Discussion:
The patient in this case report was recovering from COVID-19 infection
when he developed acute pericarditis symptoms, elevated cardiac injury
biomarkers, and LV clots.
Pericarditis is an inflammatory and non-ischemic condition that affects
the pericardium (1, 9). The clinical appearance varies greatly and may
be preceded by coryzal symptoms or generalized symptoms including
lethargy, diarrhea, or malaise. Symptomatic arrhythmias, heart failure,
myocardial infarction, cardiogenic shock, or sudden cardiac death may be
caused by cardiac inflammation (10). Pleuritic chest discomfort,
pericardial friction rub, and suggestive abnormalities in
electrocardiography are the clinical hallmarks of acute pericarditis
(4). The most frequent cause is infection, with viral infections being
the most frequently recognized in developed nations (11). Various
cardiovascular conditions, such as myocarditis, pericarditis, or more
generally, elevated cardiac injury biomarkers, have all been reported as
cardiac involvement in COVID-19, according to a growing body of research
(12). Acute coronary syndrome may be caused by localized inflammation at
the plaque level, which could destabilize coronary atheroma (13).
Our case demonstrated thrombotic complications such as coronary
thrombosis. LV clots can occur even in
COVID-19 patients with
non-specific symptoms, and gradually progress and lead to clot formation
and coronary involvement, which shows the mysterious face of COVID-19.
This complex process indicates the necessity of screening patients for
COVID-19 disease even with non-specific cardiac symptoms (14).
Moreover, the early initiation of antiviral treatment and most
importantly, the initiation of anticoagulants after diagnosis will stop
the progressive course of the disease.
These patients are at risk of cardiac re-thrombosis and cerebral
thrombosis.Therefore, it is recommended to continue anticoagulant
treatment for at least three months (15).