1. COVID-19 associated myocarditis: A systematic review
- Author
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Kaushal Shah, William Haussner, Jonathan Kamler, Danielle Haussner, Antonio P. DeRosa, Jane Torres-Lavoro, and Jacqueline Tran
- Subjects
medicine.medical_specialty ,Viral Myocarditis ,Myocarditis ,Primary cardiac collapse ,Cardiomyopathy ,Heart failure ,Article ,Risk Factors ,Internal medicine ,medicine ,Humans ,biology ,business.industry ,COVID-19 ,General Medicine ,medicine.disease ,Troponin ,Dyspnea ,Respiratory failure ,Shock (circulatory) ,Systematic review ,Emergency Medicine ,Cardiology ,biology.protein ,Etiology ,Takotsubo cardiomyopathy ,medicine.symptom ,Respiratory Insufficiency ,business - Abstract
Background 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. Objective Conduct a systematic review of COVID-19-associated myocarditis, including clinical presentation, risk factors, and prognosis. Discussion 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. Conclusion 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.
- Published
- 2022
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