Browsing by Subject "Pericarditis"

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    A case report of constrictive pericarditis following COVID-19 vaccination
    (Oxford University Press, 2023-11-06) Bain, Eric; Guglin, Maya; Medicine, School of Medicine
    Background: COVID-19 infection and the COVID-19 vaccines have been associated with rare cases of pericarditis. We present a case of constrictive pericarditis (CP) following the vaccine. Case summary: A 19-year-old healthy male started having progressive abdominal pain, emesis, dyspnoea, and pleuritic chest pain 2 weeks after the second dose of Pfizer vaccine. Computed tomography angiography chest revealed bilateral pleural effusions and pericardial thickening with effusion. Cardiac catheterization showed ventricular interdependence. Cardiac magnetic resonance (CMR) showed septal bounce and left ventricular tethering suggestive of CP. A total pericardiectomy was performed with significant symptom improvement. Pathology showed chronic fibrosis without amyloid, iron deposits, or opportunistic infections. Patient had Epstein-Barr Virus (EBV) viraemia 825 IU/mL and histoplasmosis complement-fixation positive with negative serum and urine antigen. Hypercoagulable panel and infectious workup were otherwise negative. The patient had resolution of cardiac symptoms at 3 months of follow-up. Discussion: The patient developed progressive symptoms within 2 weeks of his second Pfizer vaccine. Echocardiogram and CMR had classic signs of CP, and pericardial pathology confirmed fibrotic pericardium. The patient had no prior surgery, thoracic radiation, or bacterial infection. Epstein-Barr Virus viraemia was thought to be reactionary, and histoplasmosis complement likely represented chronic exposure. The timing of symptoms and negative multidisciplinary workup raises the suspicion for COVID vaccine-induced CP. The COVID vaccines benefits far exceed the risks, but complications still can occur. Practitioners should have a high index of suspicion to allow prompt diagnosis of CP.
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    Covid 19 and Pericarditis: Should We Be Worried about Tamponade?
    (Elsevier, 2022) Arshad, Samiullah; Gul, Muhammad Hamdan; Guglin, Maya; Medicine, School of Medicine
    Introduction: Little is known about cardiac manifestations of COVID-19 infection, yet cases of pericarditis, pericardial effusion and with tamponade due to COVID-19 have been reported. Because of the life-threatening nature of this complication, we wanted to investigate the features of pericardial effusion and the rate of occurrence of tamponade in patients with COVID-19. Methods: This systematic review was conducted by searching for studies in Pubmed/Medline and Google Scholar for the search terms ‘COVID-19’, ‘SARS-COV-2’, ‘Pericarditis’, ‘Pericardial Effusion’ and ‘Cardiac Tamponade’, performed on December 7, 2020. Results: A total of 47 patients with COVID-19 with pericarditis were included in the review from 39 published cases. There were 29 (62%) males and 18 (38%) females and mean age of patients was 53 years. Pulmonary infiltrates were seen in 30 (64%) patients, while 17 (36%) patients did not have pulmonary manifestations. Concomitant myocarditis was present in 16 (34%) patients. 43 (91%) had pericardial effusion- 4 (9%) had small, 10 (21%) had moderate, 3 (6%) had a large pericardial effusion and 26 (55%) patients had cardiac tamponade. 7 (15%) patients with tamponade died. Pericardiocentesis was done in 27 (57%) patients and pericardial window was created in 5 (11%) patients. Off these 13 (27%) patients had an exudative effusion while 1 (2%) patient had a transudative effusion. Conclusion: We found that pericarditis in patients with COVID-19 infection can be present in patients with pulmonary infiltrates and without them, as well as with myocarditis or as an isolated feature of cardiac involvement. The effusion is predominantly exudative. More than half of the patients with pericardial involvement present with tamponade, and mortality in this subset is high. The pattern of patients presenting solely with pericarditis and effusion without pulmonary infiltrates warrants further investigation.