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Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and

Bhurint Siripanthong1, Saman Nazarian2, Daniele Muser2

  • 1School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.

Heart Rhythm
|May 11, 2020
PubMed

Insights

COVID-19 myocarditis involves direct viral injury and immune response. Diagnosis uses clinical findings, imaging, and possibly biopsy, requiring vigilant monitoring for arrhythmias and long-term effects.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Pathophysiology

Background:

  • Myocarditis associated with human coronaviruses, including COVID-19, is recognized.
  • COVID-19 myocarditis pathophysiology likely involves direct viral effects and immune-mediated cardiac damage.

Purpose of the Study:

  • To outline diagnostic approaches for COVID-19 myocarditis.
  • To highlight clinical findings, imaging techniques, and potential diagnostic uncertainties.

Main Methods:

  • Review of clinical findings: electrocardiogram changes, cardiac biomarkers, and impaired cardiac function.
  • Evaluation of imaging modalities: cardiac MRI and computed tomographic angiography with delayed myocardial imaging.
  • Consideration of endomyocardial biopsy for definitive diagnosis and treatment guidance.

Main Results:

  • Clinical presentation includes ECG changes, elevated cardiac biomarkers, and reduced cardiac function.
  • Cardiac CT angiography can help rule out coronary artery disease and detect myocardial inflammation.
  • Endomyocardial biopsy may confirm active cardiac infection and inform immunosuppression risks.

Conclusions:

  • Diagnosis of COVID-19 myocarditis requires integrating prior myocarditis knowledge with current clinical and imaging data.
  • Vigilance for arrhythmias and consideration of myocardial infarction in patients with cardiovascular comorbidities are crucial.
  • The long-term sequelae of COVID-19 myocarditis remain largely unknown.

Keywords:
ArrhythmiasCoronavirus disease 2019Endomyocardial biopsyFulminant myocarditisInterleukin 6SARS-CoV-2

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