Myocarditis associated with Covid-19 disease: a systematic review of published Case reports and Case series

Abstract

Background: Covid-19 is an extremely contagious illness caused by the severe acute respiratory syndrome (SARS-CoV-2) virus. Although this disease primarily involves pulmonary tissue, rapidly advancing research has established cardiac involvement in Covid-19 patients. Objective: This systematic review article aimed to compile and illustrate clinical characteristics, diagnostic findings, management, and outcomes manifesting in myocarditis linked with Covid-19. Methods: A literature search was accomplished for published eligible articles with MEDLINE/PubMed and Embase databases. All eligible case reports and case series were included from around the world without any language restrictions. For this review, inclusion criteria were laboratory-confirmed SARS-CoV-2 infection cases reporting a diagnosis of acute myocarditis. Results: Data from 41 studies describing myocarditis in 42 Covid-19 patients was obtained. The median age of these patients was 43.4 years, with 71.4% of them being male. Fever was the most prevalent presenting symptoms seen in 57% of patients. Hypertension was the most pervasive comorbidity accompanying these patients. Cardiac biomarkers troponin and Brain natriuretic peptide (BNP) were raised in almost 90% and 87% of patients, respectively. Electrocardiogram findings were Non-specific and included ST-segment and T-wave changes. The most prevalent histopathological feature appreciated was diffuse lymphocytic inflammatory infiltrates. Antivirals and corticosteroids were the most frequently used medications. About 38% of patients also needed vasopressor assistance. Out of 42 patients, 67% recovered, and eight died. Conclusion: Due to the risk of a sudden worsening of patients conditions and myocarditis association with considerable mortality and morbidity, a knowledge of this cardiac complication of Covid-19 disease is crucial for healthcare professionals.

Association Between COVID-19 and Myocarditis Using Hospital-Based Administrative Data — United States, March 2020–January 2021

“…These findings suggest an association between COVID-19 and myocarditis, although causality cannot be inferred from observational data, and are consistent with those from previous studies (2)(3)(4)(5). Before this report, the two largest known studies, in the United States and in Israel, also found that…”

“…The risk difference for myocarditis between persons with and without COVID-19 was higher among males than among females, consistent with some earlier studies (2,5). The finding of a higher risk ratio among females than among males is novel.…”

“…Corresponding author: Tegan Boehmer, tboehmer@cdc.gov. 1 CDC COVID-19 Response Team; 2 Emory University School of Medicine, Atlanta, Georgia; 3 Children's Healthcare of Atlanta, Atlanta, Georgia.…”

Prevalence and clinical outcomes of pleural effusion in COVID‐19 patients: A systematic review and meta‐analysis

“…This binding of the SARS-CoV-2 virus through ACE2 receptors present in lung tissue may be responsible for direct viral injury leading to lung inflammation. Systemic inflammatory response syndrome due to excess cytokine release arbitrated through pathologic T cells and monocytes is another proposed mechanism 38,39. The more marked decreased lymphocytes, increased platelets, CRP, LDH, and D-dimer levels in COVID-19 patients with pleural effusion than patients without pleural effusion, suggest the role of sustained inflammatory response and cytokine storm as the pathological mechanism behind pleural effusion in COVID-19 31,33.…”

Vaccine Development Throughout History

“…From asymptomatic infection to respiratory failure, multi-organ dysfunction, and death, the COVID-19 has a wide spectrum of clinical presentations [33]. COVID-19 has been linked to harmful effects on other body systems in addition to the respiratory system [34][35][36][37][38]. Although SARS-CoV-2 has a lower mortality rate in comparison with SARS-CoV and MERS-CoV, the transmissibility and spread are much higher than SARS-CoV-1 and MERS.…”