COVID-19-associated pericarditis
Jump to navigation
Jump to search
For COVID-19 frequently asked inpatient questions, click here
For COVID-19 frequently asked outpatient questions, click here
For COVID-19 patient information, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Zand, M.D.[2] Mounika Reddy Vadiyala, M.B.B.S.[3]
Synonyms and keywords: Novel coronavirus, COVID-19, Wuhan coronavirus, coronavirus Disease-19, coronavirus disease 2019, SARS-CoV-2, COVID-19, COVID-19, 2019-nCoV, 2019 novel coronavirus, cardiovascular finding in COVID-19, pericardial injury in COVID-19, pericarditis, pericarditis in COVID-19, COVID-19-associated Pericarditis, SARS-CoV2-associated pericarditis, myocardial injury in COVID-19, COVID-19 pericarditis
Overview
COVID-19 caused by the novel coronavirus, also known as SARS-CoV-2 mainly affects the lungs, causing severe acute respiratory syndrome. It has been proposed that covid-19 invades through the angiotensin-converting enzyme 2 (ACE2) receptors present abundantly not only in the lungs but also in the heart, endothelium, cardiomyocytes, epicardial adipose tissue adjacent to the visceral pericardium.In addition, Inflammatory cascade may prompt to cardiac manifestations in covid-19. Acute pericarditis is one of the cardiac complications of covid-19 resulting from the inflammation of pericardial sac surrounding the heart. Few cases of covid-19-associated pericarditis have been reported whether none of them were proven to be due to direct invasion of pericardium by corona virus. Reports on large pericardial effusion and cardiac tamponade are rare in covid-19. Pericarditis after vaccination of covid-19 has been reported with few incidence in elderly patients.
Historical Perspective
- Acute pericarditis associated with covid-19 was first reported by Yale Tung-Chen in 2020 during investigation about worsening of pleuritic chest pain in a young covid-19 patient and finding of mild pericardial effusion by cardiac sonography.[1]
- The novel coronavirus, SARS-CoV-2, is identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China in late December 2019. SARS-CoV-2 has rapidly spread across China and in other countries, raising major global concerns.
- This novel coronavirus, SARS-CoV-2, was named the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) for it similarity severe acute respiratory syndrome related coronaviruses such as SARS-CoV, which caused acute respiratory distress syndrome (ARDS) in 2002–2003.[2][3][4][5][6]
- On January 30, 2020, the World Health Organization (WHO) declared the outbreak a Public Health Emergency of International Concern.[7]
- On March 12, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic.[8]
Classification
- There is no established system for the classification of the pericarditis seen in COVID-19.
- For general classification of pericarditis, click here.
Pathophysiology
- Viral infections are a common cause of pericarditis.
- It is hypothesized that viruses cause pericardial inflammation via direct cytotoxic effects or via immune-mediated mechanisms.[9]
- The exact mechanism of covid-19 induced pericarditis is not yet well known.
- Probable mechanisms of covid-19-associated pericarditis from the limited cases reported are:
- Direct invasion of the virus
- Cytokine storm and systemic hyperinflammatory response: This might be leading to pericarditis and subsequent pericardial effusion in certain patients.
- Pericardial biopsy of a covid-19 patients showed reactive mesothelial cells, lymphocytes, macrophages.[10]
- Increased level of cytokines including IL1, TNF-alpha as well as activated inflammatory cascade are noted in the pathogenesis of pericarditis in covid-19.[11]
- Postmortem histopatholigical analysis of heart in covid-19 patients demonstrated infiltration of CD8 lymphocytes and lymphocytes proliferation in pericardium.[11]
- SARS-COV-2 can attach to ACE2 receptos presented in the endothelium, cardiomyocytes, epicardial adipose tissue, adjacent to the pericardium. However, the exact mechanism of direct viruse damage to cardiac structure requires further investigation.[12]
Causes
Pericarditis in COVID-19 is likely caused by:
- Direct invasion by SARS-CoV-2
- Pro-inflammatory cytokine storm
Differentiating COVID-19-associated pericarditis from other diseases
- For further information about the differential diagnosis, click here.
