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Moraes FCAD, Santos RRDE, Campos JCD, Mota ACC, Pessoa FR, Sarges DC, Moraes DA, Souza DDSMD. Covid-19 and Heart Involvement: A Systematic Review of Literature. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2023. [DOI: 10.36660/ijcs.20220035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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2
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Muacevic A, Adler JR, Patel AM, Palange A, Adapa S. Post-COVID Multisystem Inflammatory Syndrome-Adult Leading to Cardiomyopathy and Autoimmune Thyroiditis: A Case Report. Cureus 2023; 15:e33754. [PMID: 36793837 PMCID: PMC9922567 DOI: 10.7759/cureus.33754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
The Coronavirus disease pandemic is an evolving disease with myriad presentations and sequelae. Multisystem inflammatory syndrome in adults (MIS-A) can affect various organ systems, including cardiovascular, gastrointestinal, and neurologic systems, with fever and abnormally increased inflammatory markers without significant respiratory affection. This is a well-known complication in children (MIS-C). Validated clinical criteria are used to diagnose this condition. Long-term sequelae of MIS-A are unclear and underreported. Here, we describe a case of Post-COVID-19 MIS-A who presented with cardiac dysfunction, hepatitis, and acute kidney injury and recovered well with steroids. He was left with persistent cardiomyopathy and thyroiditis with hypothyroidism which to date has not fully recovered. This case emphasizes that the sequelae of COVID-19 and its pathophysiology are not fully understood, and more research is needed to predict and prevent the same.
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Rubens M, Ramamoorthy V, Saxena A, Zevallos JC, Ruiz-Pelaez JG, Ahmed MA, Zhang Z, McGranaghan P, Veledar E, Jimenez J, Chaparro S. Hospital Outcomes Among COVID-19 Hospitalizations With Myocarditis from the California State Inpatient Database. Am J Cardiol 2022; 183:109-114. [PMID: 36127182 PMCID: PMC9482430 DOI: 10.1016/j.amjcard.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022]
Abstract
Many case reports have indicated that myocarditis could be a prognostic factor for predicting morbidity and mortality among patients with COVID-19. In this study, using a large database we examined the association between myocarditis among COVID-19 hospitalizations and in-hospital mortality and other adverse hospital outcomes. The present study was a retrospective analysis of data collected in the California State Inpatient Database during 2020. All hospitalizations for COVID-19 were included in the analysis and grouped into those with and without myocarditis. The outcomes were in-hospital mortality, cardiac arrest, cardiogenic shock, mechanical ventilation, and acute respiratory distress syndrome. Propensity score matching, followed by conditional logistic regression, was performed to find the association between myocarditis and outcomes. Among 164,417 COVID-19 hospitalizations, 578 (0.4%) were with myocarditis. After propensity score matching, the rate of in-hospital mortality was significantly higher among COVID-19 hospitalizations with myocarditis (30.0% vs 17.5%, p <0.001). Survival analysis with log-rank test showed that 30-day survival rates were significantly lower among those with myocarditis (39.5% vs 46.3%, p <0.001). Conditional logistic regression analysis showed that the odds of cardiac arrest (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.16 to 3.14), cardiogenic shock (OR 4.13, 95% CI 2.14 to 7.99), mechanical ventilation (OR 3.30, 95% CI 2.47 to 4.41), and acute respiratory distress syndrome (OR 2.49, 95% CI 1.70 to 3.66) were significantly higher among those with myocarditis. Myocarditis was associated with greater rates of in-hospital mortality and adverse hospital outcomes among patients with COVID-19, and early suspicion is important for prompt diagnosis and management.
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Affiliation(s)
- Muni Rubens
- Office of Clinical Research,, Baptist Health South Florida, Miami, Florida
| | | | - Anshul Saxena
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida
| | - Juan Carlos Zevallos
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida; Universidad Espiritu Santo, Guayaquil, Ecuador
| | | | - Md Ashfaq Ahmed
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida
| | - Zhenwei Zhang
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida
| | - Peter McGranaghan
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Emir Veledar
- Center for Advanced Analytics, Baptist Health South Florida, Miami, Florida
| | - Javier Jimenez
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
| | - Sandra Chaparro
- Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, Florida; Herbert Wertheim College of Medicine, Florida International University, Miami, Florida.
