COVID-19 Suspected myopericarditis without pulmonary involvement.
Steven Mirabella, Oshin Bansode, Hyfaa Mashaal and 1 others
PMID 34731691WHAT IT FOUND
A young man had suspected COVID-19 myopericarditis, shock, high troponin, ST elevations, and no lung findings on CT.
He improved after a complex ICU course; one case cannot prove any specific treatment worked.
Key findings
01The report describes a critically ill patient with suspected COVID-19 myopericarditis and no CT evidence of pulmonary involvement.
02Troponin was 553 ng/L on admission and peaked at 2898 ng/L, EKG showed ST elevations, and repeat echocardiography showed ejection fraction 50% with a small pericardial effusion.
03Pressor support was stopped by day 4, the patient was downgraded to the medicine service on day 5, and follow-up showed EKG improvement and return to baseline activity.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is one case, so it cannot show how common suspected COVID-19 myopericarditis is or that a treatment works. The diagnosis was suspected clinically; cardiac MRI or endomyocardial biopsy did not confirm myocardial inflammation, and cardiac CT was deferred. Many treatments were given together, including antibiotics, antiplatelet and anticoagulant drugs, colchicine, aspirin, pressors, hydrocortisone, and volume resuscitation, so the contribution of any one treatment cannot be separated. Follow-up was incomplete: a repeat echocardiogram was ordered but not performed at the time of writing. The patient had negative SARS-CoV-2 PCR and positive IgG antibody, so the timing of infection was not clearly established.
The easy way to misread this
Do not conclude that aspirin and colchicine caused recovery. The patient also received ticagrelor, heparin, norepinephrine, piperacillin-tazobactam, vancomycin, metronidazole, ceftriaxone, ciprofloxacin, phenylephrine, vasopressin, hydrocortisone, and volume resuscitation, and one case cannot show efficacy.