- For further information about the differential diagnosis of COVID-19, click here.
Epidemiology and Demographics
- Pericarditis is a rare manifestation of covid-19.[13][14][15][16][17][18][19]
- There is currently no available data on the incidence of pericarditis in covid-19 patients. However, the incidence of pericarditis in covid-19 patients was higher than general population without covid-19.[20]
- Post-mortem studies have shown pericarditis was approximately in 20% of covid-19 cases.[21]
Age
- There is no data on age predilection to pericarditis in COVID-19.
- Pericarditis after vaccination of COVID-19 was commonly observed in elderly patients.[22]
Gender
- There is no data on gender predilection to pericarditis in covid-19.
- The number of cases in females are more than males among the few cases reported.
Race
- There is no data on racial predilection to pericarditis in covid-19.
Natural History, Complications and Prognosis
- Pericardial involvement is an uncommon manifestation of covid-19 and requires high clinical suspicion for diagnosis and treatment.
- Early clinical features of involving pericardium include retrosternal chest pain, diffuse upward sloping ST segments, pericardial effusion in echocardiography.
- If left untreated, acute pericarditis may progress to develop cardiac tamponade, chronic constrictive pericarditis, chronic effusive pericarditis.[23]
- Reported complications of pericarditis related to covid-19 in literature are:
- Tamponade[24]
- Large hemorrhagic pericardial effusion[25]
- Acute effusive pericarditis [26]
- Acute myopericarditis [27]
- Prognosis is generally good. However, the presence of large pericardial effusion, tamponade, myopericarditis, high CRP, NO response to colchicine make the prognosis worse.[28]
Diagnosis
- High clinical suspicion is necessary to identify the involvement of pericardial layer in covid-19 patients.
- In the suspicion of acute pericarditis, obtaining an ECG, blood test sampling of inflammatory and myocardial injury parameters and transthoracic echocardiography are recommended.[28]
Symptoms
Symptoms of pericarditis in COVID-19 may include the following:
Physical Examination
Physical examination may be remarkable for:
- Fever
- Pericardial friction rub
- Tachycardia, hypotension and distant heart sounds seen in cardiac tamponade
Laboratory Findings
Inflammatory biomarkers
- Non-specific markers of inflammation are commonly elevated in pericarditis.[29] These include:
- Elevated inflammatory markers, specifically WBC count and CRP was seen in COVID-19-associated pericarditis cases.[17][13][18][14]
Cardiac biomarkers
- In the presence of concomitant myocarditis and pericarditis (myopericarditis), serum biomarkers of myocardial injury, are elevated.[30][31][32] These include:
- Creatine Kinase (CK)
- Cardiac troponin I or T
- Serum LDH
- Elevated cardiac markers was seen in COVID-19-associated pericarditis cases.[14][17][13][18][16]
Electrocardiogram
- Electrocardiogram (ECG) findings see in the reported cases of COVID-19-associated pericarditis include:
- ST elevation and PR depression are seen;[33][17][16] but these changes are not specific to COVID-19 pericarditis.
- Non-specific ST changes.[13]
- T wave inversion in the inferior leads (II, III and aVF).[18][34]
- For ECG changes in pericarditis in general, click here.
Imaging
Chest X-ray
- Chest X-ray is usually within normal limits in acute pericarditis.
- Chest x-ray demonstrated an enlarged cardiac silhouette in patients with COVID-19 complicated by cardiac tamponade.[13][35]
- For Chest X-ray findings in pericarditis, click here.
