Acute Myocarditis Related to COVID-19: Comparison to SARS and MERS
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COVID-19
Acute Myocarditis Related to COVID-19: Comparison to SARS and MERS Angeliki M. Chasouraki 1
&
Odyssefs A. Violetis 1 & Mahmoud Abdelrasoul 1 & Eleftheria P. Tsagalou 2
Accepted: 29 September 2020 # Springer Nature Switzerland AG 2020
Abstract Myocardial involvement has been described during previous SARS and MERS outbreaks. Infection by SARS-CoV-2 (COVID19) can range from asymptomatic to life-threatening multi-system disease. Heart involvement most commonly occurs during severe COVID-19 infection. Myocardial injury, based on elevated levels of myocardial enzymes, has been noted in up to 30% of patients with COVID-19 infection and could be a marker for worse prognosis. A few cases of possible myocarditis due to SARSCoV-2 have been described, providing variable degree of evidence of direct myocardial involvement. We reviewed in detail those cases in comparison to relevant literature on SARS and MERS and attempted to draw initial conclusions in regard to clinical presentation, treatment and prognosis. Keywords COVID-19 . Myocarditis . Myocardial injury . Troponin . Corticosteroids . Treatment
Introduction Infection by the new coronavirus SARS-CoV-2 (COVID-19 infection) is a multi-systemic illness [1]. Cardiac injury has been reported in 20% to 30% of hospitalised patients [2]. Reported cardiac involvement includes arrhythmias, acute myocardial infarction, heart failure and cardiogenic shock [2], (https://www.escardio.org/Education/COVID-19-andCardiology/ESC-COVID-19-Guidance).
This article is part of the Topical Collection on COVID-19 * Angeliki M. Chasouraki [email protected] Odyssefs A. Violetis [email protected] Mahmoud Abdelrasoul [email protected] Eleftheria P. Tsagalou [email protected] 1
Internal Medicine Clinic, Pammakaristos Hospital of Divine Providence (Reference Centre for COVID-19 infection), Iakovaton 43, 11144 Athens, Greece
2
Therapeutic Clinic, Alexandra University Hospital, Lourou 4-2, 11528 Athens, Greece
Acute myocarditis is another condition which has been reported to complicate the COVID-19 infection [3]. Ten cases have been reported so far. Cases of acute myocarditis have been previously attributed to other coronaviruses such as SARS-CoV and MERS-CoV [4, 5]. In fact, postmortem real-time polymerase chain reaction analyses of heart tissue from the SARS epidemic, detected the viral genome in 35% of patients (n = 7/20) who died from SARS (https://www. escardio.org/Education/COVID-19-and-Cardiology/ESCCOVID-19-Guidance). SARS-COV-2 mRNA has also been detected in autopsy specimens as well as endomyocardial biopsies in patients with suspected myocarditis. [6, 7]
Pathogenesis of Myocardial Injury Increases in troponin I and CK-MB, which are suggestive of myocardial injury, are frequent findings in COVID 19 disease and associated with adverse prognosis. Huang et al. reported that 31% of patients with COVID-19 hospitalised in ICU had an increase in troponin I compared to 4% of non-ICU patients [8]. In a meta-analysis, including 341 patients, levels of troponin I we
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