COVID-19-associated pericarditis: Difference between revisions
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'''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]'''<br> | '''For COVID-19 frequently asked inpatient questions, click [[COVID-19 frequently asked inpatient questions|here]]'''<br> | ||
'''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]'''<br> | '''For COVID-19 frequently asked outpatient questions, click [[COVID-19 frequently asked outpatient questions|here]]'''<br> | ||
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{{SK}} Novel coronavirus, COVID-19, Wuhan Coronavirus, Coronavirus Disease-19, Coronavirus Disease 2019, SARS-CoV-2, COVID-19, COVID-19, 2019-nCoV, 2019 novel coronavirus, Cardiovascular finding in COVID-19, Pericardial injury in COVID-19, Pericarditis, Pericarditis in COVID-19, COVID-19-associated Pericarditis, SARS-CoV2-associated Pericarditis, Myocardial injury in COVID-19, COVID-19 pericarditis | {{SK}} Novel coronavirus, COVID-19, Wuhan Coronavirus, Coronavirus Disease-19, Coronavirus Disease 2019, SARS-CoV-2, COVID-19, COVID-19, 2019-nCoV, 2019 novel coronavirus, Cardiovascular finding in COVID-19, Pericardial injury in COVID-19, Pericarditis, Pericarditis in COVID-19, COVID-19-associated Pericarditis, SARS-CoV2-associated Pericarditis, Myocardial injury in COVID-19, COVID-19 pericarditis | ||
==Overview== | ==Overview== | ||
[[COVID-19]] is caused by the [[novel coronavirus]], also known as [[SARS-CoV-2]]. It mainly affects the lungs, causing [[severe acute respiratory syndrome]]. It invades through the [[Angiotensin-converting enzyme 2]] (ACE2) receptors present abundantly not only in the [[lungs]] but also in the [[heart]], [[kidneys]], [[intestine]], [[brain]], [[skin]] thus causing [[multiorgan dysfunction]]. Studies have demonstrated that [[COVID-19]] interacts with the [[cardiovascular system]], thereby causing [[myocardial injury]] and dysfunction as well as increasing [[morbidity]] among patients with underlying cardiovascular conditions. [[Pericarditis]] in [[COVID-19]] is a rare complication. Reports on large [[pericardial effusion]] and [[cardiac tamponade]] are rare in [[COVID-19]] | [[COVID-19]] is caused by the [[novel coronavirus]], also known as [[SARS-CoV-2]]. It mainly affects the [[lungs]], causing [[severe acute respiratory syndrome]]. It invades through the [[Angiotensin-converting enzyme 2]] ([[Angiotensin-converting enzyme 2|ACE2]]) receptors present abundantly not only in the [[lungs]] but also in the [[heart]], [[kidneys]], [[intestine]], [[brain]], [[skin]] thus causing [[Multiple organ dysfunction syndrome|multiorgan dysfunction]]. Studies have demonstrated that [[COVID-19]] interacts with the [[cardiovascular system]], thereby causing [[myocardial injury]] and [[dysfunction]] as well as increasing [[morbidity]] among patients with underlying [[cardiovascular]] conditions. [[Pericarditis]] in [[COVID-19]] is a rare complication. Reports on large [[pericardial effusion]] and [[cardiac tamponade]] are rare in [[COVID-19]]. | ||
To view the complete page of COVID-19, [[COVID-19|click here]] | |||
==Historical Perspective== | ==Historical Perspective== | ||
*The [[novel coronavirus]], [[SARS-CoV-2]], is identified as the cause of an outbreak of [[respiratory illness]] first detected in [[Wuhan]], [[China]] in late December 2019. [[SARS-CoV-2]] has rapidly spread across China and in other countries, raising major global concerns. This [[novel coronavirus]], [[SARS-CoV-2]], was named the [[severe acute respiratory syndrome coronavirus-2]] [[(SARS-CoV-2)]] for it similarity [[severe acute respiratory syndrome related coronaviruses]] such as [[SARS-CoV]], which caused [[acute respiratory distress syndrome]] ([[ARDS]]) in 2002–2003.<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/about/index.html|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="LuCui2020">{{cite journal|last1=Lu|first1=Jian|last2=Cui|first2=Jie|last3=Qian|first3=Zhaohui|last4=Wang|first4=Yirong|last5=Zhang|first5=Hong|last6=Duan|first6=Yuange|last7=Wu|first7=Xinkai|last8=Yao|first8=Xinmin|last9=Song|first9=Yuhe|last10=Li|first10=Xiang|last11=Wu|first11=Changcheng|last12=Tang|first12=Xiaolu|title=On the origin and continuing evolution of SARS-CoV-2|journal=National Science Review|year=2020|issn=2095-5138|doi=10.1093/nsr/nwaa036}}</ref><ref name="HuangWang2020">{{cite journal|last1=Huang|first1=Chaolin|last2=Wang|first2=Yeming|last3=Li|first3=Xingwang|last4=Ren|first4=Lili|last5=Zhao|first5=Jianping|last6=Hu|first6=Yi|last7=Zhang|first7=Li|last8=Fan|first8=Guohui|last9=Xu|first9=Jiuyang|last10=Gu|first10=Xiaoying|last11=Cheng|first11=Zhenshun|last12=Yu|first12=Ting|last13=Xia|first13=Jiaan|last14=Wei|first14=Yuan|last15=Wu|first15=Wenjuan|last16=Xie|first16=Xuelei|last17=Yin|first17=Wen|last18=Li|first18=Hui|last19=Liu|first19=Min|last20=Xiao|first20=Yan|last21=Gao|first21=Hong|last22=Guo|first22=Li|last23=Xie|first23=Jungang|last24=Wang|first24=Guangfa|last25=Jiang|first25=Rongmeng|last26=Gao|first26=Zhancheng|last27=Jin|first27=Qi|last28=Wang|first28=Jianwei|last29=Cao|first29=Bin|title=Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China|journal=The Lancet|volume=395|issue=10223|year=2020|pages=497–506|issn=01406736|doi=10.1016/S0140-6736(20)30183-5}}</ref><ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref>{{cite web |url=https://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/ |title=WHO | Novel Coronavirus – China |format= |work= |accessdate=}}</ref> | *The [[novel coronavirus]], [[SARS-CoV-2]], is identified as the cause of an [[outbreak]] of [[respiratory illness]] first detected in [[Wuhan]], [[China]] in late December 2019. [[SARS-CoV-2]] has rapidly spread across China and in other countries, raising major global concerns. This [[novel coronavirus]], [[SARS-CoV-2]], was named the [[severe acute respiratory syndrome coronavirus-2]] [[(SARS-CoV-2)]] for it similarity [[severe acute respiratory syndrome]] related [[coronaviruses]] such as [[SARS-CoV]], which caused [[acute respiratory distress syndrome]] ([[ARDS]]) in 2002–2003.<ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/about/index.html|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="LuCui2020">{{cite journal|last1=Lu|first1=Jian|last2=Cui|first2=Jie|last3=Qian|first3=Zhaohui|last4=Wang|first4=Yirong|last5=Zhang|first5=Hong|last6=Duan|first6=Yuange|last7=Wu|first7=Xinkai|last8=Yao|first8=Xinmin|last9=Song|first9=Yuhe|last10=Li|first10=Xiang|last11=Wu|first11=Changcheng|last12=Tang|first12=Xiaolu|title=On the origin and continuing evolution of SARS-CoV-2|journal=National Science Review|year=2020|issn=2095-5138|doi=10.1093/nsr/nwaa036}}</ref><ref name="HuangWang2020">{{cite journal|last1=Huang|first1=Chaolin|last2=Wang|first2=Yeming|last3=Li|first3=Xingwang|last4=Ren|first4=Lili|last5=Zhao|first5=Jianping|last6=Hu|first6=Yi|last7=Zhang|first7=Li|last8=Fan|first8=Guohui|last9=Xu|first9=Jiuyang|last10=Gu|first10=Xiaoying|last11=Cheng|first11=Zhenshun|last12=Yu|first12=Ting|last13=Xia|first13=Jiaan|last14=Wei|first14=Yuan|last15=Wu|first15=Wenjuan|last16=Xie|first16=Xuelei|last17=Yin|first17=Wen|last18=Li|first18=Hui|last19=Liu|first19=Min|last20=Xiao|first20=Yan|last21=Gao|first21=Hong|last22=Guo|first22=Li|last23=Xie|first23=Jungang|last24=Wang|first24=Guangfa|last25=Jiang|first25=Rongmeng|last26=Gao|first26=Zhancheng|last27=Jin|first27=Qi|last28=Wang|first28=Jianwei|last29=Cao|first29=Bin|title=Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China|journal=The Lancet|volume=395|issue=10223|year=2020|pages=497–506|issn=01406736|doi=10.1016/S0140-6736(20)30183-5}}</ref><ref>{{Cite web|url=https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html|title=|last=|first=|date=|website=|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref>{{cite web |url=https://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/ |title=WHO | Novel Coronavirus – China |format= |work= |accessdate=}}</ref> | ||