Echocardiography
- Echocardiography is the first-line test in the diagnosis of pericarditis and its complications.[36]
- On imaging by echocardiography in the reported cases of COVID-19-associated pericarditis, findings included:
- Small to moderate pericardial effusion.[14][18][16]
- In the cases complicated by cardiac tamponade, findings included: [13][37][16]
- Large pericardial effusion
- Right ventricular diastolic collapse
- Increased respiratory variation in peak E-wave mitral inflow velocity
- Dilated inferior vena cava
For echocardiography findings in pericarditis in general, click here.
CT scan
- On CT chest, the reported cases showed pericardial effusion.[17]
Cardiac magnetic resonance
- Finding of cardiac magnetic resonance in recently recovered covid-19 patients was pericardial late gadolinium enhancement in 22% of patients.[38][15][14]
Pericardial fluid analysis
- In the reported cases of cardiac tamponade in COVID-19 patients, pericardial fluid analysis from emergency pericardiocentesis showed:[13][39]
- Other work-up included:
- Fluid cytology for malignant cells - negative
- Gram stain, Acid-fast stain - negative
- Bacterial, mycobacterial and fungal cultures - negative
- Serum auto-immune work-up - negative
- Since there are no established laboratory parameters to help distinguish COVID-19-related pericardial effusion from other etiologies, complete biochemical, bacteriological and cytological analysis of pericardial fluid is suggested to rule out other etiologies of pericardial effusion.
- In a reported case, SARS-COV-2 was detected by a RT-PCR kit in pericardial fluid of a patient presented with cardiac tamponade. [40]
Treatment
Medical Therapy
- NSAIDs and high-dose aspirin and are the mainstay of therapy for acute pericarditis.[9]
- Colchicine is recommended as first-line therapy for acute pericarditis as an adjunctive to NSAIDs/Aspririn.
- The efficacy of colchicine in acute pericarditis is related to reducing chest pain, decreasing the leukocyte mobility and phagocytosis observing in inflammatory process.[41]
- Corticosteroids is reserved for cases with a contraindication or failure of first-line therapies.
- With early anecdotal reports linking NSAIDs and corticosteroids with a worsening clinical condition in patients with COVID-19, there have been recommendations against the use of these agents.[42][43] However, according to the recommendations from the US Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC), NSAIDs can be used when clinically indicated in COVID-19 patients.[44]
- There is no literature and existing data to provide definite evidence for or against the use of high- or low-dose aspirin when clinically indicated in patients with COVID-19.
- In one of the reported cases of COVID-19-associated pericarditis and cardiac tamponade, colchicine was well tolerated as monotherapy.[45]
- In another case of COVID-19 and cardiac tamponade, the combination of corticosteroids and colchicine was well tolerated and successful.[13]
- Response to treatment can be monitored with serial transthoracic echocardiogram (TTE).
Surgery
- In all the reported cases of COVID-19 with large effusions and cardiac tamponade, pericardiocentesis showed improvement in clinical condition.
- Response to treatment can be monitored with serial transthoracic echocardiogram (TTE).
Primary Prevention
- There are no established measures for the primary prevention of COVID-19-associated pericarditis.
- For primary preventive measures of [COVID-19], click here.
Secondary Prevention
- There are no established measures for the secondary prevention of COVID-19-associated pericarditis.
- For secondary preventive measures of COVID-19, click here.
References
- ↑ Tung-Chen Y (July 2020). "Acute pericarditis due to COVID-19 infection: An underdiagnosed disease?". Med Clin (Engl Ed). 155 (1): 44–45. doi:10.1016/j.medcle.2020.06.001. PMC 7333598 Check
|pmc=value (help). PMID 32835093 Check|pmid=value (help). - ↑ https://www.cdc.gov/coronavirus/2019-ncov/about/index.html. Missing or empty
|title=(help) - ↑ Lu, Jian; Cui, Jie; Qian, Zhaohui; Wang, Yirong; Zhang, Hong; Duan, Yuange; Wu, Xinkai; Yao, Xinmin; Song, Yuhe; Li, Xiang; Wu, Changcheng; Tang, Xiaolu (2020). "On the origin and continuing evolution of SARS-CoV-2". National Science Review. doi:10.1093/nsr/nwaa036. ISSN 2095-5138.
