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Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management.
Heart Rhythm. 2020 09; 17(9):1463-1471.HR

Abstract

Human coronavirus-associated myocarditis is known, and a number of coronavirus disease 19 (COVID-19)-related myocarditis cases have been reported. The pathophysiology of COVID-19-related myocarditis is thought to be a combination of direct viral injury and cardiac damage due to the host's immune response. COVID-19 myocarditis diagnosis should be guided by insights from previous coronavirus and other myocarditis experience. The clinical findings include changes in electrocardiogram and cardiac biomarkers, and impaired cardiac function. When cardiac magnetic resonance imaging is not feasible, cardiac computed tomographic angiography with delayed myocardial imaging may serve to exclude significant coronary artery disease and identify myocardial inflammatory patterns. Because many COVID-19 patients have cardiovascular comorbidities, myocardial infarction should be considered. If the diagnosis remains uncertain, an endomyocardial biopsy may help identify active cardiac infection through viral genome amplification and possibly refine the treatment risks of systemic immunosuppression. Arrhythmias are not uncommon in COVID-19 patients, but the pathophysiology is still speculative. Nevertheless, clinicians should be vigilant to provide prompt monitoring and treatment. The long-term impact of COVID-19 myocarditis, including the majority of mild cases, remains unknown.

Authors+Show Affiliations

School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom.Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.Department of Cardiology, Newham University Hospital and Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom; NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London UK.Mayo Clinic, Jacksonville, Florida.Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Mayo Clinic, Rochester, Minnesota; Royal Papworth Hospital, Cambridge, United Kingdom. Electronic address: anwar.chahal@uphs.upenn.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32387246

Citation

Siripanthong, Bhurint, et al. "Recognizing COVID-19-related Myocarditis: the Possible Pathophysiology and Proposed Guideline for Diagnosis and Management." Heart Rhythm, vol. 17, no. 9, 2020, pp. 1463-1471.
Siripanthong B, Nazarian S, Muser D, et al. Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm. 2020;17(9):1463-1471.
Siripanthong, B., Nazarian, S., Muser, D., Deo, R., Santangeli, P., Khanji, M. Y., Cooper, L. T., & Chahal, C. A. A. (2020). Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. Heart Rhythm, 17(9), 1463-1471. https://doi.org/10.1016/j.hrthm.2020.05.001
Siripanthong B, et al. Recognizing COVID-19-related Myocarditis: the Possible Pathophysiology and Proposed Guideline for Diagnosis and Management. Heart Rhythm. 2020;17(9):1463-1471. PubMed PMID: 32387246.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Recognizing COVID-19-related myocarditis: The possible pathophysiology and proposed guideline for diagnosis and management. AU - Siripanthong,Bhurint, AU - Nazarian,Saman, AU - Muser,Daniele, AU - Deo,Rajat, AU - Santangeli,Pasquale, AU - Khanji,Mohammed Y, AU - Cooper,Leslie T,Jr AU - Chahal,C Anwar A, Y1 - 2020/05/05/ PY - 2020/5/11/pubmed PY - 2020/9/10/medline PY - 2020/5/11/entrez KW - Arrhythmias KW - Coronavirus disease 2019 KW - Endomyocardial biopsy KW - Fulminant myocarditis KW - Interleukin 6 KW - SARS-CoV-2 SP - 1463 EP - 1471 JF - Heart rhythm JO - Heart Rhythm VL - 17 IS - 9 N2 - Human coronavirus-associated myocarditis is known, and a number of coronavirus disease 19 (COVID-19)-related myocarditis cases have been reported. The pathophysiology of COVID-19-related myocarditis is thought to be a combination of direct viral injury and cardiac damage due to the host's immune response. COVID-19 myocarditis diagnosis should be guided by insights from previous coronavirus and other myocarditis experience. The clinical findings include changes in electrocardiogram and cardiac biomarkers, and impaired cardiac function. When cardiac magnetic resonance imaging is not feasible, cardiac computed tomographic angiography with delayed myocardial imaging may serve to exclude significant coronary artery disease and identify myocardial inflammatory patterns. Because many COVID-19 patients have cardiovascular comorbidities, myocardial infarction should be considered. If the diagnosis remains uncertain, an endomyocardial biopsy may help identify active cardiac infection through viral genome amplification and possibly refine the treatment risks of systemic immunosuppression. Arrhythmias are not uncommon in COVID-19 patients, but the pathophysiology is still speculative. Nevertheless, clinicians should be vigilant to provide prompt monitoring and treatment. The long-term impact of COVID-19 myocarditis, including the majority of mild cases, remains unknown. SN - 1556-3871 UR - https://www.unboundmedicine.com/medline/citation/32387246/Recognizing_COVID_19_related_myocarditis:_The_possible_pathophysiology_and_proposed_guideline_for_diagnosis_and_management_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1547-5271(20)30422-7 DB - PRIME DP - Unbound Medicine ER -