*On January 30, 2020,the [[World Health Organization]]([[WHO]]) declared the outbreak as a [[Public Health Emergency]] of International Concern.<ref>{{cite web |url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen |title=Coronavirus (COVID-19) events as they happen |format= |work= |accessdate=}}</ref> | *On January 30, 2020,the [[World Health Organization]]([[WHO]]) declared the outbreak as a [[Public Health Emergency]] of International Concern.<ref>{{cite web |url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen |title=Coronavirus (COVID-19) events as they happen |format= |work= |accessdate=}}</ref> | ||
*On March 12, 2020, the [[World Health Organization]] declared the [[COVID-19]] outbreak a [[pandemic]].<ref>{{cite web |url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen |title=Coronavirus (COVID-19) events as they happen |format= |work= |accessdate=}}</ref> | *On March 12, 2020, the [[World Health Organization]] declared the [[COVID-19]] outbreak a [[pandemic]].<ref>{{cite web |url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen |title=Coronavirus (COVID-19) events as they happen |format= |work= |accessdate=}}</ref> | ||
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==Classification== | ==Classification== | ||
*There is no established system for the classification of the [[pericarditis]] seen in [[COVID-19]]. | *There is no established system for the classification of the [[pericarditis]] seen in [[COVID-19]]. | ||
*For | *For general classification of [[pericarditis]], [[pericarditis classification|click here]]. | ||
==Pathophysiology== | ==Pathophysiology== | ||
*[[Viral]] infections are a common cause of [[pericarditis]]. It is hypothesized that | *[[Viral]] [[infections]] are a common cause of [[pericarditis]]. It is hypothesized that [[virus]]es cause [[pericardial]] [[inflammation]] via direct [[cytotoxic]] effects or via [[immune]]-mediated mechanisms.<ref name="TomkowskiSwedberg2015">{{cite journal|last1=Tomkowski|first1=Witold|last2=Swedberg|first2=Karl|last3=Seferovic|first3=Petar|last4=Sabaté Tenas|first4=Manel|last5=Ristić|first5=Arsen D|last6=Pavie|first6=Alain|last7=Mayosi|first7=Bongani|last8=Maisch|first8=Bernhard|last9=Lionis|first9=Christos|last10=Klingel|first10=Karin|last11=Gueret|first11=Pascal|last12=Brucato|first12=Antonio|last13=Bogaert|first13=Jan|last14=Barón-Esquivias|first14=Gonzalo|last15=Badano|first15=Luigi|last16=Imazio|first16=Massimo|last17=Charron|first17=Philippe|last18=Adler|first18=Yehuda|last19=Achenbach|first19=Stephan|last20=Agewall|first20=Stefan|last21=Al-Attar|first21=Nawwar|last22=Angel Ferrer|first22=Juan|last23=Arad|first23=Michael|last24=Asteggiano|first24=Riccardo|last25=Bueno|first25=Héctor|last26=Caforio|first26=Alida L P|last27=Carerj|first27=Scipione|last28=Ceconi|first28=Claudio|last29=Evangelista|first29=Arturo|last30=Flachskampf|first30=Frank|last31=Giannakoulas|first31=George|last32=Gielen|first32=Stephan|last33=Habib|first33=Gilbert|last34=Kolh|first34=Philippe|last35=Lambrinou|first35=Ekaterini|last36=Lancellotti|first36=Patrizio|last37=Lazaros|first37=George|last38=Linhart|first38=Ales|last39=Meurin|first39=Philippe|last40=Nieman|first40=Koen|last41=Piepoli|first41=Massimo F|last42=Price|first42=Susanna|last43=Roos-Hesselink|first43=Jolien|last44=Roubille|first44=François|last45=Ruschitzka|first45=Frank|last46=Sagristà Sauleda|first46=Jaume|last47=Sousa-Uva|first47=Miguel|last48=Uwe Voigt|first48=Jens|last49=Luis Zamorano|first49=Jose|last50=Zamorano|first50=Jose Luis|last51=Aboyans|first51=Victor|last52=Achenbach|first52=Stephan|last53=Agewall|first53=Stefan|last54=Badimon|first54=Lina|last55=Barón-Esquivias|first55=Gonzalo|last56=Baumgartner|first56=Helmut|last57=Bax|first57=Jeroen J|last58=Bueno|first58=Héctor|last59=Carerj|first59=Scipione|last60=Dean|first60=Veronica|last61=Erol|first61=Çetin|last62=Fitzimons|first62=Donna|last63=Gaemperli|first63=Oliver|last64=Kirchhof|first64=Paulus|last65=Kolh|first65=Philippe|last66=Lancellotti|first66=Patrizio|last67=Lip|first67=Gregory YH|last68=Nihoyannopoulos|first68=Petros|last69=Piepoli|first69=Massimo F|last70=Ponikowski|first70=Piotr|last71=Roffi|first71=Marco|last72=Torbicki|first72=Adam|last73=Vaz Carneiro|first73=Antonio|last74=Windecker|first74=Stephan|last75=Shuka|first75=Naltin|last76=Sisakian|first76=Hamayak|last77=Mascherbauer|first77=Julia|last78=Isayev|first78=Elnur|last79=Shumavets|first79=Vadim|last80=Van Camp|first80=Guy|last81=Gatzov|first81=Plamen|last82=Hanzevacki|first82=Jadranka Separovic|last83=Moustra|first83=Hera Heracleous|last84=Linhart|first84=Ales|last85=Møller|first85=Jacob Eifer|last86=Aboleineen|first86=Mohamed Wafaie|last87=Põder|first87=Pentti|last88=Lehtonen|first88=Jukka|last89=Antov|first89=Slobodan|last90=Damy|first90=Thibaud|last91=Schieffer|first91=Bernhard|last92=Dimitriadis|first92=Kyriakos|last93=Kiss|first93=Robert Gabor|last94=Rafnsson|first94=Arnar|last95=Arad|first95=Michael|last96=Novo|first96=Salvatore|last97=Mirrakhimov|first97=Erkin|last98=Stradinš|first98=Peteris|last99=Kavoliuniene|first99=Ausra|last100=Codreanu|first100=Andrei|last101=Dingli |first101=Philip|last102=Vataman|first102=Eleonora|last103=El Hattaoui|first103=Mustapaha|last104=Samstad|first104=Stein Olav|last105=Hoffman|first105=Piotr|last106=Lopes|first106=Luís Rocha|last107=Dimulescu|first107=Doina Ruxandra|last108=Arutyunov|first108=Grigory P|last109=Pavlovic|first109=Milan|last110=Dúbrava|first110=Juraj|last111=Sauleda|first111=Jaume Sagristà|last112=Andersson|first112=Bert|last113=Müller|first113=Hajo|last114=Bouma|first114=Berto J|last115=Abaci|first115=Adnan|last116=Archbold|first116=Andrew|last117=Nesukay|first117=Elena|title=2015 ESC Guidelines for the diagnosis and management of pericardial diseases|journal=European Heart Journal|volume=36|issue=42|year=2015|pages=2921–2964|issn=0195-668X|doi=10.1093/eurheartj/ehv318}}</ref> | ||
*The exact mechanism of [[COVID-19]] induced [[pericarditis]] is not yet well known. | *The exact mechanism of [[COVID-19]] induced [[pericarditis]] is not yet well known. | ||
*Probable mechanisms of COVID-19-associated [[pericarditis]] from the limited cases reported: | *Probable mechanisms of [[COVID-19]]-associated [[pericarditis]] from the limited cases reported: | ||
**Direct invasion of the [[virus]] | **Direct invasion of the [[virus]] | ||
**[[Cytokine storm]] and systemic hyperinflammatory response: This might be leading to [[pericarditis]] and subsequent [[pericardial effusion]] in certain patients | **[[Cytokine storm]] and systemic hyperinflammatory response: This might be leading to [[pericarditis]] and subsequent [[pericardial effusion]] in certain patients. | ||
==Causes== | ==Causes== | ||
[[Pericarditis]] in [[COVID-19]] is caused by: | [[Pericarditis]] in [[COVID-19]] is caused by: | ||
*Direct invasion by [[SARS-CoV-2]] | *Direct invasion by [[SARS-CoV-2]] | ||
*Pro-inflammatory [[cytokine storm]] | *Pro-inflammatory [[cytokine storm]] | ||
==Differentiating | ==Differentiating COVID-19-associated pericarditis from other diseases== | ||
[[Pericarditis]] in COVID-19 must be differentiated from other diseases that cause [[chest pain]], [[dyspnea]] such as: | [[Pericarditis]] in [[COVID-19]] must be differentiated from other diseases that cause [[chest pain]], [[dyspnea]] such as: | ||
*[[Myocarditis]] | *[[Myocarditis]] | ||
*[[Pleural effusion]] | *[[Pleural effusion]] | ||
