Myocarditis in COVID-19 patients: current problems

Abstract

Myocarditis has been reported as a possible clinical presentation or complication in patients with coronavirus disease (COVID)-19 due to SARS-CoV-2. Despite the alarm that this possibility generated among physicians, there is paucity of information about mechanisms, prevalence, prognosis, diagnosis and therapy of myocarditis in the context of COVID-19. This brief review has the goal to revise and summarize current knowledge on myocarditis in COVID-19 patients and underline problems especially related to diagnosis and treatment.

SARS-CoV-2 infection in the Syrian hamster model causes inflammation as well as type I interferon dysregulation in both respiratory and non-respiratory tissues including the heart and kidney

“…Monocytes are among cell types known to infiltrate the heart in myocardial inflammation, producing IL-10, IL-1 beta, IL-6 and TNF 92 , as well as IL-12 93,94 , all of which were upregulated in the heart post SARS-CoV-2 inoculation in our present study. In addition, another subset of cardiac issues related to COVID-19 have been attributed eosinophils resulting in eosinophilic myocarditis 95 . Other viruses are known to cause eosinophilic myocarditis after infection [96][97][98][99] .…”

“…This pathology typically results from the virus infecting the tissues of the heart for instance with Coxsackie virus B3 infection 100 . Eosinophilic myocarditis has been diagnosed in COVID-19 patients, where upon autopsy the heart tissue exhibited infilation of inflammatory cells including lymphocytes, macrophages and prominently, eosinophils 95 . In this case, the increase in eosinophils and overall inflammation in the heart was found despite the lack of live virus in the heart at the time of death 101 .…”

SARS-CoV-2 infection in the Syrian hamster model causes inflammation as well as type I interferon dysregulation in both respiratory and non-respiratory tissues including the heart and kidney

“…Monocytes are among cell types known to infiltrate the heart in myocardial inflammation, producing IL-10, IL-1beta, IL-6 and TNF [86], as well as IL-12 [87,88], all of which were upregulated in the heart post SARS-CoV-2 inoculation in our present study. In addition, another subset of cardiac issues related to COVID-19 have been attributed eosinophils resulting in eosinophilic myocarditis [89]. Other viruses are known to cause eosinophilic myocarditis after infection [90][91][92][93].…”

Acute myocarditis after the second dose of SARS-CoV-2 vaccine: Serendipity or atypical causal relationship?

“…The second is that the vaccine triggered immunologically mediated heart damage induced by the autoimmune/inflammatory response to vaccine compounds in a patient with an unknown underlying disease or a predisposing immunological profile (5).…”