COVID-19 and acute myocarditis: current literature review and diagnostic challenges
Tufan Çınar1, Mert İlker Hayıroğlu2, Vedat Çiçek1
1. Department of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.
Insights
COVID-19 can cause acute myocarditis, presenting with varied clinical and imaging findings. Some severe cases show improvement with steroid and immunoglobulin therapy, though diagnosis remains challenging.
Area of Science:
- Cardiology
- Infectious Diseases
- Internal Medicine
Background:
- An increasing number of COVID-19 cases are associated with acute myocarditis.
- Current literature primarily focuses on fulminant myocarditis, limiting understanding of broader clinical presentations.
Purpose of the Study:
- To review clinical characteristics, imaging findings, and in-hospital outcomes of COVID-19-induced acute myocarditis.
- To discuss diagnostic challenges and limitations in the context of the COVID-19 pandemic.
Main Methods:
- A literature review was conducted using PubMed, Embase, and Cochrane databases.
- All identified case reports of patients diagnosed with COVID-19-induced acute myocarditis were analyzed.
Main Results:
- Sixteen case reports of COVID-19-induced acute myocarditis were identified.
- Electrocardiogram (ECG) findings were often non-specific, including ST-segment elevation and conduction delays.
- Echocardiography revealed a spectrum of findings, from normal left ventricular ejection fraction (LVEF) to global hypokinesia.
- A subset of fulminant myocarditis cases responded positively to glucocorticoid and immunoglobulin therapy.
Conclusions:
- Despite the global pandemic, documented cases of COVID-19-induced myocarditis remain limited.
- Accurate differential diagnosis of acute myocarditis in COVID-19 patients presents significant challenges.
Introduction:
In the current literature, there has been an upsurge of cases of COVID-19-induced acute myocarditis. In this case-based review, we aimed to describe the clinical characteristics, imaging findings, and in-hospital course of acute myocarditis. In addition, the limitations of the myocarditis diagnosis were discussed since only fulminant myocarditis cases have been mentioned in the current literature.
Methods:
We performed a review of the literature of all patients who were diagnosed with COVID-19-induced acute myocarditis using the databases of PubMed, Embase, and the Cochrane.
Results:
16 case reports were found to be related to COVID-19-induced acute myocarditis. We observed that the ECG findings in most of the COVID-19 patients were non-specific, including diffuse ST-segment elevation, non-specific intraventricular conduction delay, sinus tachycardia, and inverted T-waves in anterior leads. Echocardiographic findings of COVID-19-induced acute myocarditis patients ranged from preserved left ventricular ejection fraction (LVEF) without segmental abnormalities to reduced LVEF with global hypokinesia. Interestingly, a few patients with COVID-19-induced acute fulminant myocarditis were steroid-responsive and had an amelioration with glucocorticoid and immunoglobulin therapy.
Conclusion:
Despite the COVID-19 pandemic worldwide, a limited number of cases has been shared in the current literature. There are a lot of difficulties in the differential diagnosis of acute myocarditis in the context of COVID-19.
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