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).