signs of a chronic suppurative inflammation, with absence of a mesothelial or endothelial wall layer, thus consistent with a pseudocyst. Based on tomographic and surgical findings, it is suspected that the pseudocyst, together with the pericardial effusion, evolved by an inflammation of the remnant of the umbilical cord during the umbilical hernia surgical repair 1 month prior to presentation. The underlying PPDH most likely favored the development of the pericardial pseudocyst. However, due to prior antibiotic therapy initiated by the private vet, an infectious origin cannot be ruled out completely.New or Unique Information Provided: There are a few case reports describing PPDH and/or pericardial pseudocysts in veterinary patients, but the current case report is unique, since it describes PPDH associated with a pericardial pseudocyst and coexisting severe pericardial effusion resulting in cardiac tamponade. As far as the authors know, such a case has not been described in veterinary medicine before.

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Cardiac Tamponade as Initial Presentation of Hodgkin Lymphoma

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.172971 ◽

2015 ◽

Vol 5 ◽

pp. 67 ◽

Cited By ~ 4

Author(s):

Adrija Hajra ◽

Dhrubajyoti Bandyopadhyay ◽

Manas Layek ◽

Sabyasachi Mukhopadhyay

Keyword(s):

Pericardial Effusion ◽

Malignant Lymphoma ◽

Cardiac Tamponade ◽

Hodgkin Lymphoma ◽

Male Patient ◽

Cardiac Involvement ◽

Case Reports ◽

Initial Presentation ◽

Classical Type

Cardiac involvement in malignant lymphoma is one of the least investigated subjects. Pericardial effusion is rarely symptomatic in patients of Hodgkin lymphoma (HL). Few case reports are available in the literature. There are case reports of diagnosed HL patients presenting with pericardial effusion. HL patients who present with recurrent episodes of pericardial effusion have also been reported. Pericardial effusion has also been reported in cases of non HL. However, pericardial effusion leading to cardiac tamponade as an initial presentation of HL is extremely rare. Very few such cases are there in the literature. Here, we present a case of a 26-year-old male patient who presented with cardiac tamponade and in due course was found to be a case of classical type of HL. This case is interesting because of its presentation.

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P1340 Clinical report: alert to iatrogenia

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.778 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

B Redondo Bermejo ◽

M M De La Torre Carpente ◽

M C Alonso Rodriguez ◽

C Tapia Ballesteros ◽

J C Munoz San Jose ◽

...

Keyword(s):

Pericardial Effusion ◽

Cardiac Injury ◽

Invasive Procedure ◽

Pericardial Tamponade ◽

Percutaneous Closure ◽

Surgical Removal ◽

Unusual Complication ◽

Clinical Report ◽

Pericardial Window ◽

Left Pleural Effusion

Abstract Background Leftatrial appendageclosure is an alternative to systemic anticoagulation for stroke prevention in appropriate atrial fibrillation patients,however, it is not without complications. Most complications arise during the procedure and in the following days, however they can also be extended over time and therefore, we must be alert. Case summary We present the clinical case of a 68-year-old man admitted to our hospital three weeks after being discharged due to a percutaneous closure of the left appendage complicated with a pericardial tamponade resolved mediated pericadiocentesis with pericarditis clinic with persistent severe pericardial effusion. After a week without being able to remove the drainage tube, he required pericardiotomy due to superinfection with adequate subsequent evolution. In the following weeks he presented a recurrent left pleural effusion that required several evacuating thoracocentesis. After last thoracocentesis, he presented a cardiac perforation showing the catheter lodged in the pulmonary artery in the chest Computed Tomography, so he was again submitted to cardiac surgery for catheter extraction. Finally after stabilization, the patient could be discharged and after 6 months of follow-up he is stable and without new complications. Discussion Post-cardiac injury syndromes is a group of inflammatory pericardial syndromes including post-myocardial infarction pericarditis, post-pericardiotomy syndrome and post-traumatic pericarditis iatrogenic or not, that’s include pericarditis after invasive cardiac interventions. It is presumed that these syndromes have an autoimmune pathogenesis triggered by an initial damage and after a latent period of a few weeks are revealed. Our patient evidence of pericardial effusion with elevated CRP several weeks after a cardiac injury due to perforated during a percutaneous closure of the left appendage complicated with a pericardial tamponade resolved mediated pericadiocentesis. The persistent effusion motivated he imposibility of removed pericadiocentesis tube, and it superinfecction required an urgent pericardiotomy. After pericardial window, the effusion continued into the left pleural. The perforation of cardiac cavities after an evacuatorythoracocentesis is a described but unusual complication that requires surgical removal. Our patient survived a pericardiocentesis, several evacuatorythoracocentesis and two cardiac surgeries, all after a percutaneous closure of the left appendage. Conclusion Any invasive procedure presents a risk of iatrogenic complication, especially in elderly patients with comorbidities. We must be alert and start a treatment as soon as possible to solve the problem. Abstract P1340 Figure. Chest-CT_EECHO2019

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COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options

Cardiovascular Research ◽

10.1093/cvr/cvaa106 ◽

2020 ◽

Vol 116 (10) ◽

pp. 1666-1687 ◽

Cited By ~ 266

Author(s):

Tomasz J Guzik ◽

Saidi A Mohiddin ◽

Anthony Dimarco ◽

Vimal Patel ◽

Kostas Savvatis ◽

...

