A CARDIOVASCULAR COMPLICATION OF COVID-19: DELAYED PRESENTATION OF ACUTE MYOPERICARDITIS

Abstract

SESSION TITLE: Medical Student/Resident Cardiovascular Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: “SARS CoV-2” is an enveloped non segmented positive-sense RNA virus,. In December 2019, SARS CoV-2 started as a pandemic in Wuhan city of China and spread to the rest of the world. The classical clinical picture of COVID-19 is variable ranging from asymptomatic, a flu-like syndrome of mild severity, to interstitial pneumonia and a variable degree of respiratory failure with elevation of cardiac troponin I (cTnI) levels and arrhythmia in most cases. In here we present a case of delayed presentation of acute Viral Myopericarditis by COVID 19 even after the patient had recovered from infection. CASE PRESENTATION: A previously healthy 29 year old female presented with acute chest pressure of 5 hour duration, 10/10 in intensity, located at left sternal border. It was worsened with lying flat, and deep breathing and better with sitting up and bending forward. Forty five days before this presentation, she had cough, fever and fatigue and was diagnosed with COVID 19. After 14 days, patient was cleared by the state health department. Physical examination including the CVS and respiratory systems was normal. Laboratory tests showed on elevated troponin-1 level of 0.5 µg/L, which peaked to 8.09 µg/L the following day, (ESR) elevated at 35mm/hr, lactate dehydrogenase (LDH) elevated at 244U/L, C-reactive protein (CRP) elevated at 19.2mg/L. and D-dimer elevated at 561 FEUng/m. Two repeat SARS CoV-2 testing were negative. Electrocardiogram showed some non-specific T wave inversions in leads V3 with normal sinus rhythm at a rate of 87 beats per minute. Transthoracic echocardiography performed which did not demonstrate wall motion abnormalities or pericardial effusion. Chest CTA was negative for acute pulmonary embolism. The patient was diagnosed with viral myopericarditis caused by COVID 19. The patient was managed with pain medications, ibuprofen, and colchicine and was discharged in 2 days. DISCUSSION: Viral myopericarditis is the most common cause of myopericarditis. The exact mechanism COVID 19 causing cardiac injury is not clear. It could be either due to direct invasion of the cardiac myocytes or through immune mediated which is more likely in our patient. The cardiac manifestation of COVID 19 ranges from patients having asymptomatic troponin leak, acute CHF exacerbation due to dilated cardiomyopathy and arrhythmias. The treatment at this time is mainly supportive with medications such as remdesivir, favipivir, protease inhibitors under trial. CONCLUSIONS: A thorough history and physical for previous history and timing of exposure, and also help establish diagnosis and exclusion for acute coronary syndrome, to avoid delay in anti-inflammatory therapy and unnecessary testing. Post-viral acute myopericardial damage should be suspected even in the absence of residual viral genome Reference #1: Management of Acute and Recurrent Pericarditis. J Am Coll Cardiol 2020;75:76-92. Chiabrando JG, Bonaventura A, Vecchié A, et al. DISCLOSURES: No relevant relationships by Navya Akula, source=Web Response No relevant relationships by Miluska Mejia Trebejo, source=Web Response No relevant relationships by tausif syed, source=Web Response