| Line 41: | Line 43: | ||
*[[Acute coronary syndrome]] | *[[Acute coronary syndrome]] | ||
For | For the differential diagnosis of [[pericarditis]], [[Differentiating Pericarditis from other Diseases|click here]]. | ||
==Epidemiology and Demographics== | ==Epidemiology and Demographics== | ||
*[[Pericarditis]] is a rare manifestation of [[COVID-19]]. | *[[Pericarditis]] is a rare manifestation of [[COVID-19]]. | ||
*There is currently no available data on the [[incidence]] of [[pericarditis]] in [[COVID-19]] patients. | *There is currently no available data on the [[incidence]] of [[pericarditis]] in [[COVID-19]] patients. | ||
*Very few case reports of [[pericarditis]] in COVID-19 patients.<ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref><ref name="InciardiLupi2020">{{cite journal|last1=Inciardi|first1=Riccardo M.|last2=Lupi|first2=Laura|last3=Zaccone|first3=Gregorio|last4=Italia|first4=Leonardo|last5=Raffo|first5=Michela|last6=Tomasoni|first6=Daniela|last7=Cani|first7=Dario S.|last8=Cerini|first8=Manuel|last9=Farina|first9=Davide|last10=Gavazzi|first10=Emanuele|last11=Maroldi|first11=Roberto|last12=Adamo|first12=Marianna|last13=Ammirati|first13=Enrico|last14=Sinagra|first14=Gianfranco|last15=Lombardi|first15=Carlo M.|last16=Metra|first16=Marco|title=Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)|journal=JAMA Cardiology|year=2020|issn=2380-6583|doi=10.1001/jamacardio.2020.1096}}</ref><ref name="MaceiraLopez-Lereu2020">{{cite journal|last1=Maceira|first1=Alicia M|last2=Lopez-Lereu|first2=Maria P|last3=Higueras Ortega|first3=Laura|last4=García-Gonzalez|first4=Pilar|last5=Broseta Torres|first5=Ricardo|last6=Solsona Caravaca|first6=Javier|last7=Ventura Perez|first7=Bruno|last8=Andres Soler|first8=Jorge|last9=Dominguez Mafe|first9=Eloy|last10=Monmeneu|first10=Jose V|last11=Voges|first11=Inga|title=Subacute perimyocarditis in a young patient with COVID-19 infection|journal=European Heart Journal - Case Reports|year=2020|issn=2514-2119|doi=10.1093/ehjcr/ytaa157}}</ref><ref name="ByrneSado2020">{{cite journal|last1=Byrne|first1=Jonathan|last2=Sado|first2=Daniel|last3=O’Gallagher|first3=Kevin|last4=Hua|first4=Alina|title=Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19|journal=European Heart Journal|volume=41|issue=22|year=2020|pages=2130–2130|issn=0195-668X|doi=10.1093/eurheartj/ehaa253}}</ref><ref name="CizgiciZencirkiran Agus2020">{{cite journal|last1=Cizgici|first1=Ahmet Yasar|last2=Zencirkiran Agus|first2=Hicaz|last3=Yildiz|first3=Mustafa|title=COVID-19 myopericarditis: It should be kept in mind in today's conditions|journal=The American Journal of Emergency Medicine|volume=38|issue=7|year=2020|pages=1547.e5–1547.e6|issn=07356757|doi=10.1016/j.ajem.2020.04.080}}</ref><ref name="Tung-Chen2020">{{cite journal|last1=Tung-Chen|first1=Yale|title=Acute pericarditis due to COVID-19 infection: An underdiagnosed disease?|journal=Medicina Clínica|volume=155|issue=1|year=2020|pages=44–45|issn=00257753|doi=10.1016/j.medcli.2020.04.007}}</ref><ref>{{cite web |url=https://www.ejcrim.com/index.php/EJCRIM/article/view/1701/2100 |title=View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge |format= |work= |accessdate=}}</ref> | *Very few case reports of [[pericarditis]] in [[COVID-19]] patients.<ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref><ref name="InciardiLupi2020">{{cite journal|last1=Inciardi|first1=Riccardo M.|last2=Lupi|first2=Laura|last3=Zaccone|first3=Gregorio|last4=Italia|first4=Leonardo|last5=Raffo|first5=Michela|last6=Tomasoni|first6=Daniela|last7=Cani|first7=Dario S.|last8=Cerini|first8=Manuel|last9=Farina|first9=Davide|last10=Gavazzi|first10=Emanuele|last11=Maroldi|first11=Roberto|last12=Adamo|first12=Marianna|last13=Ammirati|first13=Enrico|last14=Sinagra|first14=Gianfranco|last15=Lombardi|first15=Carlo M.|last16=Metra|first16=Marco|title=Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)|journal=JAMA Cardiology|year=2020|issn=2380-6583|doi=10.1001/jamacardio.2020.1096}}</ref><ref name="MaceiraLopez-Lereu2020">{{cite journal|last1=Maceira|first1=Alicia M|last2=Lopez-Lereu|first2=Maria P|last3=Higueras Ortega|first3=Laura|last4=García-Gonzalez|first4=Pilar|last5=Broseta Torres|first5=Ricardo|last6=Solsona Caravaca|first6=Javier|last7=Ventura Perez|first7=Bruno|last8=Andres Soler|first8=Jorge|last9=Dominguez Mafe|first9=Eloy|last10=Monmeneu|first10=Jose V|last11=Voges|first11=Inga|title=Subacute perimyocarditis in a young patient with COVID-19 infection|journal=European Heart Journal - Case Reports|year=2020|issn=2514-2119|doi=10.1093/ehjcr/ytaa157}}</ref><ref name="ByrneSado2020">{{cite journal|last1=Byrne|first1=Jonathan|last2=Sado|first2=Daniel|last3=O’Gallagher|first3=Kevin|last4=Hua|first4=Alina|title=Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19|journal=European Heart Journal|volume=41|issue=22|year=2020|pages=2130–2130|issn=0195-668X|doi=10.1093/eurheartj/ehaa253}}</ref><ref name="CizgiciZencirkiran Agus2020">{{cite journal|last1=Cizgici|first1=Ahmet Yasar|last2=Zencirkiran Agus|first2=Hicaz|last3=Yildiz|first3=Mustafa|title=COVID-19 myopericarditis: It should be kept in mind in today's conditions|journal=The American Journal of Emergency Medicine|volume=38|issue=7|year=2020|pages=1547.e5–1547.e6|issn=07356757|doi=10.1016/j.ajem.2020.04.080}}</ref><ref name="Tung-Chen2020">{{cite journal|last1=Tung-Chen|first1=Yale|title=Acute pericarditis due to COVID-19 infection: An underdiagnosed disease?|journal=Medicina Clínica|volume=155|issue=1|year=2020|pages=44–45|issn=00257753|doi=10.1016/j.medcli.2020.04.007}}</ref><ref>{{cite web |url=https://www.ejcrim.com/index.php/EJCRIM/article/view/1701/2100 |title=View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge |format= |work= |accessdate=}}</ref> | ||
===Age=== | ===Age=== | ||
*There is no data on age predilection to [[pericarditis]] in [[COVID-19]]. | *There is no data on age predilection to [[pericarditis]] in [[COVID-19]]. | ||
| Line 60: | Line 62: | ||
===Natural History=== | ===Natural History=== | ||
*[[Pericarditis]] is [[inflammation]] of the [[pericardium]]. | *[[Pericarditis]] is [[inflammation]] of the [[pericardium]]. | ||
*There can be an accompanying accumulation of either [[serous]] or [[fibrinous]] fluid leading to the development of [[pericardial effusion]] and [[cardiac tamponade]]. *The underlying myocardium may or may not be inflamed as well. If the myocardium is involved in the inflammatory process, it is called [[myopericarditis]], and the CK and troponin levels may be elevated. Subsequent scarring of the [[pericardium]] may lead to [[constrictive pericarditis]]. | *There can be an accompanying accumulation of either [[serous]] or [[fibrinous]] fluid leading to the development of [[pericardial effusion]] and [[cardiac tamponade]]. | ||
*The underlying [[myocardium]] may or may not be [[inflamed]] as well. If the [[myocardium]] is involved in the [[inflammatory]] process, it is called [[myopericarditis]], and the [[CK]] and [[troponin]] levels may be elevated. Subsequent [[scarring]] of the [[pericardium]] may lead to [[constrictive pericarditis]]. | |||
===Complications=== | ===Complications=== | ||
| Line 69: | Line 72: | ||
===Prognosis=== | ===Prognosis=== | ||
There is no sufficient data on prognosis of [[COVID-19-associated pericarditis]]. | There is no sufficient data on the prognosis of [[COVID-19]]-associated [[pericarditis]]. | ||
== Diagnosis == | == Diagnosis == | ||
| Line 86: | Line 89: | ||
:*[[Fever]] | :*[[Fever]] | ||
:*[[Pericardial friction rub]] | :*[[Pericardial friction rub]] | ||
:*[[Tachycardia]], [[hypotension]] and [[ | :*[[Tachycardia]], [[hypotension]] and distant [[heart sounds]] seen in [[cardiac tamponade]] | ||
