A 25-year-old man presented to the emergency department with acute-onset chest pain and shortness of breath. A physical examination revealed coarse crackles in the both lower lungs. Consolidation and ground-glass opacities suggesting viral infection were detected in the right lower lobe on chest computed tomography. Laboratory findings revealed elevated troponin, leukocytosis, and lymphopenia. Electrocardiography revealed ST segment elevation with PR depression in leads I, aVL, V5, and V6, and ST depression and PR elevation in aVR. Echocardiography revealed diffuse cardiac hypokinesia and a decreased left ventricular ejection fraction. Suspecting coronavirus disease 2019 (COVID-19)–related myopericarditis, the patient was hospitalized. After one week of empirical antibiotics, antivirals, and supportive therapy, his condition improved. Antibody testing for COVID-19 was positive on hospitalization day 8. The presentation of myopericarditis can be vague and mislead physicians during the COVID-19 pandemic. Myopericarditis should be included as a differential diagnosis for patients with suspected COVID-19.
Although cardiovascular complications of coronavirus disease 2019 (COVID-19) are well defined in hospitalized patients, emergency department presentation of patients suggesting COVID-19 related myopericarditis is scarce.
Myopericarditis is an insidious condition that can accompany COVID-19. Emergency physicians should consider myopericarditis as an important differential diagnosis in patients with COVID-19.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing coronavirus disease 2019 (COVID-19) was first reported in China in December 2019. Subsequently, it was declared as a pandemic by the World Health Organization in March 2020, and the global burden of COVID-19 was reported as 37,888,384 cases and 1,081,868 deaths as of October 14, 2020 [
While most COVID-19-related clinical conditions are associated with the respiratory system, cardiovascular involvement is also common and related to high mortality rates among hospitalized patients [
We report a case of COVID-19-associated myopericarditis and review the current literature to increase emergency physicians’ awareness of COVID-19-associated myopericarditis as they care for patients with COVID-19.
A 25-year-old man presented to the emergency department (ED) with acute onset chest pain and shortness of breath (SOB). The patient’s medical history was unremarkable; however, the patient had a 4-day history of progressive fatigue and fever. In the ED, the patient’s blood pressure was 130/80 mmHg, heart rate was 140 beats per minute, oxygen saturation was 98% in room air, and temperature was 37.1°C. A physical examination revealed tachycardia and coarse crackles in the both lower lung zones. An electrocardiogram (ECG) showed sinus tachycardia with ST segment elevation and PR depression in leads I, aVL, V5, and V6 and ST depression and PR elevation in aVR (
Myopericarditis is a challenging diagnosis encountered in the ED. Although it should be suspected in any patients with chest pain, increased troponin levels, and dynamic ECG changes, these findings are non-specific and can also be seen in patients with systemic infections, including those with COVID-19 [
Most patients with COVID-19 present to the ED with fever, cough, and SOB [
Cardiac biomarkers such as troponin or N-terminal pro-B-type natriuretic peptide (NT-proBNP) were elevated in patients with myopericarditis [
Utilizing echocardiography as an initial diagnostic workup in the ED may facilitate the care of patients with myopericarditis [
In conclusion, myopericarditis is an insidious condition that can accompany COVID-19. Emergency physicians should consider myopericarditis as an important differential diagnosis for patients with COVID-19.
No potential conflict of interest relevant to this article was reported.
Supplementary Table is available from:
The literature on the presented case
Electrocardiogram and computerized tomography findings of the patients. (A) Electrocardiogram findings of the patients. (B) Consolidation and ground glass opacities on the computed tomography image.
Progression of laboratory findings
Day 1 | Day 2 | Day 3 | Day 4 | |
---|---|---|---|---|
TnI (ng/mL) | 6.499 | 3.197 | 1.137 | 0.161 |
ref: 0.012–0.02 ng/mL | ||||
CK-MB (ng/mL) | 37.1 | 8.4 | 1.8 | 3 |
ref: 0.6–6.3 ng/mL | ||||
WBC (× 103/μL) | 11.58 | 12.76 | NT | NT |
ref: 4.5–11 × 103/μL | ||||
CRP (mg/L) | 47.10 | 50.64 | 67.11 | 14.85 |
ref: < 5 mg/L | ||||
Lymphocyte (× 103/μL) | 1.00 | NT | NT | NT |
ref 1.5–4 × 103/μL |
TnI, troponin I; CK-MB, creatine kinase-MB; WBC, white blood cells; CRP, C-reactive protein; NT, not tested.