SHM Converge Scientific Abstract ePoster Gallery-A Case of Hemorrhagic Pericardial Effusion With Early Sign of Tamponade in Sars-Cov-2

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This case report describes a 76-year-old Hispanic man with hypertension, prediabetes, obesity, and a history of unprovoked DVT/PE on apixaban who presented with two weeks of worsening dyspnea and orthopnea. He had no chest pain, fever, or other typical infectious symptoms. Initial tests were largely normal except for elevated D-dimer and a positive SARS-CoV-2 PCR. CT angiography showed a small pericardial effusion and left pleural effusion without pulmonary embolism.<br /><br />Although he was initially stable, he developed tachycardia and jugular venous distension within 48 hours. Repeat echocardiography showed a moderate circumferential pericardial effusion with early signs of cardiac tamponade, including respiratory variation of mitral inflow and mild right ventricular diastolic collapse. Emergent pericardiocentesis was performed, and grossly bloody pericardial fluid confirmed hemopericardium, with subsequent clinical improvement.<br /><br />Workup for autoimmune, infectious, and malignant causes was negative. Pericardial fluid analysis showed a hemorrhagic, exudative effusion with high RBC count, neutrophilic predominance, elevated LDH, and elevated protein. The authors conclude that COVID-19 was the most likely cause of the hemorrhagic pericardial effusion, especially since tamponade symptoms began only after the patient tested positive. They note that pericardial effusion and tamponade are rare COVID-19 complications, often appearing late in the disease course, and that the exact mechanism remains unclear. Potential mechanisms include cytokine-mediated inflammation, ACE2 pathway activation, and hypoxia-related myocardial injury.

Asset Subtitle

Rabia Ashraf

Meta Tag

Author List Maham Siddique, Mubarak H. Yusuf, Rabia Ashraf

Category Clinical Vignettes

Concept COVID-19

Concept Hemorrhagic Pericardial Effusion

Concept Cardiac Tamponade

Concept Pericardiocentesis

Concept Pericardial Effusion

Distinguished Non-Finalist

Presenter Organization Lincoln Medical Center

Presenting Author Rabia Ashraf

Track Adult

Keywords

COVID-19

hemopericardium

cardiac tamponade

pericardial effusion

pericardiocentesis

SARS-CoV-2

dyspnea

orthopnea

pleural effusion

D-dimer

COVID-19

Hemorrhagic Pericardial Effusion

Cardiac Tamponade

Pericardiocentesis

Pericardial Effusion