Myocarditis Associated With COVID-19 Infection and Mrna Vaccination: A Review Article

Abstract

Coronavirus disease 2019 (Covid-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Initially, COVID-19 was considered a respiratory illness, but later on, it was found out that this disease can affect many organ systems. Cardiovascular manifestations of this disease include myocarditis, heart failure, myocardial infarction, and thromboembolism. Myocarditis related to COVID-19 is thought to be due to the direct viral injury and host immune response. The cases of myocarditis after the COVID-19 mRNA vaccine have been reported in the literature as well. COVID-19 myocarditis can present as chest pain, shortness of breath, acute heart failure, arrhythmia, and possibly death. The initial workup should include an electrocardiogram (ECG) and troponins if myocarditis is suspected. Further screening should be done if troponins are elevated, or the patient has ECG changes concerning myocardial damage. Noninvasive imaging that helps to diagnose COVID-19 myocarditis includes echocardiograms, computerized tomographic (CT) with contrast, and cardiac magnetic resonance imaging (CMR). An endomyocardial biopsy (EMB) can be performed if the diagnosis remains unclear. Initial treatment of COVID-19 myocarditis is mainly supportive, and intravenous immunoglobulin (IVIG) and corticosteroid may be effective, particularly in fulminant myocarditis. If the patient develops life-threatening arrhythmias or shock, advanced mechanical support is required. Early intervention is a critical factor in decreasing morbidity and mortality. Further research is needed to determine the efficacy of different treatment modalities, including IVIG and corticosteroids, in patients with COVID-19 myocarditis.