Keyword(s):

Cardiovascular System ◽

Troponin I ◽

Inflammatory Responses ◽

Myocardial Dysfunction ◽

Angiotensin Receptor Blockers ◽

Ventricular Tachyarrhythmia ◽

Cardiac Injury ◽

Fulminant Myocarditis ◽

Rapid Progression ◽

Cardiac Damage

Abstract The novel coronavirus disease (COVID-19) outbreak, caused by SARS-CoV-2, represents the greatest medical challenge in decades. We provide a comprehensive review of the clinical course of COVID-19, its comorbidities, and mechanistic considerations for future therapies. While COVID-19 primarily affects the lungs, causing interstitial pneumonitis and severe acute respiratory distress syndrome (ARDS), it also affects multiple organs, particularly the cardiovascular system. Risk of severe infection and mortality increase with advancing age and male sex. Mortality is increased by comorbidities: cardiovascular disease, hypertension, diabetes, chronic pulmonary disease, and cancer. The most common complications include arrhythmia (atrial fibrillation, ventricular tachyarrhythmia, and ventricular fibrillation), cardiac injury [elevated highly sensitive troponin I (hs-cTnI) and creatine kinase (CK) levels], fulminant myocarditis, heart failure, pulmonary embolism, and disseminated intravascular coagulation (DIC). Mechanistically, SARS-CoV-2, following proteolytic cleavage of its S protein by a serine protease, binds to the transmembrane angiotensin-converting enzyme 2 (ACE2) —a homologue of ACE—to enter type 2 pneumocytes, macrophages, perivascular pericytes, and cardiomyocytes. This may lead to myocardial dysfunction and damage, endothelial dysfunction, microvascular dysfunction, plaque instability, and myocardial infarction (MI). While ACE2 is essential for viral invasion, there is no evidence that ACE inhibitors or angiotensin receptor blockers (ARBs) worsen prognosis. Hence, patients should not discontinue their use. Moreover, renin–angiotensin–aldosterone system (RAAS) inhibitors might be beneficial in COVID-19. Initial immune and inflammatory responses induce a severe cytokine storm [interleukin (IL)-6, IL-7, IL-22, IL-17, etc.] during the rapid progression phase of COVID-19. Early evaluation and continued monitoring of cardiac damage (cTnI and NT-proBNP) and coagulation (D-dimer) after hospitalization may identify patients with cardiac injury and predict COVID-19 complications. Preventive measures (social distancing and social isolation) also increase cardiovascular risk. Cardiovascular considerations of therapies currently used, including remdesivir, chloroquine, hydroxychloroquine, tocilizumab, ribavirin, interferons, and lopinavir/ritonavir, as well as experimental therapies, such as human recombinant ACE2 (rhACE2), are discussed.

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Myocarditis and Subclinical-Like Infection Associated With SARS-CoV-2 in Two Cats Living in the Same Household in France: A Case Report With Literature Review

Frontiers in Veterinary Science ◽

10.3389/fvets.2021.748869 ◽

2021 ◽

Vol 8 ◽

Author(s):

Valérie Chetboul ◽

Pierre Foulex ◽

Kahina Kartout ◽

Anne Marie Klein ◽

Corinne Sailleau ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Literature Review ◽

Left Atrial ◽

Troponin I ◽

Close Contact ◽

Cardiac Injury ◽

First Episode ◽

Extensive Literature ◽

Human Pathology

This report provides the first clinical, radiographic, echocardiographic, and biological description of SARS-CoV-2-associated myocarditis with a 6-month follow-up in a 5-year-old obese male domestic shorthair cat (Cat-1) presented for refractory congestive heart failure, with high cardiac troponin-I level (5.24 ng/ml), and a large lingual ulcer. The animal was SARS-CoV-2 positive on serology. The other cat living in the same household (Cat-2) never showed any clinical sign but was also confirmed SARS-CoV-2 positive on serology. Both cats were SARS-CoV-2 PCR negative. Cat-1 had closer contact than Cat-2 with their owner, who had been in close contact with a coworker tested PCR positive for COVID-19 (Alpha (B.1.1.7) variant) 4 weeks before Cat-1's first episode of congestive heart failure. A focused point-of-care echocardiography at presentation revealed for Cat-1 numerous B-lines, pleural effusion, severe left atrial dilation and dysfunction, and hypertrophic cardiomyopathy phenotype associated with focal pulmonary consolidations. Both myocarditis and pneumonia were suspected, leading to the prescription of cardiac medications and antibiotics. One month later, Cat-1 recovered, with normalization of left atrial size and function, and radiographic and echocardiography disappearance of heart failure signs and pulmonary lesions. An extensive literature review of SARS-CoV-2-related cardiac injury in pets in comparison with human pathology is discussed.

