Covid 19 and Pericarditis: Should We Be Worried about Tamponade?

Abstract

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.