COVID-19 and the Heart (part 5)
In my previous post, I explained the disease of myocarditis which can occur with COVID-19. Myocarditis involves the severe inflammation of the muscle of the heart leading the pump to fail. Pericarditis is a more benign condition that involves the inflammation of the sack around the heart ( the pericardium). Pericarditis is painful. The patients complain of chest pain often exacerbated by breathing deep or lying down. Many viruses other than Sars-COV-2 can cause pericarditis and we treat the condition with anti-inflammatory medications called NSAIDS ( non-steroidal anti-inflammatory drugs). Ibuprofen, indomethacin, naproxen are common NSAIDS and are used for the condition. We also often add an anti-inflammatory medicine called colchicine which is also used to treat gout. Pericarditis once treated has a good prognosis and is not fatal. But it can come back and if it does, it is treated the same way but longer duration.
If patients cannot take NSAIDS because they have gastrointestinal intolerance such as history of ulcers or bleeding or because they have underlying kidney disease, then we used steroids such as prednisone reluctantly. That is because there is some data that patients treated with prednisone are at higher risk of having recurrence of pericarditis. Regardless, pericarditis has a much better prognosis than myocarditis or a heart attack (myocardial infarction).
Stay tuned for COVID-19 and the heart (part 6). There is more to the heart being affected by COVID-19.
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