COVID19 MYOCARDITIS: A MULTI-MODALITY IMAGING APPROACH TO DIAGNOSIS
Recommended Citation
Chou A, Vishwanath R, Dawdy J, Ananthasubramaniam K. COVID19 MYOCARDITIS: A MULTI-MODALITY IMAGING APPROACH TO DIAGNOSIS. J Am Coll Cardiol 2025; 85(12):3550.
Document Type
Conference Proceeding
Publication Date
4-1-2025
Publication Title
J Am Coll Cardiol
Keywords
C reactive protein, gadolinium, heparin, troponin, cardiogenic shock, cardiovascular magnetic resonance, case report, clinical article, complication, conference abstract, coronavirus disease 2019, diagnosis, drug therapy, echocardiography, human, intravenous drug administration, male, medical history, mortality rate, myocarditis, special situation for pharmacovigilance, thorax pain
Abstract
Background: COVID19 is primarily a respiratory illness, but with multisystem organ involvement. The incidence of COVID19 myocarditis in the USA is estimated to be < 1%. Patients present with a range of symptoms from chest pain to fulminant cardiogenic shock. Case A 24 year old male with no past medical history presented to the ER after multiple syncopal episodes and 3 days of respiratory symptoms. Labs were notable for HS troponins < 4 and he was positive for COVID19. He improved with IV fluids and was discharged. Three days later, he re-presented to the ER with 12 hours of substernal chest pain. Labs showed elevated HS troponins, CRP and ESR. He was started on a heparin drip and admitted to the hospital Decision-making An echocardiogram showed normal ejection fraction with no wall motion abnormalities, but abnormal strain with a value of -15.2% concerning for possible early myocardial dysfunction. Given high suspicion for myocarditis, heparin drip was stopped and a cardiac MRI was ordered. Cardiac MRI showed increased T2-weighted signal and mid myocardial to subepicardial late gadolinium enhancement consistent with acute myocarditis. Conclusion Myocarditis is a rare complication of COVID19 infection that has been associated with a mortality rate as high as 15%. It is more common in young males. Given non-specific presenting symptoms, a multi-modality imaging approach is important to establish a diagnosis. While TTE is an important first line diagnostic tool, cardiac MRI can help provide a definitive diagnosis. [Formula presented]
Volume
85
Issue
12
First Page
3550
