COVID-19 and acute myocarditis: current literature review and diagnostic challenges

Abstract

SUMMARY 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.

Electrocardiographic markers of increased risk of sudden cardiac death in patients with COVID‐19 pneumonia

“…The finding of increased QRS duration and QTc interval in patients with COVID‐19 pneumonia is consistent with other studies (Antzelevitch, 2005; Bertini et al., 2020; Çınar et al., 1992).…”

“…Yenerçağ et al and M. Öztürk F et al have shown a significant increase in TDR(Tp‐e interval and Tp‐e/QTc) in newly diagnosed COVID‐19 patients compared to controls. (Çınar et al., 1992; Yenerçağ et al., 2020) However, lack of enrollment of patients with COVID‐19 pneumonia or lung involvement and controls before COVID‐19 infection were the main limitations of the above 2 studies.…”

COVID-19-Induced Acute Myocarditis: Two Clinical Presentations with Different Electrocardiographic Findings

“…Moreover, because both arterial and venous thromboses are common in COVID-19 cases, anticoagulation should be given as in our cases. The current literature reports that patients diagnosed as having acute fulminant myocarditis and cytokine syndrome, most likely resulting from SARS-CoV-2 infection, can be treated with tocilizumab, intravenous immunoglobulin, and high-dose corticosteroids even though results regarding this issue are conflicting (4,8,9). Lastly, patients with acute fulminant myocarditis due to COVID-19 who are resistant to medical therapy can be treated with extracorporeal membrane oxygenation support (10).…”

A Suspected COVID-19-associated Myocarditis Case Mimicking Life-threatening STEMI: a Shark Fin Appearance

“…PCT was elevated on 0.53%, similar to Oleszak"s study on 1.95% [6,9,10] . As myocardium injured in myocarditis, cardiac enzymes are usually elevated from baseline, including troponin, N-terminal pro-B-type natriuretic peptide (NT-pro BNP) and BNP [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] . Cardiac biomarker was also elevated in our case with CKMB 9.6 ng/ml (n<4.3 ng/ml) similar to Fereirra"s study.…”