=== Laboratory Findings === | === Laboratory Findings === | ||
====Inflammatory biomarkers==== | ====Inflammatory biomarkers==== | ||
Non-specific markers of inflammation are commonly elevated in pericarditis.<ref>{{cite web |url=https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Diagnosis-of-acute-pericarditis |title=Diagnosis of acute pericarditis |format= |work= |accessdate=}}</ref> These include: | Non-specific markers of [[inflammation]] are commonly elevated in [[pericarditis]].<ref>{{cite web |url=https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Diagnosis-of-acute-pericarditis |title=Diagnosis of acute pericarditis |format= |work= |accessdate=}}</ref> These include: | ||
*[[Leukocyte | *[[Leukocyte]] count | ||
*[[C-reactive protein]] (CRP) | *[[C-reactive protein]] ([[CRP]]) | ||
*[[Erythrocyte Sedimentation Rate]] (ESR) | *[[Erythrocyte Sedimentation Rate]] ([[ESR]]) | ||
Elevated [[inflammatory | Elevated [[inflammatory]] markers, specifically [[WBC]] count and [[CRP]] was seen in [[COVID-19]]-associated [[pericarditis]] cases.<ref name="CizgiciZencirkiran Agus2020">{{cite journal|last1=Cizgici|first1=Ahmet Yasar|last2=Zencirkiran Agus|first2=Hicaz|last3=Yildiz|first3=Mustafa|title=COVID-19 myopericarditis: It should be kept in mind in today's conditions|journal=The American Journal of Emergency Medicine|volume=38|issue=7|year=2020|pages=1547.e5–1547.e6|issn=07356757|doi=10.1016/j.ajem.2020.04.080}}</ref><ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref><ref name="Tung-Chen2020">{{cite journal|last1=Tung-Chen|first1=Yale|title=Acute pericarditis due to COVID-19 infection: An underdiagnosed disease?|journal=Medicina Clínica|volume=155|issue=1|year=2020|pages=44–45|issn=00257753|doi=10.1016/j.medcli.2020.04.007}}</ref><ref name="InciardiLupi2020">{{cite journal|last1=Inciardi|first1=Riccardo M.|last2=Lupi|first2=Laura|last3=Zaccone|first3=Gregorio|last4=Italia|first4=Leonardo|last5=Raffo|first5=Michela|last6=Tomasoni|first6=Daniela|last7=Cani|first7=Dario S.|last8=Cerini|first8=Manuel|last9=Farina|first9=Davide|last10=Gavazzi|first10=Emanuele|last11=Maroldi|first11=Roberto|last12=Adamo|first12=Marianna|last13=Ammirati|first13=Enrico|last14=Sinagra|first14=Gianfranco|last15=Lombardi|first15=Carlo M.|last16=Metra|first16=Marco|title=Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)|journal=JAMA Cardiology|year=2020|issn=2380-6583|doi=10.1001/jamacardio.2020.1096}}</ref> | ||
====Cardiac biomarkers==== | ====Cardiac biomarkers==== | ||
In the presence of concomitant [[myocarditis]] and [[pericarditis]] [[ | In the presence of concomitant [[myocarditis]] and [[pericarditis]] ([[myopericarditis]]), [[serum biomarkers]] of [[myocardial injury]], are elevated.<ref>{{cite web |url=https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-15/Diagnosis-of-acute-pericarditis |title=Diagnosis of acute pericarditis |format= |work= |accessdate=}}</ref><ref name="ImazioDemichelis2003">{{cite journal|last1=Imazio|first1=Massimo|last2=Demichelis|first2=Brunella|last3=Cecchi|first3=Enrico|last4=Belli|first4=Riccardo|last5=Ghisio|first5=Aldo|last6=Bobbio|first6=Marco|last7=Trinchero|first7=Rita|title=Cardiac troponin i in acute pericarditis|journal=Journal of the American College of Cardiology|volume=42|issue=12|year=2003|pages=2144–2148|issn=07351097|doi=10.1016/j.jacc.2003.02.001}}</ref><ref name="Bonnefoy2000">{{cite journal|last1=Bonnefoy|first1=E|title=Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis|journal=European Heart Journal|volume=21|issue=10|year=2000|pages=832–836|issn=0195668X|doi=10.1053/euhj.1999.1907}}</ref> These include: | ||
*[[ | *[[Creatine Kinase]] ([[CK]]) | ||
*[[Cardiac troponin]] I or T | *[[Cardiac troponin]] I or T | ||
*Serum [[LDH]] | *Serum [[LDH]] | ||
Elevated [[cardiac markers]] was seen in [[COVID-19-associated pericarditis]] cases.<ref name="InciardiLupi2020">{{cite journal|last1=Inciardi|first1=Riccardo M.|last2=Lupi|first2=Laura|last3=Zaccone|first3=Gregorio|last4=Italia|first4=Leonardo|last5=Raffo|first5=Michela|last6=Tomasoni|first6=Daniela|last7=Cani|first7=Dario S.|last8=Cerini|first8=Manuel|last9=Farina|first9=Davide|last10=Gavazzi|first10=Emanuele|last11=Maroldi|first11=Roberto|last12=Adamo|first12=Marianna|last13=Ammirati|first13=Enrico|last14=Sinagra|first14=Gianfranco|last15=Lombardi|first15=Carlo M.|last16=Metra|first16=Marco|title=Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)|journal=JAMA Cardiology|year=2020|issn=2380-6583|doi=10.1001/jamacardio.2020.1096}}</ref><ref name="CizgiciZencirkiran Agus2020">{{cite journal|last1=Cizgici|first1=Ahmet Yasar|last2=Zencirkiran Agus|first2=Hicaz|last3=Yildiz|first3=Mustafa|title=COVID-19 myopericarditis: It should be kept in mind in today's conditions|journal=The American Journal of Emergency Medicine|volume=38|issue=7|year=2020|pages=1547.e5–1547.e6|issn=07356757|doi=10.1016/j.ajem.2020.04.080}}</ref><ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref><ref name="Tung-Chen2020">{{cite journal|last1=Tung-Chen|first1=Yale|title=Acute pericarditis due to COVID-19 infection: An underdiagnosed disease?|journal=Medicina Clínica|volume=155|issue=1|year=2020|pages=44–45|issn=00257753|doi=10.1016/j.medcli.2020.04.007}}</ref><ref name="ByrneSado2020">{{cite journal|last1=Byrne|first1=Jonathan|last2=Sado|first2=Daniel|last3=O’Gallagher|first3=Kevin|last4=Hua|first4=Alina|title=Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19|journal=European Heart Journal|volume=41|issue=22|year=2020|pages=2130–2130|issn=0195-668X|doi=10.1093/eurheartj/ehaa253}}</ref> | Elevated [[cardiac markers]] was seen in [[COVID-19]]-associated [[pericarditis]] cases.<ref name="InciardiLupi2020">{{cite journal|last1=Inciardi|first1=Riccardo M.|last2=Lupi|first2=Laura|last3=Zaccone|first3=Gregorio|last4=Italia|first4=Leonardo|last5=Raffo|first5=Michela|last6=Tomasoni|first6=Daniela|last7=Cani|first7=Dario S.|last8=Cerini|first8=Manuel|last9=Farina|first9=Davide|last10=Gavazzi|first10=Emanuele|last11=Maroldi|first11=Roberto|last12=Adamo|first12=Marianna|last13=Ammirati|first13=Enrico|last14=Sinagra|first14=Gianfranco|last15=Lombardi|first15=Carlo M.|last16=Metra|first16=Marco|title=Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)|journal=JAMA Cardiology|year=2020|issn=2380-6583|doi=10.1001/jamacardio.2020.1096}}</ref><ref name="CizgiciZencirkiran Agus2020">{{cite journal|last1=Cizgici|first1=Ahmet Yasar|last2=Zencirkiran Agus|first2=Hicaz|last3=Yildiz|first3=Mustafa|title=COVID-19 myopericarditis: It should be kept in mind in today's conditions|journal=The American Journal of Emergency Medicine|volume=38|issue=7|year=2020|pages=1547.e5–1547.e6|issn=07356757|doi=10.1016/j.ajem.2020.04.080}}</ref><ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref><ref name="Tung-Chen2020">{{cite journal|last1=Tung-Chen|first1=Yale|title=Acute pericarditis due to COVID-19 infection: An underdiagnosed disease?|journal=Medicina Clínica|volume=155|issue=1|year=2020|pages=44–45|issn=00257753|doi=10.1016/j.medcli.2020.04.007}}</ref><ref name="ByrneSado2020">{{cite journal|last1=Byrne|first1=Jonathan|last2=Sado|first2=Daniel|last3=O’Gallagher|first3=Kevin|last4=Hua|first4=Alina|title=Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19|journal=European Heart Journal|volume=41|issue=22|year=2020|pages=2130–2130|issn=0195-668X|doi=10.1093/eurheartj/ehaa253}}</ref> | ||
===Electrocardiogram=== | ===Electrocardiogram=== | ||
*[[Electrocardiogram]] [[ | *[[Electrocardiogram]] ([[ECG]]) findings see in the reported cases of [[COVID-19]]-associated [[pericarditis]] include: | ||