- ↑ Huang, Chaolin; Wang, Yeming; Li, Xingwang; Ren, Lili; Zhao, Jianping; Hu, Yi; Zhang, Li; Fan, Guohui; Xu, Jiuyang; Gu, Xiaoying; Cheng, Zhenshun; Yu, Ting; Xia, Jiaan; Wei, Yuan; Wu, Wenjuan; Xie, Xuelei; Yin, Wen; Li, Hui; Liu, Min; Xiao, Yan; Gao, Hong; Guo, Li; Xie, Jungang; Wang, Guangfa; Jiang, Rongmeng; Gao, Zhancheng; Jin, Qi; Wang, Jianwei; Cao, Bin (2020). "Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China". The Lancet. 395 (10223): 497–506. doi:10.1016/S0140-6736(20)30183-5. ISSN 0140-6736.
- ↑ https://www.cdc.gov/coronavirus/2019-ncov/about/transmission.html. Missing or empty
|title=(help) - ↑ "WHO | Novel Coronavirus – China".
- ↑ "Coronavirus (COVID-19) events as they happen".
- ↑ "Coronavirus (COVID-19) events as they happen".
- ↑ 9.0 9.1 Tomkowski, Witold; Swedberg, Karl; Seferovic, Petar; Sabaté Tenas, Manel; Ristić, Arsen D; Pavie, Alain; Mayosi, Bongani; Maisch, Bernhard; Lionis, Christos; Klingel, Karin; Gueret, Pascal; Brucato, Antonio; Bogaert, Jan; Barón-Esquivias, Gonzalo; Badano, Luigi; Imazio, Massimo; Charron, Philippe; Adler, Yehuda; Achenbach, Stephan; Agewall, Stefan; Al-Attar, Nawwar; Angel Ferrer, Juan; Arad, Michael; Asteggiano, Riccardo; Bueno, Héctor; Caforio, Alida L P; Carerj, Scipione; Ceconi, Claudio; Evangelista, Arturo; Flachskampf, Frank; Giannakoulas, George; Gielen, Stephan; Habib, Gilbert; Kolh, Philippe; Lambrinou, Ekaterini; Lancellotti, Patrizio; Lazaros, George; Linhart, Ales; Meurin, Philippe; Nieman, Koen; Piepoli, Massimo F; Price, Susanna; Roos-Hesselink, Jolien; Roubille, François; Ruschitzka, Frank; Sagristà Sauleda, Jaume; Sousa-Uva, Miguel; Uwe Voigt, Jens; Luis Zamorano, Jose; Zamorano, Jose Luis; Aboyans, Victor; Achenbach, Stephan; Agewall, Stefan; Badimon, Lina; Barón-Esquivias, Gonzalo; Baumgartner, Helmut; Bax, Jeroen J; Bueno, Héctor; Carerj, Scipione; Dean, Veronica; Erol, Çetin; Fitzimons, Donna; Gaemperli, Oliver; Kirchhof, Paulus; Kolh, Philippe; Lancellotti, Patrizio; Lip, Gregory YH; Nihoyannopoulos, Petros; Piepoli, Massimo F; Ponikowski, Piotr; Roffi, Marco; Torbicki, Adam; Vaz Carneiro, Antonio; Windecker, Stephan; Shuka, Naltin; Sisakian, Hamayak; Mascherbauer, Julia; Isayev, Elnur; Shumavets, Vadim; Van Camp, Guy; Gatzov, Plamen; Hanzevacki, Jadranka Separovic; Moustra, Hera Heracleous; Linhart, Ales; Møller, Jacob Eifer; Aboleineen, Mohamed Wafaie; Põder, Pentti; Lehtonen, Jukka; Antov, Slobodan; Damy, Thibaud; Schieffer, Bernhard; Dimitriadis, Kyriakos; Kiss, Robert Gabor; Rafnsson, Arnar; Arad, Michael; Novo, Salvatore; Mirrakhimov, Erkin; Stradinš, Peteris; Kavoliuniene, Ausra; Codreanu, Andrei; Dingli, Philip; Vataman, Eleonora; El Hattaoui, Mustapaha; Samstad, Stein Olav; Hoffman, Piotr; Lopes, Luís Rocha; Dimulescu, Doina Ruxandra; Arutyunov, Grigory P; Pavlovic, Milan; Dúbrava, Juraj; Sauleda, Jaume Sagristà; Andersson, Bert; Müller, Hajo; Bouma, Berto J; Abaci, Adnan; Archbold, Andrew; Nesukay, Elena (2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases". European Heart Journal. 36 (42): 2921–2964. doi:10.1093/eurheartj/ehv318. ISSN 0195-668X.
