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COVID-19 myopericarditis: A case report
Miopericarditis por COVID-19: A propósito de un caso
G. Pérez-Acosta
, L. Santana-Cabrera, J. Blanco-López, J.C. Martín-González
Corresponding author
Servicio de Medicina Intensiva, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
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"tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "311" "paginaFinal" => "312" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es la nutrición el factor de riesgo olvidado en la infección por COVID-19?" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2071 "Ancho" => 2925 "Tamanyo" => 460394 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The interrelationship between nutritional status, health, and COVID-19 progress.</p> <p id="spar0001" class="elsevierStyleSimplePara elsevierViewall">Several mechanisms have been implicated in COVID-19 progress. Host-related factors include sex, age, and lung and metabolic diseases. A more unknown aspect is the interrelationship between nutritional status and health at not only the individual, but also the community and global levels. Several factors contribute to nutritional status, including economic stability; medical comorbidities; racism or other discrimination; and food insecurity, as determined by unequal access to essential nutrients or healthy food. All condition community and individual health status such that, through impaired innate and acquired immunity or unhealthy gut microbiota, they predispose individuals to infectious diseases as well as more aggressive and severe COVID-19 disease.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Carretero Gómez, J.P. Miramontes González, C. Dueñas Gutiérrez, J.C. Arévalo Lorido" "autores" => array:4 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Carretero Gómez" ] 1 => array:2 [ "nombre" => "J.P." "apellidos" => "Miramontes González" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Dueñas Gutiérrez" ] 3 => array:2 [ "nombre" => "J.C." "apellidos" => "Arévalo Lorido" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256521000035" "doi" => "10.1016/j.rce.2020.12.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256521000035?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000242?idApp=WRCEE" "url" => "/22548874/0000022100000005/v3_202105110748/S2254887421000242/v3_202105110748/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Correspondence</span>" "titulo" => "COVID-19 myopericarditis: A case report" "tieneTextoCompleto" => true "saludo" => "Dear Director:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "312" "paginaFinal" => "313" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "G. Pérez-Acosta, L. Santana-Cabrera, J. Blanco-López, J.C. Martín-González" "autores" => array:4 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Pérez-Acosta" "email" => array:1 [ 0 => "gperaco@gobiernodecanarias.org" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Santana-Cabrera" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Blanco-López" ] 3 => array:2 [ "nombre" => "J.C." "apellidos" => "Martín-González" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Intensiva, Complejo Hospitalario Universitario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Miopericarditis por COVID-19: A propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 988 "Ancho" => 1743 "Tamanyo" => 236122 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Chest radiography. B) CT showing thrombi in both main pulmonary arteries (arrows), in addition to interstitial infiltrates (star). C) ECG with generalised concave ST elevation.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">SARS-CoV-2 fundamentally causes a severe respiratory infection characterised by diffuse interstitial infiltrates. Some cases of myocarditis have been reported as causing arrhythmia, heart failure, cardiogenic shock, and even death in some patients.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> The most likely pathophysiological mechanism is multifactorial: from the direct damage of the virus to the cardiomyocytes, the immune response generated by the body against the viral infection, or the hypoxia-induced injury.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 61-year-old male with a history of obesity who self-referred for symptoms of progressive dyspnoea of five days since onset and was admitted with severe hypoxemic respiratory failure.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The chest radiography showed bilateral interstitial infiltrate (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). Severe pneumonia due to Covid-19 was suspected and confirmed via PCR. Due to hemodynamic and respiratory instability, orotracheal intubation and mechanical ventilation was required; a transthoracic echocardiogram (TTE) was performed which showed severe dysfunction of the right ventricle with paradoxical septal motion due to overload of the right cavities, in addition to severe tricuspid regurgitation.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">With suspected pulmonary thromboembolism, computed tomography angiography (CT angiogram) of the chest was performed, confirming the presence of thrombi in both main pulmonary arteries (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). This clinical situation required high dose catecholamines and elevated oxygen requirements, so systemic fibrinolysis was administered. During admission, a progressive trend towards stabilisation of the clinical picture was observed with improved right ventricular function and normalisation of the cardiac damage markers.</p><p id="par0025" class="elsevierStylePara elsevierViewall">On the seventh day of admission, under sedation and analgesia and connected to invasive mechanical ventilation, the patient presented electrocardiographic changes (ECG) with generalised concave ST elevation (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C), confirming elevation of the cardiac damage markers. A new TTE was performed, showing adequate left ventricular ejection fraction (LVEF), with mild to moderate pericardial effusion, suggestive of acute myopericarditis.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The patient showed satisfactory evolution and was moved to the ward 14 days after his initial admission.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, SARS-CoV-2 infection can cause systemic involvement beyond respiratory failure, with cardiac complications common during the clinical progress of this disease,<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> with elevated morbidity and mortality. Therefore, it is vitally important to be highly aware when preventing and diagnosing these cardiac complications in order to properly manage these types of patients in intensive care units.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Serial ECG analysis, cardiac markers, and echocardiograms are recommended in patients with SARS-CoV-2 infection. Nevertheless, it can be hard to clinically differentiate between cardiac involvement due to sepsis or stress cardiomyopathy or due to a coronary syndrome.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0045" class="elsevierStylePara elsevierViewall">This study did not receive any type of funding.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors declare that they do not have any conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflicts of interest" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Pérez-Acosta G, Santana-Cabrera L, Blanco-López J, Martín-González JC. Miopericarditis por COVID-19: A propósito de un caso. Rev Clin Esp. 2021;221:312–313.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 988 "Ancho" => 1743 "Tamanyo" => 236122 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Chest radiography. B) CT showing thrombi in both main pulmonary arteries (arrows), in addition to interstitial infiltrates (star). C) ECG with generalised concave ST elevation.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "First case of COVID-19 infection with fulminant myocarditis complication: case report and insights" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.H. Zeng" 1 => "Y.X. Liu" 2 => "J. Yuan" 3 => "F.X. Wang" 4 => "W.B. Wu" 5 => "J.X. Li" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s15010-020-01424-5" "Revista" => array:6 [ "tituloSerie" => "Infection." "fecha" => "2020" "volumen" => "48" "paginaInicial" => "773" "paginaFinal" => "777" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32277408" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R.M. Inciardi" 1 => "L. Lupi" 2 => "G. Zaccone" 3 => "L. Italia" 4 => "M. Raffo" 5 => "D. Tomasoni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/jamacardio.2020.1096" "Revista" => array:6 [ "tituloSerie" => "JAMA Cardiol." 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