https://doi.org/10.4081/cardio.2024.21
COVID-19 myocarditis
Published: March 28, 2024
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Background: Myocarditis can be observed in patients with COVID-19. Myocarditis can also be seen in patients vaccinated against SARS-CoV-2 infection, the etiological agent of this disease. Epidemiological, morphological, pathophysiological, clinical aspects, clinical course, and potential therapeutics for patients with COVID-19 myocarditis are not entirely clear.
Methods: We perform a search in PubMed linking the terms “COVID-19 and myocarditis”, “SARS-CoV-2 and myocarditis”, and “vaccine and myocarditis and COVID-19”. A hand-search of references from retrieved papers has also been done. We selected papers dealing with the epidemiological, morphological, clinical aspects, and therapeutic regarding COVID-19 myocarditis.
Results: Myocarditis can be clinically diagnosed in about 2% of patients with COVID-19 illness, but its prevalence is higher (up to 33%) in autopsied with this disease. At magnetic resonance imaging, myocarditis can be diagnosed in up to 60% patients in the short-term follow up after SARS-CoV-2 infection. A few ultrastructural studies have detected SARS-CoV-2 in endothelial cells, macrophages, neutrophils, fibroblasts, and inside cardiomyocytes. Shortness of breath, fever, cough, and precordial chest pain are the main clinical symptoms; in half patients, ground glass opacities in chest X-ray are also observed, although oxygen saturation may be normal. COVID-19 myocarditis may occur in a patient with no past cardiac history and may alternatively be a late phenomenon in the course of the disease. COVID-19 myocarditis can also affect children and adolescents; acute heart failure is the predominant clinical manifestation, including fulminant myocarditis, in this population. Elevated troponin blood levels are observed in the majority of patients. Abnormal electrocardiogram findings – usually ST-segment changes and inverted T waves – can be detected in at least 25% of cases. Abnormal echocardiography can be found in 3% of cases and left ventricular systolic dysfunction can be found in 67% of such cases. The clinical course of COVID-19 myocarditis is usually benign with most patients recovering from the myocardial insult. Non-steroidal anti-inflammatory drugs are the treatment for noncomplicated cases; colchicine is added in case of associated pericarditis. Corticosteroids have largely been used. Mechanical support is lifesaving in cases of cardiogenic shock. Post-vaccination myocarditis is very rare, and less frequently found than COVID-19 myocarditis.
Conclusions: Although relative rare, myocarditis may be a serious complication of COVID-19 illness.
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How to Cite
Bestetti, R. B., Furlan-Daniel, R., & Pereira, L. P. (2024). COVID-19 myocarditis. Global Cardiology, 2(1). https://doi.org/10.4081/cardio.2024.21
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