How COVID broke my heart: a case report of tamponade after SARS-CoV-2 infection

Abstract

SARS-CoV-2 leading to COVID-19 is a global pandemic, the likes of which have been unprecedented in our lifetime, with many presentations, unknown complications, and few effective treatment options. The most common organ affected by COVID-19 is the lungs, but another well-known effect of COVID-19 infection is thromboembolic phenomena. In this case, a patient previously infected with SARSCoV-2 developed chest pain radiating to the back, shortness of breath, and marked hypertension and was diagnosed with an acute ST-segment elevation myocardial infarction (STEMI) complicated by a moderate pericardial effusion which led to a cardiac tamponade. The patient had all three of the components of Beck's Triad: muffled heart sounds, jugular venous distention, and hypotension as well as a narrow pulse pressure and had COVID-19 induced myocarditis resulting in a pericardial effusion and tamponade physiology. This COVID-19 associated pericardial effusion has, to our knowledge, been reported only six times in the literature and this presentation was unique because the patient was in the subacute phase with COVID-19, had a cardiac tamponade, and had a thrombosed stent during the catheterization despite being on long term apixaban. The patient underwent emergency percutaneous coronary intervention (PCI) with two stents and was transferred to the intensive care unit where he was noted to have worsening hypotension despite aggressive vasopressor support. Ultimately, despite an emergent bedside pericardiocentesis, the patient succumbed to complications of COVID-19 infection. To our knowledge, there have only been six reported cases in the literature of COVID-19 associated pericardial effusions, and four had cardiac tamponade. It is imperative that clinicians be wary of, and educated about, the less common effects of COVID-19 infection even after the acute phase has passed, which include a persistent prothrombotic state. © Journal of Emergency and Critical Care Medicine. All rights reserved.