COVID myocarditis: a review of the literature
Angelica Cersosimo1, Mattia Di Pasquale1, Gianmarco Arabia1
1Cardiology Unit, Department of Medical and Surgical Specialities, Radiological Sciences and Public Health, University of Brescia.
Insights
Myocarditis, an inflammation of the heart muscle, is a severe complication of COVID-19. Early detection and potential treatments like immunoglobulins and corticosteroids are crucial for managing this condition.
Area of Science:
- Cardiology
- Infectious Diseases
- Immunology
Background:
- Myocarditis is a potentially fatal complication of COVID-19, distinct from other viral causes.
- COVID-19 myocarditis presents with diverse symptoms, including chest pain, dyspnea, heart failure, and arrhythmias.
- Early detection of myocarditis, particularly fulminant cases, is critical.
Purpose of the Study:
- To review current evidence on COVID-19-associated myocarditis.
- To summarize distinct inflammatory characteristics and clinical presentations.
- To discuss diagnostic methods and emerging treatment strategies.
Main Methods:
- Literature review of current evidence on COVID-19 myocarditis.
- Analysis of diagnostic approaches including troponins, ECG, echocardiography, cardiac MRI, and endomyocardial biopsy.
- Evaluation of treatment options, including immunoglobulins and corticosteroids.
Main Results:
- COVID-19 myocarditis exhibits unique inflammatory profiles.
- Diagnostic workup involves serial biomarkers, imaging, and potentially biopsy.
- Treatment strategies, especially for fulminant cases, are under investigation, with potential roles for IVIG and corticosteroids.
Conclusions:
- Further research is needed to establish the incidence of COVID-19 myocarditis.
- Large randomized controlled trials are required to confirm the efficacy of combined IVIG and corticosteroid therapy.
- Understanding and managing COVID-19 myocarditis remains a critical area of research.
Abstract:
Myocarditis is a potentially fatal complication of coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. COVID-19 myocarditis appears to have distinct inflammatory characteristics that distinguish it from other viral etiologies. COVID-19 myocarditis can present with symptoms ranging from dyspnea and chest pain to acute heart failure and death. It is critical to detect any cases of myocarditis, especially fulminant myocarditis, which can be characterized by signs of heart failure and arrhythmias. Serial troponins, echocardiography, and electrocardiograms should be performed as part of the initial workup for suspected myocarditis. The second step in detecting myocarditis is cardiac magnetic resonance imaging and endomyocardial biopsy. Treatment for COVID-19 myocarditis is still debatable; however, combining intravenous immunoglobulins and corticosteroids may be effective, especially in cases of fulminant myocarditis. Overall, more research is needed to determine the incidence of COVID-19 myocarditis, and the use of intravenous immunoglobulins and corticosteroids in combination requires large randomized controlled trials to determine efficacy. The purpose of this review is to summarize current evidence on the subject.
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