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Cited by 29Viral Infections and Immunology ResearchCOVID-19 Clinical Research StudiesKawasaki Disease and Coronary Complications

COVID-19 and Myocarditis: Review of Clinical Presentations, Pathogenesis and Management

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Lovell, Jana P, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA, Čiháková, Daniela, Department of Pathology, Johns Hopkins University of Medicine, Baltimore, MD, USA, W. Harry Feinstone Department of Molecular Microbiology and Immunology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA, Gilotra, Nisha A, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA·2022·Heart International
DOI 10.17925/hi.2022.16.1.20PMC PMC9524641
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Abstract

There are four main myocarditis presentations identified in the context of severe acute respiratory coronavirus 2 (SARS-CoV-2): myocarditis associated with acute coronavirus disease 2019 (COVID-19) infection, post-acute COVID-19 syndrome, multisystem inflammatory syndrome, and vaccination-associated myocarditis. This article reviews the clinical features and current management strategies for each of these presentations. The overall prevalence of myocarditis is considered to be rare, although accurate estimation is affected by heterogeneity in diagnostic criteria and reporting, as well as infrequent use of gold-standard diagnostic endomyocardial biopsy. Severity of disease can range from mild symptoms to fulminant myocarditis. Therapeutic interventions are typically supportive and extrapolated from treatment for non-COVID-19 viral myocarditis. Several pathogenic mechanisms for the development of myocarditis have been proposed, and ongoing research is critical for elucidating disease pathogenesis and potentially identifying therapeutic targets. The long-term cardiovascular sequelae of SARS-CoV-2 infections and associated myocarditis require further elucidation and understanding.

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  • Myocarditis and pericarditis/myopericarditis from COVID-19 present similarly to other forms of viral myocarditis and pericarditis, with symptoms including fever, cough, chest pain/pressure, dyspnea, palpitations, and syncope.

    “Myocarditis and pericarditis/myopericarditis from COVID-19 present similarly to other forms of viral myocarditis and pericarditis, with symptoms including fever, cough, chest pain/pressure, dyspnea, palpitations, and syncope.”

    From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [31]

    The Clinical manifestations section (page not provided) describes COVID-19-associated myocarditis with fever, cough, shortness of breath, chest pain and arrhythmias. Table 1 (page not provided) also lists chest pain or pressure, dyspnoea, palpitations and syncope as myocarditis symptoms. The copy does not establish the claimed similarity to other viral myocarditis or pericarditis, or describe that full symptom list specifically for COVID-19 pericarditis/myopericarditis. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Successful application of anti-inflammatory approaches in patients with COVID-19 has been reported, likely because of the overwhelming proinflammatory and cytokine response observed early after SARS-CoV-2 infection.

    “Successful application of anti-inflammatory approaches in patients with COVID-19 has been reported in the literature, likely because of the overwhelming proinflammatory and cytokine response observed early after SARS-CoV-2 infection.”

    From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [31]

    The Management section (page not provided) reports that steroids may be associated with favourable outcomes in acute COVID-19 myocarditis, and the pathogenesis section describes dysregulated immune activation and cytokine release. The paper does not establish successful anti-inflammatory treatment for COVID-19 patients generally or attribute that success to an overwhelming cytokine response early after infection. (LLM, conf=0.84)

    Experimental — accuracy not yet measured

  • Management of COVID-19 myocarditis is essentially the same as pre-COVID myocarditis and is based on the expert opinion recommendations by the American College of Cardiology and the European Society of Cardiology guidelines.

    “Management of COVID-19 myocarditis is essentially the same as pre-COVID myocarditis and is based on the expert opinion recommendations by the American College of Cardiology and the European Society of”

    From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [31]

    The Abstract says treatment is typically supportive and extrapolated from non-COVID-19 viral myocarditis. The Management section also says post-recovery recommendations are extrapolated from expert consensus on acute myocarditis. It does not say that COVID-19 myocarditis management is essentially the same as pre-COVID management or that it is based on both American College of Cardiology and European Society of Cardiology guidelines; it describes COVID-specific therapies and management that varies with clinical severity. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Macrophages are the primary infiltrate with fewer T cells in autoimmune models of myocarditis.

    “and macrophages are the primary infiltrate with fewer T cells in autoimmune models of myocarditis (Figure 2). 2,31,127”

    From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [31]

    The section on SARS-CoV-2 entry reports macrophage/monocyte-predominant infiltration in hearts from patients with acute COVID-19, contrasting it with lymphocyte-predominant typical viral myocarditis. It does not describe autoimmune models of myocarditis or establish that those models have fewer T cells. Page numbers are unavailable in our copy. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • CD68+ macrophages with fewer T cells are a characteristic finding of immunohistochemistry on EMB from patients with COVID-19 myocarditis/pericarditis.

    “CD68+ macrophages with fewer T cells are a characteristic finding of immunohistochemistry performed on EMB from patients with COVID-19 myocarditis/pericarditis”

    From COVID-19, Myocarditis and Pericarditis (2023) · cites this paper as [31]

    The pathogenesis section reports increased CD68-positive macrophages and monocytes in autopsied hearts with COVID-19-associated myocarditis, contrasting this with the lymphocyte-predominant infiltrates of typical viral myocarditis (page not provided). It does not establish this as an immunohistochemical finding on endomyocardial biopsy (EMB), quantify fewer T cells, or extend the finding to pericarditis. The Clinical manifestations section says EMB was infrequently used. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

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Cites

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Authors
Lovell, J. P., Division of Cardiology, D. O. M., Čiháková, D., Department of Pathology, J. H. U. O. M., W. Harry Feinstone Department of Molecular Microbiology and Immunology, J. H. U. B. S. O. P. H., Gilotra, N. A., & Division of Cardiology, D. O. M.
Affiliations
Johns Hopkins University (US)
ORCID
Venue
Heart International
Publisher
Touch Medical Media, Ltd.
Published
2022
Volume
16
Issue
1
Pages
20
ISSN
  • 1826-1868 (ISSN-L)
  • 2036-2579
DOI
10.17925/hi.2022.16.1.20
PMC
PMC9524641
OpenAlex
W4288779005
Cited by
29
References
9
Citations by year
2026: 4 · 2025: 8 · 2024: 7 · 2023: 9 · 2022: 1
FWCI
1.27
Type
journal article
Language
en
Open access
Licence
Locations
  • Heart International (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
This article is published under the Creative Commons Attribution Non-commercial License.
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
  • Health Sciences › Medicine › Surgery › Kawasaki Disease and Coronary Complications
Keywords
COVID-19 pandemic, myocarditis, SARS-CoV-2, long COVID, multisystem inflammatory syndrome, vaccine-associated myocarditis, endomyocardial biopsy, cardiovascular sequelae, fulminant myocarditis

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