**[[ST elevation]] and [[PR depression]] are seen;<ref>{{cite web |url=https://www.ejcrim.com/index.php/EJCRIM/article/view/1701/2100 |title=View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge |format= |work= |accessdate=}}</ref><ref name="CizgiciZencirkiran Agus2020">{{cite journal|last1=Cizgici|first1=Ahmet Yasar|last2=Zencirkiran Agus|first2=Hicaz|last3=Yildiz|first3=Mustafa|title=COVID-19 myopericarditis: It should be kept in mind in today's conditions|journal=The American Journal of Emergency Medicine|volume=38|issue=7|year=2020|pages=1547.e5–1547.e6|issn=07356757|doi=10.1016/j.ajem.2020.04.080}}</ref><ref name="ByrneSado2020">{{cite journal|last1=Byrne|first1=Jonathan|last2=Sado|first2=Daniel|last3=O’Gallagher|first3=Kevin|last4=Hua|first4=Alina|title=Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19|journal=European Heart Journal|volume=41|issue=22|year=2020|pages=2130–2130|issn=0195-668X|doi=10.1093/eurheartj/ehaa253}}</ref> but these changes are | **[[ST elevation]] and [[PR depression]] are seen;<ref>{{cite web |url=https://www.ejcrim.com/index.php/EJCRIM/article/view/1701/2100 |title=View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge |format= |work= |accessdate=}}</ref><ref name="CizgiciZencirkiran Agus2020">{{cite journal|last1=Cizgici|first1=Ahmet Yasar|last2=Zencirkiran Agus|first2=Hicaz|last3=Yildiz|first3=Mustafa|title=COVID-19 myopericarditis: It should be kept in mind in today's conditions|journal=The American Journal of Emergency Medicine|volume=38|issue=7|year=2020|pages=1547.e5–1547.e6|issn=07356757|doi=10.1016/j.ajem.2020.04.080}}</ref><ref name="ByrneSado2020">{{cite journal|last1=Byrne|first1=Jonathan|last2=Sado|first2=Daniel|last3=O’Gallagher|first3=Kevin|last4=Hua|first4=Alina|title=Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19|journal=European Heart Journal|volume=41|issue=22|year=2020|pages=2130–2130|issn=0195-668X|doi=10.1093/eurheartj/ehaa253}}</ref> but these changes are not [[specificity|specific]] to [[COVID-19]] [[pericarditis]]. | ||
**Non-specific ST changes.<ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref> | **Non-specific [[ST]] changes.<ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref> | ||
**[[T wave inversion]] in the | **[[T wave inversion]] in the inferior leads (II, III and aVF).<ref name="Tung-Chen2020">{{cite journal|last1=Tung-Chen|first1=Yale|title=Acute pericarditis due to COVID-19 infection: An underdiagnosed disease?|journal=Medicina Clínica|volume=155|issue=1|year=2020|pages=44–45|issn=00257753|doi=10.1016/j.medcli.2020.04.007}}</ref><ref>{{cite web |url=https://www.ejcrim.com/index.php/EJCRIM/article/view/1701/2100 |title=View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge |format= |work= |accessdate=}}</ref> | ||
For | For [[ECG]] changes in [[pericarditis]] in general, [[Pericarditis electrocardiogram|click here]]. | ||
===Imaging=== | ===Imaging=== | ||
| Line 118: | Line 121: | ||
====Chest X-ray==== | ====Chest X-ray==== | ||
*[[Chest X-ray]] is usually within normal limits in [[acute pericarditis]]. | *[[Chest X-ray]] is usually within normal limits in [[acute pericarditis]]. | ||
*Chest x-ray demonstrated an [[enlarged cardiac silhouette]] in patients with [[COVID-19]] complicated by [[cardiac tamponade]].<ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref><ref>{{cite web |url=https://www.ejcrim.com/index.php/EJCRIM/article/view/1701/2100 |title=View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge |format= |work= |accessdate=}}</ref> | *[[Chest x-ray]] demonstrated an [[enlarged cardiac silhouette]] in patients with [[COVID-19]] complicated by [[cardiac tamponade]].<ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref><ref>{{cite web |url=https://www.ejcrim.com/index.php/EJCRIM/article/view/1701/2100 |title=View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge |format= |work= |accessdate=}}</ref> | ||
For | For [[Chest X-ray]] findings in [[pericarditis]], [[Pericarditis x ray|click here]]. | ||
====Echocardiography==== | ====Echocardiography==== | ||
| Line 128: | Line 131: | ||
**In the cases complicated by [[cardiac tamponade]],<ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref><ref>{{cite web |url=https://www.ejcrim.com/index.php/EJCRIM/article/view/1701/2100 |title=View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge |format= |work= |accessdate=}}</ref><ref name="ByrneSado2020">{{cite journal|last1=Byrne|first1=Jonathan|last2=Sado|first2=Daniel|last3=O’Gallagher|first3=Kevin|last4=Hua|first4=Alina|title=Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19|journal=European Heart Journal|volume=41|issue=22|year=2020|pages=2130–2130|issn=0195-668X|doi=10.1093/eurheartj/ehaa253}}</ref> findings included: | **In the cases complicated by [[cardiac tamponade]],<ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref><ref>{{cite web |url=https://www.ejcrim.com/index.php/EJCRIM/article/view/1701/2100 |title=View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge |format= |work= |accessdate=}}</ref><ref name="ByrneSado2020">{{cite journal|last1=Byrne|first1=Jonathan|last2=Sado|first2=Daniel|last3=O’Gallagher|first3=Kevin|last4=Hua|first4=Alina|title=Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19|journal=European Heart Journal|volume=41|issue=22|year=2020|pages=2130–2130|issn=0195-668X|doi=10.1093/eurheartj/ehaa253}}</ref> findings included: | ||
***Large [[pericardial effusion]] | ***Large [[pericardial effusion]] | ||
***[[Right ventricular diastolic | ***[[Right ventricle|Right ventricular]] [[diastolic]] collapse | ||
***Increased [[respiratory | ***Increased [[respiratory]] variation in peak E-wave [[mitral]] inflow velocity | ||
***Dilated [[inferior vena cava]] | ***Dilated [[inferior vena cava]] | ||
For | For [[echocardiography]] findings in [[pericarditis]] in general, [[Pericarditis echocardiography and ultrasound|click here]]. | ||
====CT scan==== | ====CT scan==== | ||
| Line 138: | Line 141: | ||
====Cardiac magnetic resonance==== | ====Cardiac magnetic resonance==== | ||
In two of the reported cases, late [[gadolinium sequences]] of [[cardiac magnetic resonance | In two of the reported cases, late [[gadolinium sequences]] of [[Cardiovascular magnetic resonance imaging (CMR)|cardiac magnetic resonance (CMR)]] done to rule out [[myocarditis]] also showed extensive enhancement of the walls of the [[heart]] and the [[pericardium]].<ref name="MaceiraLopez-Lereu2020">{{cite journal|last1=Maceira|first1=Alicia M|last2=Lopez-Lereu|first2=Maria P|last3=Higueras Ortega|first3=Laura|last4=García-Gonzalez|first4=Pilar|last5=Broseta Torres|first5=Ricardo|last6=Solsona Caravaca|first6=Javier|last7=Ventura Perez|first7=Bruno|last8=Andres Soler|first8=Jorge|last9=Dominguez Mafe|first9=Eloy|last10=Monmeneu|first10=Jose V|last11=Voges|first11=Inga|title=Subacute perimyocarditis in a young patient with COVID-19 infection|journal=European Heart Journal - Case Reports|year=2020|issn=2514-2119|doi=10.1093/ehjcr/ytaa157}}</ref><ref name="InciardiLupi2020">{{cite journal|last1=Inciardi|first1=Riccardo M.|last2=Lupi|first2=Laura|last3=Zaccone|first3=Gregorio|last4=Italia|first4=Leonardo|last5=Raffo|first5=Michela|last6=Tomasoni|first6=Daniela|last7=Cani|first7=Dario S.|last8=Cerini|first8=Manuel|last9=Farina|first9=Davide|last10=Gavazzi|first10=Emanuele|last11=Maroldi|first11=Roberto|last12=Adamo|first12=Marianna|last13=Ammirati|first13=Enrico|last14=Sinagra|first14=Gianfranco|last15=Lombardi|first15=Carlo M.|last16=Metra|first16=Marco|title=Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)|journal=JAMA Cardiology|year=2020|issn=2380-6583|doi=10.1001/jamacardio.2020.1096}}</ref> | ||
===Pericardial fluid analysis=== | ===Pericardial fluid analysis=== | ||
| Line 144: | Line 147: | ||
