B49-23 A Silent Compression: Covid-19 and Pericardial Effusion

Abstract Introduction Pericardial effusion may result from malignancy, trauma, autoimmune disease, kidney dysfunction, or infection. Viral, bacterial, and fungal pathogens are known causes of pericarditis; common viral agents include Coxsackievirus, Epstein-Barr virus, influenza, and coronavirus disease 2019 (COVID-19). Cardiovascular complications of COVID-19, including pericardial inflammation, are increasingly recognized. Description A 45-year-old female with hypertension, prediabetes, iron deficiency anemia, thalassemia minor, and class III obesity presented to the ED with worsening flu-like symptoms. One week prior, she experienced fever and weakness that resolved spontaneously but recurred with chest pain, shortness of breath, dizziness, and fatigue. On arrival, she was afebrile but in acute distress: heart rate 150, blood pressure 68/55 mmHg, respiratory rate 27, and oxygen saturation 100% on room air. She appeared pale with bilateral lower extremity edema and delayed capillary refill. Chest X-ray showed cardiomegaly with a flat cardiac silhouette. An EKG showed electrical alternans in lead II and lateral leads. Bedside echocardiography revealed a large pericardial effusion with right ventricular diastolic collapse. A CT scan confirmed massive pericardial effusion. Labs showed leukocytosis and lactate of 8.3 mmol/L. Due to concern for obstructive shock from tamponade, she received 2 liters of intravenous fluids, empiric antibiotics, colchicine, and ibuprofen. She was admitted to the ICU. Ultrasound-guided pericardiocentesis drained 900 mL of blood-tinged fluid with immediate improvement. She also tested positive for COVID-19 pneumonia. After stabilization and drain removal, she was downgraded to the medical floor and discharged on colchicine and prednisone. Discussion COVID-19-associated pericardial effusion is rare but can be life-threatening when tamponade develops. The inflammatory response triggered by the virus may contribute to pericardial involvement. Early recognition through imaging and clinical signs is critical, particularly in unstable patients. Management ranges from anti-inflammatory therapy to urgent drainage, depending on severity. Clinicians should maintain a high index of suspicion for cardiac complications in COVID-19 patients presenting with cardiopulmonary symptoms. This abstract is funded by: Self