COVID-19 associated myocarditis: A systematic review

• Published in: The American journal of emergency medicine 2022-01, Vol.51, p.150-155
• Main Authors: Haussner, William, DeRosa, Antonio P., Haussner, Danielle, Tran, Jacqueline, Torres-Lavoro, Jane, Kamler, Jonathan, Shah, Kaushal
• Format: Article
• Language: English
• Subjects: Asthma; Biopsy; Calcium-binding protein; Cardiac catheterization; Cardiomyopathy; Congestive heart failure; Coronaviruses; Cough; COVID-19; COVID-19 - complications; Diabetes; Dyspnea; Ejection fraction; EKG; Emergency medical care; Etiology; Fever; Heart failure; Heart Failure - virology; Humans; Hypertension; Intubation; Mortality; Myocarditis; Myocarditis - virology; Patients; Pneumonia; Primary cardiac collapse; Respiration; Respiratory failure; Respiratory Insufficiency - virology; Risk Factors; Severe acute respiratory syndrome coronavirus 2; Steroid hormones; Steroids; Systematic review; Takotsubo cardiomyopathy; Takotsubo Cardiomyopathy - virology; Troponin
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2021.10.001

Most COVID-19 infections result in a viral syndrome characterized by fever, cough, shortness of breath, and myalgias. A small but significant proportion of patients develop severe COVID-19 resulting in respiratory failure. Many of these patients also develop multi-organ dysfunction as a byproduct of their critical illness. Although heart failure can be a part of this, there also appears to be a subset of patients who have primary cardiac collapse from COVID-19. Conduct a systematic review of COVID-19-associated myocarditis, including clinical presentation, risk factors, and prognosis. Our review demonstrates two distinct etiologies of primary acute heart failure in surprisingly equal incidence in patients with COVID-19: viral myocarditis and Takotsubo cardiomyopathy. COVID myocarditis, Takotsubo cardiomyopathy, and severe COVID-19 can be clinically indistinguishable. All can present with dyspnea and evidence of cardiac injury, although in myocarditis and Takotsubo this is due to primary cardiac dysfunction as compared to respiratory failure in severe COVID-19. COVID-19-associated myocarditis differs from COVID-19 respiratory failure by an early shock state. However, not all heart failure from COVID-19 is from direct viral infection; some patient's develop takotsubo cardiomyopathy. Regardless of etiology, steroids may be a beneficial treatment, similar to other critically ill COVID-19 patients. Evidence of cardiac injury in the form of ECG changes or elevated troponin in patients with COVID-19 should prompt providers to consider concurrent myocarditis. •COVID-19 complications can include myocardial injury, thrombotic events and heart failure.•Patients with COVID-19-associated myocarditis had similar risk factors to those with severe COVID-19.•Evidence of cardiac injury in patients with COVID-19 should urge providers to consider concurrent myocarditis.