In the reported cases of [[cardiac tamponade]] in [[COVID-19]] patients,<ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref><ref>{{cite web |url=https://www.ejcrim.com/index.php/EJCRIM/article/view/1701/2100 |title=View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge |format= |work= |accessdate=}}</ref> [[pericardial fluid analysis]] from emergency [[pericardiocentesis]] showed: | In the reported cases of [[cardiac tamponade]] in [[COVID-19]] patients,<ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref><ref>{{cite web |url=https://www.ejcrim.com/index.php/EJCRIM/article/view/1701/2100 |title=View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge |format= |work= |accessdate=}}</ref> [[pericardial fluid analysis]] from emergency [[pericardiocentesis]] showed: | ||
*Largely [[exudative]] [[effusion]] | *Largely [[exudative]] [[effusion]] | ||
*High [[polymorphonuclear]] cell count | *High [[neutrohil|polymorphonuclear]] [[cell]] count | ||
*High [[protein]] and [[LDH]] levels | *High [[protein]] and [[LDH]] levels | ||
Other work-up included: | Other work-up included: | ||
*[[ | *Fluid [[cytology]] for [[malignant]] cells - negative | ||
*[[Gram stain]], [[Acid-fast]] stain - negative | *[[Gram stain]], [[Acid-fast]] stain - negative | ||
*[[Bacterial]], [[mycobacterial]] and [[fungal]] cultures - negative | *[[Bacterial]], [[mycobacterial]] and [[fungal]] cultures - negative | ||
*Serum [[auto-immune]] work-up - negative | *Serum [[auto-immune]] work-up - negative | ||
Since there are no established laboratory parameters to help distinguish [[COVID-19]]-related [[pericardial effusion]] from other etiologies, complete [[biochemical]], [[bacteriological]] and [[cytological]] analysis of [[pericardial fluid]] is suggested to rule out other etiologies of [[pericardial effusion]]. | Since there are no established laboratory parameters to help distinguish [[COVID-19]]-related [[pericardial effusion]] from other etiologies, complete [[biochemical]], [[bacteria|bacteriological]] and [[cytological]] analysis of [[pericardial fluid]] is suggested to rule out other etiologies of [[pericardial effusion]]. | ||
== Treatment == | == Treatment == | ||
| Line 163: | Line 166: | ||
*But according to the recommendations from the US [[Food and Drug Administration]] (FDA) and the [[Centers for Disease Control and Prevention]] (CDC), [[NSAIDs]] can be used when clinically indicated in [[COVID-19]] patients.<ref>{{cite web |url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19 |title=FDA advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19 | FDA |format= |work= |accessdate=}}</ref> | *But according to the recommendations from the US [[Food and Drug Administration]] (FDA) and the [[Centers for Disease Control and Prevention]] (CDC), [[NSAIDs]] can be used when clinically indicated in [[COVID-19]] patients.<ref>{{cite web |url=https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatory-drugs-nsaids-covid-19 |title=FDA advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19 | FDA |format= |work= |accessdate=}}</ref> | ||
*There is no literature and existing data to provide definite evidence for or against the use of high- or low-dose aspirin when clinically indicated in patients with COVID-19. | *There is no literature and existing data to provide definite evidence for or against the use of high- or low-dose aspirin when clinically indicated in patients with COVID-19. | ||
*In one of the reported cases of [[COVID-19-associated pericarditis]] and [[cardiac tamponade]], [[colchicine]] was well tolerated as monotherapy.<ref>{{cite web |url=https://www.ejcrim.com/index.php/EJCRIM/article/view/1701/2100 |title=View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge |format= |work= |accessdate=}}</ref> | *In one of the reported cases of [[COVID-19]]-associated [[pericarditis]] and [[cardiac tamponade]], [[colchicine]] was well tolerated as monotherapy.<ref>{{cite web |url=https://www.ejcrim.com/index.php/EJCRIM/article/view/1701/2100 |title=View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge |format= |work= |accessdate=}}</ref> | ||
*In another case of [[COVID-19]] and [[cardiac tamponade]], the combination of [[corticosteroids]] and [[colchicine]] was well tolerated and successful.<ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref> | *In another case of [[COVID-19]] and [[cardiac tamponade]], the combination of [[corticosteroids]] and [[colchicine]] was well tolerated and successful.<ref name="DabbaghAurora2020">{{cite journal|last1=Dabbagh|first1=Mohammed F.|last2=Aurora|first2=Lindsey|last3=D’Souza|first3=Penny|last4=Weinmann|first4=Allison J.|last5=Bhargava|first5=Pallavi|last6=Basir|first6=Mir B.|title=Cardiac Tamponade Secondary to COVID-19|journal=JACC: Case Reports|year=2020|issn=26660849|doi=10.1016/j.jaccas.2020.04.009}}</ref> | ||
*In all the reported cases of [[COVID-19]] with large [[effusions]] and [[cardiac tamponade]], [[pericardiocentesis]] showed improvement in symptoms. | *In all the reported cases of [[COVID-19]] with large [[effusions]] and [[cardiac tamponade]], [[pericardiocentesis]] showed improvement in symptoms. | ||
*Response to treatment can be monitored with serial [[transthoracic echocardiogram]] (TTE). | *Response to treatment can be monitored with serial [[echocardiogram|transthoracic echocardiogram]] (TTE). | ||
=== Prevention === | === Prevention === | ||
*There are no primary preventive measures available for [[COVID-19-associated pericarditis]]. | *There are no primary preventive measures available for [[COVID-19]]-associated [[pericarditis]]. | ||
*For | *For primary preventive measures of [[COVID-19]], [[COVID-19 primary prevention|click here]]. | ||
==References== | ==References== | ||
Revision as of 08:46, 11 July 2020
For COVID-19 frequently asked inpatient questions, click here
For COVID-19 frequently asked outpatient questions, click here
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COVID-19 Microchapters |
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Diagnosis |
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Case Studies |
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COVID-19-associated pericarditis On the Web |
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American Roentgen Ray Society Images of COVID-19-associated pericarditis |
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Risk calculators and risk factors for COVID-19-associated pericarditis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mounika Reddy Vadiyala, M.B.B.S.[2]
Synonyms and keywords: Novel coronavirus, COVID-19, Wuhan Coronavirus, Coronavirus Disease-19, Coronavirus Disease 2019, SARS-CoV-2, COVID-19, COVID-19, 2019-nCoV, 2019 novel coronavirus, Cardiovascular finding in COVID-19, Pericardial injury in COVID-19, Pericarditis, Pericarditis in COVID-19, COVID-19-associated Pericarditis, SARS-CoV2-associated Pericarditis, Myocardial injury in COVID-19, COVID-19 pericarditis
Overview
COVID-19 is caused by the novel coronavirus, also known as SARS-CoV-2. It mainly affects the lungs, causing severe acute respiratory syndrome. It invades through the Angiotensin-converting enzyme 2 (ACE2) receptors present abundantly not only in the lungs but also in the heart, kidneys, intestine, brain, skin thus causing multiorgan dysfunction. Studies have demonstrated that COVID-19 interacts with the cardiovascular system, thereby causing myocardial injury and dysfunction as well as increasing morbidity among patients with underlying cardiovascular conditions. Pericarditis in COVID-19 is a rare complication. Reports on large pericardial effusion and cardiac tamponade are rare in COVID-19.
