Life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19

This case report describes the clinical course and management of a 47-year-old Afro-Caribbean with previous myopericarditis was admitted in March 2020 with breathlessness, chest pain, dry cough, and subjective fevers She had no cardiovascular risk factors An angiogram in 2017 had shown unobstructed coronary arteries Despite initial i v fluid resuscitation, she did not respond and was transferred to the intensive treatment unit (ITU) for vasopressor support Repeat echocardiogram revealed further accumulation of pericardial effusion to a maximal depth of 2 cm, with evidence of cardiac tamponade Her haemodynamic parameters worsened, including hypotension and tachycardia Pericardiocentesis was performed in view of acute deterioration Due to her clinical condition and infective status, it was deemed unsuitable to transfer her to the cardiac laboratory for fluoroscopic-guided pericardiocentesis This was therefore performed on the ITU under echocardiographic guidance Improvement in haemodynamic parameters was observed immediately A total of 540 mL of serosanguinous fluid was drained and tested negative for COVID-19 This case report highlights the first cardiac tamponade case in COVID-19 Cardiac tamponade is an important differential to consider in a deteriorating patient with COVID-19