- ↑ Amoozgar B, Kaushal V, Mubashar U, Sen S, Yousaf S, Yotsuya M (September 2020). "Symptomatic pericardial effusion in the setting of asymptomatic COVID-19 infection: A case report". Medicine (Baltimore). 99 (37): e22093. doi:10.1097/MD.0000000000022093. PMC 7489591 Check
|pmc=value (help). PMID 32925751 Check|pmid=value (help). - ↑ 11.0 11.1 Basso C, Leone O, Rizzo S, De Gaspari M, van der Wal AC, Aubry MC, Bois MC, Lin PT, Maleszewski JJ, Stone JR (October 2020). "Pathological features of COVID-19-associated myocardial injury: a multicentre cardiovascular pathology study". Eur Heart J. 41 (39): 3827–3835. doi:10.1093/eurheartj/ehaa664. PMC 7543528 Check
|pmc=value (help). PMID 32968776 Check|pmid=value (help). - ↑ Patel AB, Verma A (May 2020). "COVID-19 and Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers: What Is the Evidence?". JAMA. 323 (18): 1769–1770. doi:10.1001/jama.2020.4812. PMID 32208485 Check
|pmid=value (help). - ↑ 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 Dabbagh, Mohammed F.; Aurora, Lindsey; D’Souza, Penny; Weinmann, Allison J.; Bhargava, Pallavi; Basir, Mir B. (2020). "Cardiac Tamponade Secondary to COVID-19". JACC: Case Reports. doi:10.1016/j.jaccas.2020.04.009. ISSN 2666-0849.
- ↑ 14.0 14.1 14.2 14.3 14.4 Inciardi, Riccardo M.; Lupi, Laura; Zaccone, Gregorio; Italia, Leonardo; Raffo, Michela; Tomasoni, Daniela; Cani, Dario S.; Cerini, Manuel; Farina, Davide; Gavazzi, Emanuele; Maroldi, Roberto; Adamo, Marianna; Ammirati, Enrico; Sinagra, Gianfranco; Lombardi, Carlo M.; Metra, Marco (2020). "Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19)". JAMA Cardiology. doi:10.1001/jamacardio.2020.1096. ISSN 2380-6583.
- ↑ 15.0 15.1 Maceira, Alicia M; Lopez-Lereu, Maria P; Higueras Ortega, Laura; García-Gonzalez, Pilar; Broseta Torres, Ricardo; Solsona Caravaca, Javier; Ventura Perez, Bruno; Andres Soler, Jorge; Dominguez Mafe, Eloy; Monmeneu, Jose V; Voges, Inga (2020). "Subacute perimyocarditis in a young patient with COVID-19 infection". European Heart Journal - Case Reports. doi:10.1093/ehjcr/ytaa157. ISSN 2514-2119.