To view the complete page of COVID-19, click here
Historical Perspective
- The novel coronavirus, SARS-CoV-2, is identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China in late December 2019. SARS-CoV-2 has rapidly spread across China and in other countries, raising major global concerns. This novel coronavirus, SARS-CoV-2, was named the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) for it similarity severe acute respiratory syndrome related coronaviruses such as SARS-CoV, which caused acute respiratory distress syndrome (ARDS) in 2002–2003.[1][2][3][4][5]
- On January 30, 2020,the World Health Organization(WHO) declared the outbreak as a Public Health Emergency of International Concern.[6]
- On March 12, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic.[7]
Classification
- There is no established system for the classification of the pericarditis seen in COVID-19.
- For general classification of pericarditis, click here.
Pathophysiology
- Viral infections are a common cause of pericarditis. It is hypothesized that viruses cause pericardial inflammation via direct cytotoxic effects or via immune-mediated mechanisms.[8]
- The exact mechanism of COVID-19 induced pericarditis is not yet well known.
- Probable mechanisms of COVID-19-associated pericarditis from the limited cases reported:
- Direct invasion of the virus
- Cytokine storm and systemic hyperinflammatory response: This might be leading to pericarditis and subsequent pericardial effusion in certain patients.
Causes
Pericarditis in COVID-19 is caused by:
- Direct invasion by SARS-CoV-2
- Pro-inflammatory cytokine storm
Differentiating COVID-19-associated pericarditis from other diseases
Pericarditis in COVID-19 must be differentiated from other diseases that cause chest pain, dyspnea such as:
For the differential diagnosis of pericarditis, click here.
Epidemiology and Demographics
- Pericarditis is a rare manifestation of COVID-19.
- There is currently no available data on the incidence of pericarditis in COVID-19 patients.
- Very few case reports of pericarditis in COVID-19 patients.[9][10][11][12][13][14][15]
Age
- There is no data on age predilection to pericarditis in COVID-19.
Gender
- There is no data on gender predilection to pericarditis in COVID-19; but among the few cases reported, the number of cases in females is more than males.
Race
- There is no data on racial predilection to pericarditis in COVID-19.
Natural History, Complications and Prognosis
Natural History
- Pericarditis is inflammation of the pericardium.
- There can be an accompanying accumulation of either serous or fibrinous fluid leading to the development of pericardial effusion and cardiac tamponade.
- The underlying myocardium may or may not be inflamed as well. If the myocardium is involved in the inflammatory process, it is called myopericarditis, and the CK and troponin levels may be elevated. Subsequent scarring of the pericardium may lead to constrictive pericarditis.
Complications
Common complications include:
Prognosis
There is no sufficient data on the prognosis of COVID-19-associated pericarditis.
Diagnosis
Symptoms
- Symptoms of pericarditis in COVID-19 may include the following:
Physical Examination
- Physical examination may be remarkable for:
- Fever
- Pericardial friction rub
- Tachycardia, hypotension and distant heart sounds seen in cardiac tamponade
Laboratory Findings
Inflammatory biomarkers
Non-specific markers of inflammation are commonly elevated in pericarditis.[16] These include:
Elevated inflammatory markers, specifically WBC count and CRP was seen in COVID-19-associated pericarditis cases.[13][9][14][10]
Cardiac biomarkers
In the presence of concomitant myocarditis and pericarditis (myopericarditis), serum biomarkers of myocardial injury, are elevated.[17][18][19] These include:
- Creatine Kinase (CK)
- Cardiac troponin I or T
- Serum LDH
Elevated cardiac markers was seen in COVID-19-associated pericarditis cases.[10][13][9][14][12]
Electrocardiogram
- Electrocardiogram (ECG) findings see in the reported cases of COVID-19-associated pericarditis include:
- ST elevation and PR depression are seen;[20][13][12] but these changes are not specific to COVID-19 pericarditis.
- Non-specific ST changes.[9]
- T wave inversion in the inferior leads (II, III and aVF).[14][21]
For ECG changes in pericarditis in general, click here.
Imaging
Chest X-ray
- Chest X-ray is usually within normal limits in acute pericarditis.
- Chest x-ray demonstrated an enlarged cardiac silhouette in patients with COVID-19 complicated by cardiac tamponade.[9][22]
For Chest X-ray findings in pericarditis, click here.
Echocardiography
- Echocardiography is the first-line test in the diagnosis of pericarditis and its complications.[23]
- On imaging by echocardiography in the reported cases of COVID-19-associated pericarditis, findings included:
- Small to moderate pericardial effusion.[10][14][12]
- In the cases complicated by cardiac tamponade,[9][24][12] findings included:
- Large pericardial effusion
- Right ventricular diastolic collapse
- Increased respiratory variation in peak E-wave mitral inflow velocity
- Dilated inferior vena cava
For echocardiography findings in pericarditis in general, click here.
CT scan
On CT chest, the reported cases showed pericardial effusion.[13]
Cardiac magnetic resonance
In two of the reported cases, late gadolinium sequences of cardiac magnetic resonance (CMR) done to rule out myocarditis also showed extensive enhancement of the walls of the heart and the pericardium.[11][10]
Pericardial fluid analysis
In the reported cases of cardiac tamponade in COVID-19 patients,[9][25] pericardial fluid analysis from emergency pericardiocentesis showed:
Other work-up included:
- Fluid cytology for malignant cells - negative
- Gram stain, Acid-fast stain - negative
- Bacterial, mycobacterial and fungal cultures - negative
- Serum auto-immune work-up - negative
Since there are no established laboratory parameters to help distinguish COVID-19-related pericardial effusion from other etiologies, complete biochemical, bacteriological and cytological analysis of pericardial fluid is suggested to rule out other etiologies of pericardial effusion.
Treatment
Medical Therapy
- NSAIDs and high-dose aspirin and are the mainstay of therapy for acute pericarditis.[8]
- Colchicine is recommended as first-line therapy for acute pericarditis as an adjunctive to NSAIDs/Aspririn
- Corticosteroids are reserved for cases with a contraindication or failure of first-line therapies.
- With early anecdotal reports linking NSAIDs and corticosteroids with a worsening clinical condition in patients with COVID-19, there have been recommendations against the use of these agents.[26][27]
- But according to the recommendations from the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), NSAIDs can be used when clinically indicated in COVID-19 patients.[28]
- There is no literature and existing data to provide definite evidence for or against the use of high- or low-dose aspirin when clinically indicated in patients with COVID-19.
- In one of the reported cases of COVID-19-associated pericarditis and cardiac tamponade, colchicine was well tolerated as monotherapy.[29]
- In another case of COVID-19 and cardiac tamponade, the combination of corticosteroids and colchicine was well tolerated and successful.[9]
- In all the reported cases of COVID-19 with large effusions and cardiac tamponade, pericardiocentesis showed improvement in symptoms.
- Response to treatment can be monitored with serial transthoracic echocardiogram (TTE).
Prevention
- There are no primary preventive measures available for COVID-19-associated pericarditis.
- For primary preventive measures of COVID-19, click here.
References
- ↑ https://www.cdc.gov/coronavirus/2019-ncov/about/index.html. Missing or empty
|title=(help) - ↑ Lu, Jian; Cui, Jie; Qian, Zhaohui; Wang, Yirong; Zhang, Hong; Duan, Yuange; Wu, Xinkai; Yao, Xinmin; Song, Yuhe; Li, Xiang; Wu, Changcheng; Tang, Xiaolu (2020). "On the origin and continuing evolution of SARS-CoV-2". National Science Review. doi:10.1093/nsr/nwaa036. ISSN 2095-5138.
