Myocarditis and pericarditis in patients with COVID-19

COVID-19 has been associated with a variety of cardiac manifestations. Myocarditis and pericarditis have been reported as one of the many cardiac manifestations in association with COVID-19. We describe below three cases of myocarditis, pericarditis with associated pericardial effusion and myopericarditis, respectively, in the setting of COVID-19. Although these entities may occur in isolation, they often occur in association to varying degrees. It could either be the initial diagnosis at the time of presentation or it could occur later in the course of COVID-19 infection. Pericarditis may occasionally be associated with significant pericardial effusion and tamponade requiring therapeutic pericardiocentesis. The assessment of pericardial effusion has been found to be exudative and is usually negative for SARS-CoV-2. Treatment of pericarditis with nonsteroidal anti-inflammatory drugs, colchicine, and corticosteroids has proven to be safe in COVID-19. Myocarditis may present with severe left ventricular systolic dysfunction and cardiogenic shock requiring inotropes and mechanical circulatory support.