- ↑ 16.0 16.1 16.2 16.3 16.4 Byrne, Jonathan; Sado, Daniel; O’Gallagher, Kevin; Hua, Alina (2020). "Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19". European Heart Journal. 41 (22): 2130–2130. doi:10.1093/eurheartj/ehaa253. ISSN 0195-668X.
- ↑ 17.0 17.1 17.2 17.3 17.4 Cizgici, Ahmet Yasar; Zencirkiran Agus, Hicaz; Yildiz, Mustafa (2020). "COVID-19 myopericarditis: It should be kept in mind in today's conditions". The American Journal of Emergency Medicine. 38 (7): 1547.e5–1547.e6. doi:10.1016/j.ajem.2020.04.080. ISSN 0735-6757.
- ↑ 18.0 18.1 18.2 18.3 18.4 Tung-Chen, Yale (2020). "Acute pericarditis due to COVID-19 infection: An underdiagnosed disease?". Medicina Clínica. 155 (1): 44–45. doi:10.1016/j.medcli.2020.04.007. ISSN 0025-7753.
- ↑ "View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge".
- ↑ Miró Ò, Llorens P, Jiménez S, Piñera P, Burillo-Putze G, Martín A, Martín-Sánchez FJ, González Del Castillo J (August 2020). "Frequency of five unusual presentations in patients with COVID-19: results of the UMC-19-S1". Epidemiol Infect. 148: e189. doi:10.1017/S0950268820001910. PMC 7477462 Check
|pmc=value (help). PMID 32843127 Check|pmid=value (help). - ↑ Hanley B, Naresh KN, Roufosse C, Nicholson AG, Weir J, Cooke GS, Thursz M, Manousou P, Corbett R, Goldin R, Al-Sarraj S, Abdolrasouli A, Swann OC, Baillon L, Penn R, Barclay WS, Viola P, Osborn M (October 2020). "Histopathological findings and viral tropism in UK patients with severe fatal COVID-19: a post-mortem study". Lancet Microbe. 1 (6): e245–e253. doi:10.1016/S2666-5247(20)30115-4. PMC 7440861 Check
|pmc=value (help). PMID 32844161 Check|pmid=value (help). - ↑ Diaz GA, Parsons GT, Gering SK, Meier AR, Hutchinson IV, Robicsek A (September 2021). "Myocarditis and Pericarditis After Vaccination for COVID-19". JAMA. 326 (12): 1210–1212. doi:10.1001/jama.2021.13443. PMID 34347001 Check
|pmid=value (help). - ↑ Kloos JA (December 2015). "Characteristics, Complications, and Treatment of Acute Pericarditis". Crit Care Nurs Clin North Am. 27 (4): 483–97. doi:10.1016/j.cnc.2015.08.001. PMID 26567493.
- ↑ Hua A, O'Gallagher K, Sado D, Byrne J (June 2020). "Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19". Eur Heart J. 41 (22): 2130. doi:10.1093/eurheartj/ehaa253. PMC 7184427 Check
|pmc=value (help). PMID 32227076 Check|pmid=value (help). - ↑ Dabbagh MF, Aurora L, D'Souza P, Weinmann AJ, Bhargava P, Basir MB (July 2020). "Cardiac Tamponade Secondary to COVID-19". JACC Case Rep. 2 (9): 1326–1330. doi:10.1016/j.jaccas.2020.04.009. PMC 7177077 Check
|pmc=value (help). PMID 32328588 Check|pmid=value (help). - ↑ Fox K, Prokup JA, Butson K, Jordan K (July 2020). "Acute Effusive Pericarditis: A Late Complication of COVID-19". Cureus. 12 (7): e9074. doi:10.7759/cureus.9074. PMC 7348211 Check
|pmc=value (help). PMID 32656050 Check|pmid=value (help). - ↑ Cizgici AY, Zencirkiran Agus H, Yildiz M (July 2020). "COVID-19 myopericarditis: It should be kept in mind in today's conditions". Am J Emerg Med. 38 (7): 1547.e5–1547.e6. doi:10.1016/j.ajem.2020.04.080. PMC 7187845 Check
|pmc=value (help). PMID 32360119 Check|pmid=value (help). - ↑ 28.0 28.1 Cremer PC, Kumar A, Kontzias A, Tan CD, Rodriguez ER, Imazio M, Klein AL (November 2016). "Complicated Pericarditis: Understanding Risk Factors and Pathophysiology to Inform Imaging and Treatment". J Am Coll Cardiol. 68 (21): 2311–2328. doi:10.1016/j.jacc.2016.07.785. PMID 27884251.
