key: cord-0810749-8zrwkfvc
authors: García-Cruz, Edgar; Manzur-Sandoval, Daniel; Lazcano-Díaz, Emmanuel Adrián; Soria-Castro, Elizabeth; Jiménez-Becerra, Silvia
title: Cardiac Tamponade in a Patient With Myocardial Infarction and COVID-19 Infection; Electron Microscopy Findings
date: 2020-08-04
journal: JACC Case Rep
DOI: 10.1016/j.jaccas.2020.07.042
sha: b99df16977cfcea6fdf6122ccdb5dd85996a2573
doc_id: 810749
cord_uid: 8zrwkfvc

Abstract. We present the case of a patient with myocardial infarction and COVID-19 infection who developed hemorrhagic pericardial effusion and cardiac tamponade. The differential diagnosis included postinfarction pericarditis and mechanical complications, thrombolysis, Dressler´s syndrome and viral pericarditis. The histopathological examination of the pericardial tissue sample and electron microscopy established the diagnosis.

We present the case of a patient with myocardial infarction and COVID-19 infection who developed hemorrhagic pericardial effusion and cardiac tamponade. The differential diagnosis included postinfarction pericarditis and mechanical complications, thrombolysis, Dressler´s syndrome and viral pericarditis. The histopathological examination of the pericardial tissue sample and electron microscopy established the diagnosis.

A 64 year-old-male admitted with chest pain, dry cough and fever (38.3ºC). He was dyspneic with SaO 2 85%, HR 84 bpm and BP 106/87 mmHg. Diffuse pulmonary rales were found predominatly at the left lung base. The ECG showed ST segment elevation at inferior and posterior leads. Chest X ray showed bilateral diffuse interstitial infiltrates predominantly at left lung. A RT-PCR for detection of SARS-CoV-2 RNA was positive, so antiviral therapy was (Figure 1C and 1D) ; electron microscopy showed viral particles ( Figure 1E and 1F) . During COVID-19 pandemic the treatment of STEMI has changed prioritizing a safe intra-hospital environment preferring thrombolysis over primary angioplasty (1) . In this patient with hemorrhagic pericardial effusion the differential diagnosis included: postinfarction pericarditis, mechanical complications of myocardial infarction, associated with thrombolysis, Dressler´s syndrome and viral pericarditis. Viral pericarditis has been recognized as the cause of up to 62% of hemorrhagic pericardial effusions (2) . The presence of SARS-CoV-2 in pericardial fluid has been recently reported (also hemorrhagic) (3) . For this reason, we sent a pericardium sample to the pathology service, where compatible changes with acute pericarditis were found and with electron microscopy the presence of viral particles was documented, so the final diagnosis was hemorrhagic pericardial effusion with cardiac tamponade secondary to 

The presence of echogenic pericardial effusion suggests its hemorrhagic origin. 2. In the current COVID-19 pandemic, SARS-CoV-2 could be the etiology of acute pericarditis and hemorrhagic pericardial effusion

Recommendations from the Peking Union Medical College Hospital for the management of acute myocardial infarction during the COVID-19 outbreak

The Usefulness of Diagnostic Tests on Pericardial Fluid

Cardiac Tamponade Secondary to COVID-19