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4
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Jum'ah H, Kundrapu S, Jabri A, Kondapaneni M, Tomashefski JF, Loeffler AG. Cardiac Macrophage Density in Covid-19 Infection: Relationship to Myocyte Necrosis and Acute Lung Injury. Cardiovasc Pathol 2022; 60:107447. [PMID: 35718082 PMCID: PMC9212794 DOI: 10.1016/j.carpath.2022.107447] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/27/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022] Open
Abstract
SARS-Cov-2 infection is not limited to the respiratory tract and can involve other organs including the heart, blood vessels, kidneys, liver, gastrointestinal tract, placenta, and skin. Covid-19 patients with cardiac involvement usually have higher morbidity and mortality compared to those without cardiac involvement. The frequency and the specificity of the myocardial pathological changes in patients who die after documented infection with SARS-Cov-2 is uncertain. Macrophages can be found in the normal heart (interstitium, around the endothelial cells and in the epicardial adipose tissue), and they are considered part of the major immune cell population in the heart. In this case-control autopsy study, we compare the gross and microscopic cardiac findings, and the available clinical characteristics between a group of 10 Covid-19 decedents and a control group of 20 patients who died with non-SARS-Cov-2 severe bronchopneumonia and/or diffuse alveolar damage. The objectives of this semi-quantitative study are to study single myocyte necrosis and its relation to the strain on the heart caused by lung injury as a causative mechanism, and to study the density of myocardial and epicardial macrophages in Covid-19 hearts in comparison to the control group, and in Covid-19 hearts with single myocyte necrosis in comparison to Covid-19 hearts without single myocyte necrosis. Lymphocytic myocarditis was not identified in any of the hearts from the Covid-19 or the control group. Single myocyte necrosis is more frequent in the Covid-19 group compared to the control group, suggesting that it is unrelated to the strain on the heart caused by underlying lung injury. The density of the macrophages in the epicardium and myocardium in the hearts of the Covid-19 group is higher compared to those in the control group. The density of epicardial macrophages is higher in the Covid-19 hearts with single myocyte necrosis than in those without. These observations contribute to our increasing appreciation of the role of macrophages in the pathophysiologic response to infection by SARS-CoV-2.
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Affiliation(s)
- Husam Jum'ah
- Department of Pathology, MetroHealth Medical Center, Cleveland, OH, US; Case Western Reserve University School of Medicine, Cleveland, OH
| | - Sirisha Kundrapu
- Department of Pathology, MetroHealth Medical Center, Cleveland, OH, US; Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ahmad Jabri
- Case Western Reserve University School of Medicine, Cleveland, OH; Department of Cardiology, MetroHealth Medical Center, Cleveland, OH, US
| | - Meera Kondapaneni
- Case Western Reserve University School of Medicine, Cleveland, OH; Department of Cardiology, MetroHealth Medical Center, Cleveland, OH, US
| | - Joseph F Tomashefski
- Department of Pathology, MetroHealth Medical Center, Cleveland, OH, US; Case Western Reserve University School of Medicine, Cleveland, OH
| | - Agnes G Loeffler
- Department of Pathology, MetroHealth Medical Center, Cleveland, OH, US; Case Western Reserve University School of Medicine, Cleveland, OH.