- ↑ "Diagnosis of acute pericarditis".
- ↑ "Diagnosis of acute pericarditis".
- ↑ Imazio, Massimo; Demichelis, Brunella; Cecchi, Enrico; Belli, Riccardo; Ghisio, Aldo; Bobbio, Marco; Trinchero, Rita (2003). "Cardiac troponin i in acute pericarditis". Journal of the American College of Cardiology. 42 (12): 2144–2148. doi:10.1016/j.jacc.2003.02.001. ISSN 0735-1097.
- ↑ Bonnefoy, E (2000). "Serum cardiac troponin I and ST-segment elevation in patients with acute pericarditis". European Heart Journal. 21 (10): 832–836. doi:10.1053/euhj.1999.1907. ISSN 0195-668X.
- ↑ "View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge".
- ↑ "View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge".
- ↑ "View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge".
- ↑ "Diagnosis of acute pericarditis".
- ↑ "View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge".
- ↑ Puntmann VO, Carerj ML, Wieters I, Fahim M, Arendt C, Hoffmann J, Shchendrygina A, Escher F, Vasa-Nicotera M, Zeiher AM, Vehreschild M, Nagel E (November 2020). "Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19)". JAMA Cardiol. 5 (11): 1265–1273. doi:10.1001/jamacardio.2020.3557. PMC 7385689 Check
|pmc=value (help). PMID 32730619 Check|pmid=value (help). - ↑ "View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge".
- ↑ Farina A, Uccello G, Spreafico M, Bassanelli G, Savonitto S (June 2020). "SARS-CoV-2 detection in the pericardial fluid of a patient with cardiac tamponade". Eur J Intern Med. 76: 100–101. doi:10.1016/j.ejim.2020.04.045. PMC 7177062 Check
|pmc=value (help). PMID 32359887 Check|pmid=value (help). - ↑ Adler Y, Charron P, Imazio M, Badano L, Barón-Esquivias G, Bogaert J, Brucato A, Gueret P, Klingel K, Lionis C, Maisch B, Mayosi B, Pavie A, Ristic AD, Sabaté Tenas M, Seferovic P, Swedberg K, Tomkowski W (November 2015). "2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: The European Association for Cardio-Thoracic Surgery (EACTS)". Eur Heart J. 36 (42): 2921–2964. doi:10.1093/eurheartj/ehv318. PMC 7539677 Check
|pmc=value (help). PMID 26320112. - ↑ Russell, Beth; Moss, Charlotte; Rigg, Anne; Van Hemelrijck, Mieke (2020). "COVID-19 and treatment with NSAIDs and corticosteroids: should we be limiting their use in the clinical setting?". ecancermedicalscience. 14. doi:10.3332/ecancer.2020.1023. ISSN 1754-6605.
- ↑ Bancos, Simona; Bernard, Matthew P.; Topham, David J.; Phipps, Richard P. (2009). "Ibuprofen and other widely used non-steroidal anti-inflammatory drugs inhibit antibody production in human cells". Cellular Immunology. 258 (1): 18–28. doi:10.1016/j.cellimm.2009.03.007. ISSN 0008-8749.
- ↑ "FDA advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19 | FDA".
- ↑ "View of Acute Pericarditis and Cardiac Tamponade in a Patient with COVID-19: A Therapeutic Challenge".