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Prevalence, Predictors, and Clinical Presentation of Acute Pericardial Effusion Following Percutaneous Coronary Intervention

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.759164 ◽

2022 ◽

Vol 8 ◽

Author(s):

Bei Zhao ◽

Jie Zhang ◽

Yun Li ◽

Xueyao Feng ◽

Shuai Mao ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Pericardial Effusion ◽

Clinical Presentation ◽

Troponin T ◽

Cardiac Injury ◽

Coronary Intervention ◽

Cardiac Damage ◽

Total Occlusion ◽

Percutaneous Coronary ◽

Procedural Time

Background: Iatrogenic pericardial effusion (PE) has been demonstrated to lead to cardiac injury as a sign of systemic inflammatory response.Objectives: This study sought to determine the anatomical characteristics and clinical presentation associated with PE after percutaneous coronary intervention (PCI) by using echocardiography.Methods: The clinical outcomes of all patients with coronary artery disease who underwent PCI from July 2014 to December 2018 were evaluated. The quantitative and qualitative analyses of PE were performed. The associations between the presence of PE and procedural factors were also evaluated.Results: A total of 882 patients were enrolled. PE was found in 144 patients (16.3%) and was mostly located in the anterior pericardium at low amounts. The serum levels of high-sensitive C-reaction protein before PCI and troponin T in the group with PE after PCI were significantly higher than those in the group without PE (p < 0.0001). The presence of PE was associated with the procedural time (OR = 1.02, p = 0.035) and the degree of interventional complexity (multiple vessels OR = 1.89, p = 0.014; chronic total occlusion OR = 2.04, p = 0.005; and PCI with rotational atherectomy OR = 1.15, p = 0.011) independent of the number of culprit vessels and stents. During 1-year follow-up, a significantly higher number of cardiac deaths (3) and myocardial infarctions (8) occurred in patients with PE than in patients without PE (P < 0.05).Conclusion: Post-PCI acute PE was frequent, generally mild, mainly asymptomatic, and independently associated with procedural time and complexity. This effusion, which is considered as a cardiac damage marker, could be a predominant clinical sign for long-term prognosis.

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Abstract 023: Effects Of Sodium Reduction And The Dash Diet On Subclinical Cardiac Damage: Results From The Dash-Sodium Trial

Circulation ◽

10.1161/circ.143.suppl_1.023 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Stephen P Juraschek ◽

Lara Kovell ◽

Lawrence J Appel ◽

Edgar R Miller ◽

Frank M Sacks ◽

...

Keyword(s):

Troponin I ◽

Control Diet ◽

Cardiac Injury ◽

High Sensitivity ◽

Cardiac Biomarkers ◽

Sodium Reduction ◽

Cardiac Damage ◽

Dash Diet ◽

High Sodium ◽

Hs Crp

Background: We recently documented that the DASH diet has beneficial effects on cardiac biomarkers. The effects of sodium reduction, alone or combined with the DASH diet, are unknown. Objective: To determine the effects of sodium reduction and the DASH diet, alone or combined, on biomarkers of cardiac injury, strain, and inflammation. Methods: DASH-Sodium was a controlled, feeding study in adults with pre- or stage 1 hypertension, who were randomly assigned to the DASH diet or a control diet. On their assigned diet, participants consumed each of three sodium levels for 4 weeks. Body weight was kept constant. The three sodium levels were low (50 mmol/d), medium (100 mmol/d), and high (150 mmol/d). Outcomes were 3 biomarkers representing distinct pathways of cardiac damage: high-sensitivity cardiac troponin I (hs-cTnI, measure of cardiac injury), N-terminal b-type pro natriuretic peptide (NT-proBNP, measure of strain), and high-sensitivity C-reactive protein (hs-CRP, measure of inflammation), collected at baseline and at the end of each feeding period. Results: Of the original 412 participants, mean age was 48 yr; 56% were women, and 56% black. Mean baseline SBP/DBP was 135/86 mm Hg. Lower sodium reduced NT-proBNP independent of diet (overall %-difference of -19%; 95% CI: -24, -14), but not hs-cTnI or hs-CRP ( Figure ). In contrast, DASH (vs control) reduced hs-cTnI by 18% (95% CI: -27, -7) and hs-CRP by 13% (95% CI: -24, -1), but not NT-proBNP. Combining both sodium reduction with DASH reduced hs-cTnI by 20% (95% CI: -31%, -7%), NT-proBNP by 23% (95% CI: -32%, -12%), and hs-CRP by 7% (95% CI: -22%, 9%) compared to the high sodium, control diet. Conclusions: Combining sodium reduction with a DASH dietary pattern represents an efficacious strategy to lower three distinct mechanisms of subclinical cardiac damage: injury, strain, and to a lesser extent inflammation.

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