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5
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Petersen SE, Friedrich MG, Leiner T, Elias MD, Ferreira VM, Fenski M, Flamm SD, Fogel M, Garg R, Halushka MK, Hays AG, Kawel-Boehm N, Kramer CM, Nagel E, Ntusi NA, Ostenfeld E, Pennell DJ, Raisi-Estabragh Z, Reeder SB, Rochitte CE, Starekova J, Suchá D, Tao Q, Schulz-Menger J, Bluemke DA. Cardiovascular Magnetic Resonance for Patients With COVID-19. JACC Cardiovasc Imaging 2022; 15:685-699. [PMID: 34656482 PMCID: PMC8514168 DOI: 10.1016/j.jcmg.2021.08.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 02/07/2023]
Abstract
COVID-19 is associated with myocardial injury caused by ischemia, inflammation, or myocarditis. Cardiovascular magnetic resonance (CMR) is the noninvasive reference standard for cardiac function, structure, and tissue composition. CMR is a potentially valuable diagnostic tool in patients with COVID-19 presenting with myocardial injury and evidence of cardiac dysfunction. Although COVID-19-related myocarditis is likely infrequent, COVID-19-related cardiovascular histopathology findings have been reported in up to 48% of patients, raising the concern for long-term myocardial injury. Studies to date report CMR abnormalities in 26% to 60% of hospitalized patients who have recovered from COVID-19, including functional impairment, myocardial tissue abnormalities, late gadolinium enhancement, or pericardial abnormalities. In athletes post-COVID-19, CMR has detected myocarditis-like abnormalities. In children, multisystem inflammatory syndrome may occur 2 to 6 weeks after infection; associated myocarditis and coronary artery aneurysms are evaluable by CMR. At this time, our understanding of COVID-19-related cardiovascular involvement is incomplete, and multiple studies are planned to evaluate patients with COVID-19 using CMR. In this review, we summarize existing studies of CMR for patients with COVID-19 and present ongoing research. We also provide recommendations for clinical use of CMR for patients with acute symptoms or who are recovering from COVID-19.
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Affiliation(s)
- Steffen E. Petersen
- William Harvey Research Institute, National Institute for Health Research Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom,Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom
| | - Matthias G. Friedrich
- Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Tim Leiner
- University Medical Center Utrecht, Department of Radiology, Utrecht, the Netherlands,Mayo Clinic, Department of Radiology, Rochester, Minnestoa, USA
| | - Matthew D. Elias
- Division of Cardiology, Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, British Heart Foundation Centre of Research Excellence, Oxford National Institute for Health Research Biomedical Research Centre, University of Oxford, United Kingdom
| | - Maximilian Fenski
- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Working Group on Cardiac Magnetic Resonance, Experimental Clinical Research Centre, Berlin, Germany,Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany,Deutsches Zentrum für Herz-Kreislaufforschung-Partnersite-Berlin, Berlin, Germany
| | - Scott D. Flamm
- Cardiovascular Imaging, Imaging and Heart, Vascular, and Thoracic Institutes, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mark Fogel
- Department of Pediatrics (Cardiology) and Radiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Radiology, The Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ria Garg
- Department of Medicine and Diagnostic Radiology, McGill University, Montreal, Quebec, Canada
| | - Marc K. Halushka
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore Maryland, USA
| | - Allison G. Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Nadine Kawel-Boehm
- Department of Radiology, Kantonsspital Graubuenden, Chur, Switzerland,Institute for Diagnostic Interventional Pediatric Radiology, Inselspital, Bern, University Hospital of Bern, Switzerland
| | - Christopher M. Kramer
- Cardiovascular Division, Departments of Medicine and Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, DZHK Center for Cardiovascular Imaging, University Hospital Frankfurt, Frankfurt AM Main, Germany
| | - Ntobeko A.B. Ntusi
- Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa,Groote Schuur Hospital, Cape Town, South Africa,Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Lund University, Lund, Sweden,Skåne University Hospital, Lund, Sweden
| | - Dudley J. Pennell
- National Heart and Lung Institute, Imperial College, Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, London, United Kingdom
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, National Institute for Health Research Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London, United Kingdom,Barts Heart Centre, St Bartholomew’s Hospital, Barts Health National Health Service Trust, West Smithfield, London, United Kingdom
| | - Scott B. Reeder
- Departments of Radiology, Medical Physics, Biomedical Engineering, Medicine, and Emergency Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Carlos E. Rochitte
