Abstract
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) gained worldwide attention at the end of 2019 when it was identified to cause severe respiratory distress syndrome. While it primarily affects the respiratory system, we now have evidence that it affects multiple organ systems in the human body. Cardiac manifestations may include myocarditis, life threatening arrhythmias, acute coronary syndrome, systolic heart failure, and cardiogenic shock. Myocarditis is increasingly recognized as a complication of Coronavirus-19 (COVID-19) and may result from direct viral injury or from exaggerated host immune response. The diagnosis is established similar to other etiologies, and is based on detailed history, clinical exam, laboratory findings and non-invasive imaging studies. When available, cardiac MRI is the preferred imaging modality. Endomyocardial biopsy may be performed if the diagnosis remains uncertain. Current management is mainly supportive with the potential addition of interventions recommended for severe COVID-19 disease, such as remdesivir, steroids, and convalescent plasma. In the setting of cardiogenic shock and refractory, life-threatening arrhythmias that persist despite medical therapy, advanced mechanical circulatory support devices should be considered. Ultimately, early recognition and aggressive intervention are key factors in reducing morbidity and mortality. Our management strategy is expected to evolve further as we learn more about COVID-19 disease and the associated cardiac complications.
Highlights
Coronavirus-19 (COVID-19) disease is caused by the Severe Acute Respiratory SyndromeCoronavirus 2 (SARS-CoV-2)
Common findings include rhythm disturbances, low QRS voltage due to myocardial edema, ST-segment and T-wave changes, as well as conduction abnormalities [24,45]. None of these abnormalities are sensitive or specific enough to establish the diagnosis of myocarditis and are thought to be related to direct myocardial injury caused by SARS-CoV-2, hypoxia, and COVID-19 associated systemic inflammatory response [46,47]
Patients that develop heart failure from COVID-19 myocarditis should be treated with guideline-directed medical therapy, including angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), or angiotensin receptor-neprilysin inhibitors (ARNi), beta blockers, mineralocorticoid receptor antagonists, and diuretics as clinically indicated [54]
Summary
Coronavirus-19 (COVID-19) disease is caused by the Severe Acute Respiratory Syndrome. This novel virus gained worldwide attention in December 2019 after it was isolated and identified to cause severe acute respiratory distress syndrome in a cluster of patients in China’s Hubei Province [1]. The World Health Organization declared COVID-19 a global pandemic on 11 March 2020 [2]. While initially thought to primarily target the respiratory system, it soon became evident that infection with SARS-CoV-2 affects multiple organ systems in the human body. Myocarditis is a recognized severe complication of COVID-19 prompting numerous research groups to focus on developing early diagnostic approaches and management strategies. The primary goal of this article is to provide a review of COVID-19 disease with special focus on myocarditis.
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