COVID-19 and Myocarditis: What Do We Know So Far?

COVID-19 has been declared a global pandemic by the World Health Organization and is responsible for hundreds of thousands of deaths worldwide. COVID-19 is caused by SARS-CoV-2, and common clinical symptoms include fever, cough, sore throat, headache, and fatigue. Myocardial injury is relatively common in COVID-19, accounting for 7-23% of cases, and is associated with a higher morbidity and mortality. There is a discrepancy in the literature about myocarditis as the etiology of myocardial injury in COVID-19; although many anecdotal reports of myocarditis have been noted, there are only a handful of case reports in the literature about myocarditis related to COVID-19. This review summarizes the most up-to-date literature around the association between COVID-19 and myocarditis and gives clinicians a practical framework about the clinical manifestations, diagnostic tools and treatment options currently available. Importantly, this review will heighten suspicion for myocarditis as an etiology of myocardial injury in COVID-19 patients, therefore improving clinical outcomes and encouraging shared clinical decision-making. This will also open the door for further research to build around this review. Emergent treatment options for COVID-19 are in clinical trials and may be of benefit to COVID-19 patients with myocarditis in addition to current guideline-based recommendations.
COVID-19 is responsible for hundreds of thousands of deaths worldwide. Myocarditis as a possible sequela of COVID-19 infection is a likely underestimated cause of mortality and morbidity in critically ill COVID-19 patients. Investigations for suspected myocarditis among COVID-19 patients should include high-sensitivity troponin, ECGs, and echocardiography. Treatment options are currently limited to guideline-directed heart failure therapy, supportive care and/or mechanical circulatory support. Physicians should have a high index of suspicion to ensure a timely diagnosis and subsequent consultation with multidisciplinary subspecialists for ongoing management.