- Heart Institute, InCor, University of São Paulo Medical School and Heart Hospital, Hospital do Coração, São Paulo, Brazil
| | - Jitka Starekova
- Department of Radiology, University of Wisconsin, Madison, Wisconsin, USA
| | - Dominika Suchá
- University Medical Center Utrecht, Department of Radiology, Utrecht, the Netherlands
| | - Qian Tao
- Department of Imaging Physics, Delft University of Technology, Delft, the Netherlands,Division of Imaging Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeanette Schulz-Menger
- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Working Group on Cardiac Magnetic Resonance, Experimental Clinical Research Centre, Berlin, Germany,Helios Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany,Deutsches Zentrum für Herz-Kreislaufforschung-Partnersite-Berlin, Berlin, Germany
| | - David A. Bluemke
- Departments of Radiology and Medical Physics, University of Wisconsin, Madison, Wisconsin, USA,Address for correspondence: Dr David A. Bluemke, University of Wisconsin School of Medicine and Public Health, 600 Highland Drive, Madison, Wisconsin 53792, USA
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Rathore SS, Rojas GA, Sondhi M, Pothuru S, Pydi R, Kancherla N, Singh R, Ahmed NK, Shah J, Tousif S, Baloch UT, Wen Q. Myocarditis associated with Covid-19 disease: A systematic review of published case reports and case series. Int J Clin Pract 2021; 75:e14470. [PMID: 34235815 DOI: 10.1111/ijcp.14470] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/11/2021] [Accepted: 05/24/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Covid-19 is an extremely contagious illness caused by the severe acute respiratory syndrome (SARS-CoV-2) virus. The cardiac involvement in such a public health emergency disease has not been well studied and a conflicting evidence exists on this issue. OBJECTIVE This systematic review article aimed to compile and illustrate clinical characteristics, diagnostic findings, management, and outcomes manifesting in myocarditis linked with Covid-19. METHODS A literature search was accomplished for published eligible articles with MEDLINE/PubMed and Embase databases. All eligible case reports and case series were included from around the world without any language restrictions. For this review, inclusion criteria were laboratory-confirmed SARS-CoV-2 infection cases reporting a diagnosis of acute myocarditis. RESULTS Data from 41 studies describing myocarditis in 42 Covid-19 patients was obtained. The median age of these patients was 43.4 years, with 71.4% of them being men. Fever was the most prevalent presenting symptoms seen in 57% of patients. Hypertension was the most pervasive comorbidity accompanying these patients. Cardiac biomarkers troponin and brain natriuretic peptide (BNP) were raised in almost 90% and 87% of patients, respectively. Electrocardiogram findings were nonspecific and included ST-segment and T-wave changes. Echocardiogram commonly showed left ventricular systolic dysfunction with increased heart size. Cardiac magnetic resonance imaging (CMRI) exhibited myocardial edema and injury. The most prevalent histopathological feature appreciated was diffuse lymphocytic inflammatory infiltrates. Antivirals and corticosteroids were the most frequently used medications. About 38% of patients also needed vasopressor assistance. Out of 42 patients, 67% recovered, and eight died. CONCLUSION Because of the risk of a sudden worsening of patients conditions and myocarditis association with considerable mortality and morbidity, a knowledge of this cardiac complication of Covid-19 disease is crucial for healthcare professionals.
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Affiliation(s)
| | - Gianpier Alonzo Rojas
- Internal Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Scientific society of medical students, Lima, Perú
| | - Manush Sondhi
- Internal Medicine, Kasturba Medical College, Manipal, India
| | | | - Reshma Pydi
- Internal Medicine, Andhra Medical College, Visakhapatnam, India
| | | | - Romil Singh
- Department of Critical Care, Mayo Clinic, Rochester, MN, USA
| | | | - Jill Shah
- Internal Medicine, Tambov State University named after G.R. Derzhavin, Tambov, Russia
| | - Sohaib Tousif
- Internal Medicine, Ziauddin Medical University, Karachi, Pakistan
| | | | - Qingqing Wen
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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7
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Zaveri S, Tagliaferri AR, Woldemariam S, Aron P, Palacios C, Melki G, Michael P. A Case of Multifactorial Viral Myocarditis. Cureus 2021; 13:e18950. [PMID: 34812324 PMCID: PMC8604421 DOI: 10.7759/cureus.18950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
We present a case of viral myocarditis in the setting of Coxsackievirus and coronavirus disease 2019 (COVID-19) infection. This case is unique as there were two underlying active infections that could have caused the patient's myocarditis. Though both viruses have been shown to cause myocarditis, it was difficult to differentiate the exact etiology in this particular case. The unique nature of this case presents the opportunity to explore whether further diagnostic workup is warranted.
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Affiliation(s)
- Sahil Zaveri
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | | | - Sara Woldemariam
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Polina Aron
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Carlos Palacios
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
| | - Gabriel Melki
- Gastroenterology, St. Joseph's University Medical Center, Paterson, USA
| | - Patrick Michael
- Internal Medicine, St. Joseph's University Medical Center, Paterson, USA
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8
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Abstract
The emergence of the novel SARS coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has resulted in an unprecedented pandemic that has been accompanied by a global health crisis. Although the lungs are the main organs involved in COVID-19, systemic disease with a wide range of clinical manifestations also develops in patients infected with SARS-CoV-2. One of the major systems affected by this virus is the cardiovascular system. The presence of preexisting cardiovascular disease increases mortality in patients with COVID-19, and cardiovascular injuries, including myocarditis, cardiac rhythm abnormalities, endothelial cell injury, thrombotic events, and myocardial interstitial fibrosis, are observed in some patients with COVID-19. The underlying pathophysiology of COVID-19-associated cardiovascular complications is not fully understood, although direct viral infection of myocardium and cytokine storm have been suggested as possible mechanisms of myocarditis. In this Review, we summarize available data on SARS-CoV-2-related cardiac damage and discuss potential mechanisms of cardiovascular implications of this rapidly spreading virus.
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Kallel O, Bourouis I, Bougrine R, Housni B, El Ouafi N, Ismaili N. Acute myocarditis related to Covid-19 infection: 2 cases report. Ann Med Surg (Lond) 2021; 66:102431. [PMID: 34075319 PMCID: PMC8152366 DOI: 10.1016/j.amsu.2021.102431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/17/2021] [Accepted: 05/22/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Since COVID 19 was described for the first time in December 2019, we have not stopped discovering its different clinical manifestations. Despite the respiratory complication which is the most common symptomatology, multi-organ dysfunction and multiple cardiovascular complications were described such as acute myocarditis, heart failure and even arrhythmias. CASES PRESENTATION Two patients aged 26 and 56 year-old, developed acute myocarditis related to Covid-19 infection but with different symptomatology. CASE 1 Presented to the emergency room with digestive symptomatology, Covid-19 infection was confirmed by a positive chest CT scan and positive COVID-19 serology testing. Clinical, biological, radiological findings allowed making the diagnosis of a Covid-19 infection with a bacterial superinfection complicated by a fulminant myocarditis. CASE 2 Presented to the emergency department with a chest pain, dyspnoea, paroxistic cough, myalgia and fever. A Covid-19 infection was confirmed. The electrocardiogram showed a diffuse ST elevation, echocardiography showed normal systolic function and the high-sensitivity cardiac troponin I level was high. Invasive coronary angiography was performed, revealing angiographically normal coronary arteries. CLINICAL DISCUSSION Our 2 cases were treated differently, case 1 received antibiotherapy because of the bacterial superinfection and inotropic support for the septic and cardiogenic choc. Contrarily to case 2 who received inotropic support, immunoglobulin and corticosteroid. With a total recovery for both patients. CONCLUSION This article can help in considering cardiac affection due to SARS-CoV2, even with poor respiratory symptomatology, and to insist on the importance of the cardiac evaluation for young patients with a sever Covid-19 infection.
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Affiliation(s)
- O. Kallel
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - I. Bourouis
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - R. Bougrine
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - B. Housni
- Department of Anaesthesiology and Reanimation, Mohammed VI University Hospital of Oujda, Mohammed the First University of Oujda, Morocco
| | - N. El Ouafi
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
| | - N. Ismaili
- Department of Cardiology, Mohammed VI University Hospital of Oujda, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
- Laboratory of Epidemiology, Clinical Research and Public Health, Faculty of Medicine and Pharmacy, Mohammed the First University of Oujda, Morocco
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10
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Jaiswal V, Sarfraz Z, Sarfraz A, Mukherjee D, Batra N, Hitawala G, Yaqoob S, Patel A, Agarwala P, Ruchika, Sarfraz M, Bano S, Azeem N, Naz S, Jaiswal A, Sharma P, Chaudhary G. COVID-19 Infection and Myocarditis: A State-of-the-Art Systematic Review. J Prim Care Community Health 2021; 12:21501327211056800. [PMID: 34854348 PMCID: PMC8647231 DOI: 10.1177/21501327211056800] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND COVID-19 was initially considered to be a respiratory illness, but current findings suggest that SARS-CoV-2 is increasingly expressed in cardiac myocytes as well. COVID-19 may lead to cardiovascular injuries, resulting in myocarditis, with inflammation of the heart muscle. OBJECTIVE This systematic review collates current evidence about demographics, symptomatology, diagnostic, and clinical outcomes of COVID-19 infected patients with myocarditis. METHODS In accordance with PRISMA 2020 guidelines, a systematic search was conducted using PubMed, Cochrane Central, Web of Science and Google Scholar until August, 2021. A combination of the following keywords was used: SARS-CoV-2, COVID-19, myocarditis. Cohorts and case reports that comprised of patients with confirmed myocarditis due to COVID-19 infection, aged >18 years were included. The findings were tabulated and subsequently synthesized. RESULTS In total, 54 case reports and 5 cohorts were identified comprising 215 patients. Hypertension (51.7%), diabetes mellitus type 2 (46.4%), cardiac comorbidities (14.6%) were the 3 most reported comorbidities. Majority of the patients presented with cough (61.9%), fever (60.4%), shortness of breath (53.2%), and chest pain (43.9%). Inflammatory markers were raised in 97.8% patients, whereas cardiac markers were elevated in 94.8% of the included patients. On noting radiographic findings, cardiomegaly (32.5%) was the most common finding. Electrocardiography testing obtained ST segment elevation among 44.8% patients and T wave inversion in 7.3% of the sample. Cardiovascular magnetic resonance imaging yielded 83.3% patients with myocardial edema, with late gadolinium enhancement in 63.9% patients. In hospital management consisted of azithromycin (25.5%), methylprednisolone/steroids (8.5%), and other standard care treatments for COVID-19. The most common in-hospital complication included acute respiratory distress syndrome (66.4%) and cardiogenic shock (14%). On last follow up, 64.7% of the patients survived, whereas 31.8% patients did not survive, and 3.5% were in the critical care unit. CONCLUSION It is essential to demarcate COVID-19 infection and myocarditis presentations due to the heightened risk of death among patients contracting both myocardial inflammation and ARDS. With a multitude of diagnostic and treatment options available for COVID-19 and myocarditis, patients that are under high risk of suspicion for COVID-19 induced myocarditis must be appropriately diagnosed and treated to curb co-infections.
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Affiliation(s)
| | | | | | | | - Nitya Batra
- Maulana Azad Medical College, New
Delhi, India
| | | | - Sadia Yaqoob
- Jinnah Medical and Dental College,
Karachi, Pakistan
| | | | | | - Ruchika
- JJM Medical college, Davangere,
India
| | | | - Shehar Bano
- Fatima Jinnah Medical University,
Lahore, Pakistan
| | | | - Sidra Naz
- Harvard Medical School, Boston, MA,
USA
| | - Akash Jaiswal
- All India Institute of Medical
Science, New Delhi, India
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