Arq Bras Cardiol: Imagem cardiovasc. 2021; 34(1): eabc120

Coronavirus Myocarditis: Case Report

DOI: 10.47593/2675-312X/20213401eabc120

Introduction

The first cases of coronavirus 2019 disease (COVID-19) were described in Wuhan, China, in the end of December 2019. The identified pathogen was called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an RNA virus of the family Coronaviridae. Due to its rapid spread, the World Health Organization declared COVID-19 a pandemic on March 11, 2020. The main clinical presentation includes respiratory symptoms, such as fever, cough, myalgia, and dyspnea, that can progress to pneumonia or severe acute respiratory syndrome. Among many other disorders, myocardial injury is widely described in the literature, especially associated with influenza and parvovirus B-19, but more clarifications are necessary with SARS-CoV-2 about the pathophysiology involved in the intense viral replication with systemic inflammatory involvement.^,

SARS-CoV-2 is not only a cause of viral pneumonia, it also has important implications for the cardiovascular system, especially in men with risk factors, including older age, diabetes, hypertension, and obesity. Cardiac injury was detected in 19.7% of cases; of the patients who died, 10.6% had coronary heart disease, 4.1% had heart failure, and 5.3% had cerebrovascular disease. High cytokine concentrations are detected in the systemic inflammatory phase of COVID-19, such as interleukin 6 (IL-6), associated with an increase in troponin and other inflammatory biomarkers (D-dimer, ferritin, C-reactive protein, lactic dehydrogenase, procalcitonin, and leukocyte count), causing cardiovascular system injury.^– Of these disorders, myocarditis comprises approximately 7.2% of the cardiovascular complications related to the novel coronavirus. In this phase of disease progression, transthoracic echocardiography should be the method of choice to diagnose and monitor patients, improving the therapeutic management for providing hemodynamic data since patients with ventricular dysfunction are more likely to need mechanical ventilation, which consequently results in a worse prognosis.^,

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