Abdelmottaleb Wael, Salmon James Thomas, Quintanilla Rodriguez Bryan S, Portillo Ingrid, Mushiyev Savi
Internal Medicine, Metropolitan Hospital Center - New York Medical College, New York City, USA.
Cardiology, Metropolitan Hospital Center - New York Medical College, New York City, USA.
Cureus. 2022 Jul 26;14(7):e27291. doi: 10.7759/cureus.27291. eCollection 2022 Jul.
COVID-19 infection is a complex multi-organ disease, including the cardiovascular system, which may present with myocarditis. A 42-year-old female presented to our ED with generalized weakness, myalgia, and epigastric pain. Laboratory workup showed a positive SARS-CoV-2 polymerase chain reaction (PCR). An ECG showed sinus tachycardia with low voltage. A bedside echocardiogram showed a pericardial effusion with cardiac tamponade. An emergent pericardiocentesis was performed with immediate hemodynamic improvement. The patient was admitted to the coronary care unit (CCU), and colchicine and ibuprofen were started for pericarditis. Pericardial fluid bacterial and fungal cultures were negative, and serum antinuclear antibodies were also negative. On day 5 of hospitalization, creatine kinase (CK) level was high compared to on presentation. COVID-induced rhabdomyolysis was suspected and was dramatically improved with IV fluids. The patient was discharged on day 7 of admission. Our case shows that COVID-19 can present with an uncommon presentation like cardiac tamponade. Further studies are warranted to better understand the pathogenesis and management of COVID-19 myopericarditis.
新型冠状病毒肺炎（COVID-19）感染是一种复杂的多器官疾病，包括心血管系统，可能会出现心肌炎。一名42岁女性因全身无力、肌痛和上腹部疼痛就诊于我院急诊科。实验室检查显示严重急性呼吸综合征冠状病毒2（SARS-CoV-2）聚合酶链反应（PCR）呈阳性。心电图显示窦性心动过速伴低电压。床旁超声心动图显示心包积液伴心脏压塞。立即进行了紧急心包穿刺术，患者血流动力学立即得到改善。患者被收入冠心病监护病房（CCU），开始使用秋水仙碱和布洛芬治疗心包炎。心包液细菌和真菌培养均为阴性，血清抗核抗体也为阴性。住院第5天，肌酸激酶（CK）水平比入院时高。怀疑是COVID-19引起的横纹肌溶解症，通过静脉输液治疗后病情明显改善。患者于入院第7天出院。我们的病例表明，COVID-19可能会出现如心脏压塞这样不常见的表现。有必要进行进一步研究，以更好地了解COVID-19心肌心包炎的发病机制和治疗方法。