- ↑ Huang, Chaolin; Wang, Yeming; Li, Xingwang; Ren, Lili; Zhao, Jianping; Hu, Yi; Zhang, Li; Fan, Guohui; Xu, Jiuyang; Gu, Xiaoying; Cheng, Zhenshun; Yu, Ting; Xia, Jiaan; Wei, Yuan; Wu, Wenjuan; Xie, Xuelei; Yin, Wen; Li, Hui; Liu, Min; Xiao, Yan; Gao, Hong; Guo, Li; Xie, Jungang; Wang, Guangfa; Jiang, Rongmeng; Gao, Zhancheng; Jin, Qi; Wang, Jianwei; Cao, Bin (2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". The Lancet. 395 (10223): 497–506. doi:10.1016/S0140-6736(20)30183-5. ISSN 0140-6736.
- ↑ https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html. Missing or empty
|title=(help) - ↑ "WHO | Novel Coronavirus – China".
- ↑ "Coronavirus (COVID-19) events as they happen".
- ↑ "Coronavirus (COVID-19) events as they happen".
- ↑ 8.0 8.1 Tomkowski, Witold; Swedberg, Karl; Seferovic, Petar; Sabaté Tenas, Manel; Ristić, Arsen D; Pavie, Alain; Mayosi, Bongani; Maisch, Bernhard; Lionis, Christos; Klingel, Karin; Gueret, Pascal; Brucato, Antonio; Bogaert, Jan; Barón-Esquivias, Gonzalo; Badano, Luigi; Imazio, Massimo; Charron, Philippe; Adler, Yehuda; Achenbach, Stephan; Agewall, Stefan; Al-Attar, Nawwar; Angel Ferrer, Juan; Arad, Michael; Asteggiano, Riccardo; Bueno, Héctor; Caforio, Alida L P; Carerj, Scipione; Ceconi, Claudio; Evangelista, Arturo; Flachskampf, Frank; Giannakoulas, George; Gielen, Stephan; Habib, Gilbert; Kolh, Philippe; Lambrinou, Ekaterini; Lancellotti, Patrizio; Lazaros, George; Linhart, Ales; Meurin, Philippe; Nieman, Koen; Piepoli, Massimo F; Price, Susanna; Roos-Hesselink, Jolien; Roubille, François; Ruschitzka, Frank; Sagristà Sauleda, Jaume; Sousa-Uva, Miguel; Uwe Voigt, Jens; Luis Zamorano, Jose; Zamorano, Jose Luis; Aboyans, Victor; Achenbach, Stephan; Agewall, Stefan; Badimon, Lina; Barón-Esquivias, Gonzalo; Baumgartner, Helmut; Bax, Jeroen J; Bueno, Héctor; Carerj, Scipione; Dean, Veronica; Erol, Çetin; Fitzimons, Donna; Gaemperli, Oliver; Kirchhof, Paulus; Kolh, Philippe; Lancellotti, Patrizio; Lip, Gregory YH; Nihoyannopoulos, Petros; Piepoli, Massimo F; Ponikowski, Piotr; Roffi, Marco; Torbicki, Adam; Vaz Carneiro, Antonio; Windecker, Stephan; Shuka, Naltin; Sisakian, Hamayak; Mascherbauer, Julia; Isayev, Elnur; Shumavets, Vadim; Van Camp, Guy; Gatzov, Plamen; Hanzevacki, Jadranka Separovic; Moustra, Hera Heracleous; Linhart, Ales; Møller, Jacob Eifer; Aboleineen, Mohamed Wafaie; Põder, Pentti; Lehtonen, Jukka; Antov, Slobodan; Damy, Thibaud; Schieffer, Bernhard; Dimitriadis, Kyriakos; Kiss, Robert Gabor; Rafnsson, Arnar; Arad, Michael; Novo, Salvatore; Mirrakhimov, Erkin; Stradinš, Peteris; Kavoliuniene, Ausra; Codreanu, Andrei; Dingli, Philip; Vataman, Eleonora; El Hattaoui, Mustapaha; Samstad, Stein Olav; Hoffman, Piotr; Lopes, Luís Rocha; Dimulescu, Doina Ruxandra; Arutyunov, Grigory P; Pavlovic, Milan; Dúbrava, Juraj; Sauleda, Jaume Sagristà; Andersson, Bert; Müller, Hajo; Bouma, Berto J; Abaci, Adnan; Archbold, Andrew; Nesukay, Elena (2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases". European Heart Journal. 36 (42): 2921–2964. doi:10.1093/eurheartj/ehv318. ISSN 0195-668X.
- ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 Dabbagh, Mohammed F.; Aurora, Lindsey; D’Souza, Penny; Weinmann, Allison J.; Bhargava, Pallavi; Basir, Mir B. (2020). "Cardiac Tamponade Secondary to COVID-19". JACC: Case Reports. doi:10.1016/j.jaccas.2020.04.009. ISSN 2666-0849.
- ↑ 10.0 10.1 10.2 10.3 10.4 Inciardi, Riccardo M.; Lupi, Laura; Zaccone, Gregorio; Italia, Leonardo; Raffo, Michela; Tomasoni, Daniela; Cani, Dario S.; Cerini, Manuel; Farina, Davide; Gavazzi, Emanuele; Maroldi, Roberto; Adamo, Marianna; Ammirati, Enrico; Sinagra, Gianfranco; Lombardi, Carlo M.; Metra, Marco (2020). "Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)". JAMA Cardiology. doi:10.1001/jamacardio.2020.1096. ISSN 2380-6583.
- ↑ 11.0 11.1 Maceira, Alicia M; Lopez-Lereu, Maria P; Higueras Ortega, Laura; García-Gonzalez, Pilar; Broseta Torres, Ricardo; Solsona Caravaca, Javier; Ventura Perez, Bruno; Andres Soler, Jorge; Dominguez Mafe, Eloy; Monmeneu, Jose V; Voges, Inga (2020). "Subacute perimyocarditis in a young patient with COVID-19 infection". European Heart Journal - Case Reports. doi:10.1093/ehjcr/ytaa157. ISSN 2514-2119.
- ↑ 12.0 12.1 12.2 12.3 12.4 Byrne, Jonathan; Sado, Daniel; O’Gallagher, Kevin; Hua, Alina (2020). "Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19". European Heart Journal. 41 (22): 2130–2130. doi:10.1093/eurheartj/ehaa253. ISSN 0195-668X.
- ↑ 13.0 13.1 13.2 13.3 13.4 Cizgici, Ahmet Yasar; Zencirkiran Agus, Hicaz; Yildiz, Mustafa (2020). "COVID-19 myopericarditis: It should be kept in mind in today's conditions". The American Journal of Emergency Medicine. 38 (7): 1547.e5–1547.e6. doi:10.1016/j.ajem.2020.04.080. ISSN 0735-6757.
- ↑ 14.0 14.1 14.2 14.3 14.4 Tung-Chen, Yale (2020). "Acute pericarditis due to COVID-19 infection: An underdiagnosed disease?". Medicina Clínica. 155 (1): 44–45. doi:10.1016/j.medcli.2020.04.007. ISSN 0025-7753.
- ↑ "View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge".
- ↑ "Diagnosis of acute pericarditis".
- ↑ "Diagnosis of acute pericarditis".
- ↑ Imazio, Massimo; Demichelis, Brunella; Cecchi, Enrico; Belli, Riccardo; Ghisio, Aldo; Bobbio, Marco; Trinchero, Rita (2003). "Cardiac troponin i in acute pericarditis". Journal of the American College of Cardiology. 42 (12): 2144–2148. doi:10.1016/j.jacc.2003.02.001. ISSN 0735-1097.
- ↑ Bonnefoy, E (2000). "Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis". European Heart Journal. 21 (10): 832–836. doi:10.1053/euhj.1999.1907. ISSN 0195-668X.
- ↑ "View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge".
- ↑ "View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge".
- ↑ "View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge".
- ↑ "Diagnosis of acute pericarditis".
- ↑ "View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge".
- ↑ "View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge".
- ↑ Russell, Beth; Moss, Charlotte; Rigg, Anne; Van Hemelrijck, Mieke (2020). "COVID-19 and treatment with NSAIDs and corticosteroids: should we be limiting their use in the clinical setting?". ecancermedicalscience. 14. doi:10.3332/ecancer.2020.1023. ISSN 1754-6605.
- ↑ Bancos, Simona; Bernard, Matthew P.; Topham, David J.; Phipps, Richard P. (2009). "Ibuprofen and other widely used non-steroidal anti-inflammatory drugs inhibit antibody production in human cells". Cellular Immunology. 258 (1): 18–28. doi:10.1016/j.cellimm.2009.03.007. ISSN 0008-8749.
- ↑ "FDA advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19 | FDA".
- ↑ "View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge".