COVID-19 Myocarditis Clinical Presentation, Diagnosis and Management: A Narrative Review
DOI:
https://doi.org/10.38179/ijcr.v1i1.27Keywords:
COVID-19, coronavirus, myocarditis, case report, cardiovascular, clinical manifestations, diagnosis, imaging, cardiac magnetic resonance, echocardiography, endomyocardial biopsy, managementAbstract
Objective: The purpose of this article is to review the cases of myocarditis in COVID-19 patients and synthesize the current understanding regarding the presentation, diagnosis, and management of myocarditis in the setting of COVID-19 disease.
Background: The novel coronavirus disease has shown serious implications for the cardiovascular system, including acute myocardial injury, arrhythmias, venous thromboembolism, and myocarditis. Several cases of myocarditis in COVID-19 patients have been reported since the disease's emergence at the end of 2019. The diagnostic approach and management have been variable. The purpose of this narrative review is to gather the most reliable published material regarding myocarditis in COVID-19 and present it as an overview to simplify the current understanding we have of this disease.
Methods: We screened PubMed, Scopus, and Embase. We then selected peer-reviewed and pre-print articles published in English that were related to the involvement of the cardiovascular system in COVID-19, with a focus on myocarditis. We included case reports describing myocarditis in COVID-19 patients and summarized their clinical presentation, diagnosis, and management. References of the selected articles were also screened, and some were included when relevant.
Discussion: This article is subdivided into sections that discuss the clinical presentation of COVID-19 myocarditis and move on to various diagnostic approaches and management options. Each subsection presents a brief literature review followed by a summary and interpretation of what was found in the reported cases.
Conclusion: After noticing the involvement of the cardiovascular system in COVID-19 patients, specifically through myocarditis, we present this narrative review to provide the medical community with a unified article regarding the current understanding of myocarditis in COVID-19 patients. This article further stresses the necessity of establishing proper treatment guidelines for COVID-19 myocarditis.
References
Emmanuel N, Zibara V, Saad JM, et al. COVID-19: What We Know So Far: A Narrative Review. International Journal of Clinical Research. 2020 Nov 6;1(1):73-108. https://doi.org/10.38179/ijcr.v1i1.19
Harapan H, Itoh N, Yufika A, Winardi W, Keam S, Te H, Megawati D, Hayati Z, Wagner AL, Mudatsir M. Coronavirus disease 2019 (COVID-19): A literature review. J Infect Public Health. 2020 May;13(5):667-673. doi: 10.1016/j.jiph.2020.03.019. Epub 2020 Apr 8. PMID: 32340833; PMCID: PMC7142680. https://doi.org/10.1016/j.jiph.2020.03.019
Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020 Mar 19;91(1):157-160. doi: 10.23750/abm.v91i1.9397. PMID: 32191675; PMCID: PMC7569573. https://doi.org/10.23750/abm.v91i1.9397
Kochi AN, Tagliari AP, Forleo GB, et al. Cardiac and arrhythmic complications in patients with COVID-19. J Cardiovasc Electrophysiol. 2020 May;31(5):1003-1008. doi: 10.1111/jce.14479. Epub 2020 Apr 13. PMID: 32270559; PMCID: PMC7262150. https://doi.org/10.1111/jce.14479
Kang Y, Chen T, Mui D, et al. Cardiovascular manifestations and treatment considerations in COVID-19. Heart. 2020 Aug;106(15):1132-1141. doi: 10.1136/heartjnl-2020-317056. Epub 2020 Apr 30. PMID: 32354800; PMCID: PMC7211105. https://doi.org/10.1136/heartjnl-2020-317056
Nishiga M, Wang DW, Han Y, et al. COVID-19 and cardiovascular disease: from basic mechanisms to clinical perspectives. Nat Rev Cardiol. 2020 Sep;17(9):543-558. doi: 10.1038/s41569-020-0413-9. Epub 2020 Jul 20. PMID: 32690910; PMCID: PMC7370876. https://doi.org/10.1038/s41569-020-0413-9
Pollack A, Kontorovich AR, Fuster V, Dec GW. Viral myocarditis--diagnosis, treatment options, and current controversies. Nat Rev Cardiol. 2015 Nov;12(11):670-80. doi: 10.1038/nrcardio.2015.108. Epub 2015 Jul 21. PMID: 26194549. https://doi.org/10.1038/nrcardio.2015.108
Sala S, Peretto G, Gramegna M, et al. Acute myocarditis presenting as a reverse Tako-Tsubo syndrome in a patient with SARS-CoV-2 respiratory infection. Eur Heart J. 2020 May 14;41(19):1861-1862. doi: 10.1093/eurheartj/ehaa286. PMID: 32267502; PMCID: PMC7184339. https://doi.org/10.1093/eurheartj/ehaa286
Sagar S, Liu PP, Cooper LT Jr. Myocarditis. Lancet. 2012 Feb 25;379(9817):738-47. doi: 10.1016/S0140-6736(11)60648-X. Epub 2011 Dec 18. PMID: 22185868; PMCID: PMC5814111. https://doi.org/10.1016/S0140-6736(11)60648-X
Kapoor JR. Myocarditis. N Engl J Med. 2009 Jul 23;361(4):422-3; author reply 423-4. doi: 10.1056/NEJMc091013. PMID: 19625725. https://doi.org/10.1056/NEJMc091013
Inciardi RM, Lupi L, Zaccone G, et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020 Jul 1;5(7):819-824. doi: 10.1001/jamacardio.2020.1096. PMID: 32219357; PMCID: PMC7364333. https://doi.org/10.1001/jamacardio.2020.1096
Kim IC, kim JY, kim HA, han S. COVID-19-related myocarditis in a 21-year-old female patient. eur heart J. 2020 may 14;41(19):1859. doi: 10.1093/eurheartj/ehaa288. PMID: 32282027; PMCID: PMC7184491. https://doi.org/10.1093/eurheartj/ehaa288
Warchoł I, Dębska-Kozłowska A, Karcz-Socha, et al. Terra incognita: clinically suspected myocarditis in a patient with severe acute respiratory syndrome coronavirus 2 infection. Pol Arch Intern Med. 2020 May 29;130(5):446-448. doi: 10.20452/pamw.15309. Epub 2020 Apr 24. PMID: 32329981. https://doi.org/10.20452/pamw.15309
Hu H, Ma F, Wei X, Fang Y. Coronavirus fulminant myocarditis treated with glucocorticoid and human immunoglobulin. Eur Heart J. 2021 Jan 7;42(2):206. doi: 10.1093/eurheartj/ehaa190. Erratum in: Eur Heart J. 2021 Jan 7;42(2):191. PMID: 32176300; PMCID: PMC7184348. https://doi.org/10.1093/eurheartj/ehaa190
Paul JF, charles P, richaud C, et al. myocarditis revealing COVID-19 infection in a young patient. eur heart J cardiovasc imaging. 2020 jul 1;21(7):776. doi: 10.1093/ehjci/jeaa107. PMID: 32338706; PMCID: PMC7197601. https://doi.org/10.1093/ehjci/jeaa107
Doyen D, moceri P, ducreux D, dellamonica J. myocarditis in a patient with COVID-19: A cause of raised troponin and ECG changes. lancet. 2020 may 9;395(10235):1516. doi: 10.1016/S0140-6736(20)30912-0. epub 2020 apr 23. PMID: 32334650; PMCID: PMC7180035. https://doi.org/10.1016/S0140-6736(20)30912-0
Zeng JH, liu YX, yuan J, et al. first case of COVID-19 complicated with fulminant myocarditis: A case report and insights. infection. 2020 apr 10:1-5. doi: 10.1007/s15010-020-01424-5. epub ahead of print. PMID: 32277408; PMCID: PMC7146072. https://doi.org/10.1007/s15010-020-01424-5
Coyle J, igbinomwanhia E, sanchez-nadales A, et al. A recovered case of COVID-19 myocarditis and ARDS treated with corticosteroids, tocilizumab, and experimental AT-001. JACC case rep. 2020 may 3;2(9):1331-6. doi: 10.1016/j.jaccas.2020.04.025. epub ahead of print. PMID: 32368755; PMCID: PMC7196388. https://doi.org/10.1016/j.jaccas.2020.04.025
Cizgici AY, zencirkiran agus H, yildiz M. COVID-19 myopericarditis: It should be kept in mind in today's conditions. am J emerg med. 2020 jul;38(7):1547.e5-1547.e6. doi: 10.1016/j.ajem.2020.04.080. epub 2020 apr 28. PMID: 32360119; PMCID: PMC7187845. https://doi.org/10.1016/j.ajem.2020.04.080
Yuan WF, tang X, zhao XX. an 'asymptomatic' driver with COVID-19: Atypical suspected myocarditis by SARS-CoV-2. cardiovasc diagn ther. 2020 apr;10(2):242-243. doi: 10.21037/cdt.2020.03.08. PMID: 32420106; PMCID: PMC7225419. https://doi.org/10.21037/cdt.2020.03.08
Irabien-ortiz A. miocarditis fulminante por COVID-19 [fulminant myocarditis due to COVID-19]. rev esp cardiol. 2020 apr 10;73(6):503-4. spanish. doi: 10.1016/j.recesp.2020.04.001. epub ahead of print. PMID: 32292228; PMCID: PMC7151531. https://doi.org/10.1016/j.recesp.2020.04.001
Radbel J, narayanan N, bhatt PJ. use of tocilizumab for COVID-19-induced cytokine release syndrome: A cautionary case report. chest. 2020 jul;158(1):e15-e19. doi: 10.1016/j.chest.2020.04.024. epub 2020 apr 25. PMID: 32343968; PMCID: PMC7195070. https://doi.org/10.1016/j.chest.2020.04.024
Beşler MS, arslan H. acute myocarditis associated with COVID-19 infection. am J emerg med. 2020 jun 2:S0735-6757(20)30463-0. doi: 10.1016/j.ajem.2020.05.100. epub ahead of print. PMID: 32507570; PMCID: PMC7265842. https://doi.org/10.1016/j.ajem.2020.05.100
Luetkens JA, isaak A, zimmer S, et al. diffuse myocardial inflammation in COVID-19 associated myocarditis detected by multiparametric cardiac magnetic resonance imaging. circ cardiovasc imaging. 2020 may;13(5):e010897. doi: 10.1161/CIRCIMAGING.120.010897. epub 2020 may 13. PMID: 32397816. https://doi.org/10.1161/CIRCIMAGING.120.010897
Hua A, O'gallagher K, sado D, byrne J. life-threatening cardiac tamponade complicating myo-pericarditis in COVID-19. eur heart J. 2020 jun 7;41(22):2130. doi: 10.1093/eurheartj/ehaa253. PMID: 32227076; PMCID: PMC7184427. https://doi.org/10.1093/eurheartj/ehaa253
Rehman M, Gondal A, Rehman NU. Atypical manifestation of COVID-19-induced myocarditis. Cureus. 2020 jun 18;12(6):e8685. doi: 10.7759/cureus.8685. PMID: 32577331; PMCID: PMC7305571. https://doi.org/10.7759/cureus.8685
Craver R, Huber S, Sandomirsky M, et al. Fatal eosinophilic myocarditis in a healthy 17-year-old male with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2c). fetal pediatr pathol. 2020 jun;39(3):263-268. doi: 10.1080/15513815.2020.1761491. epub 2020 may 13. PMID: 32401577; PMCID: PMC7232882. https://doi.org/10.1080/15513815.2020.1761491
Khalid N, chen Y, case BC, et al. COVID-19 (SARS-cov-2) and the heart - an ominous association. cardiovasc revasc med. 2020 may 15:S1553-8389(20)30256-6. doi: 10.1016/j.carrev.2020.05.009. epub ahead of print. PMID: 32423791; PMCID: PMC7227608. https://doi.org/10.1016/j.carrev.2020.05.009
Gill GS, Vlacancich R, Mehta N, et al. spectrum of cardiac involvement in COVID-19. cureus. 2020 jun 15;12(6):e8638. doi: 10.7759/cureus.8638. PMID: 32685307; PMCID: PMC7364403. https://doi.org/10.7759/cureus.8638
Khatri A, Wallach F. Coronavirus disease 2019 (covid-19) presenting as purulent fulminant myopericarditis and cardiac tamponade: A case report and literature review. Heart Lung. 2020 Jun 9:S0147-9563(20)30251-X. doi: 10.1016/j.hrtlng.2020.06.003. epub ahead of print. PMID: 32693958; PMCID: PMC7280096. https://doi.org/10.1016/j.hrtlng.2020.06.003
Oberweis ML, codreanu A, boehm W, et al. pediatric life-threatening coronavirus disease 2019 with myocarditis. pediatr infect dis J. 2020 jul;39(7):e147-e149. doi: 10.1097/INF.0000000000002744. PMID: 32427645. https://doi.org/10.1097/INF.0000000000002744
Gnecchi M, moretti F, bassi EM, et al. myocarditis in a 16-year-old boy positive for SARS-CoV-2. lancet. 2020 jun 27;395(10242):e116. doi: 10.1016/S0140-6736(20)31307-6. PMID: 32593338; PMCID: PMC7316465. https://doi.org/10.1016/S0140-6736(20)31307-6
Pavon AG, meier D, samim D, et al. first documentation of persistent SARS-cov-2 infection presenting with late acute severe myocarditis. can J cardiol. 2020 jun 6:S0828-282X(20)30532-8. doi: 10.1016/j.cjca.2020.06.005. epub ahead of print. PMID: 32522523. https://doi.org/10.1016/j.cjca.2020.06.005
Giacomet V, manfredini VA, meraviglia G, et al. acute inflammation and elevated cardiac markers in a two-month-old infant with severe acute respiratory syndrome coronavirus 2 infection presenting with cardiac symptoms. pediatr infect dis J. 2020 jul;39(7):e149-e151. doi: 10.1097/INF.0000000000002750. PMID: 32433225. https://doi.org/10.1097/INF.0000000000002750
Hussain H, fadel A, alwaeli H, guardiola V. coronavirus (COVID-19) fulminant myopericarditis and acute respiratory distress syndrome (ARDS) in a middle-aged male patient. cureus. 2020 jun 24;12(6):e8808. doi: 10.7759/cureus.8808. PMID: 32607304; PMCID: PMC7320646. https://doi.org/10.7759/cureus.8808
Caballeros lam M, de la fuente villena A, hernández hernández A, et al. cardiac magnetic resonance characterization of COVID-19 myocarditis. rev esp cardiol (engl ed). 2020 jul 4:S1885-5857(20)30287-5. doi: 10.1016/j.rec.2020.06.018. epub ahead of print. PMID: 32694081; PMCID: PMC7334914. https://doi.org/10.1016/j.rec.2020.06.018
Schilling JD, Ravichandran AK, Mandras SA. Management of the Hospitalized COVID-19 Patient With Acute Cardiomyopathy or Heart Failure - American College of Cardiology. 2020 Apr 16. https://www.acc.org/latest-in-cardiology/articles/2020/04/16/14/42/management-of-the-hospitalized-covid-19-coronavirus-2019-patient-with-acute-cardiomyopathy-or-heart-failure
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