Acute Myocarditis Related to COVID-19: Comparison to SARS and MERS

Abstract

Myocardial involvement has been described during previous SARS and MERS outbreaks. Infection by SARS-CoV-2 (COVID-19) can range from asymptomatic to life-threatening multi-system disease. Heart involvement most commonly occurs during severe COVID-19 infection. Myocardial injury, based on elevated levels of myocardial enzymes, has been noted in up to 30% of patients with COVID-19 infection and could be a marker for worse prognosis. A few cases of possible myocarditis due to SARS-CoV-2 have been described, providing variable degree of evidence of direct myocardial involvement. We reviewed in detail those cases in comparison to relevant literature on SARS and MERS and attempted to draw initial conclusions in regard to clinical presentation, treatment and prognosis.

Diabetes, Heart Failure, and COVID-19: An Update

“…Even in binding to ACE2, key differences have been observed where the differences in the mechanism are possibly speculated to help explain the difference in infectivity between SARS-Cov2 and SARS-CoV (Shang et al, 2020;Ozono et al, 2021). Even considering these significant differences, the long-lasting effects on people infected with these viruses share similarities (Li et al, 2003;Peiris et al, 2003;Hui, 2005;Ahmed et al, 2020;Chasouraki et al, 2020;Xiong et al, 2020) which are worth investigating to understand if there is a common underlying mechanism. Researchers have proposed a few potential mechanisms of how SARS-CoV2 is involved in causing severe outcomes for people with cardiovascular disease and/or diabetes mellitus (Figure 3).…”

Activation of Immune System May Cause Pathophysiological Changes in the Myocardium of SARS-CoV-2 Infected Monkey Model

“…Additional instances of myocyte hypertrophy and myocardial fibrosis were also evident. Cardiac involvement in COVID-19 patients has been noted in severe infections and implicated as a marker for a worse prognosis [ 30 ]. Among the infected animals, aerosol-mediated infected animal AGM1 and multi-route-infected AGM2 developed ARDS and manifested a severe model of disease progression, while the remaining animals exhibited moderate symptoms, suggesting variability in disease progression depending on individual animals